Don't miss this cause of anemia in your differential in today’s episode about autoimmune hemolytic anemia!

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anjali Pawar (UC Davis pediatric hematology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Autoimmune hemolytic anemia is an extravascular hemolysis
• Symptoms can include pallor, fatigue, lightheadedness, jaundice, tachycardia, acrocyanosis, dark urine, splenomegaly, and gallstones with labs showing anemia with schistocytes, reticulocytosis, hyperbilirubinemia, elevated LDH, elevated AST, and positive Coombs testing.
• AIHA can be triggered by infections, underlying autoimmune diseases, malignancy, immunosuppression, and medications.
• Treatment is steroids or rituximab for warm AIHA and avoiding the cold for cold AIHA. In refractory cases, splenectomy or stem cell transplant may be needed. Transfusions are generally not recommended due to ongoing hemolysis unless anemia is severe.

Sources:

• Voulgaridou A, Kalfa TA. Autoimmune Hemolytic Anemia in the Pediatric Setting. J Clin Med. 2021;10(2):216. Published 2021 Jan 9. doi:10.3390/jcm10020216
• Noronha, Suzie A. "Acquired and congenital hemolytic anemia." Pediatrics in Review 37.6 (2016): 235-246. doi: 10.1542/pir.2015-0053

Plan ahead for the flu season with our episode today where we talk about how to treat the common flu, also known as influenza.

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Dean Blumberg (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• The influenza vaccine is important every flu season!
• Anti-viral neuraminidase inhibitors like oseltamivir/Tamiflu (oral), zanamavir (inhaled), and peramavir (IV) prevent the flu virus from fusing with infected cell membranes preventing the release of the virus
• Baloxivir is a endonuclease inhibitor that inhibits mRNA synthesis that can be given as a one time dose to treat influenza infections.
• Otitis media, PNA, retropharyngeal abscesses, Pott puffy tumors, empyema, meningitis, encephalitis, GBS, acute cerebella ataxia, transverse myelitis, myositis, pericarditis, and myocarditis are all serious complications that can occur with influenza infections

Sources:

• O’Leary ST, et al. Recommendations for Prevention and Control of Influenza in Children, 2024–2025: Technical Report. Pediatrics. 2024 Oct 1;154(4). doi: 10.1542/peds.2024-068508
• AAP Red Book, 2023. doi:10.1542/9781610025782-S3_068
• Moscona, A. Neuraminidase Inhibitors for Influenza. N Engl J Med 2005;353:1363-1373. 2025 Sept 9. doi: 10.1056/NEJMra05074

Have you ever wondered if your patient's snoring is concerning or not? Learn about how we screen for obstructive sleep apnea in pediatric patients in this episode.

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This episode was written by pediatricians Lidia Park, Tammy Yau, and Jessica Ahn with content support from Ambika Chidambaram (UCD pediatric pulmonology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points

• Obstructive sleep apnea (OSA) occurs when there is either complete or partial narrowing of the upper airway during sleep that causes an awakening from sleep and/or results in at least 3% drop in oxygen saturation and lasts 2 breath lengths.
• Symptoms of OSA can include episodes of apnea, gasping, choking, frequent awakenings, sleep enuresis, attention difficulties, behavioral problems, daytime sleepiness.
• On physical exam, watch out for enlarged tonsils and/or adenoids, micrognathia, retrognathia, or hypotonia.
• Untreated OSA is an independent comorbid factor for many conditions such as failure to thrive, obesity, and cardiovascular diseases like insulin resistance, fatty liver disease, and hypertension.
• Disorders associated with OSA include Down syndrome, Duchenne Muscular Dystrophy, Prader Willi, achondroplasia, hypothyroidism, and acromegaly.
• The gold standard for diagnosis of OSA is polysomnography and is based off of AHI scores: 1-5 is mild, 6-10 is moderate, and 11 or greater is severe.
• First line treatment for most children is adenotonsillectomy. If this fails, second line treatment is CPAP or BiPAP.

References

• Krishna J, Kalra M, McQuillan ME. Sleep disorders in childhood. Pediatrics in Review. 2023;44(4):189-202. doi:10.1542/pir.2022-005521
• American Academy of Sleep Medicine. Obstructive Sleep Apnea.; 2008. https://aasm.org/resources/factsheets/sleepapnea.pdf. Accessed October 29, 2024.
• Benedek P, Balakrishnan K, Cunningham MJ, et al. International Pediatric Otolaryngology group (IPOG) consensus on the diagnosis and management of pediatric obstructive sleep apnea (OSA). International Journal of Pediatric Otorhinolaryngology. 2020;138:110276. doi:10.1016/j.ijporl.2020.110276
• Basha S, Bialowas C, Ende K, Szeremeta W. Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. The Laryngoscope. 2005;115(6):1101-1103. doi:10.1097/01.mlg.0000163762.13870.83

Join us for part 2 of our 2 part series on sickle cell disease. In this episode, we’ll go over the acute complications related to sickle cell disease and their management.

