Pediagogy™

Toxoplasmosis is a parasitic TORCH infection that is often associated with cats but did you know owning a cat is not associated with increased prevalence? Learn more on how the disease is actually acquired and how to prevent infection in this episode!

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

Key points:

-Cats, undercooked meat, and raw seafood can lead to toxoplasmosis infection

-Findings of toxoplasmosis infection in utero include scattered intracranial calcifications and chorioretinitis

-Treat toxoplasmosis infection in neonates with pyrimethamine, sulfadiazine, and folinic acid

Sources:

AAP 2017 https://publications.aap.org/pediatrics/article/139/2/e20163860/59988/Diagnosis-Treatment-and-Prevention-of-Congenital?autologincheck=redirected

Learn about how the virus that causes cold sores can also cause serious complications in infants.

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

Key points:

-First time HSV infection in pregnancy is higher risk to infants than reactivation of previous infection

-Symptoms of neonatal HSV infection include seizures, vesicles, and irritability

-Diagnose HSV with viral culture or PCR of bodily fluids

-Use acyclovir to treat infants and pregnant people with HSV infection

Sources:

AAFP 2022 https://www.aafp.org/pubs/afp/issues/2002/0315/p1138.html 

Redbook 2021 https://publications.aap.org/redbook/book/347/chapter-abstract/5752755/Herpes-Simplex?redirectedFrom=fulltext 

Neoreview 2018 https://publications.aap.org/neoreviews/article/19/2/e89/87448/Neonatal-Herpes-Simplex-Virus-Infection

Despite widespread vaccination, there are still breakthroughs of varicella (commonly known as chicken pox). Let's dive into this episode of our TORCH series.

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

Key points:

-Transplacental varicella transmission can lead to congenital varicella syndrome which includes dermatomal rash, cicatrix, limb hypoplasia, microcephaly, and cataracts

-Use Acyclovir to treat neonates and pregnant people with active varicella infection. Congenital varicella syndrome does not require treatment.

-Varicella immunoglobulin can be used to prevent infection in certain cases including exposed neonates 5 days before delivery and 2 days after delivery.

Sources:

VZV in Newborns: Neoreviews (2016) 17 (9): e507–e514. https://doi.org/10.1542/neo.17-9-e507

TORCH infections: Pediatr Rev (2011) 32 (12): 537–542. https://doi.org/10.1542/pir.32-12-537

This week on our series on TORCH infections, we are discussing syphilis, an increasingly prevalent disease in the pediatric population.

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

Key points:

-Most congenital syphilis is asymptomatic. Less commonly will present with rash, snuffles, hepatosplenomegaly, anemia, and jaundice.

-Untreated disease can cause neurosyphilis and bone defects

-Compare mother's RPR titers to baby's and look for findings consistent with syphilis.

-Workup is based on whether mother was adequately treated and includes CBC, LP, skeletal survey, and LFTs.

-Treatment is with IV penicillin G for 10 days.

Sources:

AAP Red Book Syphilis chapter

Sankaran D, Partridge E, Lakshminrusimha S. Congenital Syphilis-An Illustrative Review. Children (Basel). 2023 Jul 29;10(8):1310. doi: 10.3390/children10081310. PMID: 37628309; PMCID: PMC10453258.

Fang J, Partridge E, Bautista GM, Sankaran D. Congenital Syphilis Epidemiology, Prevention, and Management in the United States: A 2022 Update. Cureus. 2022 Dec 27;14(12):e33009. doi: 10.7759/cureus.33009. PMID: 36712768; PMCID: PMC9879571.

https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf 

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.

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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:

-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.

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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/