Avsnitt
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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.
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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.
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 -
Saknas det avsnitt?
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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.
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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.
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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): e507–e514. https://doi.org/10.1542/neo.17-9-e507
TORCH infections: Pediatr Rev (2011) 32 (12): 537–542. 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.
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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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In this *shocking* episode, we discuss identifying and managing sepsis and septic shock in the pediatric population. This episode features two of our 2nd year pediatric residents, Victoria and Kat. We are so excited to have them join us and teach us about this very common chief complaint, especially for patients getting admitted to the hospital.
Follow us on Twitter/X @Pediagogypod and Instagram/Trheads @pediagogy and connect with us at [email protected]
This episode was written by Drs. Victoria Tran, Katrina Marks, Tammy Yau, and Lidia Park, with content support from Dr. Moonjoo Han. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points
Defining and differentiating SIRS, sepsis, and septic shock. Identifying the symptoms of sepsis is important for appropriate patient triage. SIRS comprises of constellation of symptoms. For SIRS criteria, 2 or more criteria must be met, which include hyper/hypothermia, leukocytosis/leukopenia, tachycardia/bradycardia, tachypnea. SIRS + infectious source = sepsisInitial management of sepsis includes broad-spectrum antibiotics and fluid resuscitation with isotonic fluids (typically 10-20 cc/kg)Sources:
Weiss, Scott L. MD, MSCE, FCCM (Co-Vice Chair) et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatric Critical Care Medicine 21(2):p e52-e106, February 2020. | DOI: 10.1097/PCC.0000000000002198
Link: https://journals.lww.com/pccmjournal/Fulltext/2020/02000/Surviving_Sepsis_Campaign_International_Guidelines.20.aspx
Menon, Kusum et al. “A Prospective Multicenter Study of Adrenal Function in Critically Ill Children.” American journal of respiratory and critical care medicine: an official journal of the American Thoracic Society, medical section of the American Lung Association. 182.2 (2010): 246–251. Web.
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In this episode, we have some special guests, Dr. Daniel Dodson, and one of our medical students, Aneri Patel, talk to us about Kawasaki disease. Special thanks to Dr. Natasha Nakra for content review.
Key points:
-Vasculitis with the clinical features in the mnemonic CRASH and Burn
-Incomplete Kawasaki has lab features including elevated ESR and CRP, thrombocytosis, hypoalbuminemia, anemia, elevated ALT, leukocytosis, and sterile pyuria.
-Treatment is to prevent coronary artery aneurysms with IVIG and aspirin.
References:
AAP Pediatrics in Review
https://publications.aap.org/pediatricsinreview/article/39/2/78/35139/Kawasaki-Disease?autologincheck=redirected
Infliximab and Kawasaki
https://www.sciencedirect.com/science/article/pii/S2352464221002704?via%3Dihub
Principles and Practices of Infectious Diseases, 6th edition
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Let’s briefly discuss the new 2023 AAP obesity guidelines in this episode.
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This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Sean Munoz. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Obesity is now the most common chronic disease of childhood
-Children 10 years of age and older with obesity should have lipid, A1c, and ALT checked.
-Children ages 2-9 with obesity should have lipid checked and potentially ALT
-Treatment is multimodal and includes lifestyle modification, medications, and surgery.
AAP 2023 obesity guidelines:
https://publications.aap.org/pediatrics/article/151/2/e2022060640/190443/Clinical-Practice-Guideline-for-the-Evaluation-and
NPR: AAP’s new childhood obesity guidance raises worries over the risk of eating disorders
https://www.npr.org/2023/02/15/1155521908/eating-disorder-obesity-guidance-risk-weight-loss
USA Today: Weight loss drugs and surgery- for kids? Why new obesity guidance is drawing scrutiny
https://www.usatoday.com/story/news/health/2023/01/19/aap-childhood-obesity-guidelines-scrutiny/11039166002/
2012 Dyslipidemia Screening
https://publications.aap.org/pediatrics/article/146/1_MeetingAbstract/636/4732/Pediatric-dyslipidemia-screening-by-pediatricians
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Want to quickly become a pro at family centered rounds? Learn the basics as well as the tips and tricks on how to navigate presenting in a patient-first and family-friendly way.
