Pediatrics Subject Collection: Tumors

Index of Suspicion [ARTICLES]

Vo, M. — 2009-11-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion Case 2 Discussion Case 3 Discussion A previously healthy 9-year-old girl presents with a 1-week history of intermittent confusion, dysphagia, visual changes, and involuntary movements of the face and left hand. During this period, she has had two episodes of disorientation and memory loss that were not associated with alteration in consciousness or behavioral changes. The involuntary movements of the left arm and leg have become progressively worse throughout the week. The facial movements are described as lip smacking and excessive blinking. Four days ago, she complained of one episode of diplopia. She denies nausea, vomiting, fever, symptoms of uppe ...

Index of Suspicion [ARTICLES]

George, R. P. — 2009-10-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion Case 2 Discussion Footnotes Case 3 Discussion A 3[1/2]-year-old boy, who lives in the southeastern United States, is referred for evaluation of eosinophilia that was detected on laboratory tests performed during a routine health supervision visit. A few days ago, he had loose stools, without blood or mucus, associated with low-grade fever. He has no history of significant illness, allergies, respiratory symptoms, weight loss, sick contacts, or travel. He is not taking any medications. He lives with his mother, aunt, three siblings, four cousins, and two dogs in a rural area that has city water ...

Disparities in Access to Pediatric Neurooncological Surgery in the United States [ARTICLES]

Mukherjee, D. — 2009-10-01

OBJECTIVE: The objective of this study was to investigate whether disparities in access to high-volume centers for neurooncological care existed in the United States in 1988-2005. METHODS: A retrospective analysis of the Nationwide Inpatient Sample (1988-2005) was performed, with additional factors incorporated from the Area Resource File (2006). International Classification of Diseases, Ninth Revision, diagnosis/procedure coding was used to identify patients. High-volume centers were defined as those with [≥]50 neurosurgical cases per year. Patients >18 years of age were excluded. Covariates included age, gender, race, Charlson Index score, insurance, and county-level characteristics (including median home value, proportion of foreign born residents, and county neurosurgeon density). Multivariate analysis was performed by using multiple logistic regression models. P values of <.05 were considered statistically significant. RESULTS: A total of 4421 patients were identified; 1651 (37.34%) were admitted to high-volume centers. Overall access to high-volume centers improved slightly over the 18-year period (odds ratio [OR]: 1.04). Factors associated with greater access to high-volume centers included greater county neurosurgeon density (OR: 1.72) and greater county home value (OR: 1.66). Factors associated with worse access included Hispanic ethnicity (OR: 0.68) and each 1% increase in foreign residents per county (OR: 0.59). All reported P values were <.05. CONCLUSION: This study demonstrates that racial and socioeconomic disparities in access to high-volume neurooncological care exist for the pediatric population. We also identify numerous prehospital factors that potentially contribute to persistent disparities and may be amenable to change through national health policy interventions.

Thrombocytopenia in the Neonatal Intensive Care Unit [ARTICLES]

Saxonhouse, M. A. — 2009-09-01

As the survival of neonates cared for in the neonatal intensive care unit (NICU) has improved, hematologic issues have been recognized as clinically significant problems in this population. Thrombocytopenia, in particular, is a common finding among sick neonates, but there is considerable debate regarding the appropriate evaluation and management of affected infants. This article provides state-of-the art information on the pathophysiology, diagnosis, and treatment of neonatal thrombocytopenia. Specifically, the risks associated with low platelet counts in neonates are discussed, and a practical approach to the differential diagnosis of neonates who develop thrombocytopenia is provided. Current recommendations for the management of immune and nonimmune varieties of thrombocytopenia also are reviewed, with an emphasis on the risks and benefits associated with platelet transfusions in this age group.

Immune-mediated Neutropenia in the Neonate [ARTICLES]

Black, L. V. — 2009-09-01

Neutropenia is a relatively common finding in ill neonates, occurring in approximately 32,000 infants each year in the United States. In this patient population, immune-mediated neutropenia results from the antibody-mediated destruction of neutrophils and is associated with such disorders as alloimmune neonatal neutropenia, neonatal autoimmune neutropenia, and autoimmune neutropenia of infancy. Such conditions only recently have begun to be understood and often are problematic in terms of clinical identification and laboratory confirmation. This article reviews the clinical presentation, laboratory diagnosis, and treatment options for these three disorders.

