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Send us a textTrajectory of Postnatal Oxygen Requirement in Extremely Preterm Infants.Groves AM, Bennett MM, Loyd J, Clark RH, Tolia VN.J Pediatr. 2025 Feb;277:114414. doi: 10.1016/j.jpeds.2024.114414. Epub 2024 Nov 20.PMID: 39577761As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a textFurosemide Safety in Preterm Infants at Risk for Bronchopulmonary Dysplasia: A Randomized Clinical Trial.Greenberg RG, Lang J, Smith PB, Shekhawat P, Courtney SE, Hudak ML, Moya F, Iyengar A, Eldemerdash A, Bloom B, Go M, Hanna M, Rhein L, Aliaga S, Lewis T, Febre A, Kiefer AS, Bhatt-Mehta V, Khoury JA, Selewski D, Anand R, Martz K, Payne EH, Zimmerman KO, Benjamin DK Jr, Laughon M; Best Pharmaceuticals for Children Act – Pediatric Trials Network Steering Committee.J Pediatr. 2025 Apr 28:114629. doi: 10.1016/j.jpeds.2025.114629. Online ahead of print.PMID: 40306549As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Episode 30 -Toni Solari - Nutrition in the Child who Aspirates In this episode of Nutrition Pearls: the Podcast, co-hosts Jen Smith and Nikki Misner speak with Toni Solari on nutrition in patients with aerodigestive diseases. Toni is a registered dietitian in the Aerodigestive Center at Boston Children's hospital where she specializes in blenderized nutrition and specialized diets for various gastrointestinal disorders. She earned her degree at UMass Amherst, and has been practicing as a pediatric dietitian for 11 years. When she is not working, Toni enjoys spending time, preferably outside, with her 3.5 year old son and 1.5 year old daughter.Nutrition Pearls is supported by an educational grant from Mead Johnson Nutrition.Resources:Aerodigestive Nutrition References: https://www.iddsi.org/standards/frameworkBolgeo T, Di Matteo R, Gallione C, Gatti D, Bertolotti M, Betti M, Roveta A, Maconi A. Intragastric prepyloric enteral nutrition, bolus vs continuous in the adult patient: A systematic review and meta-analysis. Nutr Clin Pract. 2022 Aug;37(4):762-772. doi: 10.1002/ncp.10836. Epub 2022 Feb 16. PMID: 35174544.Hirsch S, Solari T, Rosen R. Effect of Added Free Water to Enteral Tube Feeds in Children Receiving Commercial Blends. J Pediatr Gastroenterol Nutr. 2022 Mar 1;74(3):419-423. doi: 10.1097/MPG.0000000000003308. PMID: 34560723; PMCID: PMC9531939.Hron B, Rosen R. Viscosity of Commercial Food-based Formulas and Home-prepared Blenderized Feeds. J Pediatr Gastroenterol Nutr. 2020 Jun;70(6):e124-e128. doi: 10.1097/MPG.0000000000002657. PMID: 32443040; PMCID: PMC8530412.Hron B, Fishman E, Lurie M, Clarke T, Chin Z, Hester L, Burch E, Rosen R. Health Outcomes and Quality of Life Indices of Children Receiving Blenderized Feeds via Enteral Tube. J Pediatr. 2019 Aug;211:139-145.e1. doi: 10.1016/j.jpeds.2019.04.023. Epub 2019 May 23. PMID: 31128885; PMCID: PMC6660979.Jensen EA, Zhang H, Feng R, Dysart K, Nilan K, Munson DA, Kirpalani H. Individualising care in severe bronchopulmonary dysplasia: a series of N-of-1 trials comparing transpyloric and gastric feeding. Arch Dis Child Fetal Neonatal Ed. 2020 Jul;105(4):399-404. doi: 10.1136/archdischild-2019-317148. Epub 2019 Nov 4. PMID: 31685527; PMCID: PMC7453998.Koo JK, Narvasa A, Bode L, Kim JH. Through Thick and Thin: The In Vitro Effects of Thickeners on Infant Feed Viscosity. J Pediatr Gastroenterol Nutr. 2019 Nov;69(5):e122-e128. doi: 10.1097/MPG.0000000000002470. PMID: 31449171.Alyssa Courtney, Anne Bernard, Scott Burgess, Katie Davies, Kelly Foster, Vishal Kapoor, David Levitt, Peter D Sly; Bolus Versus Continuous Nasogastric Feeds for Infants With Bronchiolitis: A Randomized Trial. Hosp Pediatr January 2022; 12 (1): 1–10. https://doi.org/10.1542/hpeds.2020-005702Produced by: Corey IrwinNASPGHAN - Council for Pediatric Nutrition Professionalscpnp@naspghan.org
Send us a textSimilarities and Differences in the Neurodevelopmental Outcome of Children with Congenital Heart Disease and Children Born Very Preterm at School Entry.Wehrle FM, Bartal T, Adams M, Bassler D, Hagmann CF, Kretschmar O, Natalucci G, Latal B.J Pediatr. 2022 Nov;250:29-37.e1. doi: 10.1016/j.jpeds.2022.05.047. Epub 2022 Jun 2.PMID: 35660491 Free article.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a textImprovement Initiative: End-Tidal Carbon Monoxide Measurement in Newborns Receiving Phototherapy.Bahr TM, Shakib JH, Stipelman CH, Kawamoto K, Lauer S, Christensen RD.J Pediatr. 2021 Nov;238:168-173.e2. doi: 10.1016/j.jpeds.2021.07.008. Epub 2021 Jul 11.PMID: 34260896As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a textThe Impact of Hospital Delivery Volumes of Newborns Born Very Preterm on Mortality and Morbidity. Phibbs CS, Passarella M, Schmitt SK, Martin A, Lorch SA.J Pediatr. 2025 Jan;276:114323. doi: 10.1016/j.jpeds.2024.114323. Epub 2024 Sep 18.PMID: 39304118As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
In this Complex Care Journal Club podcast episode, Ms. Pearce and Dr. Synnes discuss a series of patient-oriented research studies aimed at partnering with parents in reimagining meaningful outcomes for premature infants. They describe the inclusion of parents on the study team, recruitment of parent participants, lessons and challenges while conducting the study, messages for other researchers and parents, and the next steps from this work. SPEAKERS Rebecca Pearce, B. Ed, MSc Vice Principal Villa Maria High School Parent Partner CHU Sainte-Justine and Canadian Premature Babies Foundation Anne Synnes, MDCM, MHSc Clinical Professor, Neonatologist University of British Columbia British Columbia's Women's Hospital and British Columbia's Children's Hospital Research Institute HOST Kilby Mann, MD Assistant Professor Pediatric Rehabilitation Medicine Children's Hospital Colorado DATE Initial publication date: February 10, 2025. ARTICLES REFERENCED Pearce R, Synnes A, Lam MM, Richter LL, Bacchini F, Jones M, Luu TM, Janvier A; PARENTS' VOICE NETWORK. Partnering With Parents to Change Measurement and Reporting of Preterm Birth Outcomes. Pediatrics. 2024 Nov 1;154(5):e2024067093. doi: 10.1542/peds.2024-067093. PMID: 39354888. Haslam MD, Lisonkova S, Creighton D, Church P, Yang J, Shah PS, Joseph KS, Synnes A; Canadian Neonatal Network and the Canadian Neonatal Follow-Up Network. Severe Neurodevelopmental Impairment in Neonates Born Preterm: Impact of Varying Definitions in a Canadian Cohort. J Pediatr. 2018 Jun;197:75-81.e4. doi: 10.1016/j.jpeds.2017.12.020. Epub 2018 Feb 3. PMID: 29398054. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/p65m4p98gppf65mz3zhmm9g/February_Pearce_and_Synnes_ccjcp_final_revisions Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Pearce R, Synnes A, Mann K. Focus on Abilities: Parent-Identified Outcomes of Preterm Infants. 2/2025. OPENPediatrics. Online Podcast: https://soundcloud.com/openpediatrics/focus-on-abilities-parent-identified-outcomes-of-preterm-infants
Send us a textLiberation from Respiratory Support in Bronchopulmonary Dysplasia.Kielt MJ, Zaniletti I, Lagatta JM, Padula MA, Grover TR, Porta NFM, Wymore EM, Jensen EA, Leeman KT, Levin JC, Evans JR, Yallapragada S, Nelin LD, Vyas-Read S, Murthy K; Children's Hospitals Neonatal Consortium Severe BPD Focus Group.J Pediatr. 2024 Nov 7:114390. doi: 10.1016/j.jpeds.2024.114390. Online ahead of print.PMID: 39521174As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a textSupplemental Iron and Recombinant Erythropoietin for Anemia in Infants Born Very Preterm: A Survey of Clinical Practice in Europe.Reibel-Georgi NJ, Scrivens A, Heeger LE, Lopriore E, New HV, Deschmann E, Stanworth SJ, Carrascosa MA, Brække K, Cardona F, Cools F, Farrugia R, Ghirardello S, Krivec JL, Matasova K, Muehlbacher T, Sankilampi U, Soares H, Szabó M, Szczapa T, Zaharie G, Roehr CC, Fustolo-Gunnink S, Dame C; Neonatal Transfusion Network.J Pediatr. 2025 Jan;276:114302. doi: 10.1016/j.jpeds.2024.114302. Epub 2024 Sep 13.PMID: 39277077 Free article. Enteral nutritional practices in extremely preterm infants: a survey of U.S. NICUs.Romero-Lopez M, Naik M, Holzapfel LF, Tyson JE, Pedroza C, Ahmad KA, Rysavy MA, Carlo WA, Zhang Y, Tibe C, Salas AA.J Perinatol. 2024 Dec 9. doi: 10.1038/s41372-024-02198-6. Online ahead of print.PMID: 39653781 No abstract available.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a textChanges in Patent Ductus Arteriosus Management and Outcomes in Infants Born at 26 to 28 Weeks' Gestation.Kaluarachchi DC, Rysavy MA, Do B, Chock VY, Laughon MM, Backes CH, Colaizy TT, Bell EF, McNamara PJ.J Pediatr. 2024 Dec 26:114456. doi: 10.1016/j.jpeds.2024.114456. Online ahead of print.PMID: 39732160As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a textChorioamnionitis and Two-Year Outcomes in Infants with Hypoxic-Ischemic Encephalopathy.Cornet MC, Gonzalez FF, Glass HC, Wu TW, Wisnowski JL, Li Y, Heagerty P, Juul SE, Wu YW.J Pediatr. 2024 Nov 20:114415. doi: 10.1016/j.jpeds.2024.114415. Online ahead of print.PMID: 39577760 Free article.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a textInpatient Skin-to-skin Care Predicts 12-Month Neurodevelopmental Outcomes in Very Preterm Infants.Lazarus MF, Marchman VA, Brignoni-Pérez E, Dubner S, Feldman HM, Scala M, Travis KE.J Pediatr. 2024 Nov;274:114190. doi: 10.1016/j.jpeds.2024.114190. Epub 2024 Jul 14.PMID: 39004169As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
How many hours a day are your children using screens? How much of that time is spent passively watching videos or scrolling through social media? Why do studies find more screen time in Black children? Check out this episode of the podcast to hear more about how screen time affects your child's mental health and development. Here are some helpful references and resources for this episode: https://www.commonsensemedia.org/sites/default/files/research/report/2020-0-8-census-fact-sheet-black-children-final2.pdf https://www.aap.org/en/patient-care/media-and-children/center-of-excellence-on-social-media-and-youth-mental-health/5cs-of-media-use/ https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-And-Watching-TV-054.aspx Nagata JM, Ganson KT, Iyer P, Chu J, Baker FC, Pettee Gabriel K, Garber AK, Murray SB, Bibbins-Domingo K. Sociodemographic Correlates of Contemporary Screen Time Use among 9- and 10-Year-Old Children. J Pediatr. 2022 Jan;240:213-220.e2. doi: 10.1016/j.jpeds.2021.08.077. Epub 2021 Sep 2. PMID: 34481807; PMCID: PMC9107378. Muppalla SK, Vuppalapati S, Reddy Pulliahgaru A, Sreenivasulu H. Effects of Excessive Screen Time on Child Development: An Updated Review and Strategies for Management. Cureus. 2023 Jun 18;15(6):e40608. doi: 10.7759/cureus.40608. PMID: 37476119; PMCID: PMC10353947.
Send us a textMitigating Alarm Fatigue and Improving the Bedside Experience by Reducing Non-actionable Alarms.Yang JK, Su F, Graber-Naidich A, Hedlin H, Madsen N, DeSousa C, Feehan S, Graves A, Palmquist A, Cable R, Kipps AK.J Pediatr. 2024 Aug 29:114278. doi: 10.1016/j.jpeds.2024.114278. Online ahead of print.PMID: 39216620As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a Text Message.Perioperative Brain Injury in Relation to Early Neurodevelopment Among Children with Severe Congenital Heart Disease: Results from a European Collaboration.Neukomm A, Claessens NHP, Bonthrone AF, Stegeman R, Feldmann M, Nijman M, Jansen NJG, Nijman J, Groenendaal F, de Vries LS, Benders MJNL, Breur JMPJ, Haas F, Bekker MN, Logeswaran T, Reich B, Kottke R, Dave H, Simpson J, Pushparajah K, Kelly CJ, Arulkumaran S, Rutherford MA, Counsell SJ, Chew A, Knirsch W, Sprong MCA, van Schooneveld MM, Hagmann C, Latal B; European Association Brain in Congenital Heart Disease (EU-ABC) consortium.J Pediatr. 2024 Mar;266:113838. doi: 10.1016/j.jpeds.2023.113838. Epub 2023 Nov 22.PMID: 37995930 Free article.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a Text Message.Antenatal Consultation Research and Practices Through the Lens of Decision Science. Haward MF, Lorenz JM, Fischhoff B.J Pediatr. 2024 Jun 26:114173. doi: 10.1016/j.jpeds.2024.114173. Online ahead of print.PMID: 38942356 No abstract available.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a Text Message.Trends in C-Reactive Protein Use in Early-Onset Sepsis Evaluations and Associated Antibiotic Use.Barboza AZ, Flannery DD, Shu D, Galloway M, Dhudasia MB, Bonafide CP, Benitz WE, Gerber JS, Mukhopadhyay S.J Pediatr. 2024 Jun 18:114153. doi: 10.1016/j.jpeds.2024.114153. Online ahead of print.PMID: 38901777As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a Text Message.Phototherapy Alters the Plasma Metabolite Profile in Infants Born Preterm with Hyperbilirubinemia.Satrom KM, Wang J, Lock EF, Snook K, Lund TC, Rao RB.J Pediatr. 2024 Jun 28:114175. doi: 10.1016/j.jpeds.2024.114175. Online ahead of print.PMID: 38945444As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a Text Message.Nine is the New Ten of Apgar Scores: An Observational Retrospective Cohort Study. Everett SS, Bomback M, Roth P, Goldshtrom N, Polin RA, Lyford A, Hays T.J Pediatr. 2024 Jun 14:114150. doi: 10.1016/j.jpeds.2024.114150. Online ahead of print.PMID: 38880381As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Send us a Text Message.Use of Initial Endotracheal Versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room: Review of a National Database.Halling C, Conroy S, Raymond T, Foglia EE, Haggerty M, Brown LL, Wyckoff MH; American Heart Association's Get With The Guidelines–Resuscitation Investigators.J Pediatr. 2024 Apr 16;271:114058. doi: 10.1016/j.jpeds.2024.114058. Online ahead of print.PMID: 38631614 As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities. Episodes originally aired from 2016 to 2021.Originally released: October 17, 2019College is a tough time for any kid. But it should also be exciting. Then to experience the freedoms of young adulthood, only later to face the horrifying reality of a progressive neurodegenerative condition...it's not something anyone should experience. In this week's continuation of the patient narrative series, Dr. Paul McIntosh (Duke) shares his life-changing story and his optimism about surviving a chronic neurologic illness.Produced by James E Siegler with the help of Paul McIntosh. For more information about Pompe Disease, check out the resources provided by the United Pompe Foundation at unitedpompe.com. Music for our program this week was courtesy of Ars Sonor, Franz Danzi, Lee Rosevere, and Scott Holmes. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter (now X) @brainwavesaudio for the latest updates to the podcast.REFERENCESBeltran Papsdorf TB, Howard JF Jr, Chahin N. Pearls & Oy-sters: clues to the diagnosis of adult-onset acid maltase deficiency. Neurology 2014;82(9):e73-5. PMID 24590251Cupler EJ, Berger KI, Leshner RT, et al. Consensus treatment recommendations for late-onset Pompe disease. Muscle Nerve 2012;45(3):319-33. PMID 22173792Gutiérrez-Rivas E, Bautista J, Vílchez JJ, et al. Targeted screening for the detection of Pompe disease in patients with unclassified limb-girdle muscular dystrophy or asymptomatic hyperCKemia using dried blood: a Spanish cohort. Neuromuscul Disord 2015;25(7):548-53. PMID 25998610Kishnani PS, Howell RR. Pompe disease in infants and children. J Pediatr 2004;144(5 Suppl):S35-43. PMID 15126982Kishnani PS, Corzo D, Nicolino M, et al. Recombinant human acid [alpha]-glucosidase: major clinical benefits in infantile-onset Pompe disease. Neurology 2007;68(2):99-109. PMID 17151339Klinge L, Straub V, Neudorf U, et al. Safety and efficacy of recombinant acid alpha-glucosidase (rhGAA) in patients with classical infantile Pompe disease: results of a phase II clinical trial. Neuromuscul Disord 2005;15(1):24-31. PMID 15639117Lukacs Z, Nieves Cobos P, Wenninger S, et al. Prevalence of Pompe disease in 3,076 patients with hyperCKemia and limb-girdle muscular weakness. Neurology 2016;87(3):295-8. PMID 27170567Van den Hout JM, Kamphoven JH, Winkel LP, et al. Long-term intravenous treatment of Pompe disease with recombinant human alpha-glucosidase from milk. Pediatrics 2004;113(5):e448-57. PMID 15121988van der Ploeg AT, Clemens PR, Corzo D, et al. A randomized study of alglucosidase alfa in late-onset Pompe's disease. N Engl J Med 2010;362(15):1396-406. PMID 20393176Wokke JH, Escolar DM, Pestronk A, et al. Clinical features of late-onset Pompe disease: a prospective cohort study. Muscle Nerve 2008;38(4):1236-45. PMID 18816591We believe that
In this Complex Care Journal Club podcast episode, Dr. Lorna Fraser discusses the results of a prospective cohort study comparing outcomes for children receiving home blends vs formula via gastrostomy tube. She describes the central role of patients and families in study design, opportunities for ensuring equitable access to blended diets, and next steps from this work. SPEAKER Lorna Fraser, PhD, MBChB, MRCPCH, MSc, MMedSci Professor of Palliative Care and Child Health, Cicely Saunders Institute and School of Life Sciences and Population Health King's College London HOST Kathleen Huth, MD, MMSc Pediatrician, Complex Care Service, Division of General Pediatrics Boston Children's Hospital Assistant Professor of Pediatrics Harvard Medical School DATES Initial Publication date: April 8, 2024 JOURNAL ARTICLES Journal Club Article Citations Fraser LK, Bedendo A, O'Neill M, Taylor J, Hackett J, Horridge KA, Cade J, Richardson G, Phung H, McCarter A, Hewitt CE. Safety, resource use and nutritional content of home-blended diets in children who are gastrostomy fed: Findings from 'YourTube' - a prospective cohort study. Arch Dis Child. 2023 Dec 21:archdischild-2023-326393. doi: 10.1136/archdischild-2023-326393. Fraser LK, Bedendo A, O'Neill M, Taylor J, Hackett J, Horridge K, Cade J, Richardson G, Phung H, Mccarter A, Hewitt C. 'YourTube' the role of different diets in gastrostomy-fed children: Baseline findings from a prospective cohort study. Dev Med Child Neurol. 2023 Nov 10. doi: 10.1111/dmcn.15799. OTHER REFERENCES Hron B, Fishman E, Lurie M, Clarke T, Chin Z, Hester L, Burch E, Rosen R. Health Outcomes and Quality of Life Indices of Children Receiving Blenderized Feeds via Enteral Tube. J Pediatr. 2019 Aug;211:139-145.e1. doi: 10.1016/j.jpeds.2019.04.023. Epub 2019 May 23. PMID: 31128885; PMCID: PMC6660979. Maddison J, Taylor J, O'Neill M, Cade J, Hewitt C, Horridge K, McCarter A, Fraser LK, Beresford B. Outcomes for gastrostomy-fed children and their parents: qualitative findings from the 'Your Tube' study. Dev Med Child Neurol. 2021 Sep;63(9):1099-1106. doi: 10.1111/dmcn.14868. Epub 2021 Apr 1. PMID: 33792913. University of York. YourTube: Home blended diets for children who are gastrostomy fed. Infographic. Accessed March 13, 2024. https://www.york.ac.uk/media/healthsciences/images/research/phs/mhrc/Yourtube%20-%200102%20Infographic%20print.pdf University of York. YourTube for parent/healthcare professional. YouTube. January 19, 2024. Accessed March 13, 2024. https://youtu.be/5POi2Cjp8og University of York. YourTube for young people. YouTube. January 19, 2024. Accessed March 13, 2024. https://youtu.be/NlVriI0O-oI TRANSCRIPT chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://op-docebo-images.s3.amazonaws.com/Transcripts/Building+the+Evidence+for+Blended+Diets_Fraser_040824.pdf Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6 Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user.For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Fraser L, Huth K. Building the Evidence for Blended Diets: Benefits and Barriers to Access. 4/2024. OPENPediatrics. Online Podcast. https://on.soundcloud.com/pcQSrJTHvF4H4yiY6
