Category Archives: Pediatrics

Pediatrics

Pediatrics Office Plans Move To Hindman Road – ButlerRadio.com – Butler, PA – butlerradio.com

A local medical provider is planning to build a new and larger facility in Butler Township.

The Butler Township Planning Commission has recommended conditional approval to a land development proposal made by Quick Care Medical for a vacant lot along Hindman Road.

Owners would like to construct a single-story, over 5,000-square foot building for use by a pediatrics practice. The business is currently located in Moraine Pointe Plaza, but has outgrown that space. The new building will also have room for a family practice and a day spa. Some questions about stormwater management remain to be answered.

This proposal will next move on for a vote at the Butler Township Commissioners meeting later this month. If given final approval, work could begin as soon as all necessary permits have been received.

Read the original post:

Pediatrics Office Plans Move To Hindman Road - ButlerRadio.com - Butler, PA - butlerradio.com

Pediatrics

Health officials address spike in pediatric brain abscess cases, still considered ‘rare’ – News3LV

Health officials address spike in pediatric brain abscess cases, still considered 'rare'

Cases of pediatric brain abscesses increased nearly threefold in 2022, according to the Southern Nevada Health District (SNHD).

On average, Clark County would have approximately five cases a year, but that number jumped to 18 last year. The sharp increase triggered a Centers for Disease Control (CDC) investigation and public health advisory from the SNHD.

Dr. Taryn Bragg is the only pediatric neurosurgeon in the state of Nevada. Because of that distinction, she was the first to treat all of the patients and noticed a pattern emerge. She recalled the CDC had been investigating similar increases in other states and asked them to investigate in Southern Nevada as well.

The findings were presented last Thursday at the CDC's Epidemic Intelligence Service Conference, as first reported by CNN.

"This is not the typical cold. This is not 'I have a mild headache. I have a low-grade fever. I might have some drainage from my nose.' This is severe symptoms, severe headache, lethargy, seizures, weakness, they may have even noticed swelling in the face or in the eyes," said Dr. Bragg. "And so these are things that are not subtle, you're not going to miss it."

Dr. Bragg said it was easy to detect an increase once she had eleven cases in a four or five-month period beginning Spring 2022. She wanted pediatric providers across Nevada to know about this increase so that they might consider imaging or increasing treatment for children who were showing symptoms of sinus or ear infections.

Dean Marc J Kahn with the Kirk Kerkorian School of Medicine in Las Vegas said the increase to 18 cases meant it's still a rare occurrence, but that it warranted some scrutiny.

"The case numbers are small. We don't know why we've seen this spike in cases, although they have gone down over the past several weeks, two months," said Dr. Kahn. "For parents, I think this is an unusual event. I think that, again, we want our kids to be vaccinated, and up to date on vaccinations. We want our kids to eat healthy, and we want them to be healthy."

Brain abscesses occur when bacteria or fungi that circulate in the blood get to the brain, causing an infection in the brain, Kahn said. When that happens, inflammatory cells fight the infection and create a walled off cavity (an abscess), which contains dead immune cells, frequently called pus.

Dr. Bragg was involved in all of the surgeries needed to treat the children with abscesses. She said it can be a lengthy process with up to six surgeries, some of which require portions of the skull to be temporarily removed for brain swelling. All of the children either fully recovered or are near full recovery, she said.

Dean Kahn from the UNLV Medical School called it a fortunate and unfortunate situation since Las Vegas and Nevada are lagging in pediatric care without a freestanding children's hospital, as outlined in a News 3 special report.

"One thing that a freestanding children's hospital brings to a community is the wide spectrum of specialists and subspecialists in pediatrics, including a pediatric neurosurgeon," said Kahn. "Unfortunately, we only have one pediatric neurosurgeon for our entire community. Fortunately, she was able to see the patients that we're talking about. But this really does underscore the need for a freestanding children's hospital in our community."

So far, the CDC investigation has not determined the exact cause for the rise in brain abscesses both in Nevada and elsewhere, but there are some theories. Since it's a respiratory illness, COVID infections were considered, but a majority of the patients did not have COVID.

Another consideration is something called "immunity debt," where children didn't build up typical immunities due to social distancing during the pandemic.

"We still don't have a clear answer for what might have potentially caused that within our county," said Dr. Jessica Penney, CDC Epidemic Intelligence Service (EIS) Officer. "But we hope by bringing this to everyone's awareness, we'll be able to continue to work with our local state and federal partners to continue monitoring and research."

Health officials also want to stress that the brain abscesses aren't contagious.

"So the big question that's come up, 'Well, is it the masks? Or 'Should we still be wearing masks?'" said Bragg. "This isn't something that's sitting next to their best friend on the school bus on the way home that they're going to be at risk for developing a sinus infection."

Dr. Bragg said parents do need to keep an eye on their children and take them to the hospital or a doctor should extreme symptoms present themselves.

According to the SNHD health advisory, the median time from symptoms to hospitalization reported was 7.5 days.

Read more from the original source:

Health officials address spike in pediatric brain abscess cases, still considered 'rare' - News3LV

Pediatrics

Community trauma focus of Pediatrics Community Health and … – University at Buffalo

Physicians training in UBs pediatrics residency program provide care for children at local clinics and at John R. Oishei Childrens Hospital.

