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Some Recent Updates in Pediatrics

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Dr KK Aggarwal, Group Editor-in-Chief IJCP Group    17 January 2018

  1. During a mumps outbreak at a university with over 20,000 enrolled students, almost all of whom had previously received two vaccine doses, nearly Renal ultrasound is recommended during the initial evaluation of hypertension in children <6 years of age and in those with abnormal urinalysis or renal function, and echocardiography is recommended only when pharmacologic therapy is being considered. Additional recommended lab testing for obese children with hypertension includes HbA1c, aspartate and alanine transaminases, and fasting lipid profile (Pediatrics. 2017;140).
  2. In the only randomized trial of epilepsy surgery to date in children with drug-resistant epilepsy, surgery plus medical therapy was superior to medical therapy alone on multiple 1-year outcomes, including rate of seizure freedom at 1 year (77% vs. 7%), seizure severity, quality-of-life, social maturity and child behavior (N Engl J Med. 2017;377:1639).
  3. After a febrile seizure, lumbar puncture to assess for infection can be avoided in most well-appearing children who have returned to their baseline, even when the febrile seizure has complex features (i.e., focal onset, >15 minutes in duration or recurrent within 24 hours). In a multicenter cohort study of more than 800 children age 6 months to 5 years presenting to a pediatric emergency department with a complex febrile seizure, rates of bacterial meningitis and herpes simplex encephalitis were 0.7% and 0%, respectively (Ann Emerg Med. 2017;70:52).
  4. New practice guidelines for hemodynamic support of pediatric and neonatal septic shock by the American College of Critical Care Medicine (ACCM) reiterates timely fluid administration, early initiation of broad-spectrum antibiotics, and, in patients with fluid refractory shock, prompt administration of vasoactive drug infusions (Crit Care Med. 2017;45(6):1061).

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