Esophageal versus Rectal Temperature Monitoring during Whole-body Therapeutic Hypothermia for Hypoxic-ischemic Encephalopathy: Association with Short and Long-term Outcomes. Wu TW, Schmicker R, Wood TR, Mietzsch U, Comstock B, Heagerty PJ, Rao R, Gonzalez F, Juul S, Wu YW.J Pediatr. 2024 Feb 1:113933. doi: 10.1016/j.jpeds.2024.113933. Online ahead of print.PMID: 38309524 Free article. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Hello Friends, We have a new episode of journal club for you this week. On this episode Ben & Daphna review the latest research in neonatology, and welcome the EBNEO team for a new commentary. The articles reviewed this week include: Esophageal versus Rectal Temperature Monitoring during Whole-body Therapeutic Hypothermia for Hypoxic-ischemic Encephalopathy: Association with Short and Long-term Outcomes. Wu TW, Schmicker R, Wood TR, Mietzsch U, Comstock B, Heagerty PJ, Rao R, Gonzalez F, Juul S, Wu YW.J Pediatr. 2024 Feb 1:113933. doi: 10.1016/j.jpeds.2024.113933. Online ahead of print.PMID: 38309524 Free article.Neonatal Outcomes After COVID-19 Vaccination in Pregnancy. Norman M, Magnus MC, Söderling J, Juliusson PB, Navér L, Örtqvist AK, Håberg S, Stephansson O.JAMA. 2024 Feb 6;331(5):396-407. doi: 10.1001/jama.2023.26945.PMID: 38319332Maternal syphilis rates tripled in the US between 2016 and 2022, data show. Tanne JH.BMJ. 2024 Feb 15;384:q416. doi: 10.1136/bmj.q416.PMID: 38359912 No abstract available. Therapeutic hypothermia for preterm infants 34-35 weeks gestational age with neonatal encephalopathy. Kim SH, El-Shibiny H, Inder T, El-Dib M.J Perinatol. 2024 Jan 16. doi: 10.1038/s41372-024-01874-x. Online ahead of print.PMID: 38228763Randomised study of a new inline respiratory function monitor (Juno) to improve mask seal and delivered ventilation with neonatal manikins. Tracy MB, Hinder M, Morakeas S, Lowe K, Priyadarshi A, Crott M, Boustred M, Culcer M.Arch Dis Child Fetal Neonatal Ed. 2024 Feb 9:fetalneonatal-2023-326256. doi: 10.1136/archdischild-2023-326256. Online ahead of print.PMID: 38336472Dextrose gel prophylaxis for neonatal hypoglycaemia and neurocognitive function at early school age: a randomised dosage trial. Wei X, Franke N, Alsweiler JM, Brown GTL, Gamble GD, McNeill A, Rogers J, Thompson B, Turuwhenua J, Wouldes TA, Harding JE, McKinlay CJD; pre-hPOD Early School-age Outcomes Study Group.Arch Dis Child Fetal Neonatal Ed. 2024 Feb 12:fetalneonatal-2023-326452. doi: 10.1136/archdischild-2023-326452. Online ahead of print.PMID: 38307710Effect of human milk-based fortification in extremely preterm infants fed exclusively with breast milk: a randomised controlled trial. Jensen, G. B., Domellöf, M., Ahlsson, F., Elfvin, A., Navér, L., & Abrahamsson, T. eClinicalMedicine (2023).Neurodevelopmental Outcomes of Extremely Preterm Infants Fed Donor Milk or Preterm Infant Formula: A Randomized Clinical Trial. Colaizy TT, Poindexter BB, McDonald SA, et al. JAMA. 2024;331(7):582–591. doi:10.1001/jama.2023.27693EBNEO Commentary: De-MIST-ifying the 2-year outcomes of non-invasive surfactant therapy. Loft L, Ferguson KN, Tingay DG. Acta Paediatr. 2024 Jan 25. doi: 10.1111/apa.17116. O As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Feasibility and safety of sildenafil to repair brain injury secondary to birth asphyxia (SANE-01): A randomized, double-blind, placebo-controlled phase Ib clinical trial. Wintermark P, Lapointe A, Steinhorn R, Rampakakis E, Burhenne J, Meid AD, Bajraktari-Sylejmani G, Khairy M, Altit G, Adamo MT, Poccia A, Gilbert G, Saint-Martin C, Toffoli D, Vachon J, Hailu E, Colin P, Haefeli WE.J Pediatr. 2023 Dec 21:113879. doi: 10.1016/j.jpeds.2023.113879. Online ahead of print.PMID: 38142044 Free article.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
Dr Lou Halamek joins Julie Arafeh in a discussion on the use of debriefing to improve team performance, including strategies and tactics for more effective and efficient debriefings.Here are some useful references to review:Halamek LP, Cady R, Sterling MR. Using briefing, simulation and debriefing to improve human and system performance. Semin Perinatol 2019;43(8):151178. Epub 2019 Aug 10. PMID 31500845Chitkara R, Bennett M, Bohnert J, Yamada N, Fuerch J, Halamek LP, Quinn J, Padua K, Gould J, Profit J, Xu X, Lee HC. In situ simulation and clinical outcomes in infants born preterm. J Pediatr. 2023 Aug 31:113715. doi: 10.1016/j.jpeds.2023.113715. Epub ahead of print. PMID: 37659586Sawyer T, Loren D, Halamek LP. Post-event debriefings during neonatal care: Why aren't we doing them, and how can we start? J Perinatol 2016;36(6):415-419. PMID: 27031321https://cape.stanford.edu/programs/BannerPage.html
Neonatal fever can raise the temperature of the entire clinical pod along with the baby, but it doesnt have to. Join as Dr. Meghan Cain, chair of the division of pediatric and adolescent emergency medicine at Mayo Clinic, talks through the nuances of evaluating fever concerns in neonates of different ages and risk profiles and empowers you to be cool as a cucumber in these situations. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O'Leary ST, Okechukwu K, Woods Jr CR. Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics. 2021 Aug;148(2):e2021052228 Powell EC, Mahajan PV, Roosevelt G, Hoyle Jr JD, Gattu R, Cruz AT, Rogers AJ, Atabaki S, Jaffe DM, Casper TC, Ramilo O, Kuppermann N. Epidemiology of bacteremia in febrile infants aged 60 days and younger. Ann Emerg Med. 2018 Feb;71(2):211-216 Mahajan P, Browne LR, Levine DA, Cohen DM, Gattu R, Linaki JG, Anders J, Borgialli D, Vitale M, Dayan PS, Casper TC, Ramilo O, Kuppermann N. Risk of bacterial coinfections in febrile infants 60 days and younger with documented viral infections. J Pediatr. 2018 Dec:203:86-91.e2
Did you know that 80% of children with biliary atresia who undergo a Kasai procedure will still require liver transplant at some point in their life? Dr. Bade, a pediatric gastroenterologist, joins medical students Tucker Oliver and Sarah Chappell to discuss evaluation and management of infants with biliary atresia. Specifically, they will: Discuss the presentation and diagnosis of biliary atresia Explain pathophysiology behind jaundice Discuss preoperative and postoperative recommendations for the Kasai procedure Review complications and outcomes of the Kasai procedure Share advice for navigating the diagnosis of biliary atresia with families Special thanks to Dr. Rebecca Yang and Dr. Jennifer Tucker for peer reviewing this episode. FREE CME Credit (requires free sign-up): Link Coming Soon! References: 1] P. J. Lupo et al., “Population-based birth defects data in the United States, 2010-2014: A focus on gastrointestinal defects.,” Birth Defects Res, vol. 109, no. 18, pp. 1504–1514, Nov. 2017, doi: 10.1002/bdr2.1145. [2] J. L. Hartley, M. Davenport, and D. A. Kelly, “Biliary atresia,” The Lancet, vol. 374, no. 9702, pp. 1704–1713, Nov. 2009, doi: 10.1016/S0140-6736(09)60946-6. [3] S. S. Sundaram, C. L. Mack, A. G. Feldman, and R. J. Sokol, “Biliary atresia: Indications and timing of liver transplantation and optimization of pretransplant care.,” Liver Transpl, vol. 23, no. 1, pp. 96–109, Jan. 2017, doi: 10.1002/lt.24640. [4] D. Volpert, F. White, M. J. Finegold, J. Molleston, M. DeBaun, and D. H. Perlmutter, “Outcome of Early Hepatic Portoenterostomy for Biliary Atresia,” J Pediatr Gastroenterol Nutr, vol. 32, no. 3, pp. 265–269, Mar. 2001, doi: 10.1097/00005176-200103000-00006. [5] R. Fawaz et al., “Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.,” J Pediatr Gastroenterol Nutr, vol. 64, no. 1, pp. 154–168, Jan. 2017, doi: 10.1097/MPG.0000000000001334. [6] P. H. Y. Chung et al., “Life long follow up and management strategies of patients living with native livers after Kasai portoenterostomy.,” Sci Rep, vol. 11, no. 1, p. 11207, May 2021, doi: 10.1038/s41598-021-90860-w. [7] E. H. Gad, Y. Kamel, T. A.-H. Salem, M. A.-H. Ali, and A. N. Sallam, “Short- and long-term outcomes after Kasai operation for type III biliary atresia: Twenty years of experience in a single tertiary Egyptian center-A retrospective cohort study.,” Ann Med Surg (Lond), vol. 62, pp. 302–314, Feb. 2021, doi: 10.1016/j.amsu.2021.01.052. [8] A. M. Calinescu et al., “Cholangitis Definition and Treatment after Kasai Hepatoportoenterostomy for Biliary Atresia: A Delphi Process and International Expert Panel.,” J Clin Med, vol. 11, no. 3, Jan. 2022, doi: 10.3390/jcm11030494. [9] S. Kiriyama et al., “Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos),” J Hepatobiliary Pancreat Sci, vol. 25, no. 1, pp. 17–30, Jan. 2018, doi: 10.1002/jhbp.512. [10] K. Decharun, C. M. Leys, K. W. West, and S. M. E. Finnell, “Prophylactic Antibiotics for Prevention of Cholangitis in Patients With Biliary Atresia Status Post-Kasai Portoenterostomy,” Clin Pediatr (Phila), vol. 55, no. 1, pp. 66–72, Jan. 2016, doi: 10.1177/0009922815594760. [11] E. Jung, W.-H. Park, and S.-O. Choi, “Late complications and current status of long-term survivals over 10 years after Kasai portoenterostomy.,” J Korean Surg Soc, vol. 81, no. 4, pp. 271–5, Oct. 2011, doi: 10.4174/jkss.2011.81.4.271. [12] S. S. Sundaram et al., “Health related quality of life in patients with biliary atresia surviving with their native liver.,” J Pediatr, vol. 163, no. 4, pp. 1052–7.e2, Oct. 2013, doi: 10.1016/j.jpeds.2013.04.037. [13] B. L. Shneider et al., “Efficacy of fat-soluble vitamin supplementation in infants with biliary atresia.,” Pediatrics, vol. 130, no. 3, pp. e607-14, Sep. 2012, doi: 10.1542/peds.2011-1423. [14] J. P. Molleston and B. L. Shneider, “Preventing variceal bleeding in infants and children: is less more?,” Gastroenterology, vol. 145, no. 4, pp. 719–22, Oct. 2013, doi: 10.1053/j.gastro.2013.08.026. [15] G. Grisotti and R. A. Cowles, “Complications in pediatric hepatobiliary surgery,” Semin Pediatr Surg, vol. 25, no. 6, pp. 388–394, Dec. 2016, doi: 10.1053/j.sempedsurg.2016.10.004. [16] F. R. Sinatra, “Consultation with the Specialist: Liver Transplantation for Biliary Atresia,” Pediatr Rev, vol. 22, no. 5, pp. 166–168, May 2001, doi: 10.1542/pir.22-5-166. [17] I. Sriram and D. Nicklas, “Biliary Atresia,” Pediatr Rev, vol. 43, no. 11, pp. 659–661, Nov. 2022, doi: 10.1542/pir.2021-005287. [18] L. H. Rodijk et al., “Parental wellbeing after diagnosing a child with biliary atresia: A prospective cohort study.,” J Pediatr Surg, vol. 57, no. 4, pp. 649–654, Apr. 2022, doi: 10.1016/j.jpedsurg.2021.05.026. [19] A. Sanchez-Valle, N. Kassira, V. C. Varela, S. C. Radu, C. Paidas, and R. S. Kirby, “Biliary Atresia: Epidemiology, Genetics, Clinical Update, and Public Health Perspective.,” Adv Pediatr, vol. 64, no. 1, pp. 285–305, Aug. 2017, doi: 10.1016/j.yapd.2017.03.012.
Este podcast está presentado por los médicos neonatólogos Dani de Luis Rosell, Elena Itriago, y Carolina Michel; nuestras futuras doctoras Valentina Giraldo y Laura Molina y su anfitriona Maria Flores Cordova, médico residente de pediatría. Creado originalmente por el Dr. Ben Courchia y la Dra. Daphna Yasova Barbeau. No dudes en enviarnos preguntas, comentarios o sugerencias a nuestro correo electrónico: nicupodcast@gmail.com Los artículos que se tratan en el episodio de hoy están listados aquí: Treatment of seizures in the neonate: Guidelines and consensus-based recommendations-Special report from the ILAE Task Force on Neonatal Seizures.Pressler RM, Abend NS, Auvin S, Boylan G, Brigo F, Cilio MR, De Vries LS, Elia M, Espeche A, Hahn CD, Inder T, Jette N, Kakooza-Mwesige A, Mader S, Mizrahi EM, Moshé SL, Nagarajan L, Noyman I, Nunes ML, Samia P, Shany E, Shellhaas RA, Subota A, Triki CC, Tsuchida T, Vinayan KP, Wilmshurst JM, Yozawitz EG, Hartmann H.Epilepsia. 2023 Oct;64(10):2550-2570. doi: 10.1111/epi.17745. Epub 2023 Sep 1.Apgar Score and Neurodevelopmental Outcomes at Age 5 Years in Infants Born Extremely Preterm.Ehrhardt H, Aubert AM, Ådén U, Draper ES, Gudmundsdottir A, Varendi H, Weber T, Zemlin M, Maier RF, Zeitlin J; EPICE-SHIPS Research Group.JAMA Netw Open. 2023 Sep 5;6(9):e2332413. doi: 10.1001/jamanetworkopen.2023.32413.Prenatal Brain Maturation is Delayed in Neonates with Congenital Diaphragmatic Hernia.Johng S, Licht DJ, Hedrick HL, Rintoul N, Linn RL, Gebb JS, Xiao R, Massey SL.J Pediatr. 2023 Sep 16;264:113738. doi: 10.1016/j.jpeds.2023.113738. Association between maternal haemoglobin concentrations and maternal and neonatal outcomes: the prospective, observational, multinational, INTERBIO-21st fetal study.Ohuma EO, Jabin N, Young MF, Epie T, Martorell R, Peña-Rosas JP, Garcia-Casal MN; INTERBIO-21st Consortium; Papageorghiou AT, Kennedy SH, Villar J.Lancet Haematol. 2023 Sep;10(9):e756-e766. doi: 10.1016/S2352-3026(23)00170-9.Prenatal Intravenous Magnesium at 30-34 Weeks' Gestation and Neurodevelopmental Outcomes in Offspring: The MAGENTA Randomized Clinical Trial.Crowther CA, Ashwood P, Middleton PF, McPhee A, Tran T, Harding JE; MAGENTA Study Group.JAMA. 2023 Aug 15;330(7):603-614. doi: 10.1001/jama.2023.12357. Bienvenidos a La Incubadora: una conversación sobre neonatología y medicina basada en evidencia. Nuestros episodios ofrecen la dosis ideal (en mg/kg) de los más recientes avances para el neonato y para las increíbles personas que forman parte de la medicina neonatal. Soy tu host, Maria Flores Cordova, MD. Presentado por los Neonatólogos Elena Itriago MD, Dani de Luis Rosell MD, Carolina Michel MD, las futuras doctoras Marla Fortoul, Valentina Giraldo, Laura Molina. Creado originalmente por Ben Courchia MD y Daphna Yasova Barbeau MD http://www.the-incubator.org
In this Complex Care Journal Club podcast episode, Dr. Mark Brittan discusses a qualitative study of stakeholders in a family-certified nursing assistant program in Colorado. He describes the limitations of the paid family caregiver model, opportunities for advocacy, and the next steps from this work. SPEAKER Mark Brittan, MD, MPH Associate Professor of Pediatrics, University of Colorado Anschutz Medical Campus Section of Pediatric Hospital Medicine, Children's Hospital Colorado HOST Kilby Mann, MD Assistant Professor of Pediatrics, University of Colorado Anschutz Medical Campus Pediatric Rehabilitation Medicine, Children's Hospital Colorado DATES Initial Publication: October 9, 2023 CITATION JOURNAL ARTICLE REFERENCED Brittan MS, Chavez C, Blakely C, Holliman BD, Zuk J. Paid Family Caregiving for Children With Medical Complexity. Pediatrics. 2023;151(6):e2022060198. doi:10.1542/peds.2022-060198 OTHER ARTICLES REFERENCED Foster CC, Kwon S, Blakely C, Carter K, Sobotka SA, Goodman DM, Agrawal R, Brittan M. Paying Family Medical Caregivers for Children's Home Healthcare in Colorado: A Working Medicaid Model. J Pediatr. 2023 Feb 10;261:113347. doi: 10.1016/j.jpeds.2022.12.043. Epub ahead of print. PMID: 36775189; PMCID: PMC10412725. Kaye N, Teshale S. Medicaid Supports for Family Caregivers. National Academy for State Health Policy. October 2020. Accessed September 22, 2023. https://www.nashp.org/wp‐content/uploads/2020/10/Medicaid‐Supports‐for‐Family‐Caregivers.pdf TRANSCRIPT https://op-docebo-images.s3.amazonaws.com/Transcripts/Financial+Compensation+of+Family+Caregivers_Brittan_100923.pdf Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6 Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu
In this episode I have tried to simplify some stuff about diabetic ketoacidosis for the residents and the first time consultants. Its a huge topic and just one episode does not do justice to it. But you do not have to follow what I say. Please do your own research too. You can go through the following the references - 1. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee; Goguen J, Gilbert J. Hyperglycemic emergencies in adults. Can J Diabetes. 2013 Apr;37 Suppl 1:S72-6. doi: 10.1016/j.jcjd.2013.01.023. Epub 2013 Mar 26. PMID: 24070967. 2. Self WH, Evans CS, Jenkins CA, et al. Pragmatic Critical Care Research Group. Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis: A Subgroup Analysis of Cluster Randomized Clinical Trials. JAMA Netw Open. 2020 Nov 2;3(11):e2024596. doi: 10.1001/jamanetworkopen.2020.24596. PMID: 33196806; PMCID: PMC7670314. 3. https://emcrit.org/ibcc/hypokalemia/#top 4. https://emcrit.org/ibcc/dka/#definition_&_severity_of_DKA 5. Tran TTT, Pease A, Wood AJ, et al. Review of evidence for adult diabetic ketoacidosis management protocols. Front Endocrinol (Lausanne). 2017;8:106. doi:10.3389/fendo.2017.00106 6. Fort P, Waters SM, Lifshitz F. Low-dose insulin infusion in the treatment of diabetic ketoacidosis: bolus versus no bolus. J Pediatr 1980;96:36e40. 7. Butkiewicz EK, Leibson CL, O'Brien PC, et al. Insulin therapy for diabetic ketoacidosis. Bolus insulin injection versus continuous insulin infusion. Diabetes Care 1995;18:1187e90.