They also play key roles advocating for children and families through collaborations with a variety of community organizations. The work of these UB physicians and the organizations they work with will be highlighted at the Community Health and Advocacy Conference taking place from 7:45 a.m. to 1 p.m. May 5 in the atrium of the Jacobs School of Medicine and Biomedical Sciences at UB.

Hosted by the UB pediatrics residency program and the Department of Pediatrics, the event is in person, with a virtual option. Register at this link.

Nearly 100 people from community-based organizations will attend, including individuals from local school districts, community health centers, refugee services, education centers, restorative justice coalitions and many others.

The conference is an effort to create an environment where our pediatric attending physicians, trainees, medical students and other health care professionals can collaborate with community-based organizations around important community health topics, says Sarah J. Ventre, clinical assistant professor of pediatrics in the Jacobs School,physician with UBMD Pediatricsand lead conference organizer.

In light of the traumas our community has faced recently, we felt that trauma prevention was an important topic to focus on and to bring community members together with health care professionals in an interdisciplinary way.

The schedule:

8 to 9 a.m.: Christopher St. Vil, UB assistant professor of social work, will give the grand rounds address, All Hands on Deck: Implementing a Community Violence Intervention Ecosystem in Buffalo, N.Y., Grounded in a Multidisciplinary Approach.

St. Vil will discuss how people in various positions, from physicians to social workers to community members, can address trauma and trauma prevention. He will discuss evidence-based models, including local examples like Buffalo SNUG (Should Never Use Guns) and Buffalo Rising Against Violence (BRAVE).

9 to 10 a.m.: Pediatric residents will do poster presentations on their community health advocacy projects.Topics range from urban gardens, food insecurity, vaccine hesitancy among teens and how to educate providers and the public about child abuse to inspiring children in diverse populations to pursue medicine as a career and diaper equity, the issue around the fact that since there is no exclusive government assistance program to cover the cost of diapers, low-income families are sometimes forced to be more sparing in their use of diapers. That, in turn, creates health problems for the child.

10a.m. to noon: Breaking Down Silos: Finding an Approach to Trauma Prevention That Fits into Your Roles, a panel discussion facilitated by Whitney Mendel, research scientist, Roswell Park Comprehensive Cancer Center. Panelists include Sourav Sengupta, associate professor of psychiatry and pediatrics in the Jacobs School and director of training in adolescent and child psychiatry; Luanne Brown, executive director, Buffalo Prenatal Perinatal Network; and Mia Ayers-Gross, executive director, Most Valuable Parents.

An interactive workshop will follow the panel.

Ventre explains that medical residents in pediatrics are required by the Accreditation Council for Graduate Medical Education to participate in advocacy, which serves to connect pediatricians closely to community organizations.

There may be gaps in care that our families and children are facing that we may not be able to address in 15 minutes in the office, so its our job to work in partnership with community organizations who can help address the systemic issues these families are facing, Ventre says.

And while it might seem that advocacy work is yet another task on top of the often-brutal schedule many pediatricians have, Ventre notes that advocacy work actually turns out to be a positive.

Doing advocacy has been shown to increase wellness and resilience for physicians, she says. It decreases burnout. When you are seeing the same issues over and over and you arent part of the solution, then you are running on a treadmill. But when you are part of the solution and part of fixing things, you feel, This is why I went into medicine.

See the original post here:

Community trauma focus of Pediatrics Community Health and ... - University at Buffalo

Pediatrics

American Academy of Pediatrics Names First Chief Health Equity … – American Academy of Pediatrics

Dr. Joseph L. Wright to lead the AAP Equity Agenda and implement a national strategy to promote health equity for all children

ITASCA, IL Joseph L. Wright, MD, MPH, FAAP has been hired by the American Academy of Pediatrics (AAP) to lead and advance the organizations Equity Agenda. He will oversee and implement the Academys national strategy to promote and achieve health equity for all children, as well as efforts for the Academy to become an equitable, diverse and inclusive organization.

Dr. Wright is the first person to serve in the role of Chief Health Equity Officer at AAP. In this role, he will provide strategic guidance to the AAP Board of Directors, the CEO and AAP leadership on all health equity, diversity, and inclusion efforts, integrating clinical, public health and societal perspectives and approaches to improve health and health care disparities.

The AAP has already greatly benefited from Dr. Wrights leadership in many areas, and we are incredibly pleased to now have the opportunity to bring him on board to lead our national equity agenda, said Mark Del Monte, JD, CEO/Executive Vice President of the AAP. This work is crucial and Dr. Wright brings a breadth and depth of knowledge, experience and wisdom that will help AAP make a meaningful impact in the lives of children and families.

Dr. Wright is a former member of the AAP Board of Directors and previous chair of the AAP Board Committee on Equity. His AAP leadership roles have also included chairing the AAP Committee on Pediatric Emergency Medicine and the AAP Task Force on Addressing Bias and Discrimination. Dr. Wright has been recognized by the Academy for his long-standing leadership as recipient of two career achievement awards for distinguished contributions to the disciplines of injury prevention and emergency medicine, and last year was recipient of the inaugural AAP Equity, Diversity, and Inclusion Excellence Award.

