Sept. 7, 2016
Volume VII | Issue No. 36

Pre-pubertal testicular tumors (PTT's) - a 44 year experience
A retrospective review of 62 pre-pubertal children treated for testicular tumors between 1971 and 2014 indicates:

1.    Age at operation: 17 months (median).

2.    Pathology: Teratomas (47%), yolk sac tumors (42%), epidermoid cysts (8%) and 1 Sertoli cell tumor and a benign cyst.

Cost-effectiveness of point-of-care (POC) electrolyte testing for acute gastroenteritis (AGE) and dehydration 
AGE and subsequent dehydration in children is commonly seen in Emergency Room departments (ED). POC testing and clinical assessment are frequently used to determine the degree (and type) of dehydration.

A cost analysis from a randomized control trial of 225 ED children with AGE and moderate dehydration compared POC testing to traditional serum chemistry. POC testing results in a cost savings of $303.30 per patient ($36.32 to the provider).

Evaluation and management of febrile children
In febrile infants <90 days of age, E. Coli urinary tract infections, increasing resistance to ampicillin and viral diagnostic have evolved as important concepts to consider.

In febrile infants 3-36 months of age wide-spread vaccination against H. influenza and strep pneumonia have significantly reduced fear for these bacterial infections; bacterial urinary tract infection however continues to be of primary concern in all age groups.

JAMA Pediatrics

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Urine testing in infants with suspected urinary tract infection (UTI)
"The likelihood of a UTI varies according to age, sex, race, circumcision status in males, and presenting signs and symptoms". While clinicians utilize a variety of techniques to collect sterile urine samples in infants, bladder catheterization and suprapubic bladder aspiration (SBA) remain popular.

A study comparing data from 83 urine positive (analysis and culture) young infants obtained by bladder catheterization to that obtained by subsequent SBA, indicates that urine specimens obtained by bladder catheterization have a high (71%) false-positive rate.
SBA is the best method to avoid bacterial contamination in infants with a suspected UTI diagnosis.
Simple sacral dimples 

A simple sacral dimple is an indentation (or pit) present at birth (of unknown cause) on the lower back usually located just above the crease between buttocks". Most are harmless and don't require treatment.

Sacral dimples with hair, skin tag or other skin discoloration may be associated with Spinal dysraphism (spina bifida occulta, meningocele or myelomeningocele) or tethered spinal cord syndrome.

A review of 9 papers addressing routine spinal ultrasound for children with simple sacral dimples strongly suggests that this practice should be discontinued.

Video Feature 
Sacral Dimples
Sacral Dimples
Cyproheptadine (Periactin) for feeding intolerance in young children
"Cyproheptadine is a first-generation antihistamine with additional anticholinergic, antiserotonergic and local anesthetic properties".

Premature infants and those with brain injury frequently suffer from recurring vomiting and feeding intolerance in infancy.

A retrospective chart review of 39 patients <3 years of age treated with Cyproheptadine for feeding intolerance or vomiting, indicates that 67% improve significantly (and an additional 28% have evidence of some benefit); appears safe with few/minimal side effects.

Risk factors and morbidity of infantile haemangiomas (IH)
An analyses of 126 questionnaires from Helsinki University Hospital's Pediatric Vascular Anomaly Clinic in Finland indicates that children with facial, segmental and indeterminate IHs have more complications with more interventions and long-term morbidity. Preterm birth predisposes infants to ulceration of IHs.

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