Nocturnal enuresis is a common problem for pediatric patients that can be quite distressing for children as well as their parents. In this episode join Madeline Snipes, a medical student at the Medical College of Georgia as she discusses nocturnal enuresis with Chief of Pediatric Urology at the Children's Hospital of Georgia, Dr. Bradley Morganstern, and Associate Professor of Pediatrics, Dr. Susan Goldberg, on an overview of nocturnal enuresis. Specifically, they will review: • The definition of nocturnal enuresis and its basic epidemiology. • The potential causes of nocturnal enuresis. • The appropriate workup for a pediatric patient with nocturnal enuresis. • When referral to a pediatric urologist is indicated. • The various treatment options for a pediatric patient with nocturnal enuresis. • And finally the potential sequelae that may result from untreated nocturnal enuresis. Special thanks to Dr. Jordan Gitlin, pediatric urologist at NYU's Winthrop Hospital, and Dr. Shreeti Kapoor, general pediatrician and associate professor of pediatric medicine at the Medical College of Georgia at Augusta University. FREE CME Credit (requires free sign-up): Link coming soon! References: 1. Nevéus T, Fonseca E, Franco I, et al. Management and treatment of nocturnal enuresis—an updated standardization document from the International Children's Continence Society. Journal of Pediatric Urology. 2020;16(1):10-19. doi:10.1016/j.jpurol.2019.12.020 2. Järvelin MR, Vikeväinen-Tervonen L, Moilanen I, Huttunen NP. Enuresis in seven-year-old children. Acta paediatrica Scandinavica. 1988;77(1):148-153. doi:10.1111/j.1651-2227.1988.tb10614. 3. de Sena Oliveira AC, Athanasio B da S, Mrad FC de C, et al. Attention deficit and hyperactivity disorder and nocturnal enuresis co-occurrence in the pediatric population: a systematic review and meta-analysis. Pediatric Nephrology. 2021;36(11):3547-3559. doi:10.1007/s00467-021-05083-y 4. Forsythe WI, Redmond A. Enuresis and spontaneous cure rate. Study of 1129 enuretis. Arch Dis Child. 1974;49(4):259-263. doi:10.1136/adc.49.4.259 5. von Gontard A, Mauer-Mucke K, Plück J, Berner W, Lehmkuhl G. Clinical behavioral problems in day- and night-wetting children. Pediatr Nephrol. 1999;13(8):662-667. doi:10.1007/s004670050677 6. Robson WL. Clinical practice. Evaluation and management of enuresis. N Engl J Med. 2009;360(14):1429-1436. doi:10.1056/NEJMcp0808009 7. Yeung CK, Sreedhar B, Sihoe JD, Sit FK, Lau J. Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study. BJU Int. 2006;97(5):1069-1073. doi:10.1111/j.1464-410X.2006.06074.x 8. Sá CA, Martins de Souza SA, Villela MCBVA, et al. Psychological Intervention with Parents Improves Treatment Results and Reduces Punishment in Children with Enuresis: A Randomized Clinical Trial. J Urol. 2021;205(2):570-576. doi:10.1097/JU.0000000000001351 9. Jackson EC. Nocturnal enuresis: giving the child a "lift". J Pediatr. 2009;154(5):636-637. doi:10.1016/j.jpeds.2009.01.041 10. Plaire JC, Pope JC 4th, Kropp BP, et al. Management of ectopic ureters: experience with the upper tract approach. J Urol. 1997;158(3 Pt 2):1245-1247. 11. Alnatour IM, Alnashrati T. Nocturnal Enuresis. Middle East Journal of Family Medicine. 2022;20(7):127-131. doi:10.5742/MEWFM.2022.9525106 12. van Summeren JJGT, Holtman GA, van Ommeren SC, Kollen BJ, Dekker JH, Berger MY. Bladder Symptoms in Children With Functional Constipation: A Systematic Review. J Pediatr Gastroenterol Nutr. 2018;67(5):552-560. doi:10.1097/MPG.0000000000002138 13. Brownrigg N, Braga LH, Rickard M, et al. The impact of a bladder training video versus standard urotherapy on quality of life of children with bladder and bowel dysfunction: A randomized controlled trial. J Pediatr Urol. 2017;13(4):374.e1-374.e8. doi:10.1016/j.jpurol.2017.06.005
Introducing EM Pulse Podcast™ Rebeat! In our Rebeat episodes, we will revisit important past episodes. In this Rebeat, we discuss a challenging but important aspect of emergency medicine - identifying and addressing child abuse or non-accidental trauma (NAT). We talk with expert Dr. Mary Clyde Pierce about her paper, which validates the TEN-4 FACESp clinical decision rule for predicting abuse in young children, and share insights on how we can save a child's life through vigilance and awareness of specific findings. Have you used TEN-4 FACESp to identify potential non-accidental trauma? Share your experience with us via social media, @empulsepodcast, or through our website, ucdavisem.com. ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis Guest: Dr. Mary Clyde Pierce, Professor of Pediatrics at Northwestern University, Pediatric Emergency Physician and Director of Child Abuse Research at Laurie Children's Hospital. Resources: Pierce MC, Kaczor K, Lorenz DJ, Bertocci G, Fingarson AK, Makoroff K, Berger RP, Bennett B, Magana J, Staley S, Ramaiah V, Fortin K, Currie M, Herman BE, Herr S, Hymel KP, Jenny C, Sheehan K, Zuckerbraun N, Hickey S, Meyers G, Leventhal JM. Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA Netw Open. 2021 Apr 1;4(4):e215832. doi: 10.1001/jamanetworkopen.2021.5832. Lorenz DJ, Pierce MC, Kaczor K, Berger RP, Bertocci G, Herman BE, Herr S, Hymel KP, Jenny C, Leventhal JM, Sheehan K, Zuckerbraun N. Classifying Injuries in Young Children as Abusive or Accidental: Reliability and Accuracy of an Expert Panel Approach. J Pediatr. 2018 Jul;198:144-150.e4. doi: 10.1016/j.jpeds.2018.01.033. Epub 2018 Mar 15. PMID: 29550228; PMCID: PMC6019119. CDC Morbidity and Mortality Weekly Report: Trends in US Emergency Department Visits Related to Suspected or Confirmed Abuse and Neglect Among Children and Adolescents Aged
Welcome to Ask Stago, The Podcast dedicated to provide expert answers to your expert questions in coagulation. In today's episode, our guest Gabrielle Pearl will explain us the particularities of thrombosis and hemostasis in pediatric population, and how to manage pediatric patient samples in the clinical laboratory. Link to previous podcasts: S2E5 - How to collect and prepare the coagulation samples properly? S2E3 - How to establish and control the reference range of my assay? Literature sources: Monagle P, Barnes C, Ignjatovic V, Furmedge J, Newall F, Chan A, De Rosa L, Hamilton S, Ragg P, Robinson S, Auldist A, Crock C, Roy N, Rowlands S. Developmental haemostasis. Impact for clinical haemostasis laboratories. Thromb Haemost. 2006 Feb;95(2):362-72. doi: 10.1160/TH05-01-0047. Monagle P, Massicotte P. Developmental haemostasis: secondary haemostasis. Semin Fetal Neonatal Med. 2011 Dec;16(6):294-300. doi: 10.1016/j.siny.2011.07.007. Attard C, van der Straaten T, Karlaftis V, Monagle P, Ignjatovic V. Developmental hemostasis: age-specific differences in the levels of hemostatic proteins. J Thromb Haemost 2013; 11: 1850–4. Flanders MM, Phansalkar AR, Crist RA, Roberts WL, Rodgers GM. Pediatric reference intervals for uncommon bleeding and thrombotic disorders. J Pediatr. 2006 Aug;149(2):275-7. doi: 10.1016/j.jpeds.2006.04.008 Lippi G, Franchini M, Montagnana M, Guidi GC. Coagulation testing in pediatric patients: the young are not just miniature adults. Semin Thromb Hemost. 2007 Nov;33(8):816-20. doi: 10.1055/s-2007-1000373. Content is scientific and technical in nature. It is intended as an educational tool for laboratory professionals and topics discussed are not intended as recommendations or as commentary on appropriate clinical practice
Hosts: Medical Student: Brooke Pace Quertermous Faculty: Katie McKie, MD Faculty: Ryan Harris, Ph.D Peer Review: Rebecca Yang, MD; Janelle McGill, MD During this episode, you will learn that Cystic Fibrosis is more than just a lung disease. Individuals with CF are also at risk for malabsorption, maldigestion, intestinal obstruction, exercise intolerance, and other systemic abnormalities. Dr. Katie McKie, Director of Pediatric Pulmonology at Augusta University, joins Dr. Ryan Harris, Founder and Director of the LIVEP and CF researcher, and Medical Student Brooke Quertermous to discuss the impact of nutrition and exercise on children with CF. Specifically, they will: Explain the mechanism by which CF affects digestion and absorption of nutrients Acknowledge the importance of frequent growth monitoring for children with CF. Understand the role of nutrient supplementation for children with CF, and when enteral nutrition is required. Describe why exercise intolerance occurs in CF and the necessity of regular exercise for these patients. FREE CME Credit (requires sign-in): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8631 Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenariosWe look forward to speaking to you on our next episode of the MCG Pediatric Podcast. References: Gajbhiye, R., et al., Cystic fibrosis transmembrane conductance regulator (CFTR) gene abnormalities in Indian males with congenital bilateral absence of vas deferens & renal anomalies. Indian J Med Res, 2016. 143(5): p. 616-23. AND Elborn, J.S., Cystic fibrosis. Lancet, 2016. 388(10059): p. 2519-2531.) (Kuk, K. and J.L. Taylor-Cousar, Lumacaftor and ivacaftor in the management of patients with cystic fibrosis: current evidence and future prospects. Ther Adv Respir Dis, 2015. 9(6): p. 313-26.) (Farrell et al, Siret el al, Sims et al). Sullivan, J. S., & Mascarenhas, M. R. (2017). Nutrition: Prevention and management of nutritional failure in cystic fibrosis. Journal of Cystic Fibrosis, 16. doi:10.1016/j.jcf.2017.07.010 Committee On Practice And Ambulatory Medicine, & Workgroup, B. (2020, March 01). 2020 recommendations for Preventive Pediatric health care. Retrieved March 22, 2021, from https://pediatrics.aappublications.org/content/145/3/e20200013 Cystic Fibrosis Foundation, et al. Cystic Fibrosis Foundation evidence-based guidelines for management of infants with cystic fibrosis, J Pediatr 2009; 155(6 Suppl):S73-93.) (Nutrition Prevention and Management Article) (Mattar AC, Leone C, Rodrigues JC, Adde FV. Sweat conductivity: an accurate diagnostic test for cystic fibrosis? J Cyst Fibros. 2014 Sep;13(5):528-33. doi: 10.1016/j.jcf.2014.01.002. Epub 2014 Jan 31. PMID: 24485874.) Ameet Daftary, James Acton, James Heubi, Raouf Amin, Fecal elastase-1: Utility in pancreatic function in cystic fibrosis, Journal of Cystic Fibrosis, Volume 5, Issue 2, 2006, Pages 71-76,ISSN 1569-1993, Walkowiak, D. Sands, A. Nowakowska, R. Piotrowski, K. Zybert, K.H. Herzig, et al. Early decline of pancreatic function in cystic fibrosis patients with class 1 or 2 CFTR mutations J Pediatr Gastroenterol Nutr, 40 (2) (2005), pp. 199-201 Witt, H. (2003). Chronic pancreatitis and cystic fibrosis. Gut, 52(90002), 31ii-41. doi:10.1136/gut.52.suppl_2.ii31 Fielding, J., Brantley, L., Seigler, N., McKie, K. T., Davison, G. W., & Harris, R. A. (2015). Oxygen uptake kinetics and exercise capacity in children with cystic fibrosis. Pediatric Pulmonology, 50(7), 647-654. doi:10.1002/ppul.23189 Orenstein, D. (2018). The Relationship between CFTR Genotype and Exercise Tolerance in Cystic Fibrosis.. AnnalsATS, 15(2), 166. Marcotte JE, Canny GJ, Grisdale R, Desmond K, Corey M, Zinman R, Levison H, Coates AL. Effects of nutritional status on exercise performance in advanced cystic fibrosis. Chest. 1986 Sep;90(3):375-9. doi: 10.1378/chest.90.3.375. PMID: 3743150. Pastré, J., Prévotat, A., Tardif, C., Langlois, C., Duhamel, A., & Wallaert, B. (2014). Determinants of exercise capacity in cystic fibrosis patients with mild-to-moderate lung disease. BMC pulmonary medicine, 14(1), 1-8. Hulzebos, Erik H. J.1; Bomhof-Roordink, Hanna1,3; van de Weert-van Leeuwen, Pauline B.2; Twisk, Jos W. R.3; Arets, H. G. M.2; van der Ent, Cornelis K.2; Takken, Tim1 Prediction of Mortality in Adolescents with Cystic Fibrosis, Medicine & Science in Sports & Exercise: November 2014 - Volume 46 - Issue 11 - p 2047-2052 doi: 10.1249/MSS.0000000000000344 Ding S., Zhong C. (2020) Exercise and Cystic Fibrosis. In: Xiao J. (eds) Physical Exercise for Human Health. Advances in Experimental Medicine and Biology, vol 1228. Springer, Singapore. https://doi.org/10.1007/978-981-15-1792-1_26 Moorcroft AJ, Dodd ME, Morris J, Webb AK. Individualised unsupervised exercise training in adults with cystic fibrosis: a 1 year randomised controlled trial. Thorax. 2004 Dec;59(12):1074-80. doi: 10.1136/thx.2003.015313. PMID: 15563708; PMCID: PMC1746905. Pianosi P, Leblanc J, Almudevar A. Peak oxygen uptake and mortality in children with cystic fibrosis. Thorax. Jan 2005;60(1):50-54. LIVEP Contact: Reva Crandall at 706-721-5483.
***Trigger warning: this episode includes discussion of child abuse*** This is a follow up episode that dives deeper on why a bruised baby is worrisome, important aspects of a social history, and screening for abuse in the ED. Please listen to our first episode “It Could Have Been Different” for more! Have you used TEN-4 FACESp to identify potential non-accidental trauma? Share your experience with us via social media, @empulsepodcast, or through our website, ucdavisem.com. ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guest: Dr. Mary Clyde Pierce, Professor of Pediatrics at Northwestern University, Pediatric Emergency Physician and Director of Child Abuse Research at Laurie Children's Hospital. Resources: “It Could Have Been Different” EM Pulse Podcast published April 17, 2021. https://ucdavisem.com/2021/04/17/it-could-have-been-different/ Pierce MC, Magana JN, Kaczor K, Lorenz DJ, Meyers G, Bennett BL, Kanegaye JT. The Prevalence of Bruising Among Infants in Pediatric Emergency Departments. Ann Emerg Med. 2016 Jan;67(1):1-8. doi: 10.1016/j.annemergmed.2015.06.021. Epub 2015 Jul 29. PMID: 26233923; PMCID: PMC4695295. Fingarson AK, Pierce MC, Lorenz DJ, Kaczor K, Bennett B, Berger R, Currie M, Herr S, Hickey S, Magana J, Makoroff K, Williams M, Young A, Zuckerbraun N. Who's Watching the Children? Caregiver Features Associated with Physical Child Abuse versus Accidental Injury. J Pediatr. 2019 Sep;212:180-187.e1. doi: 10.1016/j.jpeds.2019.05.040. Epub 2019 Jun 26. PMID: 31255388; PMCID: PMC6707841. Pierce MC, Kaczor K, Thompson R. Bringing back the social history. Pediatr Clin North Am. 2014 Oct;61(5):889-905. doi: 10.1016/j.pcl.2014.06.010. Epub 2014 Aug 12. PMID: 25242704; PMCID: PMC4171692. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.