Dr. Wright is currently Chief Health Equity Officer of the 12-hospital, 30,000 employee University of Maryland Medical System. He previously served as tenured Professor and Chair of Pediatrics at the Howard University College of Medicine, and as Senior Vice President at the Children's National Hospital, both in Washington, DC. Dr. Wright is a board-certified pediatric emergency physician with scholarly interests that include injury prevention, prehospital pediatrics, and the needs of underserved communities. He has contributed more than 120 publications to the scientific literature, served more than 30 visiting professorships, and was a principal investigator of the NIH-funded DC-Baltimore Research Center on Child Health Disparities. Dr. Wright is an elected member of the Alpha Omega Alpha (medicine) and Delta Omega (public health) honor societies, the American Pediatric Society for which he co-chairs the Committee on Diversity, Inclusion and Equity, and is the 2023 recipient of the Terrapin Award the highest honor conferred by the University of Maryland School of Public Health.

Dr. Wright provides national leadership through advisory and governance service to several health and human service entities including the Association of American Medical Colleges, the March of Dimes, and Safe Kids Worldwide as well as having previously served as an Obama administration appointee to the Pediatric Advisory Committee of the Food and Drug Administration. Dr. Wright earned a B.A. from Wesleyan University in Middletown, CT, his M.D. from Rutgers New Jersey Medical School, and a Master of Public Health in Administrative Medicine and Management from George Washington University.

I am thrilled to join AAP and help to continue the transformative work of ensuring that children and families attain their highest level of health along the path to equity. said Dr. Wright.

Dr. Wright will continue to work with the AAP in a volunteer capacity until he officially assumes the role of Chief Health Equity Officer and Senior Vice President, Equity Initiatives, in September.

###

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org or follow us on Twitter @AmerAcadPeds.

Read more:

American Academy of Pediatrics Names First Chief Health Equity ... - American Academy of Pediatrics

Pediatrics

Pediatric Oral Immunotherapy Clinic launched | VUMC Reporter … – VUMC Reporter

by Christina Echegaray

Monroe Carell Jr. Childrens Hospital at Vanderbilt has launched a new pediatric Oral Immunotherapy Clinic, which offers a special therapy to peanut-allergic children to reduce risk of a harmful immune response in the event of accidental exposure to peanuts.

Led by Rachel Glick Robison, MD, associate professor of Pediatrics within the Division of Pediatric Allergy, Immunology and Pulmonology, the clinic is located within the Allergy Clinic at Vanderbilt Health One Hundred Oaks.

Around for nearly two decades, oral immunotherapy (OIT) involves a patient eating small, but increasing, amounts of their specific allergen daily over a period until reaching a maintenance level dose. The process is known as desensitization. The maintenance dose is lifelong and must be consumed daily for continued protection.

The most important thing I tell families is that this is not a curative therapy at this point. This is a way to give you a level of protection against accidently ingesting the allergen in your daily life. We know that if you tolerate the therapy amount, then you would tolerate small amounts of the allergen if you were accidentally exposed. They also still have to carry epinephrine injectors, said Robison.

Food allergies affect about 1 in 13 children in the United States. Within that group, about 2.5% of all children have a peanut allergy. That number has steadily risen since 2010, with one study showing that by 2017, there was an estimated 21% increase in peanut allergies in the U.S.

A food allergy is a medical condition in which exposure to certain foods triggers a harmful immune response, which can range from mild (itchiness, hives) to severe or life-threatening (difficulty breathing, throat tightening). The top eight most common food allergies are: peanuts, tree nuts, milk, egg, wheat, soybeans, shellfish and fish.

Each year, about 200,000 people require emergency medical care for allergic reactions to food, according to the organization Food Allergy Research & Education.

OIT, Robison says, offers families the chance to broaden their life activities a bit, lessening some of the apprehension of daily exposure to peanuts for fear of ending up in the emergency room.

If someone has been apprehensive to travel or eat at restaurants, this can provide some benefits for them. Ive also seen people who, as their child gets older and is approaching school age or college, have concerns about accidental ingestion. For those people who really want some protection against accidental ingestion, we know OIT therapy can help provide that.

But OIT isnt for everyone. Robison says she sits down with families for an extensive conversation about all the benefits as well as the risks. She also needs to understand if a child has any other allergic disorders and a familys lifestyle/habits to ensure compliance to the daily dosing regimen. Some people would rather practice avoidance and not have the daily responsibility.

The clinic currently uses the only FDA-approved OIT for peanut allergy, PALFORZIA, which is approved for children ages 4 to 17.

The first couple doses are given in the OIT Clinic under observation. Each level of dosing lasts about two weeks over about six months until the maintenance dose is reached. Currently, the maintenance dose is lifelong.

Robison, who arrived at Vanderbilt in February 2022, previously helped build a food allergy clinical trials program at Lurie Childrens Hospital of Chicago, and she hopes to help develop something similar at Monroe Carell as understanding and therapies for food allergies continues to evolve.

I do believe OIT will likely be done earlier with more regularity and in younger kids at diagnosis, she said. But OIT is not necessarily a perfect fit for every individual, so there is still a lot of room for other options and therapies that are hopefully coming down the pipeline soon.