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. Jessica Witkowski. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Family centered rounds should involve the patient, family, and all relevant medical team members. Allow space for everyone to be heard and opportunity for questions.
-Make sure to include all the same important information as a traditional presentation, but without medical jargon. Direct your presentation at the patient and family
Sources:
2021 AAP Hospital Pediatrics: https://publications.aap.org/hospitalpediatrics/article/11/7/679/179865/Implementing-Family-Centered-Rounds-in-Hospital?autologincheck=redirected 2018 AAP Pediatrics: https://publications.aap.org/pediatrics/article-abstract/141/3/e20171883/37598/Families-Experiences-With-Pediatric-Family?redirectedFrom=fulltext2022 Michigan Medicine: https://www.ncbi.nlm.nih.gov/books/NBK582289/
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Help my kid has a UTI! Does cranberry juice have any benefit for UTIs? Find out with us in today’s episode about urinary tract infections (UTIs)!
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. Natasha Nakra. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-A fever may be your only symptom in a young child with a UTI
-If you think it’s a UTI, get a clean specimen for culture. A positive culture has more than 50k CFUs/ml on a catheter sample and more than 100k CFUs/ml on a clean catch/void sample.
-Most common bacteria causing UTIs are E. coli, Klebsiella, Proteus, Enterococcus, and Enterobacter
-Simple cystitis may only need 3-10 days of treatment depending on age, whereas pyelonephritis needs 10-14 days.
Sources
2021 AAP UTI Management: https://publications.aap.org/pediatrics/article/147/2/e2020012138/36243/Contemporary-Management-of-Urinary-Tract-Infection 2016 AAP Reaffirmation of Clinical Guideline: https://publications.aap.org/pediatrics/article/138/6/e20163026/52686/Reaffirmation-of-AAP-Clinical-Practice-Guideline UTI risk calculator: https://uticalc.pitt.edu/ CDC Urine Culture Stewardship: https://www.cdc.gov/hai/prevent/cauti/index.html 2023 UTI treatment duration: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2806198 2012 Cranberry Juice for UTIs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027998/ 2020 Comparative Effectiveness of Antibiotic Treatment Duration in Children With Pyelonephritis: https://pubmed.ncbi.nlm.nih.gov/32364593/ -
Seizures can be scary and fevers aren't fun but we'll teach you why simple febrile seizures aren't so bad in this episode!
Follow us on Twitter @Pediagogypod and connect with us at [email protected]
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Shannon Liang, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Simple febrile seizures are generalized, less than 15 minutes, and occur no more than once in a 24-hour period.
-No work-up or treatment is recommended for simple febrile seizures
Supplemental information
2011 AAP Pediatrics guidelines: https://publications.aap.org/pediatrics/article/127/2/389/65189/Febrile-Seizures-Guideline-for-the-Neurodiagnostic
2019 AAP Pediatrics - Post Vaccination Febrile Seizure Severity and Outcome https://publications.aap.org/pediatrics/article/143/5/e20182120/37133/Postvaccination-Febrile-Seizure-Severity-and
2010 AAP Pediatrics - MMRV Combination Vaccine and the Risk of Febrile Seizures: https://publications.aap.org/pediatrics/article/126/1/e1/68346/Measles-Mumps-Rubella-Varicella-Combination
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Learn about management of newborn jaundice in our 2-part series.