***Trigger warning: this episode includes discussion of child abuse*** As emergency physicians, we are uniquely positioned to identify and address child abuse, or non-accidental trauma (NAT). It’s a challenging part of our job, but our vigilance can save a child’s life. Signs of abuse can often be subtle, but there are some very specific findings that should make us consider NAT. In this episode, we talk with expert, Dr. Mary Clyde Pierce, about her recently published paper, coauthored by our own Dr. Julia Magaña, validating the TEN-4 FACESp clinical decision rule to predict abuse in young children. Have you used TEN-4 FACESp to identify potential non-accidental trauma? Share your experience with us via social media, @empulsepodcast, or through our website, ucdavisem.com. ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis Guest: Dr. Mary Clyde Pierce, Professor of Pediatrics at Northwestern University, Pediatric Emergency Physician and Director of Child Abuse Research at Laurie Children’s Hospital. Resources: Pierce MC, Kaczor K, Lorenz DJ, Bertocci G, Fingarson AK, Makoroff K, Berger RP, Bennett B, Magana J, Staley S, Ramaiah V, Fortin K, Currie M, Herman BE, Herr S, Hymel KP, Jenny C, Sheehan K, Zuckerbraun N, Hickey S, Meyers G, Leventhal JM. Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA Netw Open. 2021 Apr 1;4(4):e215832. doi: 10.1001/jamanetworkopen.2021.5832. Lorenz DJ, Pierce MC, Kaczor K, Berger RP, Bertocci G, Herman BE, Herr S, Hymel KP, Jenny C, Leventhal JM, Sheehan K, Zuckerbraun N. Classifying Injuries in Young Children as Abusive or Accidental: Reliability and Accuracy of an Expert Panel Approach. J Pediatr. 2018 Jul;198:144-150.e4. doi: 10.1016/j.jpeds.2018.01.033. Epub 2018 Mar 15. PMID: 29550228; PMCID: PMC6019119. CDC Morbidity and Mortality Weekly Report: Trends in US Emergency Department Visits Related to Suspected or Confirmed Abuse and Neglect Among Children and Adolescents Aged
FDA 批准鱼油脂肪乳用于肠道衰竭相关肝病儿童的治疗JAMA 持续肺膨胀与间歇正压通气对极早产儿支气管肺发育不良NEJM 喉罩通气在新生儿复苏中的随机试验European Respiratory Journal 利用早产儿心率特征指数预测拔管结果Scientific Report 肠道菌群移植治疗对自闭症ω-3鱼油脂肪乳（fish oil triglycerides）2018年7月，FDA批准ω-3鱼油脂肪乳（fish oil triglycerides）作为儿童肠外营养相关胆汁淤积症患者的热量和脂肪酸来源。《多阶段回顾性分析：作为热量和脂肪酸的来源，静脉注射鱼油脂肪乳可促进患有肠道衰竭相关肝病的患儿的适龄生长》Journal of Pediatrics，2020年4月 (1)研究的目的是比较静脉注射鱼油脂肪乳（fish oil liquid emulsion，FOLE）和静脉注射大豆油脂肪乳（soybean oil liquid emulsion，SOLE）治疗肠衰竭相关性肝病（intestine failure associated liver disease，IFALD）患儿的疗效和患儿的生长情况。研究纳入41名患儿和82例历史对照组，接受开放标签鱼油脂肪乳 (1g/kg/d），直到IFALD消失或停止肠外营养；历史对照组接受大豆油脂肪乳（3g/kg/d）的治疗。 28周后，接受鱼油脂肪乳治疗的患儿的平均体重的z评分在-1到1范围内，显示出与年龄相适应的生长。与大豆油脂肪乳治疗的患儿相比，鱼油脂肪乳治疗的患儿的前白蛋白更高、甘油三酯更低、血糖浓度更正常。结论：与接受大豆油脂肪乳的儿童相比，接受鱼油脂肪乳的IFALD儿童生长指标更正常、代谢异常更少。《多中心回顾性分析鱼油脂肪乳减少肠衰竭相关肝病患儿肝损伤及肝移植风险》Journal of Pediatrics，2020年10月 (2)研究旨在比较经静脉注射鱼油脂肪乳（FOLE）和大豆油脂乳（SOLE）治疗的肠衰竭相关肝病患儿的转氨酶与血小板比值指数、肝移植和死亡率。在这项多中心综合分析中，将189例接受鱼油脂肪乳（1g/kg/d）治疗的儿童，与73例接受大豆油脂肪乳（3g/kg/d）的历史对照组进行比较。与历史对照组相比，接受鱼油脂肪乳的患儿在基线时的直接胆红素水平更高（212.28μmol/L vs 109.8μmol/L，P
FDA 批准鱼油脂肪乳用于肠道衰竭相关肝病儿童的治疗JAMA 持续肺膨胀与间歇正压通气对极早产儿支气管肺发育不良NEJM 喉罩通气在新生儿复苏中的随机试验European Respiratory Journal 利用早产儿心率特征指数预测拔管结果Scientific Report 肠道菌群移植治疗对自闭症ω-3鱼油脂肪乳（fish oil triglycerides）2018年7月，FDA批准ω-3鱼油脂肪乳（fish oil triglycerides）作为儿童肠外营养相关胆汁淤积症患者的热量和脂肪酸来源。《多阶段回顾性分析：作为热量和脂肪酸的来源，静脉注射鱼油脂肪乳可促进患有肠道衰竭相关肝病的患儿的适龄生长》Journal of Pediatrics，2020年4月 (1)研究的目的是比较静脉注射鱼油脂肪乳（fish oil liquid emulsion，FOLE）和静脉注射大豆油脂肪乳（soybean oil liquid emulsion，SOLE）治疗肠衰竭相关性肝病（intestine failure associated liver disease，IFALD）患儿的疗效和患儿的生长情况。研究纳入41名患儿和82例历史对照组，接受开放标签鱼油脂肪乳 (1g/kg/d），直到IFALD消失或停止肠外营养；历史对照组接受大豆油脂肪乳（3g/kg/d）的治疗。 28周后，接受鱼油脂肪乳治疗的患儿的平均体重的z评分在-1到1范围内，显示出与年龄相适应的生长。与大豆油脂肪乳治疗的患儿相比，鱼油脂肪乳治疗的患儿的前白蛋白更高、甘油三酯更低、血糖浓度更正常。结论：与接受大豆油脂肪乳的儿童相比，接受鱼油脂肪乳的IFALD儿童生长指标更正常、代谢异常更少。《多中心回顾性分析鱼油脂肪乳减少肠衰竭相关肝病患儿肝损伤及肝移植风险》Journal of Pediatrics，2020年10月 (2)研究旨在比较经静脉注射鱼油脂肪乳（FOLE）和大豆油脂乳（SOLE）治疗的肠衰竭相关肝病患儿的转氨酶与血小板比值指数、肝移植和死亡率。在这项多中心综合分析中，将189例接受鱼油脂肪乳（1g/kg/d）治疗的儿童，与73例接受大豆油脂肪乳（3g/kg/d）的历史对照组进行比较。与历史对照组相比，接受鱼油脂肪乳的患儿在基线时的直接胆红素水平更高（212.28μmol/L vs 109.8μmol/L，P
FDA 批准免疫疗法治疗青少年花生过敏NEJM 妊娠期呼吸道合胞病毒预防接种及其对婴儿的影响Stem Cells子刊 脐带血注射治疗孤独症AR101口服免疫疗法2020年1月，FDA已经批准花生过敏原粉剂，也称为palforzia，上市用于治疗花生过敏。《ARTEMIS研究：AR101口服免疫疗法治疗花生过敏的3期试验》Lancet: Child & Adolescent Health，2020年 (1)这项多中心、双盲、随机、安慰剂对照的3期试验旨在评估AR101对花生过敏的疗效和安全性，研究纳入175例、4-17岁、患有花生过敏的青少年，分别每天给予花生蛋白过敏原粉剂或安慰剂组。每两周增加一次剂量，6个月内到达300毫克（相当于一颗花生），并维持3个月。研究结束时，参与者接受1000mg花生蛋白的挑战，治疗组有58%的参与者和安慰剂组2%的参与者能够耐受1000mg花生蛋白。大多数不良事件为轻中度。结论：口服免疫治疗诱导花生蛋白快速脱敏，是相对安全有效的。呼吸道合胞病毒感染呼吸道合胞病毒（RSV）能在所有年龄段人群中引发急性呼吸道疾病，季节性爆发一般出现在10或11月直至次年4或5月。RSV是1岁以下的及5岁以下儿童、中下呼吸道感染的最常见病因，占这个年龄段儿童全因死亡的2.3%-6.7%。RSV感染通常为自限性的，但有一些患者可能出现复发性哮鸣。药物治疗：利巴韦林虽然已被批准用于RSV感染的治疗，但是美国儿科学会只推荐利巴韦林用于重症感染合并免疫抑制的患儿（利巴韦林因其致畸作用禁用于孕妇）。免疫预防：帕利佐单抗（pavilizumab，抗RSV F糖蛋白的单克隆抗体）。《全国性队列研究：幼儿呼吸道合胞病毒相关住院情况》Pediatrics，2020年7月 (2)这个基于人群的研究，统计了2015-2016年美国因急性呼吸道感染住院的、5岁以下儿童公2969名。其中检测合胞病毒阳性占35%，
FDA 批准免疫疗法治疗青少年花生过敏NEJM 妊娠期呼吸道合胞病毒预防接种及其对婴儿的影响Stem Cells子刊 脐带血注射治疗孤独症AR101口服免疫疗法2020年1月，FDA已经批准花生过敏原粉剂，也称为palforzia，上市用于治疗花生过敏。《ARTEMIS研究：AR101口服免疫疗法治疗花生过敏的3期试验》Lancet: Child & Adolescent Health，2020年 (1)这项多中心、双盲、随机、安慰剂对照的3期试验旨在评估AR101对花生过敏的疗效和安全性，研究纳入175例、4-17岁、患有花生过敏的青少年，分别每天给予花生蛋白过敏原粉剂或安慰剂组。每两周增加一次剂量，6个月内到达300毫克（相当于一颗花生），并维持3个月。研究结束时，参与者接受1000mg花生蛋白的挑战，治疗组有58%的参与者和安慰剂组2%的参与者能够耐受1000mg花生蛋白。大多数不良事件为轻中度。结论：口服免疫治疗诱导花生蛋白快速脱敏，是相对安全有效的。呼吸道合胞病毒感染呼吸道合胞病毒（RSV）能在所有年龄段人群中引发急性呼吸道疾病，季节性爆发一般出现在10或11月直至次年4或5月。RSV是1岁以下的及5岁以下儿童、中下呼吸道感染的最常见病因，占这个年龄段儿童全因死亡的2.3%-6.7%。RSV感染通常为自限性的，但有一些患者可能出现复发性哮鸣。药物治疗：利巴韦林虽然已被批准用于RSV感染的治疗，但是美国儿科学会只推荐利巴韦林用于重症感染合并免疫抑制的患儿（利巴韦林因其致畸作用禁用于孕妇）。免疫预防：帕利佐单抗（pavilizumab，抗RSV F糖蛋白的单克隆抗体）。《全国性队列研究：幼儿呼吸道合胞病毒相关住院情况》Pediatrics，2020年7月 (2)这个基于人群的研究，统计了2015-2016年美国因急性呼吸道感染住院的、5岁以下儿童公2969名。其中检测合胞病毒阳性占35%，
FDA 批准2种治疗儿童遗传性癫痫综合征的药物NEJM 早产儿Apgar评分与新生儿死亡风险的关系Science Translational Medicine 基因治疗可逆转Danon病的代谢和多器官功能障碍司替戊醇（Stiripentol）Dravet综合征，以前称为婴儿严重肌阵挛性癫痫，是一种罕见的儿童遗传性癫痫综合征。其典型的特征是药物难治性癫痫发作，抗癫痫药物治疗是主要手段，但总体疗效有限，初始药物选择包括丙戊酸盐、苯二氮卓类药物氯巴占；一线药物治疗失败，也有选择生酮饮食疗法和神经调控技术治疗的。司替戊醇（Stiripentol，CYP450抑制剂，2018年FDA批准用于Dravet综合征的二线治疗，需与丙戊酸盐和氯巴占合用）。《STICLO-France和STICLO-Italy研究：司替戊醇治疗Dravet综合征》Drugs，2019年11月 (1)司替戊醇可以用于氯巴占和丙戊酸盐无法控制的Dravet综合征患者。佐证其疗效的最重要的两个随机对照研究分别为STICLO-France和STICLO-Italy，这两个小型的、随机对照试验，2个月的司替戊醇辅助疗法与明显优于安慰剂，两个研究数据放在一起分析，司替戊醇的缓解率是安慰剂组的10倍（70%比7%）。随后，这些短期结果被扩展为开放标签、观察性研究，当时3-21岁的参与者，长期使用该药物直至中青年，最长服药24年，疗效维持。乏力、食欲减退、体重减轻、共济失调和震颤是最常见的不良事件。结论：根据现有证据，司替戊醇作为Dravet综合征的辅助药物，疗效和安全性均较可靠。芬氟拉明（fenfluramine）2020年6月，芬氟拉明（fenfluramine），是一种安非他明的衍生物，被FDA批准用于治疗≥2岁的Dravet综合征患儿。《FAiRE DS研究：芬氟拉明剂量滴定治疗Dravet综合征的剂量滴定的3期研究》JAMA Neurology，2019年12月 (2)研究旨在评估芬氟拉明治疗司替戊醇治疗效果不佳的、Dravet综合征患者是否可以减少每月惊厥发作频率。这项双盲、安慰剂对照、平行组随机、剂量滴定的3期临床试验，纳入确诊为Dravet综合征的、2岁-18岁的、正在接受稳定剂量司替戊醇治疗的、115名儿童。他们被随机分配到芬氟拉明组和或安慰剂，经过3周的药物滴定后，进入12周的维持治疗。患儿平均年龄9.1岁，惊厥性癫痫发作平均每月25次。12周后，芬氟拉明组的患儿发作频率较安慰剂组下降54.0%；同时，芬氟拉明组54%的患者发作频率下降≥50%，而安慰剂组仅5% (P
FDA 批准2种治疗儿童遗传性癫痫综合征的药物NEJM 早产儿Apgar评分与新生儿死亡风险的关系Science Translational Medicine 基因治疗可逆转Danon病的代谢和多器官功能障碍司替戊醇（Stiripentol）Dravet综合征，以前称为婴儿严重肌阵挛性癫痫，是一种罕见的儿童遗传性癫痫综合征。其典型的特征是药物难治性癫痫发作，抗癫痫药物治疗是主要手段，但总体疗效有限，初始药物选择包括丙戊酸盐、苯二氮卓类药物氯巴占；一线药物治疗失败，也有选择生酮饮食疗法和神经调控技术治疗的。司替戊醇（Stiripentol，CYP450抑制剂，2018年FDA批准用于Dravet综合征的二线治疗，需与丙戊酸盐和氯巴占合用）。《STICLO-France和STICLO-Italy研究：司替戊醇治疗Dravet综合征》Drugs，2019年11月 (1)司替戊醇可以用于氯巴占和丙戊酸盐无法控制的Dravet综合征患者。佐证其疗效的最重要的两个随机对照研究分别为STICLO-France和STICLO-Italy，这两个小型的、随机对照试验，2个月的司替戊醇辅助疗法与明显优于安慰剂，两个研究数据放在一起分析，司替戊醇的缓解率是安慰剂组的10倍（70%比7%）。随后，这些短期结果被扩展为开放标签、观察性研究，当时3-21岁的参与者，长期使用该药物直至中青年，最长服药24年，疗效维持。乏力、食欲减退、体重减轻、共济失调和震颤是最常见的不良事件。结论：根据现有证据，司替戊醇作为Dravet综合征的辅助药物，疗效和安全性均较可靠。芬氟拉明（fenfluramine）2020年6月，芬氟拉明（fenfluramine），是一种安非他明的衍生物，被FDA批准用于治疗≥2岁的Dravet综合征患儿。《FAiRE DS研究：芬氟拉明剂量滴定治疗Dravet综合征的剂量滴定的3期研究》JAMA Neurology，2019年12月 (2)研究旨在评估芬氟拉明治疗司替戊醇治疗效果不佳的、Dravet综合征患者是否可以减少每月惊厥发作频率。这项双盲、安慰剂对照、平行组随机、剂量滴定的3期临床试验，纳入确诊为Dravet综合征的、2岁-18岁的、正在接受稳定剂量司替戊醇治疗的、115名儿童。他们被随机分配到芬氟拉明组和或安慰剂，经过3周的药物滴定后，进入12周的维持治疗。患儿平均年龄9.1岁，惊厥性癫痫发作平均每月25次。12周后，芬氟拉明组的患儿发作频率较安慰剂组下降54.0%；同时，芬氟拉明组54%的患者发作频率下降≥50%，而安慰剂组仅5% (P
Dr. Charles Scarborough joins the show to discuss the story of his son Jude, and his family's experience with his son's diagnosis with 22q11 deletion syndrome. In addition to hearing about the Scarborough's personal experience, we talk about the genetic considerations and common clinical manifestations of 22q11.2 deletion syndrome. How do you approach the general diagnostic testing and screening evaluation of a child with 22q11.2 deletion syndrome? We also discuss the impact that genetic and chronic disease has on our pediatric patients and their families. Thanks to Dr. Paul Mann, Dr. Liezl Domingo and Dr. Jacqueline Chan for providing guidance and peer review of the technical material in this episode. Citation: Hodges, Z. (Host). Scarborough, C. (Host). Mann, P. (Contributor). Chan, J. (Contributor). Domingo, L. (Contributor). (2020, Nov 1). Jude's Story/22q11 Deletion Syndrome. (S1:17) [Audio Podcast Episode]. MCG Pediatric Podcast. Medical College of Georgia Augusta. Links: MCG Pediatric Podcast: https://www.augusta.edu/mcg/pediatrics/residency/podcast.php Georgia Medicaid Katie Beckett: https://medicaid.georgia.gov/programs/all-programs/tefrakatie-beckett Clinica La fuente in Cusco, Peru http://www.lafuenteclinica.com/clinic-ingles/ If you would like to donate to Clinica La fuente https://www.mtw.org/projects/details/pe-la-fuente-centro-de-salud-integral Questions or comments? Contact us by email at mcgpediatricpodcast@augusta.edu References: Cohen JL, Crowley TB, McGinn DE, et al. 22q and two: 22q11.2 deletion syndrome and coexisting conditions. Am J Med Genet A. 2018;176(10):2203-2214. doi:10.1002/ajmg.a.40494 Campbell IM, Sheppard SE, Crowley TB, et al. What is new with 22q? An update from the 22q and You Center at the Children's Hospital of Philadelphia. Am J Med Genet A. 2018;176(10):2058-2069. doi:10.1002/ajmg.a.40637 Vorstman JA, Jalali GR, Rappaport EF, Hacker AM, Scott C, Emanuel BS. MLPA: a rapid, reliable, and sensitive method for detection and analysis of abnormalities of 22q. Hum Mutat. 2006;27(8):814-821. doi:10.1002/humu.20330 McDonald-McGinn DM, Sullivan KE. Chromosome 22q11.2 deletion syndrome (DiGeorge syndrome/velocardiofacial syndrome). Medicine (Baltimore). 2011;90(1):1-18. doi:10.1097/MD.0b013e3182060469 Bassett AS, McDonald-McGinn DM, Devriendt K, et al. Practical guidelines for managing patients with 22q11.2 deletion syndrome.J Pediatr. 2011;159(2):332-9.e1. doi:10.1016/j.jpeds.2011.02.039
The COVID-19 pandemic laid bare the racial health disparities in the United States, with markedly increased mortality especially among Blacks and Native Americans. In this episode, Tony Breu and I discuss the conception of race, racism, and the social determinants of health through three historic plagues in the United States -- from yellow fever in New Orleans, to poliomyelitis, and finally the early days of HIV/AIDS -- and what lessons we can draw for COVID-19. Along the way, we’ll discuss the unique social capital afforded by acclimation, immunity passports, the concept of the “original antigenic sin,” and constitutionalism and eugenics. This presentation was performed live at the annual meeting of the Massachusetts American College of Physicians, and is only lightly edited. SOURCES: Monath TP, Yellow fever: an update. Lancet Infect Dis. 2001 Aug;1(1):11-20. doi: 10.1016/S1473-3099(01)00016-0. Kallas EG, D'Elia Zanella LGFAB, Moreira CHV, Buccheri R, Diniz GBF, Castiñeiras ACP, Costa PR, Dias JZC, Marmorato MP, Song ATW, Maestri A, Borges IC, Joelsons D, Cerqueira NB, Santiago E Souza NC, Morales Claro I, Sabino EC, Levi JE, Avelino-Silva VI, Ho YL. Predictors of mortality in patients with yellow fever: an observational cohort study. Lancet Infect Dis. 2019 Jul;19(7):750-758. doi: 10.1016/S1473-3099(19)30125-2. Epub 2019 May 16. Erratum in: Lancet Infect Dis. 2019 Nov;19(11):e370. PMID: 31104909. Blake LE, Garcia-Blanco MA. Human genetic variation and yellow fever mortality during 19th century U.S. epidemics. mBio. 2014 Jun 3;5(3):e01253-14. doi: 10.1128/mBio.01253-14. PMID: 24895309; PMCID: PMC4049105. Jelili Ojodu, MPH1, Mary M. Hulihan, MPH2, Shammara N. Pope, MPH2, Althea M. Grant, PhD2,, MMWR, Incidence of Sickle Cell Trait — United States, 2010. IthaMaps, Haemoglobin Epidemiology. https://www.ithanet.eu/db/ithamaps?country=GR Serjeant GR, The natural history of sickle cell disease. Cold Spring Harb Perspect Med. 2013 Oct; 3(10): a011783. Hamosh A, FitzSimmons SC, Macek M Jr, Knowles MR, Rosenstein BJ, Cutting GR. Comparison of the clinical manifestations of cystic fibrosis in black and white patients. J Pediatr. 1998 Feb;132(2):255-9. doi: 10.1016/s0022-3476(98)70441-x. PMID: 9506637. Gershman KD et al, Yellow Fever Vaccine & Malaria Prophylaxis Information, by Country. CDC. Kofler N and Baylis F, Ten reasons why immunity passports are a bad idea. Nature 21 May 2020. NASEM, National Academies Release Framework for Equitable Allocation of a COVID-19 Vaccine for Adoption by HHS, State, Tribal, Local, and Territorial Authorities. Schmidt H et al, Covid-19: how to prioritize worse-off populations in allocating safe and effective vaccines.BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3795 (Published 05 October 2020). Siegal FP, Lopez C, Hammer GS, Brown AE, Kornfeld SJ, Gold J, Hassett J, Hirschman SZ, Cunningham-Rundles C, Adelsberg BR, et al. Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N Engl J Med. 1981 Dec 10;305(24):1439-44. doi: 10.1056/NEJM198112103052403. PMID: 6272110. Lushniak BD, Surgeon General’s Perspectives. Public Health Rep. 2014 Mar-Apr; 129(2): 112–114. Booske BC et al, “Different Perspectives For Assigning Weights to Determinants of Health,” University of Wisconsin Population Health Institute. Marc LG et al,HIV among Haitian-born persons in the United States, 1985–2007, AIDS. Author manuscript; available in PMC 2011 Aug 24. Rogers N, Race and the Politics of Polio: Warm Springs, Tuskegee, and the March of Dimes. Am J Public Health. 2007 May; 97(5): 784–795. Curran JW and Jaffe HW, AIDS: the Early Years and CDC’s Response. MMWR. Olivarius Kathryn, Immunity, Capital, and Power in Antebellum New Orleans. The American Historical Review, Volume 124, Issue 2, April 2019, Pages 425–455,
https://www.youtube.com/watch?v=EBhEjYhVoZk Goggin K et al. Reductions in parent interest in receiving antibiotics following a 90-second video intervention in outpatient pediatric clinics. J Pediatr 2020 Jun 15; [e-pub]. (https://doi.org/10.1016/j.jpeds.2020.06.027) acute respiratory tract illnesses (ARTIs; cough, congestion, sore throat, and earache) is a PROBLEM with a capital P. or maybe I should say its a pain in the A with a capital A and that A of course is referring to antibiotics-- parents want antibiotics, sometimes demand antibiotics and no matter what you say, its hard to say no time and time and time again and eventually EVERYONE and yes I mean everyone will eventually give an antibiotic when they in their heart of heart knows it is likely not indicated. BUT what if we could educate our pts before we walked in the room. In this study they surveyed 1051 parents about their knowledge of and interest in receiving antibiotics for their children. Surveys were conducted before and after parents watched a professionally created 90-second cartoon-- I dont have access to the cartoon but I didnt find a two minute cartoon on youtube and it is the in the show notes-- just go to details of this podcast! how do you get to the details?? if you are listening to this podcast on apple you click the little dots in the lower right hand corner, click go to show, then it goes to this show and click on details and BAM its magic all the information about this show. and ths me there is a listener named paul and I wont give the last name but you emailed me about an article and for the life of me I can’t find that article back so please re email me andrewbuelt@gmail.com back to the study in this survey Parents rated their interest in receiving an antibiotic using a visual analogue scale ranging from 0-100, with 0 being “I definitely do not want an antibiotic,” 50 “Neutral,” and 100 “I absolutely want an antibiotic.” at baseline average score was 57 and it reduced down to 47 BUT if you were one of the parents that scored much higher say a mean around 83 which is geting close to the 100 “I absolutely want an antibiotic.” your score dropped down to 63 which is much closer to neutral!! This gives you a chance to not write antibiotics if not needed- i dont take care of kids 1-5 but if I did EVERY parent would be watching this video or it would be on repeat for the education videos. last episode I talked about breast cancer screening and the age old saying is when it rains it pours which is clearly seen in this paper Le Blanc JM et al. Association of Medicaid expansion under the Affordable Care Act with breast cancer stage at diagnosis. JAMA Surg 2020 Jul 1; [e-pub]. (https://doi.org/10.1001/jamasurg.2020.1495) Affordable Care Act (ACA) went into full effect in early 2014. luckily for us as of 2018, 37 states, including the District of Columbia had adopted Medicaid expansion and 14 had not. this is prime time to look to see what happens when all of a sudden these women have insurance and can get mammograms! Ideally we should see a burst of new early cancers that then prevent all these really aggressive late cancers!! riiiiiight?? in this retrospective cohort analysis they looked at Stage at diagnosis was compared between patients who were uninsured, had Medicaid or Medicare, or were privately covered during the preexpansion years (2012-2013) and postexpansion years (2015-2016) Stage at diagnosis (early [stage 0 or 1] vs. late [stage 3 or 4]) was assessed by state and insurance status for pre-expansion years (2012–2013) compared with postexpansion years (2015–2016). “Between 2007 and 2012, the percentage of late-stage cancer was around 12% for those that were insurance or had medicaid”- this makes sense if you have insurance all things being equal all states should have pretty equal rates of breast cancer BUT Patients with late-stage cancer who were uninsured in nonexpansion states exhibited a 1 percentage–point non significant decline from 24.2% to 23.5% (P = .14), whereas patients with late-stage cancer who were uninsured or had Medicaid in the expansion states saw a significant decrease from 21.8% to 19.3% (P 10 and roughly 1 in 10 were started on thyroid therapy with TSH in normal range. Sometimes I really get worried how do you know that hip pain is osteoarthritis and not a strangulated inguinal hernia Does this patient have hip osteoarthritis?: The rational clinical examination systematic review Metcalfe D, Perry DC, Claireaux HA, et al. JAMA. 2019;322(23):2323-2333. doi: 10.1001/jama.2019.19413. Let’s say your patient has hip or groin pain. How do you know if it’s osteoarthritis (OA)? results in the end Six studies with 1,110 patients; 509 (38%) had radiographic hip OA. The following features were found to be useful: Squat causing posterior pain (likelihood ratio [LR] +6.1) Groin pain on passive adduction or abduction (LR +5.7) to rule out OA is normal passive hip adduction (LR –0.25) while these are not high LR ratios over 10 that we would hope for, if you combine a couple of them together they can work synergistically to give you a higher likelihood ratio and more secure diagnosis.