Read more from the original source:

Pediatric Oral Immunotherapy Clinic launched | VUMC Reporter ... - VUMC Reporter

Pediatrics

Parents’ Awareness and Attitude Toward Pediatrics Eye Diseases in … – Cureus

Specialty

Please chooseI'm not a medical professional.Allergy and ImmunologyAnatomyAnesthesiologyCardiac/Thoracic/Vascular SurgeryCardiologyCritical CareDentistryDermatologyDiabetes and EndocrinologyEmergency MedicineEpidemiology and Public HealthFamily MedicineForensic MedicineGastroenterologyGeneral PracticeGeneticsGeriatricsHealth PolicyHematologyHIV/AIDSHospital-based MedicineI'm not a medical professional.Infectious DiseaseIntegrative/Complementary MedicineInternal MedicineInternal Medicine-PediatricsMedical Education and SimulationMedical PhysicsMedical StudentNephrologyNeurological SurgeryNeurologyNuclear MedicineNutritionObstetrics and GynecologyOccupational HealthOncologyOphthalmologyOptometryOral MedicineOrthopaedicsOsteopathic MedicineOtolaryngologyPain ManagementPalliative CarePathologyPediatricsPediatric SurgeryPhysical Medicine and RehabilitationPlastic SurgeryPodiatryPreventive MedicinePsychiatryPsychologyPulmonologyRadiation OncologyRadiologyRheumatologySubstance Use and AddictionSurgeryTherapeuticsTraumaUrologyMiscellaneous

Read more:

Parents' Awareness and Attitude Toward Pediatrics Eye Diseases in ... - Cureus

Pediatrics

Episode 1: The Diagnosis of Pediatric Pneumonia – Medscape

This transcript has been edited for clarity. For more episodes, download the Medscape app or subscribe to the podcast on Apple Podcasts, Spotify, or your preferred podcast provider.

Todd Florin, MD: Hello. I am Dr Todd Florin, and I am an associate professor at Northwestern University's Feinberg School of Medicine and the director of research for the Division of Emergency Medicine at Ann and Robert H. Lurie Children's Hospital of Chicago. Welcome to Medscape's InDiscussion series on Pediatric Pneumonia. Today, we'll discuss the diagnosis of pediatric pneumonia, a topic that seems simple but becomes challenging as we peel back the layers of the onion. This is largely because the clinical presentation of pneumonia in children overlaps with so many other common respiratory conditions, such as asthma, bronchiolitis, and viral upper respiratory infections. We'll discuss both clinical and radiographic approaches to the diagnosis of pneumonia in children. First, let me introduce my guest, Dr Mark Neuman. Dr Neuman is an associate professor of pediatrics and emergency medicine at Harvard Medical School and the director of research in the Division of Emergency Medicine at Boston Children's Hospital. He has been conducting research in pediatric pneumonia for the past 2 decades. Welcome to InDiscussion.

Mark Neuman, MD: Hi, Todd. How are you?

Florin: Great to see you. Mark, you and I have been working in this field for quite a while now. What do you think are some of the most exciting changes in care that you've seen over your time?

Neuman: One of the best things I've seen is the development of clinical decision rules to help optimize patient care. One of the areas in which there's been huge advancements is in the care of the febrile infant. I remember when I was a fellow training here in Boston, we used to do a full sepsis workup on all infants under 90 days of age, and those kids were admitted to the hospital often for up to 3 days. Now, as a result of clinical decision rules, we typically only perform a lumbar puncture (LP) or a spinal tap on kids older than 30 days. We're even moving that range down quite a bit.

Florin: I definitely have seen that changing in my career as well. I feel that it's a good link to the discussion that we're going to have today about how the approach to diagnosis and management to common pediatric infections has really changed as we've learned more about these infections. That leads us directly into our conversation today about the diagnosis of pediatric pneumonia. Pneumonia is really a broad term. We see it used in lots of different ways, some more specific (pus and consolidation in the lung) and others more general (any findings of lower respiratory tract infection in a kid with a fever). What do you think are the best clinical features to predict the presence of a radiographic pneumonia for something that you can see on a chest radiograph?

Neuman: I think the important thing with respect to clinical signs and symptoms of pneumonia is that there's no single sign or symptom that's highly accurate for the diagnosis of pneumonia. The typical scenario of a child who comes into the emergency department with a high fever, a productive cough on exam, maybe hypoxic, working to breathe, and having focal rales is a rare phenomenon. Most children present with a variety of signs and symptoms, but I think you can't really hang your hat on a single sign or symptom to predict pneumonia. Some studies that we and other groups have done found certain findings are more likely to be associated with pneumonia in children, such as the presence of fever, fever duration, decreased breath sounds, having rales or crackles (particularly if they're focal in nature), and hypoxia. I think the biggest takeaway is that no single sign or symptom is highly accurate. With that said, in a meta-analysis that we've done, we found that hypoxia and increased work of breathing were the two findings that were more likely to be associated with pneumonia and that altered your risk of diagnosing pneumonia more than any other sign or symptom. Wheezing was associated with not having radiographic pneumonia.

Florin: When that meta-analysis came out, which was published in the Journal of the American Medical Association (JAMA), I found that really fascinating because I think that traditionally tachypnea has been considered a diagnostic criteria for pneumonia, not only in the US but worldwide. Can you speak a little bit about what you found with regard to the role of tachypnea in diagnosing pneumonia?

