Can Patent Foramen Ovales Cause Problems?
Discussion During fetal development, the heart primum and secundum septa grow and overlap leaving a small but important channel between the two atria. The foramen ovale is a flap valve moving blood from the right atrium into the left atrium directly and bypassing the high pressure pulmonary system. After birth and breathing air, the neonate’s lungs open up and the pulmonary vascular resistance decreases. The left atrium now has a relatively higher pressure than the right atria, and therefore pressure on the flap valve closes the foramen ovale. Usually within 6-12 months, the fusion of the primum and secundum of the f...
Source: PediatricEducation.org - July 24, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Are Keloids Treated?
Discussion Wound healing is a complex process and abnormalities are common. Hypertrophic or keloid scarring are the two types of excessive scarring with both having excessive scar tissue that is elevated above the normal skin. Hypertrophic scarring occurs usually only within the wound and can regress. They are common after burns and develop within 3 months of skin injury. Keloid scarring spreads beyond the original wound and does not regress, and often recur. They can occur even 1 year after injury. Keloids have an incidence of 5-15%. “Compared to normal fibroblasts, keloidal fibroblasts have longer lives, higher pro...
Source: PediatricEducation.org - July 17, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What is the Diagnostic Yield for Genetic Testing of Children with Neurodevelopmental Delays?
Discussion Children having significant neurodevelopmental disabilities are common with 17% of 3-17 year olds children having some type of such disability. Many are recommended to have genetic testing. Three main reasons for testing are determining the etiology, potential availability of targeted treatment or intervention, and determination of recurrence risk. But there are other pros and some cons to genetic testing which include: Pros Diagnosis is determined Improved understanding of diagnosis, natural history and prognosis for patient and family including decreased anxiety/guilt “Can end the diagnostic odyssey...
Source: PediatricEducation.org - July 10, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Summer Break
PediatricEducation.org is taking a short break. The next case will be published on July 10th. In the meantime, please take a look at the different Archives and Curriculum Maps listed at the top of the page. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - July 3, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Can Boric Acid Be Used For?
Discussion Boron is possibly an essential trace element for humans and is found in water and plants. Common sources are apples, beans (cooked and dried), coffee, fruits, milk, and potatoes. Borates are used as cleaning agents, fertilizers, greasing agents, food preservatives, in fiberglass production, as an insecticide, and even to help prevent wet and dry rot in wood. They can be used to acidify or thicken fluids. Toxic borate exposure can occur through inhalation, or oral and dermal routes with non-intact skin being a bigger problem. Borate toxicity can cause abdominal pain, diarrhea, emesis, fever, irritability, seizure...
Source: PediatricEducation.org - June 26, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Potential Problems of Using Povidone-Iodine?
Discussion Povidone-iodine (polyvinylpyrrolidone iodine or PVP-I) is one of the most common antiseptics for more than 150 years. It is used for antisepsis mainly topically but also in mucosal cavities (i.e. mouth, nose, throat, vagina, etc.) or surfaces (i.e. umbilical cord). It has been used to treat chronic mucosal infections such as adult chronic rhinosinusitis. It’s irritant properties are used for chemical pleurodesis. A common trade solution is Betadine® which contains “90% water, 8.5% PVP and 1% available iodine and iodine with a free iodine concentration of 1 parts-per-million.” PVP-I is a brown/...
Source: PediatricEducation.org - June 19, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Some High or Low FODMAPs Foods?
Discussion FODMAPs is an acronym standing for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. It is a diet strategy which has shown improvement for some adult patients with functional abdominal pain including some with irritable bowel syndrome. The evidence in pediatrics is murky and more well-designed studies are needed; however such studies are difficult to complete. In general, there are 3 phases to this dietary strategy: Avoidance of all high FODMAP foods for 2-6 weeks. In some adult studies there has been improvement in 1 week. Especially in the pediatric age group, some people will only res...
Source: PediatricEducation.org - June 12, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

When Do Congenital Dermal Melanocytosis Lesions Resolve?