Fox MT et al. Comparative effectiveness of antibiotic treatment duration in children with pyelonephritis. JAMA Netw vOpen 2020 May 1; 3:e203951. (https://doi.org/10.1001/jamanetworkopen.2020.3951) Rates of treatment failure did not differ significantly between the short and prolonged courses (11.2% and 9.4%). https://jamanetwork.com/journals/jama/fullarticle/2765729?guestAccessKey=2169ba8b-43fc-4360-bed7-acf7a31b1c9d&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=etoc&utm_term=051220 Effect of Biomechanical Footwear on Knee Pain in People With Knee Osteoarthritis: The BIOTOK Randomized Clinical Trial In jama may 12 – look to see if special biomechanical footwear could help osteoarthirits knee pain- At 24 weeks of follow-up, the mean standardized WOMAC pain subscore improved from 4.3 to 1.3 in the biomechanical footwear group and from 4.0 to 2.6 in the control footwear group (between-group difference in scores at 24 weeks of follow-up, −1.3 [95% CI, −1.8 to −0.9]; P
Registered dietitian Stacia Pegram discusses:Evidence regarding the use of a human milk caloric fortifier for preterm infantsRole of Prolacta’s human milk caloric fortifier as a part of an Exclusive Human Milk Diet (EHMD)Strategies for maximizing nutrient delivery in an EHMDShow notes:Learn more about Prolact CR®Prolact CR® Preparation GuidelinesRogers SP, Hicks PD, Hamzo M, Veit LE, Abrams SA. Continuous feedings of fortified human milk lead to nutrient losses of fat, calcium, and phosphorous. Nutrients. 2010;2(3):230-240. doi:10.3390/nu2030240 Hair AB, Blanco CL, Moreira AG, et al. Randomized trial of human milk cream as a supplement to standard fortification of an exclusive human milk-based diet in infants 750-1250 g birth weight. J Pediatr. 2014;165(5):915-920. doi:10.1016/j.jpeds.2014.07.005Hair AB, Bergner EM, Lee ML, et al. Premature infants 750-1250 g birth weight supplemented with a novel human milk-derived cream are discharged sooner. Breastfeed Med. 2016;11:133-137. doi:10.1089/bfm.2015.0166 Tabata M, Abdelrahman K, Hair AB, Hawthorne KM, Chen Z, Abrams SA. Fortifier and cream improve fat delivery in continuous enteral infant feeding of breast milk. Nutrients. 2015;7(2):1174-1183. doi:10.3390/nu7021174Knake LA, King BC, Gollins LA, et al. Optimizing the use of human milk cream supplement in very preterm infants: growth and cost outcomes. Nutr Clin Pract. doi:10.1002/ncp.10423
Dr. Martin Lee discusses the earliest research on the importance of human milk in the preterm populationThe story behind the development of the first and only 100% human milk-based fortifier for micropreemiesShow notes:Sullivan S, Schanler RJ, Kim JH, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010;156(4):562-567. doi:10.1016/j.jpeds.2009.10.040Modanlou HD, Lim MO, Hansen JW, Sickles V. Growth, biochemical status, and mineral metabolism in very-low-birth-weight infant.J Pediatr Gastroenterol Nutr. 1986 Sep-Oct;5(5):762-7. doi:10.1097/00005176-198609000-00017Cristofalo EA, Schanler RJ, Blanco CL, et al. Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. J Pediatr. 2013;163(6):1592-1595. doi:10.1016/j.jpeds.2013.07.011Abrams SA, Schanler RJ, Lee ML, Rechtman DJ. Greater mortality and morbidity in extremely preterm infants fed a diet containing cow milk protein products. Breastfeed Med. 2014;9(6):281-285. doi:10.1089/bfm.2014.0024
College is a tough time for any kid. But it should also be exciting. Then to experience the freedoms of young adulthood, only later to face the horrifying reality of a progressive neurodegenerative condition...it's not something anyone should experience. In this week's continuation of the patient narrative series, Dr. Paul McIntosh (Duke) shares his life-changing story, and his optimism, about surviving a chronic neurological illness. Produced by James E. Siegler with the help of Paul McIntosh. For more information about Pompe Disease, check out the resources provided by the United Pompe Foundation at unitedpompe.com. Music for our program this week was courtesy of Ars Sonor, Franz Danzi, Lee Rosevere, and Scott Holmes. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Kishnani PS and Howell RR. Pompe disease in infants and children. J Pediatr. 2004;144:S35-43. Van den Hout JM, Kamphoven JH, Winkel LP, Arts WF, De Klerk JB, Loonen MC, Vulto AG, Cromme-Dijkhuis A, Weisglas-Kuperus N, Hop W, Van Hirtum H, Van Diggelen OP, Boer M, Kroos MA, Van Doorn PA, Van der Voort E, Sibbles B, Van Corven EJ, Brakenhoff JP, Van Hove J, Smeitink JA, de Jong G, Reuser AJ and Van der Ploeg AT. Long-term intravenous treatment of Pompe disease with recombinant human alpha-glucosidase from milk. Pediatrics. 2004;113:e448-57. Klinge L, Straub V, Neudorf U, Schaper J, Bosbach T, Gorlinger K, Wallot M, Richards S and Voit T. Safety and efficacy of recombinant acid alpha-glucosidase (rhGAA) in patients with classical infantile Pompe disease: results of a phase II clinical trial. Neuromuscul Disord. 2005;15:24-31. Kishnani PS, Corzo D, Nicolino M, Byrne B, Mandel H, Hwu WL, Leslie N, Levine J, Spencer C, McDonald M, Li J, Dumontier J, Halberthal M, Chien YH, Hopkin R, Vijayaraghavan S, Gruskin D, Bartholomew D, van der Ploeg A, Clancy JP, Parini R, Morin G, Beck M, De la Gastine GS, Jokic M, Thurberg B, Richards S, Bali D, Davison M, Worden MA, Chen YT and Wraith JE. Recombinant human acid [alpha]-glucosidase: major clinical benefits in infantile-onset Pompe disease. Neurology. 2007;68:99-109. Wokke JH, Escolar DM, Pestronk A, Jaffe KM, Carter GT, van den Berg LH, Florence JM, Mayhew J, Skrinar A, Corzo D and Laforet P. Clinical features of late-onset Pompe disease: a prospective cohort study. Muscle Nerve. 2008;38:1236-45. van der Ploeg AT, Clemens PR, Corzo D, Escolar DM, Florence J, Groeneveld GJ, Herson S, Kishnani PS, Laforet P, Lake SL, Lange DJ, Leshner RT, Mayhew JE, Morgan C, Nozaki K, Park DJ, Pestronk A, Rosenbloom B, Skrinar A, van Capelle CI, van der Beek NA, Wasserstein M and Zivkovic SA. A randomized study of alglucosidase alfa in late-onset Pompe's disease. The New England journal of medicine. 2010;362:1396-406. Cupler EJ, Berger KI, Leshner RT, Wolfe GI, Han JJ, Barohn RJ, Kissel JT and Disease ACCoL-oP. Consensus treatment recommendations for late-onset Pompe disease. Muscle Nerve. 2012;45:319-33. Beltran Papsdorf TB, Howard JF, Jr. and Chahin N. Pearls & Oy-sters: clues to the diagnosis of adult-onset acid maltase deficiency. Neurology. 2014;82:e73-5. Gutierrez-Rivas E, Bautista J, Vilchez JJ, Muelas N, Diaz-Manera J, Illa I, Martinez-Arroyo A, Olive M, Sanz I, Arpa J, Fernandez-Torron R, Lopez de Munain A, Jimenez L, Solera J and Lukacs Z. Targeted screening for the detection of Pompe disease in patients with unclassified limb-girdle muscular dystrophy or asymptomatic hyperCKemia using dried blood: A Spanish cohort. Neuromuscul Disord. 2015;25:548-53. Lukacs Z, Nieves Cobos P, Wenninger S, Willis TA, Guglieri M, Roberts M, Quinlivan R, Hilton-Jones D, Evangelista T, Zierz S, Schlotter-Weigel B, Walter MC, Reilich P, Klopstock T, Deschauer M, Straub V, Muller-Felber W and Schoser B. Prevalence of Pompe disease in 3,076 patients with hyperCKemia and limb-girdle muscular weakness. Neurology. 2016;87:295-8.
Welcome to this bonus episode of the MDedge Psychcast. In this episode, as a tribute to the late Carl C. Bell, MD, we would like to replay highlights from the interview that Lorenzo Norris, MD, did with him last year at the annual IPS (Institute on Psychiatric Services) Mental Health Services conference in Chicago. Dr. Norris, host of the MDedge Psychcast, is assistant professor of psychiatry and behavioral sciences at George Washington University, Washington. Dr. Bell, who died Aug. 1, was a psychiatrist at Jackson Park Hospital in Chicago and an emeritus professor of psychiatry at the University of Illinois at Chicago. He spoke with Dr. Norris in episodes 26 and 27 about identifying and preventing fetal alcohol spectrum disorders. Conceptualizing intellectual disabilities in children In the late 1960s, African American children had twice the rates of mild intellectual disabilities as did white children. Some clinicians thought that the intellectual disabilities they were seeing among African American children were the result of social-cultural mental retardation, but that conclusion did not make sense to Dr. Bell. Julius B. Richmond, MD, former surgeon general, cocreated Head Start as a way to address some of the educational disadvantages faced by low-income children. African American psychologists began to suggest that standardized tests were biased against certain racial and low-income groups. Bell thought some African American and low-income children might have knowledge that their counterparts in other communities might not have. Fetal alcohol exposure emerges as an explanation A few years ago, Dr. Bell was talking with a woman patient with three children in the Illinois Department of Children and Family Services. The children had poor tempers, social/emotional skills. And when he looked at their mother, he saw fetal alcohol facies. After talking with the patient longer, he learned that she had not gotten far in school. She also had problems with simple subtraction. At that point, he thought that the patient might have had fetal alcohol exposure. He then began looking at family medicine patients at Jackson Park Hospital in Chicago. The question at that time was: “Were you drinking while you were pregnant?” That question did not explain why patients had children who could not do basic subtraction and had ADHD, for example. Bell realized that the right question was: When did you realize you were pregnant? In many cases, they would say that they had learned they were pregnant at 4-6 weeks. Choline deficiency and fetal alcohol exposure The Institute of Medicine recommended that pregnant women consume 450 mg/day of choline each day. Robert Freedman, MD, and his colleagues found that higher amounts of choline as a prenatal supplement are tied to more self-regulation among infants who had common maternal infections during gestation. Bell began giving choline to patients. In one example, a patient’s ability to relate to others improved dramatically after taking choline over an 18-month period. The American Medical Association passed a resolution supporting the addition of adequate amounts of choline to prenatal vitamins. References Freedle RO. Correcting the SAT’s ethnic and social-class bias: A method for reestimating SAT scores. Harvard Educ Rev. 2003. 73(1):1-42. Bell CC and J Aujla. Prenatal vitamins deficient in recommended choline intake for pregnant women. J Fam Med Dis Prevent. 2016. 4(2):1-3. Wozniak JR et al. Choline supplementation in children with fetal alcohol spectrum disorders: A randomized, double-blind, placebo-controlled trial. Am J Clin Nutr. 2015 Nov;102(5):1113-25. Wozniak JR et al. Choline supplementation in children with fetal alcohol spectrum disorders(FASD) has high feasibility & tolerability. Nutr Res. 2013. Nov;33(11):897-904. Zeisel SH and KA da Costa. Choline: An essential nutrient for public health. Nutr. Res. 2009. Nov;67(11):615-23. Freedman R et al. Higher gestational choline levels in maternal infection are protective for infant brain development. J Pediatr. 2019 May. 208:198-206. Velazquez R et al. Maternal choline supplementation ameliorates Alzheimer’s disease pathology by reducing brain homocysteine levels across multiple generations. Mol Psychiatry. 2019 Jan 8. doi: 10.1038/s41380-018-0322-z. Wilhoit F et al. Fetal alcohol spectrum disorders: Characteristics, complications, and treatment. Community Ment Health J. 2017 Aug;53(6):711-8. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych
Author: Julian Orenstein, MD Educational Pearls: Severe clonidine ingestion can present as a fluctuating mental status between typically accompanied by changes in vital signs (hypotension/bradycardia) Respiratory depression requiring intubation is not uncommon References Isbister GK, Heppell SP, Page CB, Ryan NM. Adult clonidine overdose: prolonged bradycardia and central nervous system depression, but not severe toxicity. Clin Toxicol (Phila). 2017 Mar;55(3):187-192. doi: 10.1080/15563650.2016.1277234. Epub 2017 Jan 20. PubMed PMID: 28107093. Spiller HA, Klein-Schwartz W, Colvin JM, Villalobos D, Johnson PB, Anderson DL. Toxic clonidine ingestion in children. J Pediatr. 2005 Feb;146(2):263-6. PubMed PMID: 15689921. Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD
Episode 1: Pot-Tarts In our first full episode, we explore the dangers of marijuana ingestion in kids. With several states legalizing marijuana for recreational use, we are likely to see a lot more of this in our EDs. Emergency Physicians, Dr. John Richards and Dr. Aimee Moulin, take us through their recent systematic review of unintentional cannabis ingestion in children. Medical Toxicologist, Dr. Daniel Colby, revisits an interesting case and leaves us with some pearls for identifying and managing potential marijuana ingestion. Hosts: Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis Dr. Julia Magana, Assistant Professor of Emergency Medicine at UC Davis - Pediatric Emergency Medicine Guests: Dr. John Richards, Professor of Emergency Medicine at UC Davis, Chair of Quality Management for SAEM Dr. Aimee Moulin, Associate Professor of Emergency Medicine and Director of Behavioral Health at UC Davis, President of California ACEP Dr. Daniel Colby, Assistant Professor of Emergency Medicine and Medical Toxicologist at UC Davis Resources: Unintentional Cannabis Ingestion in Children: A Systematic Review. https://www.ncbi.nlm.nih.gov/pubmed/28888560 Richards JR, Smith NE, Moulin AK. J Pediatr. 2017 Nov;190:142-152. doi: 10.1016/j.jpeds.2017.07.005. Epub 2017 Sep 6. Review. PMID: 28888560 If you are concerned that your patient may have ingested cannabis, you can call the Poison Control Center 24 hours a day at (800) 222-1222. Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magana at OM Audio Productions for audio production services. For more Toxicology, Pediatrics, and myriad other topics, join us at the UC Davis Emergency Medicine Winter Conference at the Ritz-Carlton in Lake Tahoe, February 26 through March 2nd. More information at https://www.ucdmc.ucdavis.edu/cme/course_pages/EM/emmed_pagelink.html
Abdominal pain is common; so are strongly held myths and legends about what is concerning, and what is not. One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain. Morbidity and mortality varies by age and condition. Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. Essentials: Typically presents in 1st week of life (case reports to 6 months in chronically ill children) Extend suspicion longer in NICU graduates Up to 10% of all cases of necrotizing enterocolitis are in full-term children Pathophysiology is unknown, but likely a translocation of bacteria Diagnosis: Feeding intolerance, abdominal distention Abdominal XR: pneumatosis intestinalis Management: IV access, NG tube, broad-spectrum antibiotics, surgery consult, ICU admission Intestinal Malrotation with Volvulus Essentials: Corkscrew Sign in Malrotation with Volvulus Bilious vomiting (80-100%) in the 1st month; especially in the 1st week May look well initially, then rapidly present in shock Ladd’s bands: abnormally high tethering of cecum to abdominal wall; peristalsis, volvulus, ischemia Diagnosis: History of bilious emesis is sufficient to involve surgeons Upper GI series: corkscrew appearance US (if ordered) may show abnormal orientation of and/or flow to superior mesenteric artery and vein Management: Stat surgical consult IV access, resuscitation, NG tube to decompress (bowel wall perfusion at risk, distention worsens) Hirschprung Disease Essentials: Problem in migration of neural crest cells Aganglionic colon (80% rectosigmoid; 15-20% proximal to sigmoid; 5% total colonic aganglionosis) colon (known as short-segment disease) Poor to no peristalsis: constipation, perforation, and/or sepsis Diagnosis: May be diagnosed early as “failure to pass meconium in 1st 48 hours” In ED, presents as either bowel obstruction or enterocolitis Contrast enema Beware of the toxic megacolon (vomiting, distention, sepsis) Management: Resuscitation, antibiotics, NG tube decompression, surgical consultation; stable patients may need rectal biopsy for confirmation Staged surgery (abdominoperineal pull-through with diverting colostomy, subsequent anastomosis) versus one-stage repair. Infant and Toddler (1 month to 2 years) Pyloric Stenosis Essentials: Hypertrophy of pyloric sphincter; genetic, environmental, exposure factorsString Sign in Pyloric Stenosis. Diagnosis: Hungry, hungry, not-so-hippos; they want to eat all of the time, but cannot keep things down Poor weight gain (less than 20-30 g/day) US: “π–loric stenosis” (3.14); pylorus dimensions > 3 mm x 14 mm UGI: “string sign” Management: Trial of medical treatment with oral atropine via NGT (muscarinic effects decrease pyloric tone) Ramstedt pyloromyotomy (definitive) Intussusception Essentials: Majority (90%) ileocolic; no pathological lead point Small minority (4%) ileoileocolic due to lead point: Meckel’s diverticulum, polyp, Peyer’s patches, Henoch-Schönlein purpura (intestinal hematoma) Diagnosis: Target Sign (Donut Sign). Ultrasound sensitivity and specificity near 100% in experienced hands Abdominal XR may show non-specific signs; used mainly to screen for perforation before reduction Management: Hydrostatic enema: contrast (barium or water-soluble contrast with fluoroscopy) or saline (with ultrasound) Air-contrast enema: air or carbon dioxide (with either fluoroscopy or ultrasound); higher risk for perforation than hydrostatic (1% risk), but generally safer than perforation from contrast Consider involving surgical service early (precaution before reduction) Traditional disposition is admission; controversial: home discharge from ED Young Child and Older (2 years and up) Appendicitis Essentials: Appendicitis occurs in all ages, but rarer in infants. Infants do not have fecalith; rather they have some other anatomic or congenital condition. More common in school-aged children (5-12 years) and adolescents Younger children present atypically, more likely to have perforated when diagnosed. Diagnosis: Non-specific signs and symptoms Often have abdominal pain first; vomiting comes later Location/orientation of appendix varies Appendicitis scores vary in their performance Respect fever and abdominal pain Management: Traditional: surgical On the horizon: identification of low-risk children who may benefit from trial of antibiotics If perforated, interval appendectomy (IV antibiotics via PICC for 4-6 weeks, then surgery) Obstruction SBO. Incarcerated Inguinal Hernia. Essentials: Same pathophysiology and epidemiology as adults: “ABC” – adhesions, “bulges” (hernias), and cancer. Diagnosis: Obstruction is a sign of another condition. Look for cause of obstruction: surgical versus medical Abdominal XR in low pre-test probability CT abdomen/pelvis for moderate-to-high risk; confirmation and/or surgical planning Management: Treat underlying cause NG tube to low intermittent wall suction Admission, fluid management, serial examinations Take these pearls home: Consider surgical pathology early in encounter Resuscitate while you investigate Have a low threshold for imaging and/or consultation, especially in preverbal children Selected References Necrotizing Enterocolitis Neu J, Walker A. Necrotizing Enterocolitis. N Eng J Med. 2011; 364(3):255-264. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nature. 2016; 13:590-600. Walsh MC et al. Necrotizing Enterocolitis: A Practitioner’s Perspective. Pediatr Rev. 1988; 9(7):219-226. Malrotation with Midgut Volvulus Applegate KE. Intestinal Malrotation in Children: A Problem-Solving Approach to the Upper Gastrointestinal Series. Radiographics. 2006; 26:1485-1500. Kapfer SA, Rappold JF. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. J Am Coll Surg. 2004; 199(4):628-635. Lee HC et al. Intestinal Malrotation and Catastrophic Volvulus in Infancy. J Emerg Med. 2012; 43(1):49-51. Martin V, Shaw-Smith C. Review of genetic factors in intestinal malrotation. Pediatr Surg Int. 2010; 26:769-781. Nehra D, Goldstein AM. Intestinal malrotation: Varied clinical presentation from infancy through adulthood. Surgery. 2010; 149(3):386-391. Hirschprung Disease Amiel J, Sproat-Emison E, Garcia-Barcelo M, et al. Hirschsprung disease, associated syndromes and genetics: a review. J Med Genet 2008; 45:1. Arshad A, Powell C, Tighe MP. Hirschsprung's disease. BMJ 2012; 345:e5521. Aworanti OM, McDowell DT, Martin IM, Quinn F. Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Eur J Pediatr Surg 2016; 26:192. Clark DA. Times of first void and first stool in 500 newborns. Pediatrics 1977; 60:457. Dasgupta R, Langer JC. Evaluation and management of persistent problems after surgery for Hirschsprung disease in a child. J Pediatr Gastroenterol Nutr 2008; 46:13. De Lorijn F, Reitsma JB, Voskuijl WP, et al. Diagnosis of Hirschsprung's disease: a prospective, comparative accuracy study of common tests. J Pediatr 2005; 146:787. Doig CM. Hirschsprung's disease and mimicking conditions. Dig Dis 1994; 12:106. Khan AR, Vujanic GM, Huddart S. The constipated child: how likely is Hirschsprung's disease? Pediatr Surg Int 2003; 19:439. Singh SJ, Croaker GD, Manglick P, et al. Hirschsprung's disease: the Australian Paediatric Surveillance Unit's experience. Pediatr Surg Int 2003; 19:247. Suita S, Taguchi T, Ieiri S, Nakatsuji T. Hirschsprung's disease in Japan: analysis of 3852 patients based on a nationwide survey in 30 years. J Pediatr Surg 2005; 40:197. Sulkowski JP, Cooper JN, Congeni A, et al. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. J Pediatr Surg 2014; 49:1619. Pyloric Stenosis Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pedaitr Surg. 2007; 16:27-33. Dias SC et al. Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. Insights Imaging. 2012; 3:247-250. Kawahara H et al. Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the olive? J Pediatr Surg. 2005; 40:1848-1851. Mack HC. Adult Hypertrophic Pyloric Stenosis. Arch Inter Med. 1959; 104:78-83. Meissner PE et al. Conservative treatment of infantile hypertrophic pyloric stenosis with intravenous atropine sulfate does not replace pyloromyotomy. Pediatr Surg Int. 2006; 22:1021-1024. Mercer AE, Phillips R. Can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to pyloromyotomy? Arch Dis Child. 2013; 95(6): 474-477. Pandya S, Heiss K, Pyloric Stenosis in Pediatric Surgery.Surg Clin N Am. 2012; 92:527-39. Peters B et al. Advances in infantile hypertrophic pyloric stenosis. Expert Rev Gastroenterol Hepatol. 2014; 8(5):533-541. Intussusception Apelt N et al. Laparoscopic treatment of intussusception in children: A systematic review. J Pediatr Surg. 2013; 48:1789-1793. Applegate KE. Intussusception in Children: Imaging Choices. Semin Roentgenol. 2008; 15-21. Bartocci M et al. Intussusception in childhood: role of sonography on diagnosis and treatment. J Ultrasound. 2015; 18 Gilmore AW et al. Management of childhood intussusception after reductiion by enema. Am J Emerg Med. 2011; 29:1136-1140.:205-211. Chien M et al. Management of the child after enema-reduced intussusception: hospital or home? J Emerg Med. 2013; 44(1):53-57. Cochran AA et al. Intussusception in traditional pediatric, nontraditional pediatric, and adult patients. Am J Emerg Med. 2011; 523-527. Loukas M et al. Intussusception: An Anatomical Perspective With Review of the Literature. Clin Anatomy. 2011; 24: 552-561. Mendez D et al. The diagnostic accuracy of an abdominal radiograph with signs and symptoms of intussusception. Am J Emerg Med. 2012; 30:426-431. Whitehouse et al. Is it safe to discharge intussusception patients after successful hydrostatic reduction? J Pediatr Surg. 2010; 45:1182-1186. Appendicitis Amin P, Chang D. Management of Complicated Appendicitis in the Pediatrc Population: When Surgery Doesn’t Cut it. Semin Intervent Radiol. 2012; 29:231-236 Blakely ML et al. Early vs Interval Appendectomy for Children With Perforated Appendicitis. Arch Surg. 2011; 146(6):660-665. Bundy DG et al. Does This Child Have Appendicitis? JAMA. 2007; 298(4):438-451. Cohen B et al. The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study? J Pediatr Surg. 2015 Jun;50(6):923-7 Herliczek TW et al. Utility of MRI After Inconclusive Ultrasound in Pediatric Patients with Suspected Appendicitis. AJT. 2013; 200:969-973. Janitz et al. Ultrasound Evaluation for Appendicitis. J Am Osteopath Coll Radiol. 2016; 5(1):5-12. Kanona H et al. Stump Appendicitis: A Review. Int J Surg. 2012; 10:4255-428. Kao LS et al. Antibiotics vs Appendectomy for Uncomplicated Acute Appendicitis. Evid Based Rev Surg. 2013;216(3):501-505. Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012; 10:115-119. Mazeh H et al. Tip appendicitis: clinical implications and management. Amer J Surg. 2009; 197:211-215. Puig S et al. Imaging of Appendicitis in Children and Adolescents. Semin Roentgenol. 2008; 22-28. Schizas AMP, Williams AB. Management of complex appendicitis. Surgery. 2010; 28(11):544-548. Shogilev DJ et al. Diagnosing Appendicitis: Evidence-Based Review. West J Emerg Med. 2014; 15(4):859-871. Wray CJ et al. Acute Appendicitis: Controversies in Diagnosis and Management. Current Problems in Surgery. 2013; 50:54-86 Intestinal Obstruction Babl FE et al. Does nebulized lidocaine reduce the pain and distress of nasogastric tube insertion in young children? A randomized, double-blind, placebo-controlled trial. Pediatrics. 2009 Jun;123(6):1548-55 Chinn WM, Zavala DC, Ambre J. Plasma levels of lidocaine following nebulized aerosol administration. Chest 1977;71(3):346-8. Cullen L et al. Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial. Ann Emerg Med. 2004 Aug;44(2):131-7. Gangopadhyay AN, Wardhan H. Intestinal obstruction in children in India. Pediatr Surg Int. 1989; 4:84-87. Hajivassiliou CA. Intestinal Obstruction in Neonatal/Pediatric Surgery. Semin Pediatr Surg. 2003; 12(4):241-253. Hazra NK et al. Acute Intestinal Obstruction in children: Experience in a Tertiary Care Hospital. Am J Pub Health Res. 2015; 3(5):53-56. Kuo YW et al. Reducing the pain of nasogastric tube intubation with nebulized and atomized lidocaine: a systematic review and meta-analysis. J Pain Symptom Manage. 2010 Oct;40(4):613-20. . Pediatric Surgery Irish MS et al. The Approach to Common Abdominal Diagnoses in Infants and Children. Pedaitr Clin N Am. 1998; 45(4):729-770. Louie JP. Essential Diagnosis of Abdominal Emergencies in the First Year of Life. Emerg Med Clin N Am. 2007; 25:1009-1040. McCullough M, Sharieff GQ. Abdominal surgical emergencies in infants and young children. Emerg Med Clin N Am. 2003; 21:909-935. Pepper VK et al. Diagnosis and Management of Pediatric Appendicitis, Intussusception, and Meckel Diverticulum. Surg Clin N Am. 2012 This post and podcast are dedicated to Mr Ross Fisher for his passion and spirit of collaboration in all things #FOAMed. Thank you, sir!
This week we review 1) Children and cellular aging: James S, Mclanahan S, Brooks-gunn J, et al. Sleep Duration and Telomere Length in Children. J Pediatr. 2017. https://www.newscientist.com/article/mg23531333-200-children-who-sleep-less-show-signs-of-ageing-in-their-cells/ 2) Editing our genes: Musunuru K. The Hope and Hype of CRISPR-Cas9 Genome EditingA Review. JAMA Cardiol. Published online June 14, 2017. doi:10.1001/jamacardio.2017.1713 3) Drug-resistant gonorrhea https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm Welcome to TalkingMed, the podcast where we discuss current medical news. Contact: talkingmedpodcast@gmail.com Twitter: @TalkingMedPod Song credit: Night Owl by Broke For Free from the Free Music Archive, used under CCBY Attribution License, modified from the original. Disclaimer: The information presented on this podcast are our own personal views, opinions, and research on the subject matter and do not represent those of our institution or our department. Anything discussed on this podcast should not be considered medical advice. Please contact a professional if you have any medical concerns. All content found on TalkingMed, including text, images, audio, or other formats were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have learned it from TalkingMed. Under no circumstances shall Vivek, Stephen, TalkingMed, any guests or contributors to the podcast or blog, or any employees, associates, or affiliates of TalkingMed be responsible for damages arising from use of the podcast or blog. This podcast or blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog. You hereby acknowledge that nothing contained on TalkingMed shall constitute financial, investment, legal and/or other professional advice and that no professional relationship of any kind is created between you and the TalkingMed. You hereby agree that you shall not make any financial, investment, legal and/or other decision based in whole or in part on anything contained on TalkingMed. Nothing on TalkingMed or included as a part of TalkingMed should be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. The content may contain health- or medical-related materials or discussions regarding sexually explicit disease states. If you find these materials offensive, you may not want to use this content.
