Nephrogenic diabetes insipidus

Bockenhauer D, Bichet DG. Nephrogenic diabetes insipidus. Curr Opin Pediatr. 2017 Apr;29(2):199-205.

In nephrogenic diabetes insipidus (NDI), the kidney is unable to concentrate urine despite elevated concentrations of the antidiuretic hormone arginine-vasopressin. In congenital NDI, polyuria and polydipsia are present from birth and should be immediately recognized to avoid severe episodes of dehydration. Unfortunately, NDI is still often recognized late after a ‘diagnostic odyssey’ involving false leads and dangerous treatments.Once diagnosed, appropriate treatment can be started. Moreover, laboratory studies have identified promising new compounds, which may help achieve urinary concentration independent of vasopressin.

Full-text for Children’s and Emory users.

Continue reading

Necrotizing fasciitis

VanderMeulen H, et al. A 10-Year Review of Necrotizing Fasciitis in the Pediatric Population: Delays to Diagnosis and Management. Clin Pediatr (Phila). 2017 Jun;56(7) :627-633.

“The importance of prompt diagnosis stems from its role in the initiation of therapy. Multiple reports support the association of both timely antibiotic initiation and
timely surgical debridement with reduced morbidity and mortality. [3,9,10] This process begins with proper selection of antibiotic agents. Given the delay associated with
receiving results of tissue and blood cultures, empiric therapy should be started immediately. Our data suggests that while the antibiotics initially prescribed often
covered the causative organism, the majority did not provide protection against worrisome bacteria such as MRSA. We argue that coverage against MRSA is warranted
given that it is contributing to an increasing number of cases in North America. [11,12] While various suggestions have been made in the literature, we recommend a combination of clindamycin, vancomycin, and piperacillin-tazobactam. This affords a broad-spectrum coverage of the organisms most likely to be responsible, including as streptococcal species, staphylococcal species, bacteroides species and gram-negative enterobacteriaceae. [13]”

Full-text for Children’s and Emory users.

Continue reading

Pain management in acute pancreatitis (focus on use of opioids)

Grover AS, et al. Initial Pain Management in Pediatric Acute Pancreatitis: Opioid vs. Non-Opioid. J Pediatr Gastroenterol Nutr. 2017 Oct 27.

Nearly all patients with acute pancreatitis (AP) experience some degree of abdominal pain that is severe enough to prompt medical evaluation and necessitate analgesia. Effective analgesia is a priority in caring for such patients. Despite its importance, strategies for pain management in AP have been poorly studied, particularly in the field of pediatrics. Currently, no published data examine the management of pain due to acute pancreatitis in children at the time of initial presentation. Management approaches are often extrapolated from adult practice and based on anecdotal experience in the absence of objective data. The aim of our study was to examine the initial provision of analgesia to children who presented to a pediatric emergency department (ED) with acute pancreatitis.

Full-text for Children’s and Emory users.

Continue reading

Vulnerable child syndrome

Mitchell M, Blackburn M. “What We’ve Got Here Is Failure to Communicate”: The Value of Reassurance. Hosp Pediatr. 2016 Jun;6(6):380-2.

“The hospitalist team, with assistance from our infectious disease and forensic pediatric experts, ultimately diagnosed this patient with vulnerable child syndrome. [1] The family was given a set of distinct instructions regarding the patient’s medical care, including discontinuation of lansoprazole, erythromycin, and bethanechol. The family was also instructed to abstain from taking any temperatures at home and provided with information on normal childhood illness patterns. They were agreeable to this plan of care and were given reassurance regarding the benign nature of common childhood viral illnesses, which may be accompanied by fever, along with the benign nature of fever itself. The child’s pediatrician was also given a copy of the plan and agreed to assist in providing reassurance to this family.”

Full-text for Children’s users.

Continue reading

Nontypeable Haemophilus influenza infections

Langereis JD, de Jonge MI. Invasive Disease Caused by Nontypeable Haemophilus influenza. Emerg Infect Dis. 2015 Oct;21(10):1711-8.

