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Nicklaus Children's Hospital Annual Pediatric Postgraduate Course
Miami, FL
Feb 22-25, 2018
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Latest update on initial management of anaphylaxis
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"Epinephrine (0.01 mg/kg, max. dose 0.3mg in a pre-pubertal child and up to 0.5mg in a teenager) is the medication of choice for the initial treatment of anaphylaxis." Delayed injection by giving other medications can be associated with poor outcomes. If injected properly (by intramuscular-IM, injection into the mid-outer thigh is recommended) it peaks quickly and is safer than intravenous bolus injection and faster than if given subcutaneously. Serious adverse effects of IM epinephrine in children are rare with no absolute contraindication for anaphylaxis treatment. It is beneficial to prescribe epinephrine autoinjectors for all patients who have had an anaphylactic episode and for "some high-risk" patients without a history of anaphylaxis.
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Health barriers to learning (HBL's)
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HBL's (health conditions which when unrecognized or untreated can interfere with a child's ability to learn and succeed in school), include vision and hearing deficits, uncontrolled asthma, mental and behavioral problems, dental pain, persistent hunger and effects of lead exposure. School requirements for health screening of children during their annual checkup prior to starting elementary school would benefit all children. At present no USA state mandates that schools screen for all the above conditions; <50% require comprehensive school health information and only a few utilize a specific form.
Children in pre-K/Kindergarten to 5th or 6th grade are at a critical stage for health, psychological, social and educational development - the building blocks of a successful future. Identifying the above health barriers early by State mandate would enhance likelihood of future success.
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Long-term lung pulmonary function in children following lobectomy for congenital lung malformation (CLM's)
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Asymptomatic children who undergo lobectomy (median age 5 months) for CLM's have excellent long-term pulmonary function outcomes.
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INFORMATION BONUS! Newly Updated...
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Download, print and pin this information on your office wall.
-This is a "Must Have" (Ed.)
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Pediatric lawnmower injuries
A study of demographics, injury characteristics and mechanisms of injuries, analyzed 88 children who presented to a Pediatric trauma center with lawnmower injuries. Results indicates:
- 88% are male and 42% <5 years of age.
- 72% of injuries are caused by riding lawnmowers.
- The most common mechanisms are slipping under the lawnmower/being run over 51%.
- Common injuries include; lacerations (36%), fractures (27%) amputations (22%).
- Lower extremities most frequently injured.
- Complications include infections, tissue necrosis, and death.
"Lawnmowers injuries are still prevalent in children despite national safety recommendations."
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Detergent pod-related eye injuries among preschool age children
"Laundry detergent pods are single-load capsules that contain concentrated liquid detergent within a water-soluble membrane that dissolves when in contact with moisture." They were introduced into the USA market in 2010 and multiple manufacturers now produce them. From 2012 the CDC and American Association of Poison Control Centers (AAPC) have been tracking, characterizing and reporting side effects. Poisoning choking and burns are common in young children following ingestion. Increasingly children/teenagers 13-19 years of age are "popping" them on purpose; "Tide Pod Challenge" with videos of its effects (significant caustic burns) being placed online.
Laundry detergent pod-related eye burns in children 3-4 years of age is increasing dramatically from young children handling the pods and the contents squirting onto their hands and from there on/into their eyes. Parents require vigilance and manufacturers need to redesign packaging.
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Anesthetics and cognitive (and other) neurodevelopmental impairments
Animal research over the past years has confirmed that commonly used general anesthetics (GA) and sedatives may have a detrimental effect on immature brain development with long-lasting consequences on cognitive and behavioral outcomes. In December 2016 the FDA issued an "
Advise to healthcare professionals" that procedures lasting >3 hours, or multiple procedures in children <3 years of age caries potential risks. Clinical findings in infants given general anesthetics prior to 3 years of age confirm a higher risk for learning disabilities with multiple re-exposures causing decreased cognitive abilities and academic achievement. Children between the ages of 3-10 years exposed to GA appear to be vulnerable to motor development abnormalities. 12-14% of healthy children <1 year of age exposed to GA appear to perform <5th percentile on academic achievement.
Anesthesia-induced cognitive, behavioral and motor impairments in young children require professionals to "balance the benefits of appropriate anesthesia in young children... against potential risks especially for multiple procedures and those lasting >3 hours."
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New Frontiers in Spine Surgery featuring Dr. Harry Shufflebarger
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Dr. Harry Shufflebarger, Director of the Division of Spine Surgery at Nicklaus Children's Hospital in Miam
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Take the Quiz
!
Can you describe barriers to Prep adherence among adolescent males?
Are you familiar with the AAP's new guidelines for pediatric hypertension?
Constipation in children: What are the causes?
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