Keywords: UTI, urinary tract infection (PubMed Search)
--The diagnosis and treatment of pediatric urinary tract infections (UTIs) can be broken down into different age groups. The AAP has recently updated its recommendations for children age 2 - 24 months.
--In ill-appearing febrile infants age 2 – 24 months, who require early initiation of antibiotics, clinicians should obtain urinalysis and urine culture by catheterization or suprapubic aspiration prior to administration of the first dose of antibiotics.
--Key components of diagnosing a UTI include: urinalysis with the presence of pyuria (>10 WBCs per µL) and bacteriuria. The ultimate diagnosis relies on identification of >50,000 CFUs per mL of a single urinary pathogen in culture.
--Treatment of most UTIs in well appearing infants 2-24 months can be done with oral antibiotics for a course of 7-14 days. Common antibiotics used include: amoxicillin-clavulanate, trimethoprim-sulfamethoxazole, or cephalosporins (cefpodoxime, cefixime) based on local patterns of susceptibility.
--Febrile infants with UTIs should undergo renal and bladder ultrasound (RBUS) to evaluate the renal parenchyma and identify complications of UTI in children who are not responding to treatment within 48 hours.
--Voiding cystourethrography (VCUG) to diagnose vesicoureteral reflux (VUR) as a cause of UTI should not be obtained routinely, but only in children with abnormal RBUS or with recurrent febrile UTIs.
Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Pediatrics 2011; 595 – 610.
This winter season has brought a rise in influenza and RSV activity in Maryland and in many parts of the country. It is also important to remember other potentially lethal infections that are prevalent in the winter and early spring months, such as Neisseria meningitidis. In fact, a recent study2 showed a potential increase in meningococcal disease when influenza and RSV activity is high.
Encapsulated, gram-negative diplococcus
Found in nasopharyngeal secretions, carrier rates 2-30% in normal populations
Age of incidence has 2 peaks: children < 2 years old, teens 15-19 years old
Young adults who live in shared housing, such as college dorms and military recruits
Early non-specific symptoms of URI, fever, malaise, myalgias
Meningitis: non-specific prodrome + headache, stiff neck (not found in younger children who often present atypically with irritability and/or vomiting)
Meningococcemia: above symptoms + hypotension + petechial rash (>60% of patients)
Early (!) antibiotics: 3rd generation cephalosporins (<3mo: cefotaxime; older infants, children, and teens: ceftriaxone); PCN G is antibiotic of choice for susceptible isolates
Early and aggressive management of shock
Tetravalent vaccine, MCV4 (Menactra, Menveo), available for serogroups A, C, Y and W-135 is given routinely at age 11-12 years old with an additional booster at 16-17 years old. MCV4 does not protect against serogroup B which accounts for 30% of infections.
1. Cross JT, Hannaman RA. Infectious Disease. MedStudy Pediatrics Board Review Core Curriculum: 5th edition. 2012; 5-11.
2. Jansen AG, Sanders EA, VAN DER Ende A, VAN Loon AM, Hoes AW, Hak E. Invasive pneumococcal and meningococcal disease: association with influenza virus and respiratory syncytial virus activity?. Epidemiol Infect. Nov 2008;136(11):1448-54.
3. Javid MH. Meningococcemia. Available at http://emedicine.medscape.com/article/221473. Medscape Reference. Last updated Aug. 2. 2012.
Rotavirus is the leading cause of gastroenteritis worldwide and a leading cause of infant death in the developing world.
95% of U.S. children have had a rotavirus infection by the age of 5 years.
Most cases occur in late winter and early spring.
Route of transmission is mostly fecal-oral but may be airborne in cooler months.
Most common presenting signs and symptoms include fever (1/3 of cases), vomiting (in the first 1-2 days), and diarrhea (copious, watery, lasting 5-21 days).
Diagnosis is largely based on clinical manifestations, but antigen assays are available and may be useful in patients with extraintestinal complications, such as hepatitis, pneumonitis, or encephalopathy.
Treatment is largely supportive with efforts to maintain hydration.
Prevention is key to disease control and accomplished with good hand hygiene and widespread vaccination.
Newly implemented vaccine programs worldwide have proven to be effective in decreasing hospitalizations and deaths in developing countries.
Cox, Elaine and Christenson, John. Rotavirus. Pediatrics in Review. 2012; 33 (10): 439 - 447.
Keywords: cervical spine, trauma, pediatrics (PubMed Search)
Ligamentous laxity is increased in children and ligamentous injury is more common than fractures.
If fractures occur, they are more likely to be in the upper cervical spine in infants and the lower cervical spine in older children.
Pseudosubluxation: physiologic subluxation between C2-3 and C3-4 may exist until age 16 years
Screening Assessment/Clearance for Verbal Children
-Midline C-spine tenderness?
-Pain with active motion?
-Altered level of alertness?
-Evidence of intoxication?
-Focal neurological deficit?
-Distracting painful injury?
-High impact injury?
Screening Assessment/Clearance for Pre-Verbal Children
-Neurological assessment of basic reflexes
-Response to painful stimuli
-Equal movements of all extremities
-Response to sound (eye tracking)
-Extremity strength and resistance
-Palpate posterior C-spine (observe for facial grimace)
-Feel for step-offs, deformities
-Verify full range of motion of neck (may need to be creative)
-Repeat neurological assessment
If concern arises on screening assessment, keep child in hard cervical collar and image (may start with x-ray and progress to CT if still concerned and x-rays negative).
If imaging negative, but persistent suspicion based on neurological deficits consider SCIWORA (Spinal Cord Injury WithOut Radiographic Abnormality) which exists in up to 50% of children with cervical cord injury, and may require MRI to further identify injury.
Henoch-Schonlein Purpura (aka. Anaphylactoid purpura) is a small vessel vasculitis.