How and When to Work Up Bleeding Disorder in Suspected Abuse
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Not all pediatric bruising needs workup for a bleeding disorder. This report details not only how but when to do it.
Pediatrics
Just Push It Down? Esophageal Bougienage for Coins
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Esophageal bougienage is an underutilized bedside technique for managing retained esophageal coins.
Source
Esophageal Bougienage for Management of Lodged Esophageal Coins: Safe, Effective, Efficient, and Underused. Pediatr Emerg Care. 2022 Sep 30. doi: 10.1097/PEC.0000000000002849. Online ahead of print.
Would You Hold Still for 2 Seconds? – New Fast CT Means Less Pediatric Sedation
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Newer CT scanners led to faster head CT by about 10 seconds, and this decreased the number of pediatric patients who required sedation.
Source
Impact of a Faster Computed Tomography Scanner on Sedation for Pediatric Head Computed Tomography Scans in 2 Large Emergency Departments-A Retrospective Study. Pediatr Emerg Care. 2022 Aug 5. doi: 10.1097/PEC.0000000000002816. Online ahead of print.
What’s the Best Maintenance Fluid for Children – D51/2NS or D5NS?
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Hypotonic maintenance IV fluid (MIVF) dropped serum sodium at 24 hours compared with isotonic MIVF in pediatric patients. We should stop using D51/2NS for routine MIVF in children.
Source
0.45% Versus 0.9% Saline in 5% Dextrose as Maintenance Fluids in Children Admitted With Acute Illness: A Randomized Control Trial. Pediatr Emerg Care. 2022 Sep 1;38(9):436-441. doi: 10.1097/PEC.0000000000002621. Epub 2022 Jan 26.
Should We Use Steroids for Pediatric Bell’s Palsy?
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There was no statistical difference in 1, 3, or 6 month facial recovery with prednisolone vs placebo for children with Bell’s palsy in this underpowered RCT. I plan to keep using steroids, though opinions on this will differ.
Source
Efficacy of Prednisolone for Bell Palsy in Children: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Neurology. 2022 Aug 25;10.1212/WNL.0000000000201164. doi: 10.1212/WNL.0000000000201164. Online ahead of print.
What’s the Trigger to Activate Pediatric Massive Transfusion
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A transfusion threshold of 20 ml/kg of any blood product during the first hour of pediatric trauma resuscitation maximizes sensitivity and specificity for in-hospital mortality, need for intervention, and additional bleeding episodes and may identify children in need of massive transfusion.
Source
Recognizing Life-Threatening Bleeding in Pediatric Trauma: A Standard for When to Activate Massive Transfusion Protocol. J Trauma Acute Care Surg. 2022 Sep 19. doi: 10.1097/TA.0000000000003784. Online ahead of print.
Is LP Needed for Febrile Infants 29-60 days with Abnormal UA?
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Febrile infants 29-60 days with a positive UA had no cases of bacterial meningitis. These patients do not need a lumbar puncture.
Source
Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results. Pediatrics. 2022 Sep 13;e2021055633. doi: 10.1542/peds.2021-055633. Online ahead of print.
Should Sodium Bicarbonate Be Used In Pediatric Arrest?
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Administration of sodium bicarbonate during in-hospital pediatric cardiac arrest was associated with lower rates of survival to hospital discharge, return of spontaneous circulation, and survival with favorable neurologic outcomes and functional status.
Source
Sodium Bicarbonate Use During Pediatric Cardiopulmonary Resuscitation: A Secondary Analysis of the ICU-RESUScitation Project Trial. Pediatr Crit Care Med. 2022 Jul 26. doi: 10.1097/PCC.0000000000003045. Online ahead of print.
Raising the Bar on Neonatal Hyperbilirubinemia Care
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The American Academy of Pediatrics (AAP) updated clinical guidelines for management of term infants presenting with hyperbilirubinemia. Relevant sections for ED providers include slightly raising phototherapy treatment thresholds, removing race as a consideration, and giving courses of action for infants requiring higher levels of care.
Source
Technical Report: Diagnosis and Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2022 Aug 5;e2022058865. doi: 10.1542/peds.2022-058865. Online ahead of print.
Are We Missing the Target on Febrile Infants 60 Days to 6 Months?
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The lack of evidence-based guidelines in the management of the febrile infants 2 to 6 months old results in variable practices amongst providers.
Source
Prevalence and Management of Invasive Bacterial Infections in Febrile Infants Ages 2 to 6 Months. Ann Emerg Med. 2022 Aug 5:S0196-0644(22)00441-3. doi: 10.1016/j.annemergmed.2022.06.014. Epub ahead of print.