Unequal blood pressures in the extremities and unequal brachial vs femoral pulses? Consider coarctation of the aorta. What’s that? Learn more in today's episode!

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

Key Points:

• Coarctation of the aorta is narrowing of the aorta near the ductus arteriosus (which closes and becomes the ligamentum arteriosum). Most cases occur in the first month of life.
• Symptoms of coarctation of the aorta are tachypnea, poor feeding, fussiness, and sweating with feeds. Blood pressure is elevated in the right upper extremity compared to the lower extremity. Babies can develop congestive heart failure which can lead to shock.
• CCHD does not always catch coarctations of the aorta!

Sources:

• Raza S, Aggarwal S, Jenkins P, et al. Coarctation of the Aorta: Diagnosis and Management. Diagnostics (Basel). 2023;13(13):2189. Published 2023 Jun 27. doi:10.3390/diagnostics13132189
• Salciccioli KB, Zachariah JP. Coarctation of the Aorta: Modern Paradigms Across the Lifespan. Hypertension. 2023;80(10):1970-1979. doi:10.1161/HYPERTENSIONAHA.123.19454
• Parker LE, Landstrom AP. Genetic Etiology of Left-Sided Obstructive Heart Lesions: A Story in Development. J Am Heart Assoc. 2021;10(2):e019006. doi:10.1161/JAHA.120.019006

Does your child have a barking seal like cough? You better be thinking of croup! Join us on this resident-led episode today.

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

Key points:

• Croup, acute laryngotracheitis, a viral infection causing respiratory inflammation, bark like cough, and inspiratory stridor
• Westley score can be used to determine severity of croup
• Treatment for mild symptoms is humidified air and supportive care
• Treatment for moderate/severe symptoms is racemic epinephrine breathing treatment and IV dexamethasone
• Imaging can be considered to rule out bacterial tracheitis or epiglottitis if history and physical exam cannot narrow down the differential to croup
• Antibacterials not normally given unless concurrent infection



Reference:

• AAP Point of Care Quick Reference, Retzke, 2021. https://doi.org/10.1542/aap.ppcqr.396247
• Russell KF, Liang Y, O'Gorman K, Johnson DW, Klassen TP. Glucocorticoids for croup. Cochrane Database Syst Rev. 2011;(1):CD001955. Published 2011 Jan 19. doi:10.1002/14651858.CD001955.pub3
• Cochrane Database Syst Rev. 2018;10:CD006822. Epub 2018 Oct 29.
• Juliette Anderson. “Baby with Croup Stridor Barking Cough Visual & Audio Sound - When to Hospitalize.” YouTube, 14 Apr. 2011, www.youtube.com/watch?v=Qbn1Zw5CTbA. Accessed 3 Oct. 2024.

Don’t miss this “ear”-resistible episode on outer ear infections, also known as otitis externa or swimmer’s ear!

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Lena van Der List. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Think otitis externa when your patient has ear pain, ear drainage, decreased hearing, and swelling or debris in the ear canal.
• Treat otitis externa with otic aminoglycosides (neomycin, polymyxin B, trimethoprim-sulfate) when you have an intact tympanic membrane or fluoroquinolone (ciprofloxacin, ofloxacin) if you can’t visualize the tympanic membrane or there is a perforation

Sources:

Pediatrics in Review 2013, https://doi.org/10.1542/pir.34-3-143

Get a real ear-full of information today when we talk about the 2nd most common diagnosis in the pediatric emergency department, acute otitis media (AOM)!

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Lena Van der list. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Ear pain with a red bulging tympanic membrane and decreased tympanic membrane mobility is our diagnosis for acute otitis media.
• AOM can be due to bacteria (S. pneumoniae, H. influenza, and Moraxella) and viruses (influenza, adenovirus, human metapneumovirus)
• Treat AOM with high dose amoxicillin (cephalexin or azithromycin if penicillin allergy) or amoxicillin-clavulanate. Avoid complications like mastoiditis or tympanic membrane perforation

Sources:

• Pediatrics 2013, https://doi.org/10.1542/peds.2012-3488
• Stat Pearls 2023, https://www.ncbi.nlm.nih.gov/books/NBK470332/
• World Journal of Pediatrics 2024, https://doi.org/10.1007/s12519-023-00716-8
• University of Illinois Chicago: https://dig.pharmacy.uic.edu/faqs/2022-2/december-2022-faqs/what-evidence-supports-the-recommendation-for-high-dose-amoxicillin-in-children-with-acute-otitis-media/

In today’s episode, you’ll learn how to recognize and reduce this common pediatric orthopedic injury on your own and even teach parents if needed!

