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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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August 24, 2022 | Volume 13 | Issue 34 |
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Clinical Practice Guidelines Revision: Management of Hyperbilirubinemia in the newborn infant 35 or more weeks of gestation |
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>80% of newborns will have hyperbilirubinemia some of whom will require careful monitoring and appropriate treatment to prevent acute bilirubin encephalopathy/kernicterus (characterized by some or all of; choreoathetoid cerebral palsy, upward gaze paresis, enamel dysplasia of the deciduous teeth, sensory neural deafness/auditory neuropathy or dyssynchrony auditory spectrum disorder (difficulty separating one word from another, sounds fade in and out, not understanding speech clearly, etc.) which has characteristic findings on magnetic resonance imaging (MRI).
This updated guideline replaces the 2004 American Academy of Pediatrics (AAP) Clinical practice guidelines for the management and prevention of hyperbilirubinemia n the newborn infant >35 weeks' gestation and addresses; (1) Prevention of hyperbilirubinemia (2) Providing feeding support (3) Assessment and monitoring for hyperbilirubinemia (identifying risk factors for an increased total serum bilirubin usually measured), Need for treatment, Neurotoxicity risk factors etc., and Treatments (including for those babies already discharged).
This extensive update from the AAP on Hyperbilirubinemia, its risk factors, identification and management, is a “MUST READ” for all pediatricians and those who care for the newborn infant.
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Read the full article at Pediatrics
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Defining Growing Pains: A scoping review |
"Growing pains” (aching or throbbing) in children are common (approximately 30%). They frequently “come and go”, often in both legs and thigh muscles, usually occurring late in the day and/or at night lasting 10-30 minutes, sometimes being associated with complaints of abdominal pain or headache during episodes, and the cause of which remains unknown. In spite of the known general description, It appears that “considerable uncertainty surrounds how to make the diagnosis”.
A scoping review of 8 electronic databases and 6 diagnostic classification systems which included peer-reviewed articles on “growing pains” indicates that there is extremely poor consensus in the literature on what to base the diagnosis or management with authors frequently simply noting clinical characteristics like “lower limb pain” (50% of sources), evening/nighttime pain (48%), recurrences (42%), a normal physical assessment (35%) and the bilateral nature of the condition (31%).
(80% of studies do not mention age of onset and 93% do not refer to growth!)
“Clinicians should be wary of relying on the diagnosis to direct treatment decisions”.
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Polyembolokoilamania (PEK) in child sexual abuse |
PEK (the insertion of a foreign body (FB) into a bodily orifice – mouth, vagina or anus) is not uncommon (children commonly accidentally swallow foreign bodies; adolescents intentionally insert FBs as part of risk taking and/or self-harming behavior; and adults may suffer from comorbid psychiatric diagnoses).
“When motivated by a desire for sexual gratification it can be considered a paraphilia (persistent and recurrent sexual interest, urges, fantasies or behaviors involving objects, etc.).
A 15-year retrospective review of children younger than 18 years of age characterized the physical findings in 68 children whose abuse history included anal or genital insertion of a foreign body.
In the clinical assessment of an abused child with PEK, abnormal anogenital findings are rare (89.7% are normal), the literatus documenting such cases is sparse, and sexual abuse uncommonly considered.
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2-year Prevalence and recovery rates of altered sense of smell or taste in patients (adults) with mildly symptomatic COIVD-19 |
From a follow-up study of 168 adult SARS-CoV-2 positive patients (by polymerase chain reaction) considered suitable for home management of whom 64.3% reported an altered sense of smell or taste at baseline, and who were recontacted 4 weeks, 8 weeks, 6 months and 2 years later, it appears that 38.1%, 17.3%, 16.1% and 8.3% respectively report ongoing altered smell or taste (88.2% report complete resolution of smell/taste symptoms at 2 years post-infection with most frequently reported nonchemosensory symptoms being fatigue and shortness of breath).
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Ancestral SARS-CoV-2 and Omicron replication in primary pediatric nasal epithelium |
From an interesting study that examined SARS-CoV-2 replication in nasal epithelial cells (NEC) from children and adults, it appears that the ancestral (original) and Delta variant of SARS-CoV-2 virus replicates to a significantly lower level in the NEC of children (which is associated with an increased antiviral immunologic NEC response) compared to the nasal epithelial response to Omicron variant infection which replicates in NEC to a much greater extent, and with a diminished antiviral immunological response.
This observation might explain the greater incidence of infection in children with the Omicron variant vs. the original SARS-CoV-2 isolated strain.
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Trends in management of pediatric distal (wrist) buckle fractures (DRBFx) |
A buckle fracture (also called an impacted fracture) is a type of compression incomplete bone fracture commonly seen in children <12 years of age who fall into an outstretched arm. They represent 50% of pediatric wrist injuries and frequently affect the radius bone.
A study to evaluate opinions and preferences of 317 pediatric orthopedic specialists regarding the management of DRBFx indicates that:
- 68% (particularly younger orthopedic surgeons) prefer using a removable wrist splint for 3 or fewer weeks (55%).
- 86% share decision making with their patients/families.
- Re-imaging is uncommon (36%).
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Effect of intranasal Dexmedetomidine (DEX) or Midazolam for premedication on the occurrence of respiratory adverse events in children undergoing tonsillectomy and adenoidectomy (T&A) |
A single-center, double-blind clinical trial of 384 children (0-12 years of age) undergoing elective T&A who were randomized to receive either intranasal midazolam, intranasal DEX or normal saline (control group) indicates that premedication with intranasal dexmedetomidine is associated with a decreased incidence of PRAEs and should be considered for children undergoing T&A.
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REGISTER - LEARN - EARN CME CREDIT |
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Narrative Medicine: A Prescription for Caregivers
At the completion of this activity, participants are expected to:
[1] Understand Florida law on informed consent, [2] Be aware that consent for minors must be in writing and detailed, [3] Learn about Florida’s new regulatory provision specific to pelvic exams.
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Underwriting Opportunities
Advertising in this e-journal in no way implies endorsement of a product by Nicklaus Children's Hospital.
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