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The Surveillance, Epidemiology and End Results 18 database of national statistics (for 45 years) and an institutional retrospective chart review of pediatric patients diagnosed with tonsil malignancy found 138 pediatric patients, the majority (79.7%) of whom were unilateral with male and Caucasian predominance. 84.1% are Non-Hodgkin lymphomas. A history of rapid (<12 weeks) tonsillar enlargement is common, with tonsillar asymmetry and cervical lymphadenopathy requiring a high index of suspicion.
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Asthma, airway remodeling (AR) and Montelukast administration
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Airway remodeling refers to the structural changes (subepithelial fibrosis, thickening of airway walls, increased smooth muscle mass, etc.) in the large and small airways that frequently occurs with a chronic airway inflammatory process like asthma. It leads to airway narrowing, bronchial hyper responsiveness and mucus hypersecretion. Early diagnosis and prevention may decrease disease severity.
A study in immature and adult sensitized mice examined the effects on airway inflammation before and after Montelukast (Singulair; an anti-inflammatory leukotriene receptor antagonist) administration.
Younger mices' airways have a greater inflammatory response (vs. adults) to sensitization; Montelukast administration decreases airway smooth muscle mass and cellularity, and could potentially prevent/reverse the deleterious airway remodeling found in young asthmatic children.
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Intravenous (IV) and nebulized magnesium sulfate for acute asthma in children
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A review of randomized controlled studies from a number of databases which examined the effectiveness of IV or nebulized magnesium sulfate in pediatric acute asthma, indicates that IV magnesium sulfate significantly improves pulmonary function and decreases further treatments and hospitalizations. Nebulized magnesium appears to have no beneficial effect on acute asthma.
Pediatric Emergency Care
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Management of pediatric isolated skull fracture (ISF)
"Head trauma represents one of the most common pediatric injuries and accounts for nearly 500,000 Emergency Department (ED) visits and 95,000 hospitalizations per year in the USA." Though the likelihood of clinical deterioration with an ISF is low (<1%), optimal disposition remains controversial.
It appears that decreased in-patient utilization through a "Home Surveillance" program or "Observation Unit" reduces costs associated with ISF without increased clinical risk.
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Complications after button battery ingestion (BBI)
A literature review of the complications following Button battery ingestion (over a 20 year period) indicates:
- Alkaline batteries >20mm in size are the most commonly ingested (90%) and are more prone to complications.
- Children <6 years are more frequently affected.
- Most complications are nasal/gastrointestinal (ulceration, necrosis, perforation and stricture/obstruction).
- Vascular involvement (often fatal), vocal cord paralysis and bronchopneumonia may occur but are unusual.
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Non-operative management of pectus excavatum with vacuum bell therapy
Though the minimally invasive treatment for pectus excavatum (Nuss procedure) gives excellent results children are at increased risk for post-surgical complications (occasionally severe).
A single institutions' retrospective evaluation (180 patients) of variables associated with excellent outcomes in pectus excavatum patients treated with vacuum bell therapy (over 12 consecutive months) indicates that in those relatively few children who are <11 years of age, with chest wall flexibility and with an initial wall depth <1.5cm, a non-surgical treatment program might be considered.
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Risk of death in infants who have experienced a Brief Resolved Unexplained Event (BRUE)/Apparent Life-Threatening Event (ALTE)
A review of published data (in-hospital and post discharge) from 1970 through 2014 which examined the risk of death after BRUE/ALTE (sudden alteration in infant's breathing, color, tone or responsiveness) indicates that within a 4 month post event horizon the risk appears to be no different to the base-line risk of death during the first year of life. Routine hospitalization for BRUE/ALTE may be unwarranted.
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