Follow us on Twitter @Pediagogypod and connect with us at [email protected]
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Daphne Say, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Unconjugated bilirubin is fat soluble so can cross the blood brain barrier and cause kernicterus
-Check bilirubin levels at least every 24 hours while a newborn is first hospitalized
-New AAP guidelines on hyperbilirubinemia management raised phototherapy and exchange transfusion thresholds
-Transcutaneous bilirubin monitoring has a +/- 3 margin of error
Supplemental Information
2022 AAP Pediatrics Guidelines: https://publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-of?autologincheck=redirected
2012 Journal of Perinatology – Hyperbilirubinemia in Infants < 35 weeks gestation: https://www.nature.com/articles/jp201271#Tab1
2014 AAP Pediatrics - Transcutaneous Bilirubin After Phototherapy in Term and Preterm Infants https://publications.aap.org/pediatrics/article/134/5/e1324/75870/Transcutaneous-Bilirubin-After-Phototherapy-in?autologincheck=redirected
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In the first installment of this 2-part episode, we break down the causes of unconjugated (indirect) and conjugated (direct) hyperbilirubinemia.
Follow us on Twitter @Pediagogypod and connect with us at [email protected]
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Daphne Say, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Unconjugated hyperbilirubinemia causes are due to increased bilirubin production, decreased liver conjugation, or decreased clearance
-Conjugated hyperbilirubinemia can be due to outflow or transport problem, infection, metabolic disorders, liver dysfunction, and parenteral nutrition
-Always consider biliary atresia in a newborn with pale white stools. The earlier the surgical treatment, the better outcomes
Supplemental Information
2017 Pediatrics in Review - Jaundice: Newborn to Age 2 months https://publications.aap.org/pediatricsinreview/article/38/11/499/35001/Jaundice-Newborn-to-Age-2-Months?autologincheck=redirected
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Join us today where we discuss one of the most common causes of microcytic anemia in pediatric patients.
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This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Anjali Pawar, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Excessive milk consumption inhibits iron absorption. Limit to 16-24 oz/day
-Iron supplementation dosing depends on gestational age and major food source. Prevention vs treatment dosing also differ.
-Mentzer index greater than 13 indicates iron deficiency anemia
Supplemental information
2010 AAP Pediatrics guidelines: https://publications.aap.org/pediatrics/article/126/5/1040/65343/Diagnosis-and-Prevention-of-Iron-Deficiency-and?autologincheck=redirected
2020 JAMA Network – vitamin C and irom deficiency anemia: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772395#:~:text=Vitamin%20C%20is%20the%20only,shown%20to%20promote%20iron%20absorption.&text=Iron%20absorption%20occurs%20predominantly%20in,small%20intestine%20mucosal%20epithelial%20cells
2017 AAP Pediatrics in Review – infant nutrition: https://publications.aap.org/pediatricsinreview/article/38/10/449/32000/Updates-in-Infant-Nutrition
2014 Neuropsychiatric Disease and Treatment – iron deficiency anemia and cognitive function: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235202/
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In this hot topic summer episode, listeners will learn about the management of infectious gastroenteritis.
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This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Christopher Kim, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Gastroenteritis is a major cause of pediatric morbidity annually due to dehydration
-Learn about oral rehydration with balanced electrolyte solutions vs water or sports drinks
-Understand why we avoid testing and antibiotics
-Other supportive measures that are available
Supplemental information
2012 AAP Pediatrics in Review: https://publications.aap.org/pediatricsinreview/article/33/11/487/34685/Acute-Gastroenteritis?autologincheck=redirected
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Key points:
-Bronchiolitis is seen in kids under the age of 2 and caused by RSV
-Treatment is supportive including fluids, oxygen, and suction
-Learn about palivizumab and other new preventive therapies against bronchiolitis
Supplemental Information:
AAP 2014 guidelines: https://pediatrics.aappublications.org/content/134/5/e1474
Day of Illness and Outcomes in Bronchiolitis Hospitalizations: https://publications.aap.org/pediatrics/article/146/5/e20201537/75296/Day-of-Illness-and-Outcomes-in-Bronchiolitis -
Key points:
-Brief, resolved, unexplained events in patients - Visa fler
