Faculty Bibliography

Background: In NYC, pediatric pedestrians struck by motor vehicles account for thousands of visits to pediatric emergency departments. In 2007, approximately 60 children were killed due to this mechanism of injury. Currently, NY State collects retrospective information of admitted pediatric pedestrians injured. Objectives: Our goal is to collect comprehensive information prospectively of all children injured as a pedestrian or cyclist vs. motor vehicle. This novel project will allow better delineation of risk factors to target injury prevention. Methods: We have developed a prospective database of all pedestrians/cyclists injured or killed by motor vehicles from December 22, 2008 until present. A pediatric patient is defined as age < 18 years. Information regarding circumstances of incident, injury information, and hospital course were obtained from patient, guardian, emergency responders (paramedics, police, fire officers), and other sources (witnesses and medical record). Results: of 1000 patients, 116 (12%) were pediatric patients. The mean age was 11 years, with 40% of patients in the 6-12 age range. There was a male predominance. Eighty-five percent were pedestrians. One quarter of the cyclists were wearing a helmet. Fifty-two percent did not have adult supervision at the time of the incident. Five percent of incidents occurred within two blocks of school. Forty-two percent of patients were struck mid-block, 25% were darting out into the street, and two patients were boarding a bus. Eleven percent of patients were using an electronic device at time of injury. One patient reported cocaine and one patient was ethanol intoxicated. Twenty percent of patients had loss of consciousness and 6% had a GCS < 15 upon arrival. The injury severity score was greater than 10 in 9% of patients. Twenty-eight percent of patients were admitted. There were no mortalities. Conclusion: Pediatric pedestrians and cyclists struck by motor vehicles are a public health hazard. The majority of injuries are low acuity and result in few hospitalizations. Injury prevention strategies should focus on improving traffic safety knowledge and safety gear wearing in children. (Table Presented)

The Society of Radiologists in Ultrasound (SRU) convened a panel of specialists from gynecology, radiology, and pathology to arrive at a consensus regarding the management of ovarian and other adnexal cysts imaged sonographically in asymptomatic women. The panel met in Chicago, IL, on October 27-28, 2009, and drafted this consensus statement. The recommendations in this statement are based on analysis of current literature and common practice strategies, and are thought to represent a reasonable approach to asymptomatic ovarian and other adnexal cysts imaged at ultrasonography

OBJECTIVE: We aimed to determine the risk of SBIs in febrile infants with influenza virus infections and compare this risk with that of febrile infants without influenza infections. PATIENTS AND METHODS: We conducted a multicenter, prospective, cross-sectional study during 3 consecutive influenza seasons. All febrile infants <or=60 days of age evaluated at any of 5 participating pediatric EDs between October and March of 1998 through 2001 were eligible. We determined influenza virus status by rapid antigen detection. We evaluated infants with blood, urine, cerebrospinal fluid, and stool cultures. Urinary tract infection (UTI) was defined by single-pathogen growth of either >or=5 x 10(4) colony-forming units per mL or >or=10(4) colony-forming units per mL in association with a positive urinalysis. Bacteremia, bacterial meningitis, and bacterial enteritis were defined by growth of a known bacterial pathogen. SBI was defined as any of the 4 above-mentioned bacterial infections. RESULTS: During the 3-year study period, 1091 infants were enrolled. A total of 844 (77.4%) infants were tested for the influenza virus, of whom 123 (14.3%) tested positive. SBI status was determined in 809 (95.9%) of the 844 infants. Overall, 95 (11.7%) of the 809 infants tested for influenza virus had an SBI. Infants with influenza infections had a significantly lower prevalence of SBI (2.5%) and UTI (2.4%) when compared with infants who tested negative for the influenza virus. Although there were no cases of bacteremia, meningitis, or enteritis in the influenza-positive group, the differences between the 2 groups for these individual infections were not statistically significant. CONCLUSIONS: Febrile infants <or=60 days of age with influenza infections are at significantly lower risk of SBIs than febrile infants who are influenza-negative. Nevertheless, the rate of UTI remains appreciable in febrile, influenza-positive infants

PURPOSE OF REVIEW: The alleviation of vomiting due to gastroenteritis in children can help promote oral rehydration and prevent medical visits for dehydration. RECENT FINDINGS: Recent randomized, placebo-controlled trials of newer antiemetics, such as serotonin antagonists like ondansetron, have demonstrated efficacy in relief of vomiting, decreased need for intravenous fluid therapy and hospitalizations, without serious adverse effects. SUMMARY: The ability to arrest further vomiting and prevent intravenous fluid therapy and hospitalization aids children with vomiting so they may tolerate oral fluids and be discharged from medical care. This can reduce the medical care burdens and enhance patient satisfaction. This new pharmaceutical therapy may change how gastroenteritis is managed as it is studied further

In a multicenter prospective study, 91 of 1025 febrile infants <or=60 days of age had urinary tract infections. Among patients with urinary tract infections and without traumatic lumbar punctures, sterile cerebrospinal fluid pleocytosis was uncommon (0%-8%, depending on the definition) in contrast to earlier studies reporting this association.

