Part 2 of our TORCH series discusses CMV, the most common infectious cause of hearing loss in the US.

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

Key points:

-Findings include blueberry muffin rash, microcephaly, periventricular calcifications, sensorineural hearing loss, and jaundice.

-Infection persists lifelong and treatment with valganciclovir is meant to prevent long term sequelae

-Monitor for myelosuppression with treatment.

-Frequent hearing screening is needed.

Sources:

AAP Red Book CMV chapter

Fowler KB, Boppana SB. Congenital cytomegalovirus infection. Semin Perinatol. 2018 Apr;42(3):149-154. doi: 10.1053/j.semperi.2018.02.002. Epub 2018 Mar 2. PMID: 29503048.

We are starting our mini-series on TORCH infections with congenital rubella, a rare disease nowadays in the US but prevalent still worldwide.

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected]

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

Key points:

-Think of this disease in infants of immigrant or under-immunized mothers.

-Findings include cataracts, retinopathy, PDA, hearing loss, blueberry muffin rash

-Treatment is supportive, with patients needing to isolate for at least several months.

-There is little evidence for immunoglobulin to prevent disease

Sources:

AAP Red Book chapter on Rubella

Lambert N, Strebel P, Orenstein W, Icenogle J, Poland GA. Rubella. Lancet. 2015 Jun 6;385(9984):2297-307. doi: 10.1016/S0140-6736(14)60539-0. Epub 2015 Jan 8. PMID: 25576992; PMCID: PMC4514442.

AAP 2010 Pediatrics in Review

https://publications.aap.org/pediatricsinreview/article-abstract/31/3/129/33128/Rubella?redirectedFrom=fulltext

In this *shocking​* episode, we discuss identifying and managing sepsis and septic shock in the pediatric population. This episode features two of our 2nd year pediatric residents, Victoria and Kat. We are so excited to have them join us and teach us about this very common chief complaint, especially for patients getting admitted to the hospital.

Follow us on Twitter/X @Pediagogypod and Instagram/Trheads @pediagogy and connect with us at [email protected]

This episode was written by Drs. Victoria Tran, Katrina Marks, Tammy Yau, and Lidia Park, with content support from Dr. Moonjoo Han. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points

• Defining and differentiating SIRS, sepsis, and septic shock. Identifying the symptoms of sepsis is important for appropriate patient triage.  
• SIRS comprises of constellation of symptoms. For SIRS criteria, 2 or more criteria must be met, which include hyper/hypothermia, leukocytosis/leukopenia, tachycardia/bradycardia, tachypnea. 
• SIRS + infectious source = sepsis
• Initial management of sepsis includes broad-spectrum antibiotics and fluid resuscitation with isotonic fluids (typically 10-20 cc/kg)

Sources: 

Weiss, Scott L. MD, MSCE, FCCM (Co-Vice Chair) et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatric Critical Care Medicine 21(2):p e52-e106, February 2020. | DOI: 10.1097/PCC.0000000000002198

Link: https://journals.lww.com/pccmjournal/Fulltext/2020/02000/Surviving_Sepsis_Campaign_International_Guidelines.20.aspx

Menon, Kusum et al. “A Prospective Multicenter Study of Adrenal Function in Critically Ill Children.” American journal of respiratory and critical care medicine: an official journal of the American Thoracic Society, medical section of the American Lung Association. 182.2 (2010): 246–251. Web.

In this episode, we have some special guests, Dr. Daniel Dodson, and one of our medical students, Aneri Patel, talk to us about Kawasaki disease. Special thanks to Dr. Natasha Nakra for content review.

Key points:

-Vasculitis with the clinical features in the mnemonic CRASH and Burn

-Incomplete Kawasaki has lab features including elevated ESR and CRP, thrombocytosis, hypoalbuminemia, anemia, elevated ALT, leukocytosis, and sterile pyuria.

-Treatment is to prevent coronary artery aneurysms with IVIG and aspirin.

References:

AAP Pediatrics in Review

https://publications.aap.org/pediatricsinreview/article/39/2/78/35139/Kawasaki-Disease?autologincheck=redirected

Infliximab and Kawasaki

https://www.sciencedirect.com/science/article/pii/S2352464221002704?via%3Dihub

Principles and Practices of Infectious Diseases, 6th edition

Let’s briefly discuss the new 2023 AAP obesity guidelines in this episode.

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

Key points:

-Obesity is now the most common chronic disease of childhood

-Children 10 years of age and older with obesity should have lipid, A1c, and ALT checked.

-Children ages 2-9 with obesity should have lipid checked and potentially ALT

-Treatment is multimodal and includes lifestyle modification, medications, and surgery.

AAP 2023 obesity guidelines:

https://publications.aap.org/pediatrics/article/151/2/e2022060640/190443/Clinical-Practice-Guideline-for-the-Evaluation-and

NPR: AAP’s new childhood obesity guidance raises worries over the risk of eating disorders

https://www.npr.org/2023/02/15/1155521908/eating-disorder-obesity-guidance-risk-weight-loss

USA Today: Weight loss drugs and surgery- for kids? Why new obesity guidance is drawing scrutiny

https://www.usatoday.com/story/news/health/2023/01/19/aap-childhood-obesity-guidelines-scrutiny/11039166002/

2012 Dyslipidemia Screening

https://publications.aap.org/pediatrics/article/146/1_MeetingAbstract/636/4732/Pediatric-dyslipidemia-screening-by-pediatricians

Want to quickly become a pro at family centered rounds? Learn the basics as well as the tips and tricks on how to navigate presenting in a patient-first and family-friendly way.

