Pericardial effusion

Bolin EH, et al. Characteristics of Non-postoperative Pediatric Pericardial Effusion: A Multicenter Retrospective Cohort Study from the Pediatric Health Information System (PHIS). Pediatr Cardiol. 2018 Feb; 39(2):347-353.

Little is known about the causes and risks of non-postoperative pericardial effusion (PCE) in pediatric patients. We sought to assess the diagnoses most frequently associated with admissions for PCE, and to determine if certain conditions were associated with higher in-hospital mortality and rates of readmission.

Children admitted with non-postoperative PCE have multiple associated conditions. Neoplasm and renal disease in the setting of PCE are associated with the highest odds of in-hospital mortality among concomitant conditions; children with a neoplasm, renal disease, and those undergoing pericardiocentesis have the highest odds of readmission.

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Failure to Thrive

Smith AE, Gossman WG. Failure To Thrive. 2017 Oct 6. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-.

Failure to thrive (FTT) is a common term used to describe lack of adequate weight gain in pediatric-aged patients. Accepted definitions include a weight for age less than the fifth percentile on standardized growth charts, a decrease in weight percentile of more than two major percentile lines on the growth chart, or less than the 80 percentile of median weight for height ratio weight/length ratio. Failure to thrive is important to recognize and treat because it can result in developmental delays and other long-term effects for the developing child.

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Neonatal herpes simplex virus infections

Pinninti SG, Kimberlin DW. Neonatal herpes simplex virus infections. Semin Perinatol. 2018 Mar 12. pii: S0146-0005(18)30010-7.

Neonatal herpes simplex virus (HSV) is an uncommon but devastating infection in the newborn, associated with significant morbidity and mortality. The use of PCR for identification of infected infants and acyclovir for treatment has significantly improved the prognosis for affected infants. The subsequent use of suppressive therapy with oral acyclovir following completion of parenteral treatment of acute disease has further enhanced the long-term prognosis for these infants. This review article will discuss the epidemiology, risk factors and routes of acquisition, clinical presentation, and evaluation of an infant suspected to have the infection, and treatment of proven neonatal HSV disease.

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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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Doss JL, Plioplys S. Pediatric Psychogenic Nonepileptic Seizures: A Concise Review. Child Adolesc Psychiatr Clin N Am. 2018 Jan;27(1):53-61.

Psychogenic nonepileptic seizures is a complicated biopsychosocial disorder with significant morbidity and high cost in children’s social, emotional, family, and academic functioning as well as health care service utilization. Misdiagnosis and diagnostic delay, resulting from both lack of access to approved standards for diagnosing and service providers comfortable with diagnosing and treating this disorder, impact prognosis. Treatment in close proximity to symptom onset is thought to provide the best chance for remission.

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Henoch–Schonlein purpura

Reid-Adam J. Henoch-Schonlein purpura. Pediatr Rev. 2014 Oct; 35(10) :447-9; discussion 449.

“The hallmark of HSP is cutaneous palpable purpura, often involving the lower extremities and buttocks. The appearance of the rash in this pattern reflects its tendency to distribute in pressure-dependent areas, so that in infants the rash may actually appear in upper body areas, such as the upper extremities or face. Lesions, which arise in crops and last 3 to 10 days, vary in size from petechiae to large, confluent, palpable ecchymoses. Although HSP is largely a clinical diagnosis, a skin biopsy specimen would reveal leukocytoclastic vasculitis or granulocytic infiltration of the small vessels, along with IgA deposition in the vessel walls. A nonpitting edema that involves the scalp, face, trunk, and/or extremities is also common, especially in infants and young children. This swelling does not correlate with the degree of proteinuria or level of serum albumin, although patients with HSP may also have pitting edema as a consequence of protein loss in the urine.”

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Incarcerated umbilical hernias

Abdulhai SA, et al. Incarcerated pediatric hernias. Surg Clin North Am. 2017 Feb;97(1) :129-145.

Presenting symptoms of umbilical hernia incarceration are those seen commonly with bowel obstruction, namely abdominal pain, nausea, and vomiting. Physical examination shows umbilical hernia, abdominal distention, and abdominal tenderness to palpation. There may be skin changes, such as erythema, associated with the umbilicus. [94,101,102,103,104] Although the traditional presentation is that of acute umbilical hernia incarceration, some patients have been observed to experience symptomatic, recurrent incarceration of umbilical hernia followed by spontaneous reduction. [100]

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Myocarditis

Di Filippo S. Improving outcomes of acute myocarditis in children. Expert Rev  Cardiovasc Ther. 2016;14(1):117-25.

Acute viral myocarditis may impair prognosis in children of all ages. Its true incidence is underestimated because of heterogeneity of presentation and outcome. Patients may either recover or progress to chronic cardiomyopathy or death. Improving short-term and long-term prognosis is challenging but can probably be achieved by new diagnostic techniques and novel targeted therapies. The objectives of this review are: (1) to detail the current state of knowledge of the pathophysiological mechanisms of acute myocarditis; (2) to provide an update on diagnostic tools such as magnetic resonance imaging and endomyocardial biopsy; and (3) to present new insights in therapeutic strategies, targeted therapies and management of fulminant cases. Options for improving outcomes in acute myocarditis in the pediatric population are discussed.

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Sialadenitis

Carlson ER, Ord RA. Benign Pediatric Salivary Gland Lesions. Oral Maxillofac Surg Clin North Am. 2016 Feb;28(1):67-81.

Salivary gland lesions are rare in pediatric patients. In addition, the types of salivary gland tumors are different in their distribution in specific sites in the major and minor salivary glands in children compared with adults. This article reviews benign neoplastic and nonneoplastic salivary gland disorders in pediatric patients to help clinicians to develop an orderly differential diagnosis that will lead to expedient treatment of pediatric patients with salivary gland lesions.

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Francis CL, Larsen CG. Pediatric sialadenitis. Otolaryngol Clin North Am. 2014 Oct; 47(5):763-78.

Sialadenitis in the pediatric population accounts for up to 10% of all salivary gland disease. Viral parotitis and juvenile recurrent parotitis are the two most common causes. Multiple factors, independently or in combination, can result in acute, chronic, or recurrent acute salivary gland inflammation. Sialendoscopy has emerged as the leading diagnostic technique and intervention for pediatric sialadenitis. Sialendoscopy is a safe and effective gland-preserving treatment of pediatric sialadenitis. Investigational studies are needed to address the impact of steroid instillation, postoperative stenting, and long-term outcomes of pediatric sialendoscopy. This article presents a comprehensive review of pathophysiology, clinical presentation, diagnosis, and treatment of pediatric sialadenitis.

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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.

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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]”

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