Miami, FL
April 18, 2018
     
Volume IX | Issue No. 16
Axillary and tympanic temperature measurements in children
An observational, cross-sectional study of 1,364 healthy children aged 0-17 years who had axillary and tympanic temperatures recorded, indicates that for infants 0-2 months a fever should be defined as a temperature >37.5C (99.6F) and 37.85C (98.6F) respectively for axillary and tympanic temperatures, while for older infants and children fever should be considered when temperatures are >37.0C (98.6F) and 37.8C (100.4F) respectively.

Genitourinary health of sexually abused girls and boys 
A study which compared genitourinary health problems of children and adolescents (882) with a substantiated report of sexual abuse, with matched controls indicates that younger girls (<12 years of age) have 2.1 and 1.4 times more diagnoses for urinary and genital problems respectively, compared with girls from the general population and 2.5 to 11 times more diagnoses than abused boys.

"Substantiated childhood sexual abuse is associated with more urinary and genital health problems among girls but not boys."

Journal of Pediatrics
 Kawasaki disease (KD) - Aneurysms and subsequent stenotic lesions
From a study of 214 children with KD who had at least one aneurysm on coronary angiogram done measured <100 days after the onset of the disease, it appears that subsequent 20 year prevalence (based on body surface area - BSA) of subsequent stenotic lesions can be later divided into three groups according to the maximum coronary artery aneurysm diameter found; large (>8.0mm), medium (6.0-8.0mm) and small (<6.0mm).

Children with a CAD aneurysm within 100 days of onset of KD with a diameter >6.1mm with a BSA <0.50 m2, and a diameter of >8mm with BSA >0.50 m2 have a high prevalence of subsequent stenotic lesions (40-81%) and require ongoing antithrombotic therapy and follow-up.
Did You Know? 
Lucky's Story
Lucky's Story
Childhood Obesity Facts 
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Long-term outcomes of surgical treatment for chronic pilonidal sinus disease (PSD) 

PSD is an inflammatory condition involving hair follicles (pilonidal means a "nest of hair") along the crease between the buttocks. It may present as a pit or pore containing a hair; a pilonidal sinus extending from the hair follicle; a cyst; or with infection and abscess. Three categories exist; acute PSD, chronic pilonidal disease (at least one prior abscess drainage) and complex or recurrent PSD. While there are a number of less invasive approaches to management, many treatments involve surgery.

Surgical treatment for acute PSD includes incision, drainage and curettage of the abscess cavity to remove hair nests and skin debris. Many (up to 85%) may require further surgical treatment. Excision by the Bascom procedure appears to give improved results ( only 14% require a second procedure) though a recent study indicates that the classical approach (midline incision, excision and primary repair) appears to give equally effective outcomes.
Journal of Pediatric Surgery

See related video HERE and HERE.
Video Feature
What happens to a child after he/she suffers sexual abuse?
What happens to a child after he/she suffers sexual abuse?
Relative effectiveness of dopamine antagonists for pediatric migraine 

Acute migraine headaches are both common and note- worthy for the sudden onset of severe headache located around the eyes, forehead or temple regions with an array of accompanying symptoms which include nausea, abdominal pain, vomiting, sensitivity to light (photophobia), sound (phonophobia) and/or smell (osmophobia), sensory changes and a need to sleep. Abortive drug treatments include (sleep!), ice-packs to the affected area, non-steroidal anti-inflammatory drugs (NSIDS) acetaminophen, "triptans" which target serotonin, beta-blockers and dopamine antagonists (among many others!).
 
A study of 57 children (mean age 14.5 years) with migraine headaches who presented to the ED and which examined and compared three dopamine antagonists (prochlorperazine - e.g. Compazine, metoclopramide - e.g. Reglan, or promethazine - e.g. Phenergan) indicates that migraine treatment failure (need for opioids) occurs variably, with promethazine being the least effective of the three dopamine antagonists utilized.
A randomized trial of high-flow oxygen (HiF) therapy in infants with bronchiolitis 

A multicenter, randomized, controlled trial of 1,472 infants (age <12 months) outside of the Intensive Care Unit (ICU) setting, diagnosed with bronchiolitis examined and compared the efficacy of HiF oxygen therapy through a nasal cannula, to standard-oxygen treatment.

High flow-oxygen therapy for non-ICU hospitalized infants diagnosed with bronchiolitis appears significantly better than standard-oxygen treatment with no increase in hospital stay, duration of oxygen therapy or adverse incidents.

Need for lumbar puncture (LP) in children younger than 12 months presenting with a febrile seizure 

A retrospective review of 816 children presenting with a single febrile seizure in which approximately 10% underwent LP (88% younger than 12 months of age) indicates that 6.7% show cerebral spinal pleocytosis with most of those having bacterial meningitis (immunizations up-to-date) and none having neurological signs suggestive of meningitis.

An LP should be considered in every child younger than 12 months of age who presents with a simple febrile seizure.

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