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Unequal blood pressures in the extremities and unequal brachial vs femoral pulses? Consider coarctation of the aorta. Whatâs that? Learn more in today's episode!
This episode was written by pediatricians Lidia Park and Tammy Yau with content support from Jay Yeh (UC Davis pediatric cardiologist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
Coarctation of the aorta is narrowing of the aorta near the ductus arteriosus (which closes and becomes the ligamentum arteriosum). Most cases occur in the first month of life. Symptoms of coarctation of the aorta are tachypnea, poor feeding, fussiness, and sweating with feeds. Blood pressure is elevated in the right upper extremity compared to the lower extremity. Babies can develop congestive heart failure which can lead to shock. CCHD does not always catch coarctations of the aorta!Sources:
Raza S, Aggarwal S, Jenkins P, et al. Coarctation of the Aorta: Diagnosis and Management. Diagnostics (Basel). 2023;13(13):2189. Published 2023 Jun 27. doi:10.3390/diagnostics13132189 Salciccioli KB, Zachariah JP. Coarctation of the Aorta: Modern Paradigms Across the Lifespan. Hypertension. 2023;80(10):1970-1979. doi:10.1161/HYPERTENSIONAHA.123.19454 Parker LE, Landstrom AP. Genetic Etiology of Left-Sided Obstructive Heart Lesions: A Story in Development. J Am Heart Assoc. 2021;10(2):e019006. doi:10.1161/JAHA.120.019006 -
Does your child have a barking seal like cough? You better be thinking of croup! Join us on this resident-led episode today.
This episode was written by pediatric resident Anjali Doshi and pediatricians Lidia Park and Tammy Yau with content support from Alexis Toney (UC Davis pediatric hospitalist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
Croup, acute laryngotracheitis, a viral infection causing respiratory inflammation, bark like cough, and inspiratory stridor Westley score can be used to determine severity of croup Treatment for mild symptoms is humidified air and supportive care Treatment for moderate/severe symptoms is racemic epinephrine breathing treatment and IV dexamethasone Imaging can be considered to rule out bacterial tracheitis or epiglottitis if history and physical exam cannot narrow down the differential to croup Antibacterials not normally given unless concurrent infectionï»ż
Reference:
AAP Point of Care Quick Reference, Retzke, 2021. https://doi.org/10.1542/aap.ppcqr.396247 Russell KF, Liang Y, O'Gorman K, Johnson DW, Klassen TP. Glucocorticoids for croup. Cochrane Database Syst Rev. 2011;(1):CD001955. Published 2011 Jan 19. doi:10.1002/14651858.CD001955.pub3 Cochrane Database Syst Rev. 2018;10:CD006822. Epub 2018 Oct 29. Juliette Anderson. âBaby with Croup Stridor Barking Cough Visual & Audio Sound - When to Hospitalize.â YouTube, 14 Apr. 2011, www.youtube.com/watch?v=Qbn1Zw5CTbA. Accessed 3 Oct. 2024. -
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Donât miss this âearâ-resistible episode on outer ear infections, also known as otitis externa or swimmerâs ear!
This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Lena van Der List. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
Think otitis externa when your patient has ear pain, ear drainage, decreased hearing, and swelling or debris in the ear canal. Treat otitis externa with otic aminoglycosides (neomycin, polymyxin B, trimethoprim-sulfate) when you have an intact tympanic membrane or fluoroquinolone (ciprofloxacin, ofloxacin) if you canât visualize the tympanic membrane or there is a perforationSources:
Pediatrics in Review 2013, https://doi.org/10.1542/pir.34-3-143
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Get a real ear-full of information today when we talk about the 2nd most common diagnosis in the pediatric emergency department, acute otitis media (AOM)!
This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Lena Van der list. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
Ear pain with a red bulging tympanic membrane and decreased tympanic membrane mobility is our diagnosis for acute otitis media. AOM can be due to bacteria (S. pneumoniae, H. influenza, and Moraxella) and viruses (influenza, adenovirus, human metapneumovirus)Treat AOM with high dose amoxicillin (cephalexin or azithromycin if penicillin allergy) or amoxicillin-clavulanate. Avoid complications like mastoiditis or tympanic membrane perforationSources:
Pediatrics 2013, https://doi.org/10.1542/peds.2012-3488Stat Pearls 2023, https://www.ncbi.nlm.nih.gov/books/NBK470332/ World Journal of Pediatrics 2024, https://doi.org/10.1007/s12519-023-00716-8 University of Illinois Chicago: https://dig.pharmacy.uic.edu/faqs/2022-2/december-2022-faqs/what-evidence-supports-the-recommendation-for-high-dose-amoxicillin-in-children-with-acute-otitis-media/ -
In todayâs episode, youâll learn how to recognize and reduce this common pediatric orthopedic injury on your own and even teach parents if needed!
