A large district general hospital has called to request a transfer of a 4 kg, 6-month-old ex 25-week premature infant, who is an inpatient in their level 3 NICU. The baby has not left hospital since birth and had a difficult neonatal course. He was intubated at birth and was not successfully extubated until 10 weeks of life. He has significant bronchopulmonary dysplasia (BPD) as a result of his extreme prematurity with secondary pulmonary hypertension diagnosed on echocardiogram. Although he has been relatively stable on high flow nasal cannula oxygen (HFNC) 8 L/min of flow and FiO2 0.4, he has deteriorated today. His usual medications are sildenafil for pulmonary hypertension; furosemide and spironolactone for chronic lung disease; and weaning doses of clonidine and chloral hydrate for agitation.

A 14-day-old, 4.3 kg term baby presented to his local A&E with an 18-hour history of bilious vomiting and being unsettled. There had been no urine output or bowel motion in the past 8 hours. He was born at term via spontaneous vaginal delivery, with normal antenatal scans, and was discharged home following birth with on demand breastfeeding and no risk factors for sepsis. Further medical history was limited due to language differences with parents who spoke limited English.

A previously fit and well 15-year-old boy (weight 65 kg) presented at 15:30 to the A&E in a district general hospital (DGH), with no paediatric surgical service, with abdominal pain and vomiting. The pain and vomiting started the previous night, and the vomitus had ‘turned green’ that morning. He had no appetite and was struggling to tolerate plain water.

You have received a call from the paediatric registrar at one of the district general hospitals in the region. A 2-year-old, 11 kg boy was brought in by ambulance 1 hour ago after suffering his first episode of generalised tonic-clonic seizures at home.