The MCG Pediatric Podcast mcgpediatricpodcast

Did you know that undiagnosed developmental dysplasia of the hip (DDH) is the most common cause of arthritis in women under 40? Dr. Melissa Allen, a Pediatric Orthopedic Surgeon, joins 3rd year Pediatric Resident Erica DeMaagd and 4th year medical student Jacob Weiser to discuss the evaluation and management for DDH.  Specifically, they will teach how to: 
Recognize common history and physical exam findings associated with hip dysplasia.
Be able to formulate a differential diagnosis for hip dysplasia.
Understand the initial diagnostic approach to hip dysplasia.
Select appropriate imaging to evaluate for hip dysplasia.
Help parents understand initial treatment.
Create an appropriate disposition for patients with abnormal hip exams.
Recognize when to refer patients with hip dysplasia (condition) to orthopedic surgery (specialists).
Special thanks to Dr. Lisa Leggio and Dr. Rebecca Yang for peer reviewing this episode.
CME Credit (requires free sign up):  Link coming soon!
References:
Auriemma, J., & Potisek, N. M. (2018). Developmental dysplasia of the hip. Pediatrics In Review, 39(11), 570–572. https://doi.org/10.1542/pir.2017-0239
Barrera, C. A., Cohen, S. A., Sankar, W. N., Ho-Fung, V. M., Sze, R. W., & Nguyen, J. C. (2019). Imaging of Developmental Dysplasia of the hip: Ultrasound, Radiography and Magnetic Resonance Imaging. Pediatric Radiology, 49(12), 1652–1668. https://doi.org/10.1007/s00247-019-04504-3
Centers for Disease Control and Prevention. (2022, December 8). Important Milestones: Your Baby by One Year. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-1yr.html
Imrie, M., Scott, V., Stearns, P., Bastrom, T., & Mubarak, S. J. (2010). Is Ultrasound Screening for DDH in Babies Born Breech Sufficient? Journal of Children’s Orthopaedics, 4(1), 3–8. Larson, J. E., Patel, A. R., Weatherford, B., & Janicki, J. A. (2019). Timing of Pavlik Harness Initiation: Can We wait? Journal of Pediatric Orthopaedics, 39(7), 335–338. https://doi.org/10.1097/bpo.0000000000000930
Mahan, S. T., Katz, J. N., & Kim, Y.-J. (2009). To Screen or Not to Screen? A Decision Analysis of the Utility of Screening for Developmental Dysplasia of the Hip. The Journal of Bone and Joint Surgery-American Volume, 91(7), 1705–1719. https://doi.org/10.2106/jbjs.h.00122
Nemeth, B. A., & Narotam, V. (2012). Developmental Dysplasia of the Hip. Pediatrics in Review, 33(12), 553–561. https://doi.org/10.1542/pir.33-12-553
Novais, E. (2018). Pavlik Harness. Boston, MA; Boston Children’s Hospital Child and Young Adult Hip Preservation Program.
Shaw BA, Segal LS, AAP SECTION ON ORTHOPAEDICS. Evaluation and Referral for                                    Developmental Dysplasia of the Hip in Infants. Pediatrics. 2016;138(6):e20163107
Scott Yang, Natalie Zusman, Elizabeth Lieberman, Rachel Y. Goldstein; Developmental Dysplasia of the Hip. Pediatrics January 2019; 143 (1): e20181147. 10.1542/peds.2018-1147
 

Community acquired pneumonia is unfortunately a common condition seen in children of all ages. Dr. Jacob Eichenberger, an associate professor of pediatrics at MCG and a pediatric hospitalist at the Children's Hospital of Georgia, joins recently graduated pediatric resident, Dr. Fahim Thawer, and medical student Sara Attari to discuss the evaluation and management of community acquired pneumonia.