This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Emily Andrada. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
Nursemaidâs elbow, subluxation of the radial head, or annular ligament displacement all refer to the same injury of the elbow that occurs most often when a childâs arm is pronated and pulled.Treatment of a nursemaidâs is through reduction - either by supinating and flexing the elbow (or) pronating, hyperextending, and then flexing the elbowImaging is not routinely indicated for highly suspicious nursemaidâs but should be considered if you have concern for fractureSources:
Pediatrics in Review 2013, https://doi.org/10.1542/pir.34-8-366Pediatrics 2002, https://doi.org/10.1542/peds.110.1.171Eur J Emerg Med 2009, https://doi.org/10.1097/MEJ.0b013e32831d796a
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Learn how research continues to change our ability to detect and treat pediatric patients with hepatitis C in todayâs episode.
This episode was written by Dr. Lidia Park and Dr. Tammy Yau with content support from Dr. Daniel Dodson. Drs. Lidia and Tammy take full responsibility for any errors or misinformation.
Key Points:
Perinatal hepatitis C exposure is the most common cause of pediatric hepatitis C infection NAT testing for hepatitis C RNA can be done as early as 2 months of life to detect hepatitis C infection in pediatric patients rather than waiting until 18 months of life when hepatitis C antibody testing can be done Hepatitis C positive moms can still breastfeed but should halt breastfeeding temporarily if breasts are cracked or bleedingSources:
CDC: CDC Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children â United States, 2023 | MMWR AAP Red Book 2024: Hepatitis C -
Ever wonder what CCHD meant on a newborn discharge summary? Learn about how we screen for Critical Congenital Heart Defects in newborns (and which ones we miss!) in this episode.
This episode was written by Dr. Lidia Park and Dr. Tammy Yau with content support from Dr. Heather Siefkes. Drs. Lidia and Tammy take full responsibility for any errors or misinformation.
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Key Points:
Critical Congenital Heart Defects (CCHD) screening looks for heart defects that can be life threatening in infancy such as coarctation of the aorta, single ventricle defects like hypoplastic left heart syndrome, Tetralogy of Fallot (ToF), pulmonary atresia, total anomalous pulmonary venous return (TAPVR), transposition of the great arteries (TGA), and tricuspid atresia (TA). CCHD screening does not detect atrial septal defects (ASD), ventricular septal defects (VSD), or atrioventricular septal defects (AVSD) CCHD screening is performed by checking the pulse oximeter of the right hand and either foot of a newborn. SpO2 less than 90% is an automatic fail. SpO2 differences of 3% or more or SpO2 91-95% should be repeated twice before counting as a fail. Failed CCHDâs should be followed up with an echocardiogram.Sources:
CDC: Clinical Screening and Diagnosis for Critical Congenital Heart Defects | Congenital Heart Defects (CHDs) | CDC BMC Pediatric 2021, Jullien S. Newborn pulse oximetry screening for critical congenital heart defects. doi:10.1186/s12887-021-02520-7 Pediatrics 2011, Kemper AR, Mahle WT, Martin GR, et al. Strategies for implementing screening for critical congenital heart disease. doi:10.1542/peds.2011-1317 -
Did you know that if you exercise while you have a fever, you probably meet SIRS criteria? The new Phoenix sepsis scoring systems aims to better categorize sepsis through specific categories based on the patientâs vitals, labs, and medications. Learn with us as we walk through this new scoring system in todayâs episode.
This episode was written by Dr. Lidia Park and Dr. Tammy Yau with content support from Dr. Alexis Toney. Drs. Lidia and Tammy take full responsibility for any errors or misinformation.
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Key Points:
The Phoenix sepsis score is based out of 13 points. 2 or more points meets sepsis criteria. The score is based on 4 categories: respiratory, cardiovascular, coagulation, and neurologic. The Phoenix sepsis score is better at predicting mortality than SIRS criteria but does not predict morbiditySources:
JAMA 2024, Schlapbach,âInternational Consensus Criteria for Pediatric Sepsis and Septic Shockâ: doi: 10.1001/jama.2024.0179. Hospital Pediatrics 2023, Kusma, âEffect of Viral Illness on Procalcitonin as a Predictor of Bacterial Infection in Febrile Infantsâ: doi: 10.1542/hpeds.2022-007070 -
Learn how to classify and manage pneumonia in todayâs episode!