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected] 

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

Key points: 

-Family centered rounds should involve the patient, family, and all relevant medical team members. Allow space for everyone to be heard and opportunity for questions.

-Make sure to include all the same important information as a traditional presentation, but without medical jargon. Direct your presentation at the patient and family

Sources:

• 2021 AAP Hospital Pediatrics: https://publications.aap.org/hospitalpediatrics/article/11/7/679/179865/Implementing-Family-Centered-Rounds-in-Hospital?autologincheck=redirected 
• 2018 AAP Pediatrics: https://publications.aap.org/pediatrics/article-abstract/141/3/e20171883/37598/Families-Experiences-With-Pediatric-Family?redirectedFrom=fulltext 

2022 Michigan Medicine: https://www.ncbi.nlm.nih.gov/books/NBK582289/

Help my kid has a UTI! Does cranberry juice have any benefit for UTIs? Find out with us in today’s episode about urinary tract infections (UTIs)! 

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected] 

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

Key points: 

-A fever may be your only symptom in a young child with a UTI

-If you think it’s a UTI, get a clean specimen for culture. A positive culture has more than 50k CFUs/ml on a catheter sample and more than 100k CFUs/ml on a clean catch/void sample.

-Most common bacteria causing UTIs are E. coli, Klebsiella, Proteus, Enterococcus, and Enterobacter

-Simple cystitis may only need 3-10 days of treatment depending on age, whereas pyelonephritis needs 10-14 days.

Sources

• 2021 AAP UTI Management: https://publications.aap.org/pediatrics/article/147/2/e2020012138/36243/Contemporary-Management-of-Urinary-Tract-Infection 
• 2016 AAP Reaffirmation of Clinical Guideline: https://publications.aap.org/pediatrics/article/138/6/e20163026/52686/Reaffirmation-of-AAP-Clinical-Practice-Guideline 
• UTI risk calculator: https://uticalc.pitt.edu/ 
• CDC Urine Culture Stewardship: https://www.cdc.gov/hai/prevent/cauti/index.html 
• 2023 UTI treatment duration: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2806198 
• 2012 Cranberry Juice for UTIs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027998/ 
• 2020 Comparative Effectiveness of Antibiotic Treatment Duration in Children With Pyelonephritis: https://pubmed.ncbi.nlm.nih.gov/32364593/ 

Seizures can be scary and fevers aren't fun but we'll teach you why simple febrile seizures aren't so bad in this episode! 

Follow us on Twitter @Pediagogypod and connect with us at [email protected] 

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Shannon Liang, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation. 

Key points: 

-Simple febrile seizures are generalized, less than 15 minutes, and occur no more than once in a 24-hour period. 

-No work-up or treatment is recommended for simple febrile seizures 

Supplemental information 

2011 AAP Pediatrics guidelines: https://publications.aap.org/pediatrics/article/127/2/389/65189/Febrile-Seizures-Guideline-for-the-Neurodiagnostic  

2019 AAP Pediatrics - Post Vaccination Febrile Seizure Severity and Outcome https://publications.aap.org/pediatrics/article/143/5/e20182120/37133/Postvaccination-Febrile-Seizure-Severity-and 

2010 AAP Pediatrics - MMRV Combination Vaccine and the Risk of Febrile Seizures: https://publications.aap.org/pediatrics/article/126/1/e1/68346/Measles-Mumps-Rubella-Varicella-Combination 

Learn about management of newborn jaundice in our 2-part series. 

Follow us on Twitter @Pediagogypod and connect with us at [email protected] 

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Daphne Say, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation. 

Key points: 

-Unconjugated bilirubin is fat soluble so can cross the blood brain barrier and cause kernicterus 

-Check bilirubin levels at least every 24 hours while a newborn is first hospitalized 

-New AAP guidelines on hyperbilirubinemia management raised phototherapy and exchange transfusion thresholds 

-Transcutaneous bilirubin monitoring has a +/- 3 margin of error

Supplemental Information 

2022 AAP Pediatrics Guidelines: https://publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-of?autologincheck=redirected  

2012 Journal of Perinatology – Hyperbilirubinemia in Infants < 35 weeks gestation:  https://www.nature.com/articles/jp201271#Tab1  

2014 AAP Pediatrics - Transcutaneous Bilirubin After Phototherapy in Term and Preterm Infants https://publications.aap.org/pediatrics/article/134/5/e1324/75870/Transcutaneous-Bilirubin-After-Phototherapy-in?autologincheck=redirected 

In the first installment of this 2-part episode, we break down the causes of unconjugated (indirect) and conjugated (direct) hyperbilirubinemia. 

Follow us on Twitter @Pediagogypod and connect with us at [email protected] 

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Daphne Say, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation. 

Key points: 

-Unconjugated hyperbilirubinemia causes are due to increased bilirubin production, decreased liver conjugation, or decreased clearance 

-Conjugated hyperbilirubinemia can be due to outflow or transport problem, infection, metabolic disorders, liver dysfunction, and parenteral nutrition 

-Always consider biliary atresia in a newborn with pale white stools. The earlier the surgical treatment, the better outcomes 



Supplemental Information 

2017 Pediatrics in Review - Jaundice: Newborn to Age 2 months https://publications.aap.org/pediatricsinreview/article/38/11/499/35001/Jaundice-Newborn-to-Age-2-Months?autologincheck=redirected