The incidence of severe Haemophilus influenza infections, such as sepsis and meningitis, has declined substantially since the introduction of the H. influenzae serotype b vaccine. However, the H. influenzae type b vaccine fails to protect against nontypeable H. influenzae strains, which have become increasingly frequent causes of invasive disease, especially among children and the elderly. We summarize recent literature supporting the emergence of invasive nontypeable H. influenzae and describe mechanisms that may explain its increasing prevalence over the past 2 decades.

Free full-text.

Continue reading

Methotrexate toxicity

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).

Full-text for Emory users.

Continue reading

Globus pharyngeus

Doody J, Fenton JE. Troublesome Throat Awareness (tTA) as a contemporary alternative to ‘globus pharyngeus’. Surgeon. 2017 Aug;15(4):183-185.

““Globus pharyngeus” is a tainted term suggesting that it is time to retire the title, as was done with “globus hystericus” two centuries ago. We suggest that the feeling of having a lump in the throat on dry swallow is a normal sensation that everyone experiences to some degree, is accentuated by an ‘event’ and perhaps some are predisposed to perceive this “regular” sensation more strongly than others. It is our opinion that an alternate and contemporary approach is required on this topic. We propose the new term of “troublesome Throat Awareness” (tTA) which is clear, unambiguous with an inherent and therefore therapeutic reassurance to the patient.”

Full-text for Children’s and Emory users.


Jones D, Prowse S. Globus pharyngeus: an update for general practice. Br J Gen
Pract. 2015 Oct;65(639):554-5.

“Globus pharyngeus is a common condition frequently presenting to primary care. Its aetiology remains unclear; however, gastro-oesophageal reflux may play a role in a subset of patients. It is important to consider red flags and ensure prompt referral to secondary care if present.

Management of this condition includes reassurance, vocal hygiene, and treatment of reflux if this is appropriate. Speech and language therapy and cognitive behavioural therapy may also have a role.”

Free full-text.

Continue reading

Seizures in fetal alcohol spectrum disorders

Boronat S, et al. Seizures and electroencephalography findings in 61 patients with fetal alcohol spectrum disorders. Eur J Med Genet. 2017 January; 60 (1): 72-78.

Fetal alcohol spectrum disorders (FASD) cause neurodevelopmental abnormalities. However, publications about epilepsy and electroencephalographic features are scarce. In this study, we prospectively performed electroencephalography (EEG) and brain magnetic resonance (MR) imaging in 61 patients with diagnosis of FASD. One patient had multiple febrile seizures with normal EEGs. Fourteen children showed EEG anomalies, including slow background activity and interictal epileptiform discharges, focal and/or generalized, and 3 of them had epilepsy. In one patient, seizures were first detected during the EEG recording and one case had an encephalopathy with electrical status epilepticus during slow sleep (ESES). Focal interictal discharges in our patients did not imply the presence of underlying visible focal brain lesions in the neuroimaging studies, such as cortical dysplasia or polymicrogyria. However, they had nonspecific brain MR abnormalities, including corpus callosum hypoplasia, vermis hypoplasia or cavum septum pellucidum. The latter was significantly more frequent in the group with EEG abnormal findings (p < 0.01).

Full-text for Children’s and Emory users.


Nicita F, et al. Seizures in fetal alcohol spectrum disorders: evaluation of clinical, electroencephalographic, and neuroradiologic features in a pediatric case series. Epilepsia. 2014 Jun;55(6):e60-6.

Seizures are observed with a frequency of 3-21% in children with fetal alcohol spectrum disorders (FASD). However, clinical, neuroradiologic, and electroencephalography (EEG) features are poorly described. In this study, 13 patients with FASD and epilepsy or seizures were identified retrospectively from the databases of seven Italian pediatric neurology divisions. Eleven children were affected by epilepsy, and two had at least one documented seizure. Both generalized and focal seizures were observed. EEG showed diffuse or focal epileptic activity; two children developed electric status epilepticus during sleep (ESES). Structural brain anomalies, including polymicrogyria, nodular heterotopia, atrophy, and Arnold-Chiari type 1 malformation, were discovered in almost 50% of patients. Control of seizures was not difficult to obtain in 11 cases; one patient showed pharmacoresistant epilepsy. EEG and clinical follow-up are recommended in children with FASD and epilepsy, since severe conditions requiring aggressive treatment, such as in ESES, may develop. Neuroradiological evaluation is warranted because several types of brain anomalies could be associated with maternal alcoholconsumption during pregnancy.