Neuman: Tachypnea is interesting. Tachypnea, or rapid breathing, is often associated with pneumonia. However, many of the children who are being considered for having pneumonia also are tachypneic, which makes tachypnea a tough finding to say whether it's associated with pneumonia. Around the world, in resource-poor settings, tachypnea is the criteria that's used to define pneumonia in those settings. However, because tachypnea is associated with many other respiratory illnesses like asthma, bronchiolitis, even with upper respiratory infections, it is not commonly associated with pneumonia with respect to differentiating pneumonia from other types of infections or respiratory illnesses.

Florin: I think that's important for our listeners to know. I also want to flesh out the hypoxemia criteria. At what oxygen saturation do we see that risk of radiographic pneumonia go up?

Neuman: It's a challenging question to answer. In that meta-analysis, there were many studies that were done that used different thresholds of oxygen saturation. In that meta-analysis, the best cutoff in discriminating kids with and without pneumonia was less than or equal to 96%. At that threshold, the likelihood ratio of having pneumonia was 2.8, so that altered your pretest probability of having pneumonia more significantly than other thresholds.

Florin: That's interesting. I think a lot of us consider 96% to be a pretty high threshold. Did you see any changes when you lowered that threshold? Certainly, in the International Diseases Society of America (IDSA) guidelines, you see 90%, and you see 92% in some other guidelines around the world. Did you see any threshold effects at those lower oxygen saturations?

Neuman: Yes, we probably would have. The problem is that many of the studies that looked at pneumonia had very few children who were actually hypoxic at those levels. It limits your ability to really evaluate lower levels of hypoxia for the presence or absence of radiographic pneumonia.

Florin: Let's unpack a little bit of that second criteria that you mentioned: work of breathing. How is work of breathing defined in these studies and in your meta-analysis?

Neuman: It was defined quite differently in all the different studies that looked at work of breathing. For the meta-analysis, we included any element of work of breathing: grunting, flaring, retracting. Any element of work of breathing was included in that combined variable for the purposes of a meta-analysis. Unfortunately, meta-analyses have to rely on the data in the form that it's collected. Because there's not a uniform nature in which these are assessed in different studies, we had to rely on however it was described in those individual studies.

Florin: That last symptom that you mentioned wheezing is negatively associated with radiographic pneumonia. I know you and I have done work in this area. What does wheezing say about how we can predict radiographic pneumonia in a child who's wheezing, given that it is negatively associated with radiographic pneumonia?

Neuman: I think this is interesting. When I did my fellowship, we were traditionally taught that children with asthma and bronchiolitis have higher rates of pneumonia. I think it's challenging to look at wheezing as a potential predictor of pneumonia. The issue is that most children who are undergoing an evaluation for potential pneumonia have signs or symptoms of asthma, reactive airway disease, wheezing, and bronchiolitis. The rate of pneumonia is actually much lower in those children than other children who present with similar signs, like hypoxia. It's a tough finding to look at with respect to diagnosing pneumonia. Among kids who are wheezing, the same sort of signs or symptoms (such as high fever or profound hypoxia) may make them more likely to have pneumonia. But even in those kids, the rate of pneumonia is very low among wheezing children.

Florin: Great. We've talked up to this point about these individual signs and symptoms. No one individual sign or symptom is diagnostic of radiographic pneumonia. There's been work, largely led by you, over the last decade about developing clinical prediction rules or scores that can be used to increase the accuracy of predicting pneumonia diagnosis on x-ray. Can you talk about those clinical prediction rules?

Neuman: The biggest thing that folks need to know is that physicians tend to overestimate the likelihood of pneumonia, at least based on radiographic findings. In a study we did many years ago, we asked physicians, "How likely do you think it is that this child will have radiographic pneumonia?" Across the board, physicians overestimated the likelihood of the patient having radiographic pneumonia. There are two thresholds I like to talk about. Among those children where physicians thought there was more than a 50% likelihood of pneumonia, only about 35%-40% of those kids had any radiographic finding at all, and only about 20% of those kids had radiographic pneumonia. At the highest threshold greater than 75% only 50% of those kids had any radiographic findings at all, and only 30% had definite radiographic pneumonia. I think the two factors that call for decision rules in this area are: (1) Physicians overestimate the likelihood of pneumonia, and (2) No individual finding performed well enough to hang your hat on. With that said, multiple groups have tried to develop clinical decision rules to help physicians better determine the need for either x-ray or antibiotic use in this group. The findings in a lot of these clinical decision rules showed that the individual factors are actually quite similar things like older age, fever, fever duration, and focal lung findings like decreased breath sounds and rales. Those are findings that are typically incorporated in decision rules. Wheezing is also incorporated in many of the decision rules as a negative predictor of pneumonia. I think the interesting thing with these decision rules is that we found across the board, these rules perform much better than clinical judgment for the identification of radiographic pneumonia.

Florin: That's a great summary. This brings us to the next topic of discussion. I think there's still more work to be done to externally and widely validate these clinical prediction rules or scores. Let's say once validated, you apply some of these factors and have to make a decision. Do you treat this child empirically based on this clinical prediction rule, or this set of signs and symptoms? Or do you proceed with chest radiography in the diagnosis of pneumonia? How can we best use chest radiography in the diagnosis of pneumonia in children?