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anjali Pawar (UC Davis pediatric hematology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Consider acute chest syndrome in a patient with cough, fever, hypoxemia, and new infiltrate on CXR
• Acute pain episodes should be treated with IV hydration, oxygen as needed, and adequate pain management.
• Chronic complications often result from chronic vascular blockage and inadequate oxygenation such as splenomegaly, avascular necrosis, retinopathy, nephropathy, and ulcers.

Sources:

• Pediatrics 2024, A. Yates. https://doi.org/10.1542/peds.2024-066842

In part 1 of this 2 part series on sickle cell disease, we’re going to discuss the general pediatric management of a patient with sickle cell disease including what special precautions and additional routine health maintenance they need.

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anjali Pawar (UC Davis pediatric hematologist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Patients with sickle cell disease should receive penicillin prophylaxis from 2 months old til 5 years old or until pneumococcal vaccine series is completed
• For patients with HbSS or sickle beta zero thalassemia, offer hydroxyurea at 9 months of age, even if they don’t have clinical symptoms. They should also receive stroke risk screening with an annual transcranial doppler
• Patients with sickle cell disease should receive annual screening for retinopathy and nephropathy around age 10
• Patients with sickle cell disease should receive an additional pneumococcal (20 or 23) vaccine and the meningococcal ACWY vaccine at age 10 and men B after age 10 if they have functional asplenia or a splenectomy

Sources:

Pediatrics 2024, A. Yates. https://doi.org/10.1542/peds.2024-066842

Wondering how to get pesky eczema under control? Listen up in today’s episode.

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Smita Awasthi (UC Davis pediatric dermatology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

● Daily moisturization, cotton clothing, avoiding allergens and irritants like dust mites help prevent eczema flares

● For eczema flares, treat with a topical steroid, lower potency on the face and higher potency elsewhere on the body

● Look out for superimposed bacterial infections from Staphloccocus aureus or group A streptococcus and treat with topical or oral antibiotics depending on the spread (local vs extensive)

● Eczema herpeticum is due to HSV and should be treated with acyclovir, sometimes requiring hospitalization if severe or close to the eyes



Sources:

- AAP Patient Care Atopic Dermatitis: https://www.aap.org/en/patient-care/atopic-dermatitis/treatment-of-atopic-dermatitis/

- Pediatrics in Review, April 2018, Waldman et al, https://doi.org/10.1542/pir.2016-0169

What does it mean for a child to “fail to thrive”? No, it’s not a performance evaluation. Learn when and how to evaluate an infant for faltering growth in this episode!

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This episode was written by pediatricians Lidia Park and Tammy Yau as well as pediatrics resident Megan Branson, with content support from Kelly Haas, pediatric gastroenterologist. Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.



Key Points:

• To diagnose with Faltering Growth (aka Failure to thrive): the infant must fall below weight-for-age or weight-for-length percentile or have rate of weight gain decline across 2 major percentiles.
• There are three categories to think about when evaluating the etiology of faltering growth:
• insufficient calories in
• malabsorption or increased calories out
• increased metabolic requirement

Sources:

• AAP. (2022, May 31). https://www.aap.org/en/patient-care/newborn-and-infant- nutrition/growth-faltering-in-newborns-and-infants/?srsltid=AfmBOopMEVV0n6cZIAM4QHQ02RDREPeELIC107ONgdtSRS8bnrfZs4tP
• Pediatrics in Review 2017, https://doi.org/10.1542/9781610021159-86
• AAP Books: Caring for the Hospitalized Child 2018, https://doi.org/10.1542/9781610021159-86
• Pediatrics in Review 2016, https://doi.org/10.1542/pir.2014-0122

Ever wonder why babies receive erythromycin eye ointment at birth and if it’s really necessary? We’re going to answer that and many other EYE-opening questions in today’s episode!

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This episode was written by pediatricians Lidia Park and Tammy Yau with content support from Dean Blumberg (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Erythromycin eye ointment is given to newborn babies to prevent against gonococcal infection, it does not cover chlamydia infections. 10% of babies who are exposed to gonococcus can still get eye infections even when given erythromycin
• Gonococcal eye infections (ophthalmia neonatorum) can cause ulcers, rupture, and blindness. Disseminated infections can cause arthritis, bacteremia, and meningitis

Sources:

• Red book “Gonococcal infections”, “Chlamydia”, “Neonatal ophthalmia prevention” chapters
• Kapoor VS, Evans JR, Vedula SS. Interventions for preventing ophthalmia neonatorum. Cochrane Database Syst Rev. 2020 Sep 21;9(9):CD001862. doi: 10.1002/14651858.CD001862.pub4. PMID: 32959365; PMCID: PMC8524318.
• Neoreviews (2022) 23 (9): e603–e612. https://doi.org/10.1542/neo.23-9-e603
• Commentary From the AAP Section on Ophthalmology: Century of Changes | Pediatrics | American Academy of Pediatrics