Myocardial infarction (MI) in children is uncommon, but underdiagnosed. This is due to two main factors: the etiologies are varied; and the presenting symptoms are “atypical”. We need a mental metal detector! Case examples Congenital Two main presentations of MI due to congenital lesions: novel and known. The novel presentation is at risk for underdiagnosis, due to its uncommonness and vague, atypical symptoms. There are usually some red flags with a careful H&P. The known presentation is a child with a history of congenital heart disease, addressed by corrective or palliative surgery. This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. Risk stratify, collaborate with specialists. The fussy, sweaty feeder: ALCAPA Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) is an example of what can go wrong during fetal development: any abnormality in the number, origin, course, or morphology of the coronary arteries can present as a neonate with sweating during feeds (steal syndrome), an infant in CHF, or an older child with failure to thrive or poor exercise tolerance. The stable child with chest pain: myocardial bridge Normal coronary arteries run along the epicardial surface of the heart, with projections into the myocardium. If part of the artery’s course runs within the myocardium (i.e. the artery weaves into and/or out of the myocardium), then there is a myocardial bridge of the coronary artery. With every systolic contraction, the artery is occluded. Although a myocardial bridge may not cause symptoms (especially at distal portions), the area it supplies is at risk. With any minor trauma or exertion, demand may outpace supply, resulting in ischemia. Diagnosis is made on coronary angiography. The unwell child post-cardiac surgery: Fontan problems The child with single ventricle physiology may have a Norwood procedure at birth (creation of a neoaorta, atrial septectomy, and Blalock-Taussig shunt), a Bidirectional Glenn procedure at 3-6 months (shunt removed, superior vena cava connected to pulmonary arteries), and a Fontan procedure at about 2-3 years of age (inferior vena cava blood flow is shunted into the pulmonary arteries). These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension. They are typically on an anticoagulant (often aspirin), a diuretic (e.g. furosemide), and an afterload reduction agent (e.g. enalapril). Any disturbance in volume status (hyper- or hypovolemia), anticoagulation, or afterload may cause myocardial strain or infarction. Take the child s/p Fontan seriously and involve his specialists early with any concerns. Autoimmune The body’s inflammatory-mediated reaction to a real or perceived insult can cause short- and long-term cardiac sequelae. Find out how well the underlying disease is controlled, and what complications the child has had in the past. The red, hot, crispy, flaky child: acute Kawasaki disease Kawasaki disease (KD) is an acute systemic vasculitis, diagnosed by the presence of fever for five or more days accompanied by four or more criteria: bilateral conjunctival injection, mucositis, cervical lymphadenopathy, polymorphous rash, and palmar or sole desquamation. The criteria may occur (and disappear) at any time during the illness. Infants are under double jeopardy with Kawasaki Disease. They are more likely to have incomplete KD (i.e. not fulfill strict criteria) and if they have KD, they are more likely to suffer the dangerous consequences of aneurysm formation (chiefly coronary arteries, but also brain, kidney). Have a low threshold for investigation. Treatment includes 2 g/kg/day IVIG and high-dose aspirin (30-50 mg/kg/day) acutely, then low-dose aspirin (5 mg/kg/day) for weeks to months. Regular and long-term follow-up with Cardiology is required. The aftermath: sequelae of Kawasaki disease The family and child with a history of KD may have psychological trauma and continuous anxiety about the child’s risk of MI. Approximately 4.7% of children who were promptly diagnosed and correctly treated will go on to have cardiac sequelae. Children who have no detected cardiac sequelae by 8 weeks, typically continue to be asymptomatic up to 20 years later. Smaller aneurysms tend to regress over time, especially those < 6 mm. Thrombi may calcify, or the lumen may become stenotic due to myofibroblast proliferation. Children with any coronary artery dilatation from KD should be followed indefinitely. Giant aneurysms (≥8 mm) connote the highest risk for MI. Parents often are concerned about recurrence, and any subsequent fever can be distressing. There is a low rate of recurrence for KD: approximately 2%. Infants who have coronary aneurysms are at the highest risk for recurrence. The older child with vague chest complaints and hypercoagulability: Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome Up to 15% of cases of SLE begin in childhood. Adult criteria are used, with the caveat that the diagnosis of SLE in children can be challenging; many children only manifest a few of the criteria initially before going on to develop further systemic involvement. The Systemic Lupus International Collaborating Clinics (SLICC) revised the criteria in 2012. The patient should have ≥4/17 clinical and/or immunologic criteria. The clinical criteria are: acute cutaneous (malar); chronic cutaneous (discoid); oral; alopecia; synovitis; serositis; renal; neurologic; hemolytic anemia; leukopenia; or thrombocytopenia. The immunologic criteria are: ANA; anti-dsDNA; anti-Sm; antiphospholipid; low complement; and/or Direct Coombs (in absence of hemolytic anemia). At least one criterion should be clinical, and at least one should be immunologic. Children with antiphospholipid syndrome (APS) may occur with or without SLE. Patients are at risk for venous and arterial thrombi formation. APS may also cause structural damage, such as valvular thickening and valvular nodes (Libman-Sacks endocarditis). Mitral and aortic valves are at the highest risk. Although most children with chest pain will not have MI, those with comorbidities should be investigated carefully. Trauma Direct, blunt trauma to the chest can cause myocardial stunning, dysrhythmias, or an asymptomatic rise in Troponin I. However, some children are at risk for disproportionate harm due to a previously unknown risk factor. Clinically significant cardiac injury occurs in up to 20% of patients with non-penetrating thoracic trauma. The motor vehicle collision: blunt myocardial injury Direct trauma (steering wheel, airbag, seatbelt), especially in fast acceleration-deceleration injury, may cause compression of the heart between the sternum and the thoracic spine. Electrocardiography (ECG) should be performed on any patient with significant blunt chest injury. A negative ECG is highly consistent with no significant blunt myocardial injury. Any patient with a new abnormality on ECG (dysrhythmia, heart block, or signs of ischemia) should be admitted for continuous ECG monitoring. Elevation in troponin is common, but not predicted. A solitary elevated troponin without ECG abnormality is of unclear significance. Author’s advice: obtain troponin testing if there is an abnormal ECG, more than fleeting suspicion of BCI, and/or the child will be admitted for monitoring. Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. The high-velocity object: coronary artery dissection or thrombus Direct trauma (e.g. MVC, baseball, high-velocity soccer ball) may cause damage to the left anterior descending artery or left circumflex artery, at the highest risk due to their proximity to the chest wall. Thrombosis and/or dissection may result, often presenting in a focal pattern of ischemia on the ECG. Echocardiography may reveal valvular damage related to the injury, as well as effusion and ejection fraction. Since there is often a need to investigate the coronary anatomy, percutaneous coronary intervention (PCI) is recommended. The minor trauma with disproportionate complaint: myocardial bridge As mentioned in the congenital section (above), a known variation of a coronary artery’s course involves weaving in and out of the myocardium, creating a baseline risk for ischemia. Even minor trauma in a child with a myocardial bridge may cause acute thrombus, or slow stenosis from resulting edema. Unfortunately, the presence of myocardial bridging is often unknown at the time of injury. Approximately 25% of the population may have myocardial bridging, based on autopsy studies. Take the child seriously who has disproportionate symptoms to what should be a minor injury. Hematologic Coagulopathic and thrombophilic states may predispose children to focal cardiac ischemia. The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. The child with sickle cell disease and chest pain: when it’s not acute chest syndrome Sickle cell disease (SCD) can affect any organ system, although the heart is traditionally considered a lower-risk target organ for direct sickling and ischemia. The major cardiac morbidity in sickle cell is from strain, high-output failure and multiple, serial increases in myocardial demand, causing left ventricular hypertrophy and congestive heart failure. However, there is mounting evidence that acute myocardial ischemia in sickle cell disease may be underappreciated and/or attributed to other causes of chest pain. Other cardiac sequelae from SCD include pulmonary hypertension, left ventricular dysfunction, right ventricular dysfunction, and chronic iron overload. Evidence of myocardial ischemia/infarction in children with SCD has been demonstrated on single-photon emission computed tomography (SPECT) scan. The puffy faced child with chest pain: nephrotic syndrome hypercoagulability Children who suffer from nephrotic syndrome lose proteins that contribute to the coagulation cascade. In addition, lipoprotein profiles are altered: there is a rise in the very low-density lipoproteins (LDL), contributing to accelerated atherosclerosis. Typically nephrotic patients have normal levels of high-density lipoproteins (HDL), unless there is profuse proteinuria. Children with difficult-to-control nephrotic syndrome (typically steroid-resistant) may form accelerated plaques that rupture, causing focal MI, as early as school age. The previously well child now decompensated: undiagnosed thrombophilia Asymptomatic patent foramen ovale (PFO) is the cause of some cases of cryptogenic vascular disease, such as stroke and MI. However, the presence of PFO alone does not connote higher risk. When paired with an inherited or acquired thrombogenic condition, the venous thrombus may travel from the right-sided circulation to the left, causing distal ischemia. Many of these cases are unknown until a complication arises. The chronically worried, now with a reason: hypercholesterolemia A family history of adult-onset hypercholesterolemia is not necessarily a risk factor for early complications in children, provided the child does not have the same acquired risk factors as adults (e.g. obesity, sedentary lifestyle, smoking, etc). Parents may seek help in the ED for children with chest pain and no risk factors, but adult parents who have poor cholesterol profiles. The exception is the child with familial hypercholesterolemia, who is at risk for accelerated atherosclerosis and MI. Infectious Myocarditis has varied etiologies, including infectious, medications (chemotherapy agents), immunologic (rheumatologic, transplant rejection), toxins (arsenic, carbon monoxide, heavy metals such as iron or copper), or physical stress (electrical injury, heat illness, radiation). In children, the most common cause of myocarditis is infectious (viruses, protozoa, bacteria, fungal, parasites). Of these, viral causes are the most common (adenovirus, enterovirus, echovirus, rubella, HHV6). The verbal child may complain of typical chest complaints, or may come in with flu-like illness and tachycardia or ill appearance out of proportion to presumed viral illness. The most common presenting features in children with myocarditis are: shortness of breath, vomiting, poor feeding, hepatomegaly, respiratory distress, and fever. The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’. That may very well be true, but any virus can be invasive with myocardial involvement. Infants are only able to increase their cardiac output through increasing their heart rate; they cannot respond to increased demands through ionotropy. Look for signs of acute heart failure, such as hepatomegaly, respiratory distress, and sacral edema. The child with tachycardia out of proportion to complaint: myocarditis The previously healthy child with “a bad flu” may simply be very symptomatic from influenza-like illness, or he may be developing myocarditis. Look for chest pain and tachycardia out of proportion to presumed illness, and constant chest pain, not just associated with cough. The “pneumonia” with suspicious chest x-ray: myocarditis Acute heart failure may mimic viral pneumonia. Look for disproportionate signs and symptoms. Toxins Younger children may get into others’ medications, be given dangerous home remedies, take drugs recreationally, have environmental exposures (heavy metals), suffer from a consequence of a comorbidity (iron or copper overload) or have adverse events from generally safe medications. The hyperactive boy with a hyperactive precordium: methylphenidate Attention deficit hyperactivity disorder (ADHD) is growing in rate of diagnosis and use of medications. As the only medical diagnosis based on self-reported criteria, many children are given stimulants regardless of actual neurologic disorder; with a higher proportion of children exposed to stimulants, adverse effects are seen more commonly. Methylphenidate is related to amphetamine, and they both are dopaminergic drugs. Their mechanisms of action are different, however. Methylphenidate increases neuronal firing rate. Methamphetamine reduces neuronal firing rate; cardiovascular sequelae such as MI and CHF are more common in chronic methamphetamine use. Although methylphenidate is typically well tolerated, risks include dysrhythmias such as ventricular tachycardia. The child with seizure disorder and chest pain: anti-epileptics Some anti-epileptic agents, such as carbamazepine, promote a poor lipid profile, leading to atherosclerosis and early MI. Case reports include school-aged children on carbamazepine who have foamy cells in the coronary arteries, aorta, and vasa vasorum on autopsy. It is unclear whether this is a strong association. The spice trader: synthetic cannabinoids Synthetic cannabinoids are notoriously difficult to regulate and study, as the manufacturers label them as “not for human consumption”. Once reports surface of abuse of a certain compound, the formula is altered slightly and repackaged, often in a colorful or mysterious way that is attractive to teenagers. The misperceptions are: are a) synthetics are related to marijuana and therefore safe and b) marijuana is inherently “safe”. Both tend to steer unwitting teens to take these unknown entities. Some suffer MI as a result. Exposure to tetrahydrocannabinol (THC) in high-potency marijuana has been linked to myocardial ischemia, ventricular tachycardia, and ventricular fibrillation. Marijuana can increase the heart rate from 20-100%, depending on the amount ingested. K2 (“kush 2.0”) or Spice (Zohai, Genie, K3, Bliss, Nice, Black Mamba, fake weed, etc) is a mixture of plant leaves doused in synthetic chemicals, including cannabinoids and fertilizer (JWH-108), none of which are tested or safe for human consumption. Synthetic cannabinoids have a higher affinity to cannabinoid receptors, conferring higher potency, and therefore worse adverse effects. They are thought to be 100 to 800 times more potent as marijuana. Bath salts (Purple Wave, Zoom, Cloud Nine, etc) can be ingested, snorted, or injected. They typically include some form of cathinone, such as mephedrone, similar to the substance found in the naturally occurring khat plant. Hallucinations, palpitations, tachycardia, MI, and dysrhythmias have been reported from their use as a recreational drug. Chest pain with marijuana, synthetic cannabinoid, or bath salt ingestion should be investigated and/or monitored. Riding that train: high on cocaine Cocaine is a well-known cause of acute MI in young people. In addition to the direct stimulant causes acutely, such as hypertension, tachycardia, and impaired judgement (coingestions, risky behavior), chronic cocaine use has long-term sequelae. Cocaine causes accelerated atherosclerosis. That, in conjunction with arterial vasospasm and platelet activation, is a recipe for acute MI in the young. Cranky: methamphetamine Methamphetamine is a highly addictive stimulant that is relatively inexpensive and widely available. Repeated use causes multiple psychiatric, personality, and neurologic changes. Risky behavior, violence, and motor vehicle accidents are all linked to this drug. Like cocaine, methamphetamine may cause fatal dysrhythmias, acute MI from demand ischemia, and long-term sequelae such as congestive heart failure. Summary Acute MI is a challenging presentation in children: Easily missed: uncommon and atypical Varied etiology Respect vague symptoms with a non-reassuring H&P Try to detect it: CATH IT! References Congenital AboulHosn JA et al. Fontan Operation and the Single Ventricle. Congenit Heart Dis. 2007; 2:2-11. Aliku TO et al. A case of anomalous origin of the left coronary artery presenting with acute myocardial infarction and cardiovascular collapse. African Health Sci. 2014; 14(1): 23-227. Andrews RE et al. Acute myocardial infarction as a cause of death in palliated hypoplastic left heart syndrome. Heart. 2004; 90:e17. Canale LS et al. Surgical treatment of anomalous coronary artery arising from the pulmonary artery. Interactive Cardiovascaulr and Thoracic Surgery. 2009; 8:67-69. Güvenç O et al. Correctable Cause of Dilated Cardiomyopathy in an Infant with Heart Failure: ALCAPA Syndrome. J Curr Pediatr. 2017; 15:47-50. Hastings RS et al. Embolic Myocardial Infarction in a Patient with a Fontan Circulation. World Journal for Pediatric Congenital Heart Surgery. 2014; 5(4)L631-634. Hoffman JIE et al. Electrocardiogram of Anomalous Left Coronary Artery From the Pulmonary Artery in Infants. Pediatr Cardiol. 2013; 34(3):489-491. Kei et al. Rare Case of Myocardial Infarction in a 19-Year-Old Caused by a Paradoxical Coronary Artery Embolism. Perm J.2015; 19(2):e107-e109. Liu Y, Miller BW. ALCAPA Presents in an Adult with Exercise Inlerance but Preserved Cardiac Function. Case Reports Cardiol. 2012; AID 471759. Möhlenkamp S et al. Update on Myocardial Bridging.Circulation. 2002;106:2616-2622. Murgan SJ et al. Acute myocardial infraction n the neonatal period. Cardiol Young. 2002; 12:411-413. Sieweke JT et al. Myocardial infarction in grown up patients with congenital heart disease: an emergening high-risk combination. International Journal of Cardiology. 2016; 203:138-140. Schwerzmann M et al. Anomalous Origin of the Left Coronary Artery From the Main Pulmonary Artery in Adults. Circulation. 2004; 110:e511-e513. Tomkewicz-Pajak L et al. Arterial stiffness in adult patients after Fontan procedure. Cardiovasculr Ultrasound. 2014; 12:15. Varghese MJ et al. The caveats in the diagnosis of anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Images Paediatr Cardiol. 2010; 12(3): 3–8. Autoimmune Ayala et al. Acute Myocardial Infarction in a Child with Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Turk J Rheumatol. 2009; 24:156-8. Nakano H et al. Clinical characteristics of myocardial infarction following Kawasaki disease: Report of 11 cases. J Pediatr. 1986; 108(2):198-203. Pongratz G et al. Myocardial infarction in an adult resulting from coronary aneurysms previously documented in childhood after an acute episode of Kawasaki’s disease. European Heart J. 1994. 15:1002-1004. Newburger JW et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease. A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110:2747-2771. Son MB et al. Kawaski Disease. Pediatr Rev. 2013; 34(4). Yuan S. Cardiac surgical procedures for the coronary sequelae of Kawasaki disease. Libyan J Med. 2012; 7:19796. Trauma Abdolrahim SA et al. Acute Myocardial Infarction Following Blunt Chest Trauma and Coronary Artery Dissection. J Clin Diagnost Res. 2016; 10(6):14-15. Galiuto L et al. Post-traumatic myocardial infarction with hemorrhage and microvascular damage in a child with myocardial bridge: is coronary anatomy actor or bystander. Signa Vitae. 2013; 8(2):61-63. Janella BL et al. Acute Myocardial Infarction related to Blunt Thoracic Trauma. Arq Bras Cardiol. 2006; 87:e168-e171. Liu X et al. Acute myocardial infarction in a child with myocardial bridge World J Emerg Med. 2011; 2(1):70-72. Long WA et al. Childhood Traumatic Infarction Causing Left Ventricular Aneurysm: Diagnosis by Two-Dimensional Echocardiography. JACC. 1985; 5(6):1478-83. Smith S. Right Bundle Branch Block after Blunt Trauma: A Tragic Case. [Blog Post] July 22, 2012. Retrievable at: http://hqmeded-ecg.blogspot.com/2012/07/right-bundle-branch-block-after-blunt.html. Hematologic Carano N et al. Acute Myocardial Infarction in a Child: Possible Pathogenic Role of Patent Foramen Ovale Associated with Heritable Thrombophilia. Pediatr. 2004; 114(2):255-258. Chacko P et al. Myocardial Infarction in Sickle Cell Disease. J Cardiovascl Transl Res. 2013; 6(5):752-761. De Montalembert M et al. Myocardial ischaemia in children with sickle cell disease. Arch Dis Child. 2004; 89:359-362. Gladwin MT et al. Cardiovascular Abnormalities in Sickle Cell Disease. JACC. 2012; 59(13):1123-1133. Osula S et al. Acute myocardial infarction in young adults: causes and management. Postgrad Med J. 2002; 78:27-30. Silva JMP et al. Premature acute myocardial infarction in a child with nephrotic syndrome. Pediatr Nephrol. 2002; 17:169-172. Suryawanshi SP. Myocardial infarction in children: Two interesting cases. Ann Pediatr Cardiol. 2011 Jan-Jun; 4(1): 81–83. Infectious Cunningham R et al. Viral myocarditis Presenting with Seizure and Electrocardiographic Findings of Acute Myocardial Infarction in a 14-Month-Old Child. Ann Emerg Med. 2000; 35(6):618-622. De Vettten L et al. Neonatal Myocardial Infarction or Myocarditis? Pediatr Cardiol. 2011; 32:492-497. Durani Y et al. Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med. 2009; 27:942-947. Erden I et al. Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza virus. Cardiol J. 2011; 552-555. Hover MH et al. Acute Myocarditis Simulating Myocardial Infarction in a Child. Pediatr. 1191; 87(2):250-252. Lachant D et al. Meningococcemia Presenting as a Myocardial Infarction. Case Reports in Critical Care. 2015; AID 953826. Laissy JP et al. Differentating Myocardial Infarction from Myocarditis. Radiology. 2005; 237(1):75-82. Miranda CH et al. Evaluation of Cardiac Involvement During Dengue Viral Infection. CID. 2013; 57:812-819. Rettig JS et al. Myocarditis in Children Requiring Critical Care Transport. In: "Diagnosis and Treatment of Myocarditis", Milei J, Ambrosio G (Eds). DOI: 10.5772/56177. Toxins De Chadarévian JP et al. Epilepsy, Atherosclerosis, Myocardial Infarction, and Carbamazepine. J Child Neurol. 2003; 18(2):150-151. McIlroy G et al. Acute myocardial infarction, associated with the use of a synthetic adamantly-canabinoid: a case report. BMC Pharmacology and Toxicology. 2016; 17:2. Mir A et al. Myocardial Infarction Associated with Use of the Synthetic Cannabinoid K2. Pediatr. 2011; 128(6):1-6 Munk K et al. Cardiac Arrest following a Myocardial Infarction in a Child Treated with Methylphenidate. Case Reports Pediatr. 2015; AID 905097. Rezkalla SH et al. Cocaine-Induced Acte Mycardial Infarction. Clin Med Res. 2007; 5(3):172-176. Schelleman H et al. Methylphenidate and risk of serious cardiovascular events in adults. Am J Psychiatry. 2012 Feb;169(2):178-85. Sheridan J et al. Injury associated with methamphetamine use: a review of the literature. Harm Reduction Journal, 2006; 3(14):1-18. Stiefel G et al. Cardiovascular effects of methylphenidate, amphetamines and atomoxetine in the treatment of attention-deficit hyperactivity disorder. Drug Saf. 2010 Oct 1;33(10):821-42. This post and podcast are dedicated to Edwin Leap, MD for his sanity and humanity in the practice of Emergency Medicine. Thank you, Dr Leap for all that you do.