Free full-text. 

Continue reading

Pleural effusions and empyema

Cashen K, Petersen TL. Pleural Effusions and Pneumothoraces. Pediatr Rev. 2017 Apr; 38(4):170-181.

After completing this article, readers should be able to:

  1. Describe the pathogenesis of pleural fluid accumulation.
  2. Identify the most likely causes of pleural effusion and pneumothorax.
  3. Understand the basic clinical presentation, diagnostic tests, and management of pleural effusions and pneumothoraces.
  4. Differentiate between transudative and exudative pleural effusions.
  5. Understand the natural history of spontaneous pneumothorax.

Full-text for Children’s and Emory users.


Strutt J, Kharbanda A. Pediatric Chest Tubes And Pigtails: An Evidence-Based Approach To The Management Of Pleural Space Diseases. Pediatr Emerg Med Pract.
2015 Nov;12(11):1-24;

Pediatric thoracostomy procedures are used in the emergency department to treat diseases of the pleural space. As children have unique thoracic anatomy and physiology, they may present with management challenges that the emergency clinician must consider. This issue reviews the use of chest tubes and pigtail catheters in pediatric patients, techniques and indications for placement, and possible complications. Diagnostic and treatment options for diseases of the pleural space, such as spontaneous pneumothorax, traumatic injury, and parapneumonic effusions/empyema, are examined. Additionally, this issue discusses the use of imaging modalities to aid in the diagnosis of pleural space diseases and the emerging practice of ambulatory management in certain cases.

Children’s and Emory users, request article from Emily Lawson. 

Continue reading

Juvenile dermatomyositis

Papadopoulou C, Wedderburn LR. Treatment of Juvenile Dermatomyositis: An Update. Paediatr Drugs. 2017 May 26.

The idiopathic inflammatory myopathies of childhood consist of a heterogeneous group of autoimmune diseases characterised by proximal muscle weakness and pathognomonic skin rashes. The overall prognosis of juvenile myositis has improved significantly over recent years, but the long-term outcome differs substantially from patient to patient, suggestive of distinct clinical phenotypes with variable responses to treatment. High doses of corticosteroids remain the cornerstone of therapy along with other immunosuppressant therapies depending on disease severity and response. The advent of biological drugs has revolutionised the management of various paediatric rheumatologic diseases, including inflammatory myopathies. There are few data from randomised controlled trials to guide management decisions; thus, several algorithms for the treatment of juvenile myositis have been developed using international expert opinion. The general treatment goals now include elimination of active disease and normalisation of physical function, so as to preserve normal growth and development, and to prevent long-term damage and deformities. This review summarises the newer and possible future therapies of juvenile inflammatory myopathies, including evidence supporting their efficacy and safety.

Children’s and Emory users, request article from Emily Lawson. 


McCann LJ, Pain CE. A Practical Approach to Juvenile Dermatomyositis and Juvenile Scleroderma. Indian J Pediatr. 2016 Feb;83(2):163-71.

Juvenile dermatomyositis and juvenile scleroderma are rare multisystem autoimmune disorders. Although they share some pathognomonic hallmarks with adult onset myositis or scleroderma, there are significant differences in presentation, characteristics and associated features when the diseases present in childhood. In view of this, and the rarity of the conditions, it is important for care to be led by teams with expertise in pediatric rheumatology conditions. Prognosis has improved significantly in the West; likely due to early diagnosis and aggressive treatment with immunosuppressive medications. However, this trend is not replicated in the developing world. Early recognition of these diseases is crucial to achieve rapid and sustained remission and prevent disease or medication associated complications. This article aims to provide a practical overview for recognition, diagnosis and treatment of these conditions.

Full-text for Emory users.

Continue reading