Neuman: I'll start by saying the IDSA recommends against the routine performance of chest x-ray in the outpatient setting when pneumonia is suspected. There are multiple reasons for that. The reasons cited in the guidelines include radiation exposure and the fact that chest x-ray can't reliably distinguish bacterial from viral infection. There's poor interrater reliability around specific radiographic findings. The most important one is that chest x-ray may not be accessible in all settings. The argument for chest x-ray, in my mind, relates to a couple of things. One is that clinical suspicion is not synonymous with radiographic pneumonia. Physicians tend to overestimate the likelihood of pneumonia to quite a big extent, and clinical findings are neither sensitive nor reliable for the prediction of radiographic pneumonia. One example of the argument for chest x-ray has to do with the fact that chest x-ray has a very high negative predictive value. In a study we conducted in our emergency department among 400 children in whom the clinician suspected radiographic pneumonia but had a normal or negative chest x-ray, only five children were subsequently diagnosed within the 2-week period following the emergency department visit. Thus, the negative predictive value of chest x-ray is 98.8%. Although a chest x-ray may not be particularly sensitive for the diagnosis of pneumonia, the negative predictive value is quite high.

Florin: Great. That's helpful to know. Another point that you made, which is one that I think is important to talk about, is this idea that any consolidation that you see on radiograph must be bacterial. The evidence suggests and the IDSA/Pediatric Infectious Diseases Society (PIDS) guidelines state that you cannot really differentiate viral from bacterial infection using a chest radiograph. Can you expand a bit on that point?

Neuman: I think there are certain radiographic features that make it more likely to be bacterial than viral, such as having pleural effusion or a large lobar consolidation. I think in those cases, most folks will suspect a bacterial etiology rather than a viral etiology. But most children with pneumonia actually have more subtle findings. Using radiographs to make the diagnosis of pneumonia has the challenge that most of the x-rays have findings that are not as likely for pneumonia.

Florin: Another challenge with the x-ray is that it can be notoriously difficult to interpret. We've all come across those x-rays where you see something, and you're not exactly certain if it's consolidation, atelectasis, or just peribronchial thickening that's masquerading as one of those findings. You mentioned the interrater reliability of a chest x-ray. We know that for a good reference standard, we really have to have a really reliable reference standard. Can you talk a bit about the limitations of x-ray in terms of its interrater reliability and specifically the reliability of different findings on x-ray?

Neuman: Sure. We studied radiologists and their interpretation of x-ray and looked at different findings on x-ray to see how often radiologists agree upon certain findings. We observed that, overall, the agreement for x-ray interpretation for things like infiltrate were quite low, with kappas in the range of 0.4-0.5. However, for the findings that are most suggestive of a bacterial etiology, like a pleural effusion or a lobar infiltrate, the agreement was a little bit higher. Overall, there is a lot of variation in the interpretation of x-ray, but the agreement was quite a bit higher for certain findings that are most suggestive of a bacterial etiology.

Florin: You alluded to obtaining a chest x-ray when the diagnosis might be uncertain maybe those kids in intermediate risk and avoiding x-ray when you're highly confident in the diagnosis or that the child does not have pneumonia. It's a little bit of a balance, particularly in the outpatient setting, where you may not have radiography immediately available to you. Do you obtain the chest radiograph and avoid potential antibiotics vs. empirically prescribing antibiotics without a chest radiograph and potentially overprescribing antibiotics? It's a bit of a tension, right? Can you discuss that tension between radiograph use and antibiotic use?

Neuman: In the outpatient primary care setting, where most children with suspected pneumonia are being treated and x-ray may not be as accessible, I think clinical decision rules can play a big role. Certainly, children who have a high level of suspicion of pneumonia probably don't need an x- ray as long as you're not concerned about a complicated type of pneumonia or pleural effusion. At the low end of the spectrum children in whom the suspicion is quite low I think those kids also don't need x-rays. The majority of children live in this zone of intermediate risk. For those kids, I think chest x-ray can be valuable in terms of reducing antibiotic use and potentially not treating children who likely do not have a radiographic finding.

Florin: An interesting part about all of this is the collateral damage of getting the x-ray. You alluded to the fact that most kids who have findings on an x-ray will have findings that are not going to be highly consistent with a consolidative pneumonia. There will be other findings. What's the collateral damage of getting that x-ray and seeing those other findings? The collateral damage is more antibiotic use, misdiagnosis, cost, and unnecessary radiation exposure. I completely agree with you that it really is a balance. The decision to get an x-ray is not always an insignificant one.

This was a great conversation. Today, I talked with Dr Mark Neuman about the diagnosis of pediatric pneumonia. A few takeaways I have from this conversation are that the diagnosis of pneumonia is challenging, and there is substantial overlap in the clinical symptoms of pediatric pneumonia with other common respiratory conditions, including bronchiolitis and asthma. We heard that no single sign or symptom is diagnostic of radiographic pneumonia, and we can use combinations of signs and symptoms in clinical prediction rules to help hone that accuracy to better predict which kids will have pneumonia on radiograph. The findings that are most important in combination are things like older age, longer fever duration, focal lung findings, and hypoxemia. Certainly, we think about wheezing as a negative predictive factor for having pneumonia on radiograph. The chest x-ray may be useful to exclude a clinically suspected pneumonia or to identify a complicated pneumonia, but routine chest x-ray is generally not recommended for well-appearing kids with suspected pneumonia who can be managed in the outpatient setting. The use of clinical scoring systems or clinical prediction models may help to reduce x-ray utilization and promote judicious use of antibiotics for children with respiratory illness. With that, I want to thank you for tuning in. If you haven't done so already, please take a moment to download the Medscape app to listen and subscribe to this podcast series on pediatric pneumonia. This is Dr Todd Florin for InDiscussion.