"By the pricking of my thumbs, Something wheezing this way comes." -- Witches in Macbeth, with apologies to William Shakespeare "Bronchiolitis is like a pneumonia you can’t treat. We support, while the patient heals." -- Coach, still apologetic to the Bard The Who The U.S. definition is for children less than two years of age, while the European committee includes infants less than one year of age. This is important: toddlerhood brings with it other conditions that mimic bronchiolitis – the first-time wheeze in a toddler may be his reactive airway response to a viral illness and not necessarily bronchiolitis. The What The classic clinical presentation of bronchiolitis starts just like any other upper respiratory tract infection: with nasal discharge and cough, for the first 1-2 days. Only about 1/3 of infants will have a low-grade fever, usually less than 39°C. We may see the child in the ED at this point and not appreciate any respiratory distress – this is why precautionary advice is so important in general. Then, lower respiratory symptoms come: increased work of breathing, persistent cough, tachypnea, retractions, belly breathing, grunting, and nasal flaring. Once lower respiratory symptoms are present, like increased work of breathing, they typically peak at day 3. This may help to make decisions or counsel parents depending on when the child presents and how symptomatic he is. You’ll hear fine crackles and wheeze. A typical finding in bronchiolitis is a minute-to-minute variation in clinical findings – one moment the child could look like he’s drowning in his secretions, and the next minute almost recovered. This has to do with the dynamic nature of the secretion, plugging, obstruction, coughing, dislodgement, and re-plugging. The Why Respiratory syncytial virus is the culprit in up to 90% of cases of bronchiolitis. The reason RSV is so nasty is the immune response to the virus: it binds to epithelial cells, replicates, and the submucosa becomes edematous and hypersecretes mucus. RSV causes the host epithelia and lymphocytes to go into a frenzy – viral fusion proteins turn the membranes into a sticky goop – cells fuse into other cells, and you have a pile-on of multinucleated dysfunction. This mucosal chaos causes epithelial necrosis, destruction of cilia, mucus plugs, bronchiolar obstruction, air trapping, and lobar collapse. High-Risk Groups Watch out especially for young infants, so those less than 3 months of age. Apnea may be the presenting symptom of RSV. Premature infants, especially those less than 32 weeks’ gestation are at high risk for deterioration. The critical time is 48 weeks post-conceptional age. Other populations at high-risk for deterioration: congenital heart disease, pulmonary disease, neuromuscular disorders, metabolic disorders. Guiding Principles In the full term child, greater than one month, and otherwise healthy (no cardiac, pulmonary, neuromuscular, or metabolic disease), we can look to three simple criteria for home discharge. If the otherwise healthy child one month and older is: Euvolemic Not hypoxic Well appearing He can likely go home. The How Below is a list of modalities, treatments, and the evidence and/or recommendations for or against: Chest Radiograph Usually not necessary, unless the diagnosis is uncertain, or if the child is critically ill. Factors that are predictive of a definite infiltrate are: significant hypoxia (< 92%), grunting, focal crackles, or high fever (> 39°C). Ultrasound Not ready for prime time. Two small studies, one by Caiulo et al in the European J or Pediatrics and one by Basile et al. in the BMC Pediatrics that show some preliminary data, but not enough to change practice yet. Viral Testing Qualitative PCR gives you a yes or no question – one that you’ve already answered. It is not recommended for routine use. PCR may be positive post-infection for several weeks later (details in audio). Quantitative PCR measures viral load; an increased quantitative viral load is associated with increased length of stay, use of respiratory support, need for intensive care, and recurrent wheezing. However, also not recommended for routine use. There is one instance in which viral testing in bronchiolitis can be helpful – in babies less than a month of life, the presence of RSV virus is associated with apnea. Blood or Urine Testing Routine testing of blood or urine is not recommended for children with bronchiolitis. Levine et al in Pediatrics found an extremely low risk of serious bacterial illness in young febrile infants with RSV. The main thing is not to give in to anchoring bias here. If an infant of 3 months of age or older has a clear source for his low-grade fever – and that is his bronchiolitis – then you have a source, and very rarely do you need to go looking any further. He’s showing you the viral waterfall from his nose, and his increased work of breathing. It’s not going to be in his urine. Bronchodilators! Should we use bronchodilators in bronchiolitis? It seems lately that this is a loaded question – with strong feelings on either side amongst colleagues. The short answer is that the American Academy of Pediatrics, the UK’s National Institute for Health and Care Excellence, as well as the Canadian Pediatric Society currently recommend against them. However, in continental Europe and Australia, the language is softened to “not routinely recommended”. Pros and Cons in Audio; the 2006 AAP Guidelines and the 2014 AAP Guidelines use same data to come to divergent recommendations. Steroids There is no role for steroids in the treatment of bronchiolitis, even in those with a family or personal history of atopy. Nebulized Hypertonic Saline May show some benefit in admitted patients, after repeated treatments; no data to support its use in ED patients (no immediate effect). Nebulized Epinephrine One randomized controlled double blinded study in eight centers in Norway published in the NEJM showed no benefit to nebulized epinephrine over nebulized saline. Again, probably asking too much of one single intervention. The Cochrane review found 19 studies that included a total of 2256 children with acute bronchiolitis treated with nebulized epinephrine. There were no differences in length of hospital stay between the placebo and treatment groups, and so they concluded that for inpatients, nebulized epinephrine is not worth the hassle. However – and this may just be an artifact of meta-analysis – there may be some benefit to outpatients. One study of combined high-dose steroid and epinephrine therapy was not statistically significant when other factors were controlled, but Cochrane concluded that nebulized epinephrine itself may be helpful for outpatients. It won’t affect the overall disease time course, but it may make them feel better enough to go home from the ED and continue observation there. High-Flow Nasal Cannula Oxygen High-flow oxygen via nasal cannula requires specialized equipment and delivers humidified oxygen at 1-2 L/g/min. In addition to oxygenation, high flow nasal cannula also likely offers some low-grade positive end-expiratory pressure, which may help with alveolar recruitment. The evidence for its use is based on observational studies, which have found improved respiratory parameters and reduced rates of intubation. Nasal CPAP also has some promising properties in the right clinical setting. Antibiotics Not recommended. When bronchiolitis is from a clear viral source, the risk of accompanying bacteremia is less than 1%. A meta-analysis of randomized clinical trials found that antibiotics in bronchiolitis did not improve duration of symptoms, length of hospital stay, need for oxygen therapy, or hospital admission. Summary: The Good, the Bad, and the Ugly The Good Nasal suction and hydration are your best allies. You may elect to give a bronchodilator as a trial once and reexamine, if you’re a bronchodilating believer. The Bad Steroids, antibiotics, and a blind obeying of the guidelines. Weigh the risks and benefits of every intervention, including hospitalization – it’s not always a benign thing. The Ugly Take a moment to assess the child and make a clinical diagnosis of bronchiolitis, after you’ve excluded cardiac disease, anatomic anomalies, and foreign body aspiration. Wheezing without upper respiratory symptoms is not viral, and it is not bronchiolitis. When all else fails, remember: in the otherwise healthy, term infant greater than a month of age, if he is well appearing, euvolemic, and not hypoxic, he will often do well with good precautionary advice and supportive care at home. Every thing else: be skeptical, be thorough, and above all, be careful. References Alansari K, Toaimah FH, Khalafalla H, El Tatawy LA, Davidson BL, Ahmed W. Caffeine for the Treatment of Apnea in Bronchiolitis: A Randomized Trial. J Pediatr. 2016 May 14. pii: S0022-3476(16)30170-6. [Epub ahead of print] American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006 Oct;118(4):1774-93. Beggs S, Wong ZH, Kaul S, Ogden KJ, Walters JA. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database Syst Rev. 2014 Jan 20;(1):CD009609. Bergroth E, Aakula M, Korppi M, Remes S, Kivistö JE, Piedra PA, Camargo CA Jr, Jartti T. Post-bronchiolitis Use of Asthma Medication: A Prospective 1-year Follow-up Study. Pediatr Infect Dis J. 2016 Apr;35(4):363-8. Cunningham S, Rodriguez A, Adams T, Boyd KA, Butcher I, Enderby B, MacLean M, McCormick J, Paton JY, Wee F, Thomas H, Riding K, Turner SW, Williams C, McIntosh E, Lewis SC; Bronchiolitis of Infancy Discharge Study (BIDS) group. Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet. 2015 Sep 12;386(9998):1041-8. Flett KB, Breslin K, Braun PA, Hambidge SJ. Outpatient course and complications associated with home oxygen therapy for mild bronchiolitis. Pediatrics. 2014 May;133(5):769-75. Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet. 2016 Aug 20. [Epub ahead of print] Halstead S, Roosevelt G, Deakyne S, Bajaj L. Discharged on supplemental oxygen from an emergency department in patients with bronchiolitis. Pediatrics. 2012 Mar;129(3):e605-10. Johnson LW, Robles J, Hudgins A, Osburn S, Martin D, Thompson A. Management of bronchiolitis in the emergency department: impact of evidence-based guidelines? Pediatrics. 2013 Mar;131 Suppl 1:S103-9. Lashkeri T, Howell JM, Place R. Capnometry as a predictor of admission in bronchiolitis. Pediatr Emerg Care. 2012 Sep;28(9):895-7. Lehners N, Tabatabai J, Prifert C, Wedde M, Puthenparambil J, Weissbrich B, Biere B, Schweiger B, Egerer G, Schnitzler P. Long-Term Shedding of Influenza Virus, Parainfluenza Virus, Respiratory Syncytial Virus and Nosocomial Epidemiology in Patients with Hematological Disorders. PLoS One. 2016 Feb 11;11(2):e0148258. Liet JM, Ducruet T, Gupta V, Cambonie G. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database Syst Rev. 2015 Sep 18;(9):CD006915. Mammas IN, Spandidos DA. Paediatric Virology in the Hippocratic Corpus. Exp Ther Med. 2016 Aug;12(2):541-549. Mansbach JM, Clark S, Teach SJ, Gern JE, Piedra PA, Sullivan AF, Espinola JA, Camargo CA Jr. Children Hospitalized with Rhinovirus Bronchiolitis Have Asthma-Like Characteristics. J Pediatr. 2016 May;172:202-204.e1. Meissner HC. Viral Bronchiolitis in Children. N Engl J Med. 2016 Jan 7;374(1):62-72. Munywoki PK, Koech DC, Agoti CN, Kibirige N, Kipkoech J, Cane PA, Medley GF, Nokes DJ. Influence of age, severity of infection, and co-infection on the duration of respiratory syncytial virus (RSV) shedding. Epidemiol Infect. 2015 Mar;143(4):804-12. Oakley E, Borland M, Neutze J, Acworth J, Krieser D, Dalziel S, Davidson A, Donath S, Jachno K, South M, Theophilos T, Babl FE; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial. Lancet Respir Med. 2013 Apr;1(2):113-20. Epub 2012 Dec 21. Oakley E et al. Nasogastric Hydration in Infants with Bronchiolitis Less Than 2 Months of Age. J Pediatr. 2016. [Article in Press] Principi T, Coates AL, Parkin PC, Stephens D, DaSilva Z, Schuh S. Effect of Oxygen Desaturations on Subsequent Medical Visits in Infants Discharged From the Emergency Department With Bronchiolitis. JAMA Pediatr. 2016 Jun 1;170(6):602-8. Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, Johnson DW, Light MJ, Maraqa NF, Mendonca EA, Phelan KJ, Zorc JJ, Stanko-Lopp D, Brown MA, Nathanson I, Rosenblum E, Sayles S 3rd, Hernandez-Cancio S; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014 Nov;134(5):e1474-502. Roqué i Figuls M, Giné-Garriga M, Granados Rugeles C, Perrotta C, Vilaró J. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev. 2016 Feb 1;2:CD004873. Skjerven HO et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. N Engl J Med. 2013 Jun 13;368(24):2286-93. This post and podcast are dedicated to Linda Girgis MD, FAAFP, for her authenticity, innovation, and clear and honest voice on the the frontlines. Thank you, Dr Linda. Bronchiolitis Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP
In the young child, vomiting is the great imitator: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, even Behavioral. To help us organize, below is a review of can't-miss diagnoses by age. The Neonate: Malrotation with Volvulus In children with malrotation, 50% present within the first month of life, with the majority occurring in the first week after birth. 90% of children with malrotation with volvulus will present by one year of age. This is a pre-verbal child’s disease – which makes it even more of a challenge to recognize quickly. The sequence of events usually is fussiness, irritability, and forceful vomiting. The vomit quickly turns bilious. Green vomit is a surgical emergency. Babies may also present unwell, with bloating and abdominal tenderness to palpation. Be aware that later stages of malrotation may present as shock – they present in hypovolemic shock due to third-spacing from necrotic bowel and/or septic shock from translocation or perforation. In the undifferentiated sick neonate, always consider a surgical emergency such as malrotation with volvulus. In the stable patient, get an upper GI contrast study. Rapid-fire word association for other vomiting emergencies in a neonate: Fever, irritability and vomiting? Think meningitis, UTI, or sepsis. Premature, unwell, and vomiting? Think necrotizing enterocolitis. Remember, 10% of cases of NEC can be full-term. Look for pneumatosis intestinalis. Systemically ill, afebrile, and vomiting for no other reason? Think inborn error of metabolism. Screen with a glucose, ammonia, lactate, and urine ketones. Others include congenital intestinal atresia or webs, meconium ileus, or severe GERD The Infant: Non-Accidental Trauma All that vomits is not necessarily from the gut. Abusive head injury is the most common cause of death from child abuse. Infants especially present with non-specific complaints like fussiness or vomiting. Up to 30% of infants with abusive head injury may be misdiagnosed on initial presentation. Louwers et al. in Child Abuse and Neglect developed and validated a six-question screening tool for use the in ED. The power of this tool was that it was validated for any chief complaint – it is not an injury evaluation checklist – it is a screen for potential abuse in the undifferentiated child: Is the history consistent? Was seeking medical help unnecessarily delayed? Does the onset of injury fit with the developmental level of the child? Is the behavior of the child and his interaction with his care-givers appropriate? Do the findings of the head-to-toe examination match the history? Are there any other red flags or signals that make you doubt the safety of the child or other family members? On multivariable analysis, if at least one of the questions was positive, there was an OR of 189 for abuse (CI 97 – 300). In other words, if any of those six questions are problematic, get your child protective team involved. Other important diagnoses in the infant: intussusception and pyloric stenosis (rapid review in audio). The Toddler: Diabetic Ketoacidosis (DKA) The important diagnosis not to miss in the vomiting toddler or early school age child is the initial presentation of diabetic ketoacidosis. Children under 5 (especially those under 2) and those from lower socioeconomic groups have a higher risk of DKA as their initial presentation of diabetes. This is true for any child that isn’t quite acting right – check a finger stick blood sugar as a screen. The International Society for Pediatric and Adolescent Diabetes (ISPAD) criteria for DKA: Hyperglycemia, with a blood glucose of >200 mg/dL (11 mmol/L) AND Evidence of metabolic acidosis, with a venous pH of less than 7.3 or a bicarbonate level of < 15 mEq/L AND Ketosis, found either in the urine or if directly checked in the blood. If you have access to checking a serum beta-hydroxybutryrate – the unsung ketone – it can help in diagnosis in unclear cases. Cerebral Edema Criteria: Minor criteria: headache, vomiting, irritability or lethargy; hypertension in the face of hypovolemia. Major criteria: change in mental status, including agitation or delirium; incontinence (especially if inappropriate for the child’s age); sluggish pupils and cranial nerve palsies; relative bradycardia (Cushing’s triad). Cerebral Edema Action Items: Immediately give mannitol, 1 g/kg over 15-20 minutes. May repeat it in 2 hours if needed. Hypertonic saline (3% NaCl) is second-line therapy. Put the head of the bed up 30 degrees. Alert your colleagues and counsel your parents. Make sure everyone knows what to watch out for. As you can see, vomiting in the young child can be really anything! Keep your differential broad, and think by age and by system. Differential Diagnosis of Vomiting in Children The general approach to the child with chiefly vomiting starts with the decision: sick or not sick. If ill appearing, establish rapid IV access, or if needed IO. Rapid blood sugar and if available a point of care pH and electrolytes. Be the detective in your history and doggedly go after any red flags as you go methodically by organ system. Do a careful physical exam. The general assessment is always helpful – is the child irritable, listless, agitated? What is his work of breathing? Effortless tachypnea may be a sign of acidosis or sepsis. Is the abdomen soft or is it tender or distended. Always look in the diaper area – is there a hernia, is there a high-riding, tender, discolored scrotum without cremasteric reflex? Ovarian torsion has been reported in infants as young as 7 months. Any skin signs? Look for petechiae, urticaria, purpura. In other words, use your best judgement, have the dangerous differentials in the back of your mind, and pull the trigger when red flags mount up. Otherwise, a good history and a good exam will get you where you need to be. Take home points for the young child with vomiting: Neonates are allowed to regurgitate (effortless reflux of stomach contents -- the happy spitter-upper). They are not allowed to vomit (forceful, unpleasant contraction of abdominal muscles). Consider surgical causes of forceful vomiting, especially if the child does not look anything other than well. Bilious is bad – green vomit is always a surgical emergency – do not pass go – get the surgeons involved early Not all vomiting is GI related – if it is not obviously benign, think methodically by organ system and adjust your targeted history and physical to pick up any leads. Match the tempo of your treatment to the tempo of the disease. References Applegate KE, Anderson JM, Klatte EC. Intestinal malrotation in children: a problem-solving approach to the upper gastrointestinal series. Radiographics. 2006; 26(5):1485-500. Glaser NS, Wootton-Gorges SL, Buonocore MH et al. Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis. Pediatr Diabetes. 2006 Apr;7(2):75-80. Louwers ECFM, Korfage IJ, Affourtit MJ et al. Accuracy of a screening instrument to identify potential child abuse in emergency departments. Child Abuse & Neglect. 2014; (38): 1275–1281. Lee HC, Pickard SS, Sridhar S et al. Intestinal Malrotation and Catastrophic Volvulus in Infancy. J Emerg Med. 2012; 43(1): e49–e51. Marcin JP, Glaser N, Barnett P et al. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. J Pediatr. 2002; 141(6):793-7. Parashette KR, Croffie J. Intestinal Malrotation in Children: A Problem-solving Approach to the Upper Gastrointestinal. Pediatrics in Review. 2013; (34)7: 307-321. Wolfsdorf JI, Allgrove J, Craig ME et al. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2014 Sep;15 Suppl 20:154-79. This post and podcast are dedicated to Damian Roland, BMedSci (Hons), MB BS, MRCPCH, for his fervor in the care of children and his dedication to quality medical education. Nausea and Vomiting | Non-Accidental Trauma | DKA Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP
This episode is our first audio journal club. We discuss 5 papers today with our guests, Dr Dan von Allmen, Dr George Whit Holcomb, and Dr Aaron Lipskar. Table of contents: 00:00 Introduction 00:55 Corticosteroids for biliary atresia 05:21 Dr von Allmen’s comments 10:54 Antiseptic agents and surgical site infection 14:15 Dr Holcomb’s comments 20:17 Non-operative management of non-perforated appendicitis 25:19 Dr Holcomb’s comments 30:41 Enteral autonomy after intestinal failure 33:37 Dr Lipskar’s comments 36:41 Anesthesia neurotoxicity 40:27 Dr Lipskar’s comments Use of Corticosteroids After Hepatoportoenterostomy for Bile Drainage in Infants With Biliary Atresia: the START randomized clinical trial Discussed by Dr Dan von Allmen Bezerra JA, et al. Use of Corticosteroids After Hepatoportoenterostomy for Bile Drainage in Infants With Biliary Atresia: the START randomized clinical trial. JAMA. 2014 May 7;311(17):1750–10. Dr von Allmen’s comments: • Dr von Allmen would not use corticosteroids after Kasai procedure. • The difference of bile drainage in the steroid group versus control (58.6% vs 48.6%) was not significant enough to continue use of corticosteroids. Comparative Effectiveness of Skin Antiseptic Agents in Reducing Surgical Site Infections: A Report from the Washington State Surgical Care and Outcomes Assessment Program Discussed by Dr George Whit Holcomb Hakkarainen TW, et al. Comparative Effectiveness of Skin Antiseptic Agents in Reducing Surgical Site Infections: A Report from the Washington State Surgical Care and Outcomes Assessment Program. J Am Coll Surg. 2014 Mar 1;218(3):336–44. Dr Holcomb’s comments: • This paper would not change his choice of antiseptic agent. Dr Holcomb feels that iodine based agents and chlorhexidine agents are equally appropriate based on these results. • Dr Holcomb uses chlorhexidine and isopropyl alcohol for skin preparation. Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children: a pilot randomized controlled trial Discussed by Dr George Whit Holcomb Svensson JF, et al. Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children: a pilot randomized controlled trial. Annals of Surgery. 2015 Jan;261(1):67–71. Dr Holcomb’s comments: • This is a well done pilot study that shows that a larger randomized trial is needed. • Long term follow-up is needed to determine the true risk of recurrent appendicitis after non-operative management. Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study Discussed by Dr Aaron Lipskar Khan FA, et al. Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study. J Pediatr. 2015 Jul;167(1):29–34.e1. Dr Lipskar’s comments: • It is counterintuitive that NEC is a protective factor for enteral autonomy. • It is difficult to make sense of the data as centers with transplant programs likely attract sicker patients. • This highlights the importance of intestinal failure patients being managed in a multidisciplinary intestinal failure program. Anesthetic neurotoxicity--clinical implications of animal models Discussed by Dr Aaron Lipskar Rappaport BA, et al. Anesthetic neurotoxicity--clinical implications of animal models. N Engl J Med. 2015 Feb 26;372(9):796–7. Dr Lipskar’s comments: • Until further trials in humans are conducted and provide more conclusive evidence, elective cases should be deferred until the age of 3. • It may be difficult to define what constitutes an elective procedure in pediatric surgery. Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/
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