PURPOSE OF REVIEW: Novel therapies, such as a heliox gaseous mixture and noninvasive bilevel positive pressure ventilation, are being utilized in the treatment of the patient with severe asthma who is unresponsive to conventional medical management. Aggressive treatment may prevent intubation and its untoward complications. RECENT FINDINGS: Both heliox and bilevel positive pressure ventilation have demonstrated clinical improvement in studies of patients refractory to standard care, both in adults and children. SUMMARY: The studies in children are limited but show promise, especially when these therapies are used early in the treatment course and in certain subsets of patients

PURPOSE OF REVIEW: Prescription and over-the-counter cough and cold medication abuse is rapidly becoming a national health concern for adolescents. Increased awareness of this growing epidemic is essential toward diagnosing, treating and preventing this type of substance abuse. RECENT FINDINGS: Data from surveys and poison control center records demonstrate an increased nonmedical use of prescription and over-the-counter cough and cold preparations, particularly those containing dextromethorphan. The nonmedical use of prescription medications may result in serious clinical effects with potential life-threatening complications, dependence and withdrawal syndromes. Dextromethorphan causes alterations in mental status that may contribute to judgment impairment leading to injury or fatality. Co-ingestion of other substances found in over-the-counter medications may also cause significant morbidity. Alcohol and illicit drug use is highly associated with the abuse of these medications. The incentive for abuse, such as easy accessibility, low cost and decreased perception of potential for harm, and potential interventions are described. SUMMARY: The recent trend of prescription and dextromethorphan-containing over-the-counter medication abuse in adolescents is alarming. Improved awareness for these readily available, seemingly benign yet highly dangerous medications is essential. Prevention and early education on substance abuse in young teens are critical in combating this recent epidemic

PURPOSE: We describe our experience with fetuses diagnosed with life-threatening chest masses who were delivered by ex utero intrapartum treatment with placement on extracorporeal membrane oxygenation (EXIT-to-ECMO). METHODS: The first fetus presented with a cystic mediastinal mass and enlarging echogenic lungs. Bronchoscopic evaluation during ex utero intrapartum treatment (EXIT) revealed complete airway obstruction secondary to a carinal bronchogenic cyst. The second fetus presented with a massive left congenital cystic adenomatoid malformation. The EXIT procedure was performed because of significant mediastinal shift, severe compression of the normal lung parenchyma, and signs of fetal distress. RESULTS: In both cases, extracorporeal membrane oxygenation (ECMO) was initiated while on placental support. The fetuses were then delivered, and a definitive resection of their thoracic lesions was successfully performed. There were no major perioperative complications. Both children made expedient recoveries without significant cardiopulmonary sequelae. CONCLUSION: To our knowledge, this is the first report describing the successful use of EXIT-to-ECMO as a bridge to definitive resection of large chest masses diagnosed in utero. EXIT-to-ECMO is a novel and effective management strategy for stabilizing patients with profound respiratory compromise secondary to congenital thoracic lesions.

PURPOSE: Childhood injuries are the leading cause of death in children and result in significant healthcare utilization. Injuries specifically related to all terrain vehicles, trampolines and scooter usage can be devastating and are often preventable. Our understanding of how and why these injuries occur can aid in preventing morbidity and mortality. RECENT FINDINGS: The popularity of all-terrain vehicles, nonmotorized scooters and trampolines has soared over recent years. This increased usage has led to a tremendous rise in injuries in children utilizing these recreational activities. Many of the injuries occur in younger children who may not possess the motor and cognitive skills necessary to safely engage in these activities. These activities lead to a number of head and extremity injuries, most of which can be attenuated by the use of protective gear such as helmets and protective padding. SUMMARY: Understanding the nature of these injuries can lead to advocacy and hopefully legislation to prevent further injuries from occurring

Objective. Previous research has identified clinical predictors for urinary tract infection (UTI) to guide urine screening in febrile children < 24 months of age. These studies have been limited to single centers, and few have focused on young infants who may be most at risk for complications if a UTI is missed. The objective of this study was to identify clinical and demographic factors associated with UTI in febrile infants who are < 60 days of age using a prospective multicenter cohort. Methods. We conducted a multicenter, prospective, cross- sectional study during consecutive bronchiolitis seasons. All febrile (>= 38 degrees C) infants who were < 60 days of age and seen at any of 8 pediatric emergency departments from October through March 1999 - 2001 were eligible. Clinical appearance was evaluated using the Yale Observation Scale. UTI was defined as growth of a known bacterial pathogen from a catheterized specimen at a level of (1) >= 50 000 cfu/mL or (2) >= 10 000 cfu/mL in association with a positive dipstick test or urinalysis. We used bivariate tests and multiple logistic regression to identify demographic and clinical factors that were associated with the likelihood of UTI. Results. A total of 1025 (67%) of 1513 eligible patients were enrolled; 9.0% of enrolled infants received a diagnosis of UTI. Uncircumcised male infants had a higher rate of UTI (21.3%) compared with female (5.0%) and circumcised male (2.3%) infants. Infants with maximum recorded temperature of >= 39 degrees C had a higher rate of UTI (16.3%) than other infants ( 7.2%). After multivariable adjustment, UTI was associated with being uncircumcised (odds ratio: 10.4; bias- corrected 95% confidence interval: 4.7 - 31.4) and maximum temperature (odds ratio: 2.4 per degrees C; 95% confidence interval: 1.5 - 3.6). Factors that were reported previously to be associated with risk for UTI in infants and toddlers, such as white race and ill appearance, were not significantly associated with risk for UTI in this cohort of young infants. Conclusions. Being uncircumcised and height of fever were associated with UTI in febrile infants who were <= 60 days of age. Uncircumcised male infants were at particularly high risk and may warrant a different approach to screening and management