Pediatric Pneumonia

Boston Febrile Infant Algorithm 2.0: Improving Care of the Febrile Infant 1-2 Months of Age

Imaging in Pediatric Pneumonia

Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review

The Management of Community-acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America

Physician Assessment of the Likelihood of Pneumonia in a Pediatric Emergency Department

Predicting Pneumonia From the Clinical Exam

Negative Chest Radiography and Risk of Pneumonia

Variability in the Interpretation of Chest Radiographs for the Diagnosis of Pneumonia in Children

Interrater Reliability: The Kappa Statistic

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

See the original post:

Episode 1: The Diagnosis of Pediatric Pneumonia - Medscape

Pediatrics

Avanos Recalls Certain BALLARD ACCESS Closed Suction Systems – FDA.gov

The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death.

The manifold of the BALLARD ACCESS Closed Suction System for Neonates/Pediatrics is used to provide access to the artificial airway of a child, infant, or neonate, without breaking the ventilation circuit. It is a single patient use device that is used by trained medical professionals.

The BALLARD ACCESS Closed Suction manifold is indicated for use together with the BALLARD ACCESS Closed Suction catheter to remove secretions from the artificial airway of children, infants, and neonates

Avanos Medical Inc. is recalling the Avanos BALLARD ACCESS Closed Suction System for Neonates/Pediatrics with Y-Manifold or Elbow Manifold (labeled 72-hour-use) after receiving complaints from customers about cracked manifolds during use. A cracked manifold can cause leaks in the respiratory circuit, which may lead to the patient receiving inadequate ventilation.

Inadequate ventilation and oxygenation can lead to lead serious brain damage or death, especially in the vulnerable patient population (children, infants, and neonates) who receive care using this product. Additional risks from this issue include the possibility that a foreign body could be introduced through the cracked manifold, causing infection, damage to the airway, or a blocked endotracheal tube.

Use of this product could lead to serious injury or death.

Avanos Medical, Inc. reports four injuries associated with this issue.

On February 3, 2023, Avanos Medical Inc. sent an Urgent Medical Device Recall letter to customers. The letter included the following recommended actions:

Customers will be contacted by Avanos Customer Service to arrange for product return, credit, and replacement after the acknowledgement form is submitted.

Customers with questions about this recall should email Avanos at FieldActionCare@avanos.com.

Health care professionals and consumers may report adverse reactions or quality problems they experienced using these devices to MedWatch: The FDA Safety Information and Adverse Event Reporting Program using an online form, regular mail, or FAX.

05/02/2023

See the article here:

Avanos Recalls Certain BALLARD ACCESS Closed Suction Systems - FDA.gov

Pediatrics

Rise in autism prevalence highlights continued need for early … – Contemporary Pediatrics

Contemporary Pediatrics:

Hello and thank you for joining us. I'm Joshua Fitch, editor with Contemporary Pediatrics.

J. Thomas Megerian, MD, PhD, FAAP:

Hi, I'm Tom Megerian, Joshua. I am Clinical Director at the Thompson Center for Autism and Neurodevelopmental Disorders at Children's Health of Orange County (CHOC) and work as a lead of that organization for the the the center as well as a Division Chief for the Division of Neurodevelopmental Medicine at CHOC as well.

Contemporary Pediatrics:

Today we're discussing autism prevalence and children. recent findings from the CDC has Morbidity and Mortality Weekly Report suggests approximately 1 in 36 us children aged 8 years were identified with autism spectrum disorder in 2020, higher than the 2018 estimated average. First, what trends are you observing regarding prevalence of autism and children, and are there any associations with early detection disruptions potentially resulting from the COVID-19 pandemic or otherwise that may be contributing to an increase?

Megerian:

Yes, thanks, Joshua. It's a great question. You know, it's really hard to say if we're getting, say, a bolus of more kids that just weren't being diagnosed in the last two plus years, because of reluctance to come in to tertiary care centers like ours to receive the diagnosis, we know that there was a drop off in the number of kids that were being seen and referred. We've seen that in terms of vaccinations, that number dropped. We've seen it in terms of I think, well, health care visits, and so that's definitely a possibility. The counter argument to that, though, would be that this trend, increasing trend has been going on that we see every 2 to 4 years that we monitor that's been going on for a while. And if you look at the numbers, like over the last 5 years, it was one in 56, then one in 44. Now one in 36. And so those numbers, that trend of increasing, you know, by about 10, one in 10, every two to four years that's been going on. So it's a tough question to answer. Are we seeing this increase right now? That would have maybe flattened off from the 144, because we just didn't see a number of kids early? Or is this just a continuation of the trend we saw before? Hard to answer, and I think time will tell.