Specifically, they will:
• Discuss common history and physical exam findings associated with community acquired pneumonia• Formulate a differential diagnoses• Work through the initial diagnostic approach and treatment • Discuss prognosis and prevention

Coughs are one of the most common symptoms of childhood illness. But when should we start to get worried? What is a child’s cough trying to tell you? Dr. Sunil Kapoor, a Pediatric Pulmonology Physician, joins Dr. Rebecca Yang and medical student Aparna Prasad to discuss the evaluation and management of chronic cough in children.  Specifically, they will: 
Review the history and physical examination for a child presenting with a chronic cough
Discuss the treatment for the most common causes of cough in children
Evaluate the symptoms that suggest an underlying immunodeficiency
Review the criteria for a referral to pulmonology
Special thanks to Dr. Dionne Adair, Dr.Sunil Kapoor, and Dr. Rebecca Yang for peer reviewing this episode.
CME Credit (requires free sign up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19516 
References:
Marchant, J. (2021, September 30). Causes of chronic cough in children. UpToDate. Retrieved June 2, 2022, from https://www.uptodate.com/contents/causes-of-chronic-cough-in-children?search=common+causes+of+chronic+cough+in+young+kids&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1   
Chang, A. (2020, November 18). Approach to chronic cough in children. UpToDate. Retrieved June 2, 2022, from https://www.uptodate.com/contents/approach-to-chronic-cough-in-children?search=common+causes+of+chronic+cough+in+young+kids&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2   
Gregory, S. (2021, May 4). Asthma in children younger than 12 years: Overview of initiating therapy and monitoring control. UpToDate. Retrieved June 2, 2022, from https://www.uptodate.com/contents/asthma-in-children-younger-than-12-years-overview-of-initiating-therapy-and-monitoring-control?search=chronic+cough+in+children&topicRef=91328&source=related_link   
Pratter M. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 suppl):63S-71S.

Did you know around 15 to 25% of children will have at least one syncopal episode before adulthood? Join medical students Sanya Dudani and Caleb Robertson, along with Pediatric Cardiologist Dr. John Plowden, as they discuss the evaluation and management of syncope in the pediatric patient.  Specifically, they will:
Discuss the definition of syncope and its underlying pathophysiology
Recall the incidence and risk factors of syncope in the pediatric population
Describe the various etiologies and their distinguishing factors
Understand the proper approach to taking a history for a pediatric patient with a chief complaint of syncope
Recognize findings on the physical exam that help narrow the differential diagnosis
Understand the appropriate lab tests and imaging needed
Discuss when it's appropriate to refer patients to specialists
Special thanks to Dr. Rebecca Yang and Dr. Melissa Lefebvre for peer reviewing this episode!
CME Credit (requires free sign up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19514 
References:
Arthur W, Kaye GC  The pathophysiology of common causes of syncope  Postgraduate Medical Journal 2000;76:750-753.
