PedMedicine: Pediatrics and Medicine

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

2011-09-26T09:47:00.005-05:00

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

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.

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.

Life and Death Statistics of Children in the United States

2011-05-01T09:49:00.000-05:00

The number of births in the United States decreased between 2007 and 2008. The total fertility rate decreased 2% in 2008.

The proportion of all births to unmarried women increased to 40.6% in 2008. The preterm birth rate was 12.3%.

32% of all births occurred by cesarean delivery.

Unintentional injuries and homicide were, respectively, the first and second leading causes of death in children. These 2 causes of death jointly accounted for 51.2% of all deaths of children and adolescents.

References:
Annual Summary of Vital Statistics: 2008. PEDIATRICS Vol. 127 No. 1 January 2011, pp. 146-157 (doi:10.1542/peds.2010-3175)

Pertussis (Whooping Cough) - Mayo Clinic video

2011-04-26T09:57:00.005-05:00

Mayo Clinic on Apr 8, 2011: Whooping cough. It's a bacterial infection that's risen to epidemic levels in some parts of the U.S. In adults, the symptoms can be mild, but if the infection is spread to a baby who hasn't yet received a full course of vaccinations, whooping cough can be very serious.

Related reading:

Whooping cough: Chicago-area outbreak spreads, with counties reporting numbers not seen in years. ChicagoTribune, 2011.

Comments from Twitter:

Natasha Burgert @DoctorNatasha: One of the scariest sounds a pediatrician can hear!

Pediatric Acute Myeloid Leukemia (AML) - UChicago Video

2011-04-20T10:58:00.001-05:00

Jennifer McNeer, MD, a pediatric hematologist at Comer Children's Hospital at the University of Chicago, shares how advanced diagnostic techniques help physicians to better characterize and treat each child's case of acute myeloid leukemia (AML).

Caffeine-induced rhabdomyolysis and its role in DRESS syndrome

2011-04-13T07:49:00.000-05:00

Drug-related eosinophilia with systemic symptoms (DRESS) is a potentially life-threatening, multiorgan condition that can result from drug treatment. Antiepileptic medications are the most common cause of DRESS.

Caffeine is structurally similar to adenosine. Image source: Wikipedia, public domain.

This is case report of a 16-year-old boy with bipolar disorder who was treated with aripiprazole and fluoxetine. He developed DRESS syndrome after ingestion of high doses of caffeine.

The DRESS symptoms were classic - fever, morbilliform rash, lymphadenopathy, and visceral involvement, including leukocytosis, eosinophilia, and hepatitis.

The patient dramatically improved after corticosteroid therapy and discontinuation of all psychotropic medications.

The authors think that the development of DRESS syndrome is a net result of inconsistent medication adherence coupled with the ingestion of near-toxic doses of caffeine, which can lead to rhabdomyolysis and, through renal impairment, lead to the accumulation of toxic oxidative metabolites of the psychotropic medications.

This is one of the few reported cases of caffeine-induced rhabdomyolysis which could have lead to the development of DRESS

References:
Psychotropic Drug-Related Eosinophilia With Systemic Symptoms After Acute Caffeine Ingestion. PEDIATRICS Vol. 127 No. 1 January 2011, pp. e235-e238 (doi:10.1542/peds.2010-0374).

Pediatric concussions: 69% by boys, 30% sports-related

2011-04-06T07:34:00.002-05:00

This is a cross-sectional study of children 0 to 19 years old diagnosed with concussion from the National Hospital Ambulatory Medical Care Survey.

There were 144 000 concussions annually.

69% of concussion visits were by males. 30% were sports-related.

69% of patients diagnosed with a concussion had head imaging.

28% of patients were discharged without specific instructions to follow-up with an outpatient provider for further treatment.

References:

Pediatric Concussions in United States Emergency Departments in the Years 2002 to 2006. William P. Meehan III, MDab, Rebekah Mannix, MD, MPHa. The Journal of Pediatrics.
Chronic traumatic encephalopathy (CTE): Brain bank examines athletes' hard hits - CNN, 2012.
Image source: Illustration of the human brain and skull. Wikipedia, Patrick J. Lynch, medical illustrator, Creative Commons Attribution 2.5 License 2006.

Use of Probiotics and Prebiotics in Pediatrics

2011-03-28T11:53:00.000-05:00

This clinical report (free full text) reviews the benefits of probiotic and prebiotic products.

Probiotics

Probiotics are supplements or foods that contain viable microorganisms that cause alterations of the microflora of the host. Use of probiotics is effective in:

- treating acute viral gastroenteritis
- preventing antibiotic-associated diarrhea

There is some evidence that probiotics prevent necrotizing enterocolitis in very low birth weight infants (birth weight between 1000 and 1500 g), but more studies are needed.

Probiotics were used to treat Helicobacter pylori (Hp) gastritis, irritable bowel syndrome, chronic ulcerative colitis, and infantile colic, as well as in preventing childhood atopy, but the results are preliminary.

Probiotics have not been beneficial in with Crohn disease.

There are also safety concerns with the use of probiotics in infants and children who are immunocompromised, chronically debilitated, or seriously ill.

Prebiotics

Prebiotics are supplements or foods that contain a nondigestible food ingredient that selectively stimulates the favorable growth and/or activity of indigenous probiotic bacteria.

Human milk contains a lot of prebiotics.

There may be benefit of prebiotics for the prevention of atopic eczema and common infections in infants.

References:
Probiotics and Prebiotics in Pediatrics. PEDIATRICS Vol. 126 No. 6 December 2010, pp. 1217-1231 (doi:10.1542/peds.2010-2548).

Image source: Cacık, a Turkish cold appetiser yoghurt variety, Wikipedia, Creative Commons Attribution ShareAlike 3.0 License.