Miami, FL
Aug. 15, 2018
Volume IX | Issue No. 33
Oxygen or room air for fetal resuscitation during labor
While 60% of women in labor receive oxygen to reverse perceived fetal hypoxia or fetal acidemia (fetal heart decelerations), umbilical cord gases and lactate levels suggests that there may be no benefit to this practice ("the American Academy of Pediatrics recommends against initial NEONATAL resuscitation with oxygen").
Long-term outcomes of sacrococcygeal teratomas (SCT) 
SCTs are congenital germ cell tumors and are the most common, predominantly benign tumor found in newborns; more frequently in girls than boys. They grow either externally from the lower back or internally into the pelvis. A study of 17 patients operated on for SCT compared (to healthy controls) urinary and bowel function.
On post-operative follow-up children with SCT have increased difficulty in controlling voiding, difficulty in bladder emptying, pyelonephritis and constipation (with larger and more immature teratomas increasing prevalence of complications).
Vitamin D and seasonal influenza A in infants 
A study of 400 infants (3-12 months of age) in a multicenter randomized open controlled clinical study examined (in two groups; low-dose - 400 IU/day or high-dose - 1,200 IU/day) vitamin D supplementation for 4 months in preventing influenza A in infants.  
High-dose vitamin D (1,200 IU/day for a 4 month period) appears efficacious in the prevention of seasonal influenza A in young infants, enhancing rapid symptom relief, decreasing viral load and improving disease recovery without increasing adverse events.
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Intracranial complications of pediatric sinusitis 
The American Academy of Pediatrics (AAP-2013) issued updated guidelines for the diagnosis and management of acute bacterial sinusitis (ABS) in children. According to the new guidelines, clinicians should make a diagnosis of ABS when a child with an upper respiratory tract infection (URI) presents with:
  • Persistent illness (nasal discharge and/or daytime coughing or both) for >10 days without improvement.
  • Worsening course (or new onset of nasal discharge, cough or both, severe headache, new fever, etc.).
  • Severe onset (concurrent fever >31C and purulent nasal discharge for 3-4 days).
Headache and fever are common presentations of a viral illness, and streptococcal pharyngitis is another common cause of fever and headache. Bacterial sinusitis is frequently under diagnosed and can have severe consequences.
An interesting case report of a 10-year-old child who presented with headache and fever and was found to have intracranial extension of sinusitis reminds us that, although rare, complications of ABS are age dependent; in children <5 years the most common presentation is ethmoid sinusitis; while for children (>7 years of age) its frontal sinusitis. For both intracranial complications must be considered, remembering that clinical presentation may be variable.
See related video HERE & HERE.
Video Feature
What is Sacrococcygeal Teratoma (SCT)?
What is Sacrococcygeal Teratoma (SCT)?
Diagnosis and management of Omental Infarction (OI) in children 

Omental infarction is a rare cause of acute abdominal pain in children. Most are diagnosed as an acute appendicitis as almost half present with right lower quadrant pain, with only some having associated gastrointestinal symptoms. Many are overweight/obese.
A retrospective review of 30 children (the largest series to date), mean age 10.7 years identified as having OI indicates that 83.3% are grossly overweight, diagnosis is made by initial ultrasound (US) in 86.6% (repeat US correctly detected the others), 43.3% undergo surgery (with no complications reported) while the rest are managed conservatively.
US is the investigation of choice in the diagnosis of OI, with no OI patient being incorrectly diagnosed with acute appendicitis.
Not all first finger foods are created equal 

"Incidence of foreign body aspiration accounts for up to 150 preventable pediatric deaths per year...most of which are caused by aspiration of food," with infants <1 year of age accounting for almost 40% of non-fatal and many fatal aspirations. Tongue lateralization, the presence of molars and mature chewing patterns are necessary for the ingestion of solid foods. The American Academy of Pediatrics (AAP) recommends starting finger foods when a child can sit up without support and bring objects to their mouths. For the normal full term baby these milestones are normally achieved between 6 and 9 months of age and foods should initially be soft, easy to swallow and in small pieces.  
While many products are marketed as appropriate finger foods, only a few tested samples met all three AAP criteria. Pediatricians should instruct parents how to evaluate first finger foods using AAP recommendations (a valuable article to read in full-Ed).
Clinical Pediatrics  
See related video HERE & HERE
Adnexal torsion in children/adolescents; clinical and sonographic predictors 

Adnexal organs (appendages to the uterus) include the fallopian tubes and ovaries. Ovarian torsion (OT) accounts for approximately 3% of children presenting with abdominal pain and requires immediate surgical intervention. Clinical presentation is variable with many children presenting (prior to menarche), with nausea or vomiting, signs of peritoneal irritation and pain, fever and laboratory data indicative of infection.
A retrospective study of 87 patients <18 years who presented with acute pelvic pain and who underwent pre-operative ultrasound (US) indicates that while clinical and US findings may be suggestive, NONE are sufficient to confirm or disprove the preoperative diagnosis.  
"Young patients with a clinical suspicion of adnexal torsion should undergo laparoscopy for a diagnosis of adnexal torsion to be confirmed."
Children's Health Chats
Kristen Mendez, ARNP Discusses What to Expect at the Survivorship Program
Kristen Mendez, ARNP Discusses What to Expect at the Survivorship Program
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