Cipolla MJ. The Cerebral Circulation. San Rafael (CA): Morgan & Claypool Life Sciences; 2009. Chapter 5, Control of Cerebral Blood Flow. Available from: https://www.ncbi.nlm.nih.gov/books/NBK53082/
Clark, BC, Hayman, JM, Berul, CI, Burns, KM, and Kaltman, JR. Selective use of the electrocardiogram in pediatric preparticipation athletic examinations among pediatric primary care providers. Ann Noninvasive Electrocardiol. 2017; 22:e12446. https://doi.org/10.1111/anec.12446]
De, A. and Davidson Ward, S.L. (2014), Syncope at altitude: An enigmatic case. Pediatr Pulmonol., 49: E144-E146. https://doi.org/10.1002/ppul.23062
Gupta A, Menoch M, Levasseur K, Gonzalez IE. Screening Pediatric Patients in New-Onset Syncope (SPINS) Study. Clinical Pediatrics. 2020;59(2):127-133. doi:10.1177/0009922819885660
Hainsworth, R. Pathophysiology of syncope. Clin Auton Res 14 (Suppl 1), i18–i24 (2004). https://doi.org/10.1007/s10286-004-1004-2
Phillip A. Low, Paola Sandroni, Chapter 106 - Postural Tachycardia Syndrome (POTS), Editor(s): David Robertson, Italo Biaggioni, Geoffrey Burnstock, Phillip A. Low, Julian F.R. Paton, Primer on the Autonomic Nervous System (Third Edition), Academic Press, 2012, Pages 517-519, ISBN 9780123865250, https://doi.org/10.1016/B978-0-12-386525-0.00106-2
Zavala, Rennette MD∗; Metais, Benjamin MD†; Tuckfield, Lynnia BS‡; DelVecchio, Michael MD‡; Aronoff, Stephen MD, MBA‡. Pediatric Syncope: A Systematic Review. Pediatric Emergency Care: September 2020 - Volume 36 - Issue 9 - p 442-445 doi: 10.1097/PEC.0000000000002149 

Did you know that 80% of children with biliary atresia who undergo a Kasai procedure will still require liver transplant at some point in their life? Dr. Bade, a pediatric gastroenterologist, joins medical students Tucker Oliver and Sarah Chappell to discuss evaluation and management of infants with biliary atresia. Specifically, they will:
Discuss the presentation and diagnosis of biliary atresia
Explain pathophysiology behind jaundice
Discuss preoperative and postoperative recommendations for the Kasai procedure
Review complications and outcomes of the Kasai procedure
Share advice for navigating the diagnosis of biliary atresia with families
Special thanks to Dr. Rebecca Yang and Dr. Jennifer Tucker for peer reviewing this episode.
FREE CME Credit (requires free sign-up): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19513 
References: 
1]          P. J. Lupo et al., “Population-based birth defects data in the United States, 2010-2014: A focus on gastrointestinal defects.,” Birth Defects Res, vol. 109, no. 18, pp. 1504–1514, Nov. 2017, doi: 10.1002/bdr2.1145.
[2]         J. L. Hartley, M. Davenport, and D. A. Kelly, “Biliary atresia,” The Lancet, vol. 374, no. 9702, pp. 1704–1713, Nov. 2009, doi: 10.1016/S0140-6736(09)60946-6.
[3]         S. S. Sundaram, C. L. Mack, A. G. Feldman, and R. J. Sokol, “Biliary atresia: Indications and timing of liver transplantation and optimization of pretransplant care.,” Liver Transpl, vol. 23, no. 1, pp. 96–109, Jan. 2017, doi: 10.1002/lt.24640.
[4]         D. Volpert, F. White, M. J. Finegold, J. Molleston, M. DeBaun, and D. H. Perlmutter, “Outcome of Early Hepatic Portoenterostomy for Biliary Atresia,” J Pediatr Gastroenterol Nutr, vol. 32, no. 3, pp. 265–269, Mar. 2001, doi: 10.1097/00005176-200103000-00006.
[5]         R. Fawaz et al., “Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.,” J Pediatr Gastroenterol Nutr, vol. 64, no. 1, pp. 154–168, Jan. 2017, doi: 10.1097/MPG.0000000000001334.
[6]         P. H. Y. Chung et al., “Life long follow up and management strategies of patients living with native livers after Kasai portoenterostomy.,” Sci Rep, vol. 11, no. 1, p. 11207, May 2021, doi: 10.1038/s41598-021-90860-w.
[7]         E. H. Gad, Y. Kamel, T. A.-H. Salem, M. A.-H. Ali, and A. N. Sallam, “Short- and long-term outcomes after Kasai operation for type III biliary atresia: Twenty years of experience in a single tertiary Egyptian center-A retrospective cohort study.,” Ann Med Surg (Lond), vol. 62, pp. 302–314, Feb. 2021, doi: 10.1016/j.amsu.2021.01.052.