This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Natasha Nakra. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
Pneumonia can be due to bacteria or viruses and there is no reliable way to distinguish the twoPneumonia can be diagnosed clinically based on exam or with a CXR. Lab work is not always necessaryTreatment of bacterial pneumonia depends on if you think it is community acquired (first line amoxicillin), atypical (first line azithromycin), or nosocomial/hospital acquired (consider antibiotics for pseudomonal or MRSA coverage)Sources:
AAP 2023, Pinto: https://doi.org/10.1542/aap.ppcqr.396216 Pediatrics in Review 2017, Messinger: https://doi.org/10.1542/pir.2016-0183 Pediatric Care Online 2016, Light: https://publications.aap.org/pediatriccare/book/348/chapter/5785224/Pneumonia-Chapter-315IDSA 2013: https://doi.org/10.1093/cid/cir531 -
Prolonged viral upper respiratory symptoms or is it actually sinusitis in disguise? Join us as we discuss all things sinusitis in this episode!
This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Natasha Nakra. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
Acute bacterial sinusitis can be clinically diagnosed based on persistent respiratory symptoms lasting more than 10 days without improvement, worsening or new respiratory symptoms after initial improvement, or severe symptoms at onset lasting more than 3 days. First line antibiotic treatment for acute bacterial sinusitis is with amoxicillin or amoxicillin-clavulanateComplications include orbital or intracranial spread of infectionSources:
Pediatrics in Review 2013, Demuri and Wald: https://doi.org/10.1542/pir.34-10-429 AAP Pediatrics 2013, Wald et al: https://doi.org/10.1542/peds.2013-1071 Pediatrics 2024, Conway et al: https://doi.org/10.1542/peds.2023-064244 -
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Lisa Rasmussen. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
Vitamin K is important in preventing early and late onset bleeding in newborns (up to 6 months of age), most importantly, intracranial bleeding. Intramuscular vitamin K is most effective but oral vitamin K regimens are used outside of the US and are better than not giving any vitamin KSources/Supplemental Information:
AAP Pediatrics 2022, Hand: https://doi.org/10.1542/peds.2021-056036CDC Vitamin K Handout: https://www.cdc.gov/ncbddd/vitamink/vitamin-k-fact-sheet-general.html
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Can someone with HIV breastfeed their child? You might be surprised at the answer!
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected].
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Laura Kair. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
New guidelines from the CDC recommend allowing mothers with HIV on antiretroviral therapy (ART) with an undetectable viral load to breastfeed their child if they desire, whether or not they live in a developed or underdeveloped country. The risk for HIV transmission through breastmilk in these cases is 0.6% In the US, you can call the national perinatal HIV/AIDS hotline at 1-888-448-8765 for advice ï»żSources
CDC 2023 Infant Feeding for Individuals with HIV in the US: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/hiv.html -
Stay up to date with new research on shortening antibiotic treatment duration for urinary tract infections (UTIs) with our episode today where we review a recently published randomized control trial (RCT). Learn how to critically analyze study data and what key points we take away.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected].
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Michelle Hamline. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
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Key points:
A single RCT found similar risk of UTI recurrence in children who received a 5 day course vs 10 day course of antibiotics within the first 30 daysSources
Pediatrics 2024, Montini et al: https://doi.org/10.1542/peds.2023-062598 BMJ 2007, Montini et al: https://doi.org/10.1136/bmj.39244.692442.55 Cochrane Rev 2012, Altamimi et al: https://doi.org/10.1002/14651858.CD004872.pub3 JAMA Ped 2021, Pernica et al: https://doi.org/10.1001/jamapediatrics.2020.6735 JAMA Ped, 2022, Williams et al: https://doi.org/10.1001/jamapediatrics.2021.5547 -
Ever seen a tuft of hair over the lower back or a sacral dimple? Learn how to recognize and manage normal vs abnormal back and spinal findings in our episode today.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected].
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Laura Kair. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
Spinal dysraphism is the incomplete fusion of the spine during development. Not all spinal dysphraphisms will have abnormal cutaneous manifestations that you can see on exam Diagnose spinal dysphraphisms with spinal ultrasound in young children and MRI in older children Sacral dimples can be normal but should be worked up if they are larger than 5 mm at the base, above 2.5cm from the anus, not midline, or if there are multiple dimplesSources
Pediatrics in Review 2019, Holmes and Li: https://doi.org/10.1542/pir.2018-0155 Peds in Review 2011, Zywicke and Rozzelle: https://doi.org/10.1542/pir.32-3-109 Hospital Pediatrics 2020, Aby et al: https://doi.org/10.1542/hpeds.2019-0264 -
Toxoplasmosis is a parasitic TORCH infection that is often associated with cats but did you know owning a cat is not associated with increased prevalence? Learn more on how the disease is actually acquired and how to prevent infection in this episode!
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected].