This study also had 1 patient with superimposed skin findings. This has been reported in other studies. Questions for Further Discussion 1. What are common skin lesions for major phakomatoses? A review can be found here 2. When is jaundice abnormal? Additional cases can be reviewed here 3. What is the natural history of capillary hemangiomas? Related Cases Disease: Congenital Dermal Melanocytosis or Mongolian Spots | Skin Pigmentation Disorders Symptom/Presentation: Pigmentary Lesions Specialty: Dermatology Age: Newborn To Learn More To view pediatric review articles on this topic from the past year check PubMed. Evidence-...
Source: PediatricEducation.org - June 5, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Late Spring Break
PediatricEducation.org is taking a short break. The next case will be published on June 5th. In the meantime, please take a look at the different Archives and Curriculum Maps listed at the top of the page. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - May 30, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Why Does He Rock His Body?
Discussion Stereotypies are “…patterned, repetitive, purposeless, involuntary movements that are also rhythmic and continual and tend to change little over time.” They occur at all times of the day, and can get worse with stress or heightened emotions including happiness. Stereotypies more often occur in children with developmental disabilities (up to 61%), sensory impairments (e.g. blindness) or social deprivation. They can be present more often in patients with autism (up to 88%). They can be seen in ~7% of normally developing children too. Their onset is before age 3 years and tend to improve over year...
Source: PediatricEducation.org - May 22, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Causes Pulmonary Edema?
Discussion Pulmonary edema is a potentially life threatening condition due to accumulation of excess fluid in the alveolar spaces and walls of the lung. Patients show increased respiratory effort or distress (e.g. tachypnea, dyspnea or difficulty talking, use of excessory muscles, nasal flaring, tracheal tugging, etc.) and clinicians should beware signs of tiring (e.g. bradypnea and decreased effort) as the patient may be failing. Patients may have rales or rhonchi on pulmonary examination, and pallor or color changes may be noted. Blood gas analysis shows evidence of hypoxemia and often hypercapnia depending on the severi...
Source: PediatricEducation.org - May 15, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are the Symptoms of Serotonin Syndrome?
Discussion Serotonin syndrome (SS) is a clinical diagnosis and problem which can be seen in patients of all ages. Classically SS presents with changing mental status, autonomic dysfunction and neuromuscular excitability. It is caused by increased serotonin levels because of therapeutically increasing the dose of a medication already being taken, adding an additional serotoninergic medication or one that potentiates serotonin, overlapping transition when changing medications, or intentional or unintentional overdose. It has become more common especially as selective serotonin reuptake inhibitors (SSRIs) have been used more ...
Source: PediatricEducation.org - May 8, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are the Classifications of Perinatal Stroke?
Discussion Perinatal stroke occurs in about 1:1000 live births and is a “focal vascular injury from the fetal period to 28 days postnatal age.” Perinatal stroke is the most common cause of hemiparetic cerebral palsy and causes other significant morbidity including cognitive deficits, learning disabilities, motor problems, sensory problems including visual and hearing disorders, epilepsy, and behavioral and psychological problems. Family members are also affected because of the potential anxiety and guilt feelings that having a child with a stroke presents, along with the care that may be needed over the child&#...
Source: PediatricEducation.org - May 1, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are the Goals of Hypospadias Repair?
Discussion Hypospadias is one of the most common congenital malformations and is the most common penile malformation. It is defined as the urethral opening occurring on the ventral side of the penis. Other ventral tissues can be affected thus other problems such as penile curvature and/or scrotal problems can also occur. Embryologically the penis is formed in the following way: “At the beginning of the ambisexual stage, the urethral groove [is] bounded by the urethral folds [and] extends about halfway distally along the ventral aspect of the elongating genital tubercle. At the distal aspect of the urethral groove is ...
Source: PediatricEducation.org - April 24, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How is Osgood-Schlatter Apophysitis Treated?
Discussion An apopysis is a secondary ossification center located at the tendinous insertion into a bone. Site irritation is called apophysitis and several proposed causes include genetics, rapid growth, trauma (compression or traction), anatomical differences and diet. Whatever the etiological factors, it causes pain. Examples include Sever’s disease of the calcaneus. Anterior knee pain is a common presenting problem in the pediatric age group, and the differential diagnosis is broad. Trauma, infection, tumors, and referred pain need to be considered but soft tissue problems tend to predominate if not a traumatic ca...
Source: PediatricEducation.org - April 17, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news