[8]         A. M. Calinescu et al., “Cholangitis Definition and Treatment after Kasai Hepatoportoenterostomy for Biliary Atresia: A Delphi Process and International Expert Panel.,” J Clin Med, vol. 11, no. 3, Jan. 2022, doi: 10.3390/jcm11030494.
[9]         S. Kiriyama et al., “Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos),” J Hepatobiliary Pancreat Sci, vol. 25, no. 1, pp. 17–30, Jan. 2018, doi: 10.1002/jhbp.512.
[10]      K. Decharun, C. M. Leys, K. W. West, and S. M. E. Finnell, “Prophylactic Antibiotics for Prevention of Cholangitis in Patients With Biliary Atresia Status Post-Kasai Portoenterostomy,” Clin Pediatr (Phila), vol. 55, no. 1, pp. 66–72, Jan. 2016, doi: 10.1177/0009922815594760.
[11]      E. Jung, W.-H. Park, and S.-O. Choi, “Late complications and current status of long-term survivals over 10 years after Kasai portoenterostomy.,” J Korean Surg Soc, vol. 81, no. 4, pp. 271–5, Oct. 2011, doi: 10.4174/jkss.2011.81.4.271.
[12]      S. S. Sundaram et al., “Health related quality of life in patients with

Did you know that salicylate containing substances alone were responsible for over 6,000 cases of pediatric poison exposures in 2020? Dr. Arden Conway, a Pediatric Critical Care Physician, joins Medical Students Morgan Franklin and Ifrah Waris to discuss the evaluation and management for salicylate overdose in a pediatric patient. Specifically, they will: 
• Review the pathophysiology of salicylate toxicity• Review the basic assessment skills for acutely ill pediatric patients• Discuss the diagnostic options and evaluation for a child presenting with a potential salicylate overdose• Discuss the management and monitoring of salicylate overdose• Medications and treatments reviewed: activated charcoal, elimination enhancement, hemodialysis • Discuss the potential complications of salicylate overdose
Special thanks to Dr. Rebecca Yang and Dr. Jennifer Tucker for peer reviewing this episode.
FREE CME Credit (requires free sign-up): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19512 
References: 
Anderson, M. (2021). Initial management of suspected poisoning in children and young people. Paediatrics and Child Health, 31(10), 382-387.
Chyka PA, Erdman AR, Christianson G, Wax PM, Booze LL, Manoguerra AS, Caravati EM, Nelson LS, Olson KR, Cobaugh DJ, Scharman EJ, Woolf AD, Troutman WG; Americal Association of Poison Control Centers; Healthcare Systems Bureau, Health Resources and Sevices Administration, Department of Health and Human Services. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131. doi: 10.1080/15563650600907140.
Darracq, M. A., & Cantrell, F. L. (20136). Hemodialysis and extracorporeal removal after pediatric and adolescent poisoning reported to a state poison center. The Journal of Emergency Medicine., 44(6), 1101–1107. https://doi.org/10.1016/j.jemermed.2012.12.018
Espírito Santo, R., Vaz, S., Jalles, F., Boto, L., & Abecasis, F. (2017). Salicylate Intoxication in an Infant: A Case Report. Drug safety - case reports, 4(1), 23. https://doi.org/10.1007/s40800-017-0065-9
Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Bronstein AC, Rivers LJ, Pham NPT, Weber J. 2020 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021 Dec;59(12):1282-1501. doi: 10.1080/15563650.2021.1989785.
Mukerji V, Alpert MA, Flaker GC, Beach CL, Weber RD. Cardiac conduction abnormalities and atrial arrhythmias associated with salicylate toxicity. Pharmacotherapy. 1986 Jan-Feb;6(1):41-3. doi: 10.1002/j.1875-9114.1986.tb03449.x.
Palmer, B. F., & Clegg, D. J. (2020). Salicylate toxicity. New England Journal of Medicine, 382(26), 2544-2555.
Runde TJ, Nappe TM. Salicylates Toxicity. [Updated 2021 Jul 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499879/