AAP PCO Webinar: What Every Pediatrician Needs to Know About Child Passenger Safety

Wednesday, August 21, 2019
1:00 – 2:00 pm EDT

We invite you to join us tomorrow when Benjamin Hoffman, MD, FAAP, CPST-I discusses child passenger safety.

By the end of this webinar, viewers should be able to:

  1. Discuss basic principles of child passenger safety (CPS) science, including:
    • Epidemiology
    • Physics
    • Anatomy and physiology of children
    • Crash dynamics
  2. List 5 ways car safety seats help prevent injury to children.
  3. Discuss best practice recommendations for appropriate child passenger restraint.
  4. Identify and access CPS resources in your community, including for children with special health care needs.

To view the webinar on Wednesday, August 21, please click here or use the following url: https://event.webcasts.com/starthere.jsp?ei=1254250&tp_key=2661e4c765

Unable to view the webinar live or have you missed past webinars?
All PCO webinars are archived at:
https://pediatriccare.solutions.aap.org/webinars.aspx

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Cavitary lung lesions

Gafoor K, et al. Cavitary Lung Diseases: A Clinical-Radiologic Algorithmic Approach. Chest. 2018 Jun;153(6):1443-1465.

Cavities occasionally are encountered on thoracic images. Their differential diagnosis is large and includes, among others, various infections, autoimmune conditions, and primary and metastatic malignancies. We offer an algorithmic approach to their evaluation by initially excluding mimics of cavities and then broadly classifying them according to the duration of clinical symptoms and radiographic abnormalities. An acute or subacute process (< 12 weeks) suggests common bacterial and uncommon nocardial and fungal causes of pulmonary abscesses, necrotizing pneumonias, and septic emboli. A chronic process (≥ 12 weeks) suggests mycobacterial, fungal, viral, or parasitic infections; malignancy (primary lung cancer or metastases); or autoimmune disorders (rheumatoid arthritis and granulomatosis with polyangiitis). Although a number of radiographic features can suggest a diagnosis, their lack of specificity requires that imaging findings be combined with the clinical context to make a confident diagnosis.

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SLE vasculitis

Smith EMD, Lythgoe H, Hedrich CM. Vasculitis in Juvenile-Onset Systemic Lupus Erythematosus. Front Pediatr. 2019 May 9;7:149.

Juvenile-onset systemic lupus erythematosus (JSLE) is a rare, heterogeneous multisystem autoimmune disease that can affect any organ, and present with diverse clinical and serological manifestations. Vasculitis can be a feature of JSLE. It more commonly presents as cutaneous vasculitis than visceral vasculitis, which can affect the central nervous system, peripheral nervous system, lungs, gut, kidneys, heart, and large vessels. The incidence and prevalence of vasculitis in JSLE has not been well described to date. Symptoms of vasculitis can be non-specific and overlap with other features of JSLE, requiring careful consideration for the diagnosis to be achieved and promptly treated. Biopsies are often required to make a definitive diagnosis and differentiate JSLE related vasculitis from other manifestations of JSLE, vasculopathies, and JSLE related antiphospholipid syndrome. Visceral vasculitis can be life threatening, and its presence at the time of JSLE diagnosis is associated with permanent organ damage, which further highlights the importance of prompt recognition and treatment. This review will focus on the presentation, diagnosis, management and outcomes of vasculitis in JSLE, highlighting gaps in the current evidence base.

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More PubMed results on JSLE.

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Cryptosporidiosis

Gharpure R, et al. Cryptosporidiosis Outbreaks – United States, 2009-2017. MMWR Morb Mortal Wkly Rep. 2019 Jun 28;68(25): 568-572.

Cryptosporidium is a parasite that causes cryptosporidiosis, a profuse, watery diarrhea that can last up to 3 weeks in immunocompetent patients and can lead to life-threatening malnutrition and wasting in immunocompromised patients.* Fecal-oral transmission can occur by ingestion of contaminated recreational water, drinking water, or food, or through contact with infected persons or animals. For the period 2009-2017, public health officials from 40 states and Puerto Rico voluntarily reported 444 cryptosporidiosis outbreaks resulting in 7,465 cases. Exposure to treated recreational water (e.g., in pools and water playgrounds) was associated with 156 (35.1%) outbreaks resulting in 4,232 (56.7%) cases. Other predominant outbreak exposures included contact with cattle (65 outbreaks; 14.6%) and contact with infected persons in child care settings (57; 12.8%). The annual number of reported cryptosporidiosis outbreaks overall increased an average of approximately 13% per year over time. Reversing this trend will require dissemination of prevention messages to discourage swimming or attending child care while ill with diarrhea and encourage hand washing after contact with animals. Prevention and control measures can be optimized by improving understanding of Cryptosporidium transmission through regular analysis of systematically collected epidemiologic and molecular characterization data.

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Mmbaga BT, Houpt ER. Cryptosporidium and Giardia Infections in Children: A Review. Pediatr Clin North Am. 2017 Aug;64(4):837-850.

Diarrheal disease remains the second leading cause of mortality in children in developing countries. Cryptosporidium is a leading cause and its importance stands to increase as rotavirus vaccine becomes used around the world. Cryptosporidium is particularly problematic in children younger than 2 years old and in the immunocompromised. Giardia lamblia is a common intestinal protozoan that is associated with diarrhea and, perhaps, growth faltering in impoverished settings. This review establishes the current prevalence of these infections in global settings and reviews current diagnosis and management approaches.

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Methotrexate toxicity

Hays H, et al. Evaluation of toxicity after acute accidental methotrexate ingestions in children under 6 years old: a 16-year multi-center review. Clin Toxicol (Phila). 2018 Feb; 56(2):120-125.

