Miami, FL
March 21, 2018
Volume IX | Issue No. 12
Epidemiology of sepsis-like illness in young infants 
A prospective observational cohort study of infants (<90 days of age) presenting with sepsis-like symptoms and fully investigated indicates that enterovirus (EV) and human parechovirus (HPeV) are detected in 37% and 15% of cases respectively.

"EV and HPeV infections are major causes of sepsis-like illness in infants <90 days of age. Neither clinical nor laboratory data is predictive."
Efficacy of corticosteroid treatment for severe community-acquired pneumonia
"The benefits and adverse effects of corticosteroids in the treatment of severe community-acquired pneumonia (CAP) have not been well assessed."

A review of randomized controlled trials from multiple databases where corticosteroid therapy vs. conventional treatment for severe CAP in 729 adult patients was examined, indicates that steroid therapy may reduce in-hospital mortality and length of hospital stay, but does not improve clinical status or days on mechanical ventilation.

American Journal of Emergency Medicine
Incidence of delayed splenic bleeding in pediatric blunt trauma
An ongoing concern of the non-operative management of splenic injury is delayed splenic bleeding (DSB) after a period of hemostasis.

A three year prospective study of 508 children (median age 11.6 years) who presented with blunt splenic injury (median splenic injury grade: 3) to one of ten pediatric trauma centers indicates that 92% may be managed non-operatively (3.5% requires splenectomy on admission or within three hours of injury) with no patient developing a delayed splenic bleed on follow up.

Delayed splenic bleeding after blunt injury appears uncommon.
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Patellofemoral pain 

Patellofemoral pain (pain around or under the knee cap that is worse with squatting, running, going up or down stairs or any activity which requires repeated bending of the knee) is one of the most common knee problems in runners and athletes. It specifically refers to pain that is NOT caused by structural problems of tendons, ligaments or cartilage around the knee and is believed to occur when there is a problem with how the patella tracks over the knee (maltracking). Both external causes (overuse, too much/too little training, improper shoes) and internal factors (imbalances in the strength of the muscles around the knee, very mobile knee cap, etc.) or a combination, may give rise to the pain. It is a clinical diagnosis (radiographs/MRI; normal) and treatment includes rest, activity modification, addressing external or internal causes, physical therapy and short-term analgesics. There appear to be no long-term sequelae.

See related video HERE and HERE.
Primary Ewing sarcoma (EWS) - an interesting presentation!

Ewing sarcoma is a primary bone cancer, and while it accounts for only 1% of all childhood cancers it is the second most common bone cancer in children. It can present any time during childhood, usually developing in the long bones (arms and legs, pelvis or chest) of Caucasian boys during their teenage/pubertal years. It is often misdiagnosed as it shares symptoms with an infection or injury.
An interesting case description of a five year old African American boy who presented with symptoms of acute mastoiditis (which was finally diagnosed as an Ewing sarcoma) reminds us that in any child who presents with atypical mastoiditis, or a rapidly growing mass behind the ear, a diagnosis of Ewing sarcoma should be entertained.
Video Feature
Ewing's Sarcoma
Ewing Sarcoma
Tongue tie (TT) and breastfeeding in infants
TT or ankyloglossia occurs when the tissue that attaches the tongue to the bottom of the mouth (lingual frenulum) is too short, thick or tight. Most babies don't have symptoms while some appear to have difficulty latching onto their mother's breast and sucking (less so in bottle fed babies). Older children may have associated speech, swallowing, eating, personal or social problems related to the restricted movement of the tongue.

A study of 87 infants from a TT clinic were included in a study which examined initial feedings (exclusive breast feeding, combined breast and formula fed or exclusively formula fed) against historical rates of breast feeding etc. at three months post procedural release. At three months, 80% of infants have complete, 15% moderate and 5% minimal, resolution of symptoms. All infants achieve higher exclusive, and combined breast and bottle feeding when compared to national norms.

Surgically treating TT appears to significantly improve breast feeding rates.

Journal of Pediatric Surgery
See related video HERE.
Cyanotic congenital heart disease (CCHD) and cyanotic nephropathy (CN)

A cross-sectional study of 94 patients aged 1 month - 15 years with CCHD investigated prevalence and multiple associated factors that could potentially contribute to significant albuminuria. Prevalence of significant proteinuria, significant albuminuria and decreased glomerular filtration rate (GFR) in CCHD occurs in 88.3%, 41.49% and 31.9% respectively.

Cyanotic nephropathy in CCHD children can be identified in the first ten years of life with the presentation of microalbuminuria predicted by a high hematocrit level and low platelet count. Early cardiac surgery reduces the risk.
Did You Know? 
March patient of the month: Theodore
March patient of the month: Theodore
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