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Ritu Cheema. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Cats, undercooked meat, and raw seafood can lead to toxoplasmosis infection
-Findings of toxoplasmosis infection in utero include scattered intracranial calcifications and chorioretinitis
-Treat toxoplasmosis infection in neonates with pyrimethamine, sulfadiazine, and folinic acid
Sources:
AAP 2017 https://publications.aap.org/pediatrics/article/139/2/e20163860/59988/Diagnosis-Treatment-and-Prevention-of-Congenital?autologincheck=redirected
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Learn about how the virus that causes cold sores can also cause serious complications in infants.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected]
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Ritu Cheema. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-First time HSV infection in pregnancy is higher risk to infants than reactivation of previous infection
-Symptoms of neonatal HSV infection include seizures, vesicles, and irritability
-Diagnose HSV with viral culture or PCR of bodily fluids
-Use acyclovir to treat infants and pregnant people with HSV infection
Sources:
AAFP 2022 https://www.aafp.org/pubs/afp/issues/2002/0315/p1138.html
Redbook 2021 https://publications.aap.org/redbook/book/347/chapter-abstract/5752755/Herpes-Simplex?redirectedFrom=fulltext
Neoreview 2018 https://publications.aap.org/neoreviews/article/19/2/e89/87448/Neonatal-Herpes-Simplex-Virus-Infection
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Despite widespread vaccination, there are still breakthroughs of varicella (commonly known as chicken pox). Let's dive into this episode of our TORCH series.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected]
This episode was written by Dr. Tammy Yau and Lidia Park, with content support from Dr. Ritu Cheema. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Transplacental varicella transmission can lead to congenital varicella syndrome which includes dermatomal rash, cicatrix, limb hypoplasia, microcephaly, and cataracts
-Use Acyclovir to treat neonates and pregnant people with active varicella infection. Congenital varicella syndrome does not require treatment.
-Varicella immunoglobulin can be used to prevent infection in certain cases including exposed neonates 5 days before delivery and 2 days after delivery.
Sources:
VZV in Newborns: Neoreviews (2016) 17 (9): e507âe514. https://doi.org/10.1542/neo.17-9-e507
TORCH infections: Pediatr Rev (2011) 32 (12): 537â542. https://doi.org/10.1542/pir.32-12-537
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This week on our series on TORCH infections, we are discussing syphilis, an increasingly prevalent disease in the pediatric population.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected]
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Elizabeth Partridge. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Most congenital syphilis is asymptomatic. Less commonly will present with rash, snuffles, hepatosplenomegaly, anemia, and jaundice.
-Untreated disease can cause neurosyphilis and bone defects
-Compare mother's RPR titers to baby's and look for findings consistent with syphilis.
-Workup is based on whether mother was adequately treated and includes CBC, LP, skeletal survey, and LFTs.
-Treatment is with IV penicillin G for 10 days.
Sources:
AAP Red Book Syphilis chapter
Sankaran D, Partridge E, Lakshminrusimha S. Congenital Syphilis-An Illustrative Review. Children (Basel). 2023 Jul 29;10(8):1310. doi: 10.3390/children10081310. PMID: 37628309; PMCID: PMC10453258.
Fang J, Partridge E, Bautista GM, Sankaran D. Congenital Syphilis Epidemiology, Prevention, and Management in the United States: A 2022 Update. Cureus. 2022 Dec 27;14(12):e33009. doi: 10.7759/cureus.33009. PMID: 36712768; PMCID: PMC9879571.
https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf
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Part 2 of our TORCH series discusses CMV, the most common infectious cause of hearing loss in the US.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected]
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Dean Blumberg. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Findings include blueberry muffin rash, microcephaly, periventricular calcifications, sensorineural hearing loss, and jaundice.
-Infection persists lifelong and treatment with valganciclovir is meant to prevent long term sequelae
-Monitor for myelosuppression with treatment.
-Frequent hearing screening is needed.
Sources:
AAP Red Book CMV chapter
Fowler KB, Boppana SB. Congenital cytomegalovirus infection. Semin Perinatol. 2018 Apr;42(3):149-154. doi: 10.1053/j.semperi.2018.02.002. Epub 2018 Mar 2. PMID: 29503048.
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We are starting our mini-series on TORCH infections with congenital rubella, a rare disease nowadays in the US but prevalent still worldwide.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected]
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Dean Blumberg. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Think of this disease in infants of immigrant or under-immunized mothers.
-Findings include cataracts, retinopathy, PDA, hearing loss, blueberry muffin rash
-Treatment is supportive, with patients needing to isolate for at least several months.
-There is little evidence for immunoglobulin to prevent disease
Sources:
AAP Red Book chapter on Rubella
Lambert N, Strebel P, Orenstein W, Icenogle J, Poland GA. Rubella. Lancet. 2015 Jun 6;385(9984):2297-307. doi: 10.1016/S0140-6736(14)60539-0. Epub 2015 Jan 8. PMID: 25576992; PMCID: PMC4514442.
AAP 2010 Pediatrics in Review
https://publications.aap.org/pediatricsinreview/article-abstract/31/3/129/33128/Rubella?redirectedFrom=fulltext
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