The incidence of toxicity from pediatric single, acute ingestions of methotrexate is rare and when it occurs is generally limited to no or only minimally concerning effects. Because concentrations from single ingestions were consistent with low subtoxic exposures, we believe that home monitoring without hospital referral and without methotrexate specific therapy is reasonable in those with acute ingestions up to 20 mg.

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Chan BS, et al. What can clinicians learn from therapeutic studies about the treatment of acute oral methotrexate poisoning? Clin Toxicol (Phila). 2017 Feb;55(2):88-96.

Management of acute oral poisoning: Due to the low bioavailability of MTX, treatment is not necessary for single ingestions. Oral folinic acid may be used to lower the bioavailability further with large ingestions >1 g m-2. Oral followed by intravenous folinic acid may be used in patients with staggered ingestion >36 h or patients with acute overdose and renal impairment (eGFR <45 mL/min/1.73 m2).

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What is kratom?

NIDA. (2019, April 8). Kratom (Mitragyna speciosa). Retrieved June 18, 2019.

Points to Remember:

  • Kratom is a tropical tree native to Southeast Asia, with leaves that can have psychotropic effects.
  • Kratom is not currently illegal and has been easy to order on the internet.
  • Most people take kratom as a pill or capsule. Some people chew kratom leaves or brew the dried or powdered leaves as a tea. Sometimes the leaves are smoked or eaten in food.
  • Two compounds in kratom leaves, mitragynine and 7-α-hydroxymitragynine, interact with opioid receptors in the brain, producing sedation, pleasure, and decreased pain.
  • Mitragynine can also interact with other receptor systems in the brain to produce stimulant effects.
  • Reported health effects of kratom use include nausea, sweating, seizures, and psychotic symptoms.
  • Commercial forms of kratom are sometimes laced with other compounds that have caused deaths.
  • Some users have reported becoming addicted to kratom.
  • Behavioral therapies and medications have not specifically been tested for treatment of kratom addiction.

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Hyperoxaluria in inflammatory bowel diseases

Bianchi L, et al. Renal lithiasis and inflammatory bowel diseases, an update on pediatric population. Acta Biomed. 2018 Dec 17;89(9-S):76-80.

Historical studies have demonstrated that the prevalence of symptomatic nephrolithiasis is higher in patients with inflammatory bowel disease (IBD), compared to general population. The aim of the review was to analyze literature data in order to identify the main risk conditions described in literature and the proposed treatment.

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Herpetic gingivostomatitis

de Suremain N, et al. Acute gingivostomatitis in children: Epidemiology in the emergency department, pain, and use of codeine before its restriction. Arch Pediatr. 2019 Feb;26(2):80-85.

Acute gingivostomatitis is a relative frequent reason for PED visits, and the pain and feeding difficulties that it elicits are a real challenge. Before codeine restriction, this medication played a major role in the analgesic strategy for this disease. It is essential that analgesic regimens at least as effective as codeine replace it. Morphine combined with paracetamol or the association of ibuprofen with paracetamol are options that are recommended by the French National Health Authority (HAS).

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Aslanova M, Zito PM. Herpetic Gingivostomatitis. 2018 Oct 27. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.

Herpetic gingivostomatitis is a condition that most often results from initial gingiva (gums) and oral mucosa infection with herpes simplex virus type 1 (HSV-1). While herpetic gingivostomatitis is the most common cause of gingivostomatitis in children before the age of 5, it can also occur in adults.[1] The condition is characterized by a prodrome of fever followed by an eruption of painful, ulcerative lesions of the gingiva and mucosa, and often, yellow, perioral, vesicular lesions. HSV-1 is usually spread from direct contact or via droplets of oral secretions or lesions from an asymptomatic or symptomatic individual. Once a patient is infected with the herpes simplex virus, the infection can recur in the form of herpes labialis with intermittent re-activation occurring throughout life.[2]

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Psychogenic nonepileptic seizures (PNES)

Milán-Tomás Á, et al. An Overview of Psychogenic Non-Epileptic Seizures: Etiology, Diagnosis and Management. Can J Neurol Sci. 2018 Mar;45(2):130-136.

The purpose of this review is to provide an update of the research regarding the etiology, diagnosis and management of psychogenic non-epileptic seizures (PNES). A literature search using Pubmed, Ovid MEDLINE and EMBASE database was performed from 2000 up to August 2017. We have evaluated the different factors leading to PNES as well as the diagnostic approach and management of this disorder which continue to be very difficult. The coexistence of epilepsy and PNES poses special challenges and requires the coordinated efforts of the family physicians, psychiatrists, psychologists and neurologists. Although this condition has an overall poor prognosis, a multidisciplinary approach in the diagnosis and management of this disorder would likely improve the outcomes. We have proposed a diagnostic and treatment algorithm for PNES and suggested a national registry of patients suffering from this condition. The registry would contain data regarding treatment and outcomes to aid in the understanding of this entity.

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Incomplete and atypical Kawasaki disease

Behmadi M, et al. Comparison of Clinical Symptoms and Cardiac Lesions in Children with Typical and Atypical Kawasaki Disease. Med Sci (Basel). 2019 Apr 18;7(4). pii: E63.

Based on the findings of the current study, the fever duration from onset to diagnosis was slightly more in atypical KD patients than in the typical group, but not statistically significant, possibly due to more timely diagnosis of atypical KD. There was no difference in coronary aneurysm between the two groups at the time of diagnosis. The atypical group had a higher frequency of coronary ectasia and lack of tapering, indicating cardiac involvement. Consequently, these conditions should be given more attention in the atypical patients. Furthermore, the higher frequency of anemia and thrombocytosis in the atypical patients can be useful for diagnosis of this kind of KD.

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