Contemporary Pediatrics:

Certainly. And on that point, my next question is what kind of research needs to be completed on a national scale to kind of get a better idea to maybe differentiate some of those timing factors you just mentioned?

Megerian:

I think continuing the research we're doing we do have, I think it's 11 or 12 monitoring sites in the monitoring network, the disabilities monitoring network. I know that there's opportunities, it sites can sign on to be a monitoring site network, we're considering doing that ourselves here. And I think having more of those, right now they are distributed across the country. So there's west coast, there's Midwest, there's east coast, I think adding more sites like, like the ones that are already in the developmental disabilities monitoring network, would be probably the best thing we can do, because those sites are already set up. And they do show really significant differences depending on the location, they have numbers that are much lower than one in 36 in certain areas of the country, and numbers that are much higher than one in 36 and other areas. So there's definitely a difference depending on the state. So having more surveillance locations within each state would be a great idea. Ideally, it would be phenomenal if every state would have one of those centers that that does surveillance monitoring for for the prevalence that would contribute to the national database.

Contemporary Pediatrics:

Obviously this upward trend in prevalence isn't something healthcare professionals want to see what is the reaction? What are next steps when findings such as these are presented? With this increased prevalence and austism. When these results are released? What is the reaction? What are some of the next steps healthcare professionals take?

Megerian:

I think it reminds them to be vigilant to continue monitoring. I know that here in in Orange County, Population Health Program at Children's Hospital of Orange County has been very good about encouraging the providers in network to really be vigilant about their monitoring and doing screenings, and so those numbers have gone up dramatically. The number of percentage of pediatricians doing screening has really gone from below 50% to well above I think at last I heard is upwards of 70% or more of practices are doing routine screening that is structured screening programs, not just kind of asking how are things going, but actually administering a structured screening tool. And that's really what we need to see, we need to get that number across the country up to 100%.

Contemporary Pediatrics:

You mentioned the screenings, what are some of the immediate benefits of earlier diagnosis and treatment for children at risk of behavioral health conditions,

Megerian:

Early intervention, that's really the number one, the number one intervention that we have that's effective has been proven time and time again to be early intervention. Be it speech for kids with speech delay, be it occupational therapy for kids with fine motor delay, physical therapy for kids with more gross motor delays, and then applied behavior analysis for the children who've got autism. Although even ABA, applied behavior analysis is now being used for other conditions besides autism, and has been shown to be effective as well. And getting those programs started as early as possible during the developmental window of neuroplasticity is so critical. The older a child is before they start receiving services, the more difficult it is for those services, or those therapies to be effective. They're still effective, so I don't want anyone to get the impression we shouldn't start therapies if the child is older. But we do know that because of the developmental windows, we can do better the earlier we start, and we we know that we've had that information for years. So starting as early as possible, is the number one improvement we can make in society to help kids maximize whatever potential they have.

Contemporary Pediatrics:

Certainly that early screening process sounds like it's top priority. What are some other ways then parents, healthcare professionals, even caregivers, can address autistic traits kind of before they begin to manifest further as a disorder.

Megerian:

You know, if you see a child, who has some traits of autism, not taking the watchful waiting approach is probably the best thing that we could do. There was there was always this tendency to say, well, let's see what happens. I see I see what you're talking about. Eye contact isn't great in your child. But let's just see if that's just, you know, a, an incidental finding that is really not going to be present in a year from now we'll just watch it. I think that's probably one of the lessons we've we've learned over the last several years is not to do that. And to really be more aggressive. Using some of the new tools that are out there, there are a number of new tools that are out for the primary care physician, especially in the AI field that can help with getting early diagnosis. There's also there are structured types of play up observations there's so I mentioned, artificial intelligence tools, there's a number of those that are out there that can help pediatricians really take a more proactive approach to saying, Does this child meet criteria for autism now? Or should I watch and see what happens?

Contemporary Pediatrics:

Certainly, and thank you very much. Is there anything else you'd like to add or comment regarding prevalence for this patient population, what you hope to see going forward or frankly, what you think needs to happen going forward?

Megerian:

I think putting diagnosis in the hands of primary care pediatricians and not having to have them refer to tertiary care centers for everybody is probably the number one thing we can do. And I think we need to address the insurance issues around that. Making sure that pediatricians are entitled and able to make a diagnosis and have payers cover both the diagnosis that pediatricians do and also approve referrals for therapies based on those diagnosis we do you see a lot of pushback, where payers will tell a pediatrician, no, you need to send this child for a further evaluation, or you need to do one of these very specified tests to make a diagnosis, you can't make the diagnosis using you know, one of the new tools that are out there. It's these three or four tools that we like you to use, and if you don't use them, we want to prove the referrals. I think that's a big mistake. I think pediatricians are trained to make these diagnosis, and there are tools out there, as I mentioned, that can help them make the diagnosis and help them feel more confident, and I don't think we need to have every child referred to a tertiary care center. We have waitlists that are I know if some centers three years to get an evaluation, you can't wait three years to refer a kid for therapy. It's like you said what can we do? What's the immediate approach that pediatricians can take when they have a suspicion for autism? If a child has to wait three years for them to get a, quote, "official diagnosis" is a tertiary center that's that's just that puts them outside that development the window where therapies can be most effective.

See the article here:

Rise in autism prevalence highlights continued need for early ... - Contemporary Pediatrics