June 10, 2015   Vol. VI, Issue 23
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Lung ultrasound (LUS) to diagnose pneumonia 

"Pneumonia is the leading cause of death in children". To date neither pediatric nor adult guidelines currently recommend the use of LUS as a diagnostic tool in spite of a large number of recent studies indicating its value in diagnosing pneumonia.


Studies of 285 adult and 765 pediatric patients who had chest x-ray/CT performed for clinical reasons and LUS, indicates that LUS represents a reliable diagnostic tool for the bedside diagnosis in all patients with suspected pneumonia. Physicians should actively seek to be trained in its utilization.




American Journal of Emergency Medicine 

Defecation patterns in infants 

The prevalence and natural history of dyschezia (constipation with hard and/or difficult to pass stools) defined by Rome III criteria as straining and crying for at least 10 minutes before successful passage of soft stools, is lacking in infants.


A study involving bowel diaries and standardized questionnaires of 1292 infants aged 1, 3 and 9 months suggests that many infants at 1 and 3 months of age (3.9% and 0.9% respectively) fulfill Rome III criteria. Many more however ( 17.3% and 6.5% of infants respectively ) report dyschezia-like symptoms prior to stooling. By 9 months of age very few infants fulfill criteria with many still having modified symptoms.


Many young infants (<9 months of age) present with specific criteria and non-criteria specific symptoms of constipation at an early age. By 9 months of age most symptoms of functional constipation have disappeared.


Archives of Diseases in Childhood 

Pulse oximetry screening in the diagnosis of simple transposition of the great arteries (TGA)

Most babies with TGA are cyanosed after birth; however in the presence of a large patent ductus arteriosus, atrial septal defect or ventricular septal defect, oxygenated blood may still reach the rest of the body. This may result in significantly less clinical cyanosis, making it easier to miss the diagnosis.


A retrospective study of 89 post-operative babies diagnosed with TGA born in oximetry screening and non-screening hospitals, indicates that where post-natal pulse oximetry screening is routine many babies are identified with TGA who might not have been diagnosed prior to discharge.


"Pulse oximetry minimizes the risk of discharging non-diagnosed newborn infants with TGA".


Acta Paediatrica 



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Codeine and breast feeding 


Codeine is a weak pro-drug opioid requiring metabolism in the liver to produce active metabolites. Until recently it was considered safe to be given to breast feeding mothers however morphine toxicity due to genetic polymorphisms governing the enzymes that metabolize codeine have resulted in varying amounts of toxic drugs being found in breast milk.


Serious adverse events (and questionable efficacy in breast-fed infants following maternal ingestion of codeine) have resulted in restrictions of its use by the FDA (and European Medicine Agency) in mothers who are breast feeding and children under 12 years of age.


Acta Paediatrica 



In general the outcome of near-drowning victims depends significantly on the rapidity of retrieval and effectiveness of resuscitation.


A study of 281 near-drowning children (median age 3 years) from swimming pools (77%) and bath tubs (16%) in which vomiting occurred during resuscitation indicates that these victims are less likely to be intubated, and/or have a low Glasgow Coma Scale in the Emergency Department, die in the first 24 hours following hospitalization or have a poor outcome at hospital discharge (children who vomit are more likely to have received CPR or chest compressions than just rescue breaths).


American Journal of Emergency Medicine

Video Feature

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Near Drowning

Magnetic Resonance Arthrography (MRIa) and partial rotator cuff tears 


"The rotative cuff is a group of tendons and muscles in the shoulder connecting the humerus to scapula" which provide stability to the shoulder. The 4 tendons of the rotator cuff muscles join together to form one large tendon called the rotator cuff tendon. Almost 2 million people per year in the USA sustain rotator cuff problems-partial or full thickness tears.


MRIa involves contrast being first injected into the joint

Anatomy of the rotator cuff
Anatomy of the rotator cuff

(arthrogram) followed by a MRI - these together enhance the accuracy of diagnosis.


A MRIa study of <19 year old athletes who underwent shoulder surgery indicates:

  1. 34% have partial rotator cuff injury.
  2. Though MRIa is 72% diagnostic for partial rotator cuff injuries, there is a high false-negative rate.
  3. If clinical injury suggests a partial rotator cuff tear, surgical management should be considered in the face of a negative MRIa.

Journal of Pediatric Orthopaedics 

Suppurative cervical lymphadenitis in infancy   

A retrospective chart review of infants/children who underwent surgical management of suppurative cervical lymphadenitis examined the associations between patients age, physiological factors and the microbiology of pediatric neck infections.


The incidence of MRSA infection is high in infants with cervical lymphadenitis who fail empiric antibiotic therapy. Beta Lactams may not provide adequate coverage for early cervical lymphadenitis.


Clinical Pediatrics 

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