Current opinion in pediatrics
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The ex-utero intrapartum treatment (EXIT procedure) can be life-saving for fetuses with large neck masses. Advances in fetal imaging and access to prenatal care have improved the ability to anticipate and plan for the treatment of these fetuses. This review will highlight advances in imaging techniques, modification of anesthesia and case selection for the EXIT procedure. Long-term maternal and fetal outcomes will also be discussed. ⋯ The EXIT procedure can be performed safely in a skilled multidisciplinary setting with minimal maternal and fetal morbidity and excellent fetal outcomes. Recent reports have helped further identify which fetuses will benefit from the EXIT procedure.
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Curr. Opin. Pediatr. · Jun 2012
ReviewBeyond appendicitis: evaluation and surgical treatment of pediatric acute abdominal pain.
Evaluation of the child with acute abdominal pain is challenging because of the wide range of potential diagnoses. Presenting symptoms, clinical examination, and laboratory findings can guide selection of diagnostic imaging. ⋯ Presenting symptoms and physical examination findings can narrow the number of potential diagnoses in pediatric acute abdominal pain and thereby guide diagnostic imaging selection. Abdominal/pelvic ultrasound, rather than computed tomography scan, is the preferred modality for initial evaluation of many potential causes of pediatric abdominal pain.
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There is currently limited ability to identify which infants and young children with recurrent wheezing will ultimately develop persistent asthma. In addition, it is not clear how risk factors influence the development of asthma in later childhood and adulthood. This review will discuss efforts to categorize these children with recurrent wