PedMedicine: Pediatrics and Medicine

Adenotonsillectomy for Childhood Sleep Apnea does not improve attention or executive function

2013-05-23T08:07:00.000-05:00

Adenotonsillectomy for Childhood Sleep Apnea does not improve attention or executive function.

However, as compared with the watchful-waiting group, the early-adenotonsillectomy group had significant improvement on polysomnographic, behavioral, symptomatic, and quality-of-life measures.

However, 46% of the patients in the watchful-waiting group had a normalization of polysomnographic findings after 7 months

References:

NEJM article: http://buff.ly/167Vndb and editorial: http://bit.ly/14xa1WZ

Things Summer Camps Won't Tell You

2013-05-08T12:08:00.006-05:00

From WSJ and MarketWatch:

10 things sleepaway camps won’t say - 10 things - MarketWatch http://on.mktw.net/11STOcg

Things Summer Camps Won't Tell You:

Shopping for Kids Shoes - Mayo Clinic video

2013-01-24T11:30:00.000-06:00

The average toddler outgrows their shoes four times a year. It's enough to keep parents on their toes. But, there's no need to stress over making the right choices for healthy feet. A few simple considerations will save you worry and money:

Stopping a Nosebleed (video)

2013-01-23T00:38:00.001-06:00

Nosebleeds are common, but can be scary for a child. If they're not treated properly they could become a medical problem. Dr. Kim Giuliano, a pediatrician at Cleveland Clinic Children's Hospital says if your child's nose begins bleeding, the first thing to do is to get them upright:

Children who had a dog during first year of life get fewer respiratory infections

2012-07-09T12:05:00.002-05:00

Children who had a dog during first year of life get fewer respiratory infections - a Cleveland Clinic pediatrician comments on a Finnish study: http://goo.gl/j0XeH

Febrile seizures - 2012 review from Am Fam Physician

2012-02-28T09:44:00.014-06:00

From Am Fam Physician:

Febrile seizures are common in the first 5 years of life.

Initial evaluation should determine whether features of a complex seizure are present and identify the source of fever.

Routine blood tests, neuroimaging, and electroencephalography are not recommended.

Lumbar puncture is no longer recommended in patients with uncomplicated febrile seizures.

In the unusual case of febrile status epilepticus, intravenous lorazepam and buccal midazolam are first-line agents.

After an initial febrile seizure, physicians should reassure parents about the low risk of long-term effects. However, there is a 15-70% risk of recurrence in the first 2 years after an initial febrile seizure.

This risk is increased in patients:

- younger than 18 months
- with a lower fever
- short duration of fever before seizure onset
- family history of febrile seizures

Antiepileptic or antipyretic medications are not recommended for the prevention of recurrent febrile seizures.

References:

Febrile seizures: risks, evaluation, and prognosis. Graves RC, Oehler K, Tingle LE. Am Fam Physician. 2012 Jan 15;85(2):149-53.

http://www.ncbi.nlm.nih.gov/pubmed/22335215?dopt=Abstract

Making Doctor Visits Fun (video)

2011-11-23T11:08:00.001-06:00

From Doctors TV: Making Doctor Visits Fun (video)

Ho to Avoid Illness at School - Cleveland Clinic Video

2011-11-16T09:31:00.000-06:00

Ho to Avoid Illness at School - Cleveland Clinic Video.

Recommendations for Prevention of Influenza in Children - CDC

2011-11-01T10:42:00.000-05:00

Image of the H1N1 Influenza Virus, CDC.

The key points for the upcoming 2011–2012 season are:

- the influenza vaccine composition for the 2011–2012 season is unchanged from the 2010–2011 season

- a simplified dosing algorithm for administration of influenza vaccine to children 6 months through 8 years of age has been created

- most children presumed to have egg allergy can safely receive influenza vaccine in the office without need for an allergy consultation. Most egg-allergic children can now receive influenza vaccine safely.

- an intradermal trivalent inactivated influenza vaccine has been licensed for the 2011–2012 season for use in people 18 through 64 years of age

References:

PEDIATRICS Vol. 128 No. 4 October 1, 2011, pp. 813 -825, (doi: 10.1542/peds.2011-2295)

Idiopathic Thrombocytopenic Purpura (ITP) in Children - Mayo Clinic Video

2011-10-26T11:53:00.001-05:00

Dr. Carola Arndt, a Pediatric Hematologist/Oncologist at Mayo Clinic, discusses Idiopathic Thrombocytopenic Purpura (ITP). ITP, also called immune thrombocytopenic purpura, is a blood-clotting disorder that can lead to easy or excessive bruising and bleeding. Dr. Arndt discusses symptoms, diagnoses, and treatment options.

"Slapped cheek" syndrome - NHS video

2011-10-18T10:34:00.001-05:00

From NHS Choices YouTube channel: Slapped cheek syndrome is a viral infection and the fifth most common disease in children. Here, a GP talks about the symptoms to look out for.

How To Stop A Child's Nosebleed - Seattle Mama Doc video

2011-10-10T10:55:00.000-05:00

How To Stop A Nosebleed | Seattle Mama Doc - http://goo.gl/VwIeR

Recombinant Human Growth Hormone Improves Treatment of Patients With Cystic Fibrosis

2011-10-02T07:18:00.002-05:00

Recombinant human growth hormone (rhGH) improves growth in patients with growth hormone deficiency or idiopathic short stature.

This meta-analysis suggests that rhGH improved almost all intermediate measures of pulmonary function, height, and weight in patients with CF. Improvements in bone mineral content are also promising.

However, with the exception of hospitalizations, the benefits on final health outcomes cannot be directly determined at this time

References:

Recombinant Human Growth Hormone in the Treatment of Patients With Cystic Fibrosis. PEDIATRICS Vol. 126 No. 5 November 2010, pp. e1211-e1226 (doi:10.1542/peds.2010-2007).

From Care To Cure for Celiac Disease - UChicago To Host International Symposium in 2013

2011-09-26T09:47:00.006-05:00

The University of Chicago Celiac Disease Center has been selected to host the 15th International Celiac Disease Symposium in 2013. This is a short informational video about the host city Chicago. The video also includes "From Care To Cure," created to highlight the center's mission and activities, especially the path from Care to Cure, and the goal to cure celiac disease in the next 10-15 years.

New classification is being proposed for gluten-related disorders: celiac disease; dermatitis herpetiformis; gluten ataxia; wheat allergy; gluten sensitivity. WSJ, 2012.

Related reading:

Think Like a Doctor - The Right Test Solved the Mystery - Celiac Disease http://goo.gl/XagL3 - NYTimes published actual patient records online

Lack of awareness of celiac could be contributing to a delay of up to 11 years in diagnosis of adults in North America, http://goo.gl/sy778

Dr. Guandalini, a renowned UChicago celiac disease expert, answers patient questions on YouTube http://goo.gl/QADXY

Recent studies support the existence of the new condition nonceliac gluten sensitivity which is defined as symptoms with negative celiac antibodies and biopsy (http://goo.gl/57IlB).

Nebulized epinephrine plus oral dexamethasone is the most cost-effective treatment in bronchiolitis

2011-09-14T10:28:00.003-05:00

Using data from the Canadian Bronchiolitis Epinephrine Steroid Trial, the authors assessed the cost-effectiveness of treatments with epinephrine and dexamethasone for infants between 6 weeks and 12 months of age with bronchiolitis.

Comparators were:

- nebulized epinephrine plus oral dexamethasone
- nebulized epinephrine alone
- oral dexamethasone alone
- no active treatment

The combination of nebulized epinephrine plus oral dexamethasone was dominant over the other 3 comparators in that it was both the most effective and least costly. Average societal costs were $1,115 for the combination therapy, $1,210 for no active treatment.

The average time to curtailment of all symptoms was 12 days for the combination therapy, 12.7 days for no active treatment.

Treating infants with bronchiolitis with a combination of nebulized epinephrine plus oral dexamethasone is the most cost-effective treatment option.

References:
Cost-effectiveness of Epinephrine and Dexamethasone in Children With Bronchiolitis. PEDIATRICS Vol. 126 No. 4 October 2010, pp. 623-631 (doi:10.1542/peds.2009-3663)

Pediatric Velopharyngeal Insufficiency (VPI)

2011-09-08T10:35:00.004-05:00

Pediatric VPI (Velopharyngeal Insufficiency) Evaluation Clinic - Mayo Clinic video: Dr. Shelagh Cofer performs the VPI Evaluation Clinic and explains the various components of the evaluation.

Etanercept as Adjunctive Therapy for Kawasaki Disease?

2011-09-06T10:34:00.001-05:00

This study evaluated the the safety of etanercept (manufactured by Amgen) a tumor necrosis factor-α receptor blocker, in children with acute Kawasaki disease (KD).

Standard therapy of acute KD includes intravenous immunoglobulin (IVIG) and high-dose aspirin, but a substantial number of patients are refractory and require additional treatment. Tumor necrosis factor-α levels are elevated in children with KD, suggesting a role for etanercept in treatment.

The researchers performed a prospective open-label trial of etanercept in 17 patients with KD (age range, 6 months-5 years) meeting clinical criteria and with fever of 10 days.

All received IVIG and high-dose aspirin. They received etanercept immediately after IVIG infusion and then weekly two times.

No patient demonstrated prolonged or recrudescent fever requiring re-treatment with IVIG. No patient showed an increase in coronary artery diameter or new coronary artery dilation/cardiac dysfunction.

Etanercept appears to be safe and well tolerated in children with KD. The data support performance of a placebo-controlled trial.

References:

Prospective Open-Label Trial of Etanercept as Adjunctive Therapy for Kawasaki Disease. Volume 157, Issue 6, Pages 960-966.e1 (December 2010).

IV methylprednisolone-pulse plus IVIG for initial treatment of patients predicted to have refractory Kawasaki disease. Pediatrics, 2012.

Addition of prednisolone to standard treatment with IVIG improves coronary artery outcomes in severe Kawasaki disease http://goo.gl/VTae3

Kawasaki Disease - JAMA Patient Page http://bit.ly/IHglhZ

MMR Vaccine and Autism: Vaccine Nihilism and Postmodern Science - Mayo Clinic Video

2011-09-01T09:25:00.000-05:00

Dr. Gregory Poland, Professor of Medicine and Director of the Mayo Vaccine Research Group at Mayo Clinic in Rochester, MN, discusses his article appearing in the September 2011 issue of Mayo Clinic Proceedings on concerns with the misrepresentation by the media regarding a relationship between vaccinations and autism. Available at:
http://www.mayoclinicproceedings.com/content/86/9/869.abstract

Teething and Fever (video)

2011-07-19T10:06:00.001-05:00

Source: Seattle Mama Doc

Child asthma - inhaler techniques - NHSChoices video

2011-07-16T10:21:00.001-05:00

NHSChoices: The symptoms of childhood asthma, how it can be treated, and which inhaler is right for children.

Live and dead insects in the ear (video)

2011-07-14T08:14:00.000-05:00

A video clip having two patients with similar foriegn bodies in the ear, one with a live insect, and other with a dead insect, being removed by suction.

Endocrine Dysfunction following Traumatic Brain Injury in Children

2011-07-12T09:33:00.000-05:00

This study included a prospective evaluation of 31 children after traumatic brain injury (TBI).

The researchers evaluated thyroid function, insulin-like growth factor I, insulin-like growth factor-binding protein 3, and cortisol at 1, 3, 6, and 12 months after injury, and assessed prolactin at 3 and 6 months. At 6 months, they also assessed overnight growth hormone secretion, nocturnal thyrotropin surge, adrenal reserve, and serum and urine osmolarity.

The average patient age was 11.6 years, and mean Glascow Coma Scale score was 6.

The incidence of endocrine dysfunction was 15% at 1 month, 75% at 6 months, and 29% at 12 months.

At 12 months after injury, 14% had precocious puberty, 9% had hypothyroidism, and 5% had growth hormone deficiency.

Endocrine dysfunction after TBI is common in children, but most cases resolve by 1 year. The study authors recommended endocrine surveillance at both 6 and 12 months following moderate or severe TBI.

References:
Endocrine Dysfunction following Traumatic Brain Injury in Children, Volume 157, Issue 6, Pages 894-899 (December 2010).

Foreign body (toy car wheel) in nose (video)

2011-07-11T08:11:00.001-05:00

Foreign body (toy car wheel) in nose (video)

New Heart Saves Little Boys Life - Cleveland Clinic Video

2011-05-25T11:01:00.000-05:00

ClevelandClinic | February 18, 2011

Pediatric Stem Cell Transplant - UChicagoMedCenter Video

2011-05-23T15:20:00.000-05:00

UChicagoMedCenter | February 08, 2011 | How do pediatric stem cell transplants work? What conditions can be treated with this therapy? John Cunningham, MD, an internationally known expert in pediatric stem cell transplant and chief of the University of Chicago Section of Pediatric Hematology/Oncology and Stem Cell Transplantation provides an overview.