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Emily Andrada. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Nursemaid’s elbow, subluxation of the radial head, or annular ligament displacement all refer to the same injury of the elbow that occurs most often when a child’s arm is pronated and pulled.
• Treatment of a nursemaid’s is through reduction - either by supinating and flexing the elbow (or) pronating, hyperextending, and then flexing the elbow
• Imaging is not routinely indicated for highly suspicious nursemaid’s but should be considered if you have concern for fracture

Sources:

• Pediatrics in Review 2013, https://doi.org/10.1542/pir.34-8-366
• Pediatrics 2002, https://doi.org/10.1542/peds.110.1.171

Eur J Emerg Med 2009, https://doi.org/10.1097/MEJ.0b013e32831d796a

Learn how research continues to change our ability to detect and treat pediatric patients with hepatitis C in today’s episode.

This episode was written by Dr. Lidia Park and Dr. Tammy Yau with content support from Dr. Daniel Dodson. Drs. Lidia and Tammy take full responsibility for any errors or misinformation.

Key Points:

• Perinatal hepatitis C exposure is the most common cause of pediatric hepatitis C infection

• NAT testing for hepatitis C RNA can be done as early as 2 months of life to detect hepatitis C infection in pediatric patients rather than waiting until 18 months of life when hepatitis C antibody testing can be done

• Hepatitis C positive moms can still breastfeed but should halt breastfeeding temporarily if breasts are cracked or bleeding

Sources:

• CDC: CDC Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children — United States, 2023 | MMWR

• AAP Red Book 2024: Hepatitis C

Ever wonder what CCHD meant on a newborn discharge summary? Learn about how we screen for Critical Congenital Heart Defects in newborns (and which ones we miss!) in this episode.

This episode was written by Dr. Lidia Park and Dr. Tammy Yau with content support from Dr. Heather Siefkes. Drs. Lidia and Tammy take full responsibility for any errors or misinformation.



Key Points:

• Critical Congenital Heart Defects (CCHD) screening looks for heart defects that can be life threatening in infancy such as coarctation of the aorta, single ventricle defects like hypoplastic left heart syndrome, Tetralogy of Fallot (ToF), pulmonary atresia, total anomalous pulmonary venous return (TAPVR), transposition of the great arteries (TGA), and tricuspid atresia (TA).

• CCHD screening does not detect atrial septal defects (ASD), ventricular septal defects (VSD), or atrioventricular septal defects (AVSD)

• CCHD screening is performed by checking the pulse oximeter of the right hand and either foot of a newborn. SpO2 less than 90% is an automatic fail. SpO2 differences of 3% or more or SpO2 91-95% should be repeated twice before counting as a fail. Failed CCHD’s should be followed up with an echocardiogram.

Sources:

• CDC: Clinical Screening and Diagnosis for Critical Congenital Heart Defects | Congenital Heart Defects (CHDs) | CDC
• BMC Pediatric 2021, Jullien S. Newborn pulse oximetry screening for critical congenital heart defects. doi:10.1186/s12887-021-02520-7

• Pediatrics 2011, Kemper AR, Mahle WT, Martin GR, et al. Strategies for implementing screening for critical congenital heart disease. doi:10.1542/peds.2011-1317

Did you know that if you exercise while you have a fever, you probably meet SIRS criteria? The new Phoenix sepsis scoring systems aims to better categorize sepsis through specific categories based on the patient’s vitals, labs, and medications. Learn with us as we walk through this new scoring system in today’s episode.

This episode was written by Dr. Lidia Park and Dr. Tammy Yau with content support from Dr. Alexis Toney. Drs. Lidia and Tammy take full responsibility for any errors or misinformation.



Key Points:

• The Phoenix sepsis score is based out of 13 points. 2 or more points meets sepsis criteria. The score is based on 4 categories: respiratory, cardiovascular, coagulation, and neurologic.

• The Phoenix sepsis score is better at predicting mortality than SIRS criteria but does not predict morbidity

Sources:

• JAMA 2024, Schlapbach,“International Consensus Criteria for Pediatric Sepsis and Septic Shock”: doi: 10.1001/jama.2024.0179.

• Hospital Pediatrics 2023, Kusma, “Effect of Viral Illness on Procalcitonin as a Predictor of Bacterial Infection in Febrile Infants”: doi: 10.1542/hpeds.2022-007070