February 4, 2015   Vol. VI, Issue 5
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Overtriage of tachycardia in pediatric Emergency Departments (ED).

A retrospective follow-up design study of 42,000 pediatric patients seen in tertiary care pediatric ED's indicates that perceived abnormalities in vital signs result in upgrading of clinical status in 13.6% of admissions. As heart rate is affected by emotional responses as well as disease processes it may be valuable to diminish (or modify) the role of heart rate (and perhaps "vital signs") in the triage in pediatric ED patients.


The American Journal of Emergency Medicine 

Ultrasound (U/S) -guided radial artery catheterization. 

A multilingual review of a variety of English and non-English databases examining the benefits of U/S - guided radial artery catheterization, appears to indicate that this technique is associated with a 47% improvement in the rate of first-attempt success, compared with the palpation technique.


The American Journal of Emergency Medicine 

Cerebral oxygenation during intermittent hypoxia & bradycardia in preterm infants. 

"Episodes of hypoxemia and bradycardia frequently occur with apnea of prematurity in preterm infants".


A study of 16 preterm infants with intermittent hypoxemia and/or bradycardia had cerebral tissue oxygen saturation measured (near-infrared spectroscopy) with simultaneous recordings of heart rate and pulse oximetry saturations.


Regardless of type of event, 75% of infants maintain cerebral oxygenation levels >60% in spite of severe pulse oximetry desaturations (bradycardia has the least impact and combined bradycardia and hypoxemia the most).





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Identifying child abuse before it's too late. 


Reasons for a missed diagnosis of child abuse include:


1.   "No history obtained from verbal children"

2.   "Acceptance of inadequate explanation for injuries"

3.   "Insufficient explanation of signs and symptoms"

4.   "Inattention to skin and subconjunctival findings"

5.   "Incorrect diagnosis form radiologic examination"

6.   "Non-adherence to the maltreatment pathway"

7.   "Non-(or limited) access to previous medical records"

8.   "Admission to less-than-optimal setting"


Clinical Pediatrics 

Video Feature 

(via YouTube)
Identifying Child Abuse
Identifying Child Abuse

Benralizumab (a monoclonal antibody) for the management of asthma exacerbations.


Benralizumab is an investigational humanized monoclonal whole antibody directed against the interleukin-5 receptor. Interleukin-5 is a selective cytokine produced by a number of cell types and is responsible for the maturation and release of eosinophils in the bone marrow; these are frequently prominent in the inflammatory process associated with asthma.


Patients with frequent asthma episodes are at risk for future exacerbations. A randomized, double-blind, placebo controlled study of a single IV infusion of placebo vs. Benralizumab indicates that the drug appears to reduce asthma exacerbation rates and hospitalization by 49% and 60% respectively.


Benralizumab is an investigational drug that appears to hold promise for a select group of asthmatic patients - particularly those who are steroid resistant with high blood eosinophil counts.


The American Journal of Emergency Medicine
Topiramate for weight reduction in severely obese adolescence.


Topiramate (Topamax, Trokendi XR �) is an anti-epilepsy drug which was approved in 2012 (in combination with

Adolescent Obesity Raises Risk of Severe Obesity in Adulthood
Adolescent Obesity Raises Risk of Severe Obesity
in Adulthood

phentermine) by the FDA for weight loss. In obese adults it has been found with lifestyle modifications (LSM) to result in weight reduction. Few drugs (with LSM) are available to manage severely obese adolescents.


A retrospective chart review investigation of 28 obese (mean BMI : 46.2) adolescents (mean age: 15.2 years) treated with LSM plus Topiramate in a pediatric program for at least three months, indicates that for severely obese adolescents a meaningful reduction in weight can be achieved (randomized control clinical trials for efficacy and safety still needed).


Clinical Pediatrics 

Congenital constrictive band syndrome (CBS) with limb defects.


CBS (also known as "amniotic band syndrome") is a congenital disorder caused by fibrous bands in utero entrapping fetal parts, usually limbs. The cause/s of the bands is/are unknown but at present there are (at least) two theories; partial rupture of the amniotic sac resulting in floating bands and/or a defect in blood circulation (vascular disruption theory - to account for frequently associated cleft palate).


A study of 71 cases with limb CBS indicates that in 49% only the upper limb, in 18% the lower limb only and in 38% of patients both upper and lower limbs are involved. 30% of infants have other anomalies which are associated with a higher mortality, lower birth weight and shorter gestational period.


Journal of Pediatric Orthopedics 

PPGC 2015