Preeclampsia and Neonatal Neutropenia [ARTICLES]

Moallem, M. — 2009-09-01

Neutropenia is a common hematologic disorder in the newborn intensive care unit, particularly in preterm neonates. Although its cause varies, a significant proportion of the episodes are associated with pregnancy complicated by preeclampsia. In this review, we provide a brief overview of preeclampsia and neonatal neutropenia, with a focus on the neonatal neutropenia associated with maternal preeclampsia. We discuss potential contributory mechanisms to and the natural history of this type of neutropenia, as well as reasonable management strategies in affected neonates.

Index of Suspicion [ARTICLES]

Bekmezian, A. — 2009-08-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion Case 2 Discussion Case 3 Discussion References An 18-month-old boy presents with a 1-year history of poor weight gain and vomiting. He weighed 3.3 kg when born at term and was growing well until 6 months of age, when he was switched from human milk to formula. His appetite is poor and he vomits intermittently, some weeks with every meal. The emesis is nonbilious, is nonbloody, and usually occurs within 30 minutes of eating but occasionally several hours after eating. The vomiting seems to be worse when he is lying down and has not improved with metoclopramide, lansoprazole, or formula change. He has had no swallowing difficulty or choking. ...

Side Effects of Methylphenidate in Childhood Cancer Survivors: A Randomized Placebo-Controlled Trial [ARTICLES]

Conklin, H. M. — 2009-07-01

OBJECTIVES: To investigate the frequency and severity of side effects of methylphenidate among childhood survivors of acute lymphoblastic leukemia and brain tumors and identify predictors of higher adverse effect levels. METHODS: Childhood cancer survivors (N = 103) identified as having attention and learning problems completed a randomized, double-blind, 3-week, home-crossover trial of placebo, low-dose methylphenidate (0.3 mg/kg; 10 mg twice daily maximum) and moderate-dose methylphenidate (0.6 mg/kg; 20 mg twice daily maximum). Caregivers completed the Barkley Side Effects Rating Scale (SERS) at baseline and each week during the medication trial. Siblings of cancer survivors (N = 49) were recruited as a healthy comparison group. RESULTS: There was a significantly higher number and severity of symptoms endorsed on the SERS when patients were taking moderate dose compared with placebo or low dose, but not low dose compared with placebo. The number of side effects endorsed on the SERS was significantly lower during all 3 home-crossover weeks (placebo, low dose, moderate dose) when compared with baseline symptom scores. The severity of side effects was also significantly lower, compared with baseline screening, during placebo and low-dose weeks but not moderate-dose weeks. Both the number and severity of symptoms endorsed at baseline were significantly higher for patients compared with siblings. Female gender and lower IQ were associated with higher adverse effect levels. CONCLUSIONS: Methylphenidate is generally well tolerated by childhood cancer survivors. There is a subgroup at increased risk for side effects that may need to be closely monitored or prescribed a lower medication dose. The seemingly paradoxical findings of increased "side effects" at baseline must be considered when monitoring side effects and designing clinical trials.

Index of Suspicion [ARTICLES]

Rizkalla, N. — 2009-07-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion Case 2 Discussion Footnotes Case 3 Discussion References A 14-year-old Hispanic boy is evaluated for progressive difficulty in breathing through his nose and nosebleeds over the past 9 months. In the past week, he has produced blood-streaked sputum. He has lost 8 lb. He denies fevers, rashes, vomiting, easy bruising, headaches, or vision changes. He has received medications for sinusitis and allergies without improvement of his symptoms. Physical examination reveals a well-developed boy who looks pale and is breathing through his mouth. His temperature is 97.2{degrees}F (36.3{degrees}C), heart rate is 133 beats/min, ...

Index of Suspicion in the Nursery [ARTICLES]

Moussa, A. — 2009-07-01

Case Presentation Case Presentation Case Discussion References A newborn boy is admitted to the neonatal intensive care unit (NICU) because of pallor and respiratory distress. His mother is a 32-year-old primigravida, who has type 2 diabetes mellitus and whose pre-pregnancy treatment with metformin was changed to insulin early in the pregnancy. In the first trimester, the mother had a throat infection that was treated with clarithromycin. Results of routine antenatal serologic screening, ultrasonography, and fetal echocardiography were normal. The mother presented to hospital with decreased fetal movements at 36 weeks and 3 days of gestation. Electronic fetal heart rate monitoring (EFM) was performed (Fig. 1) and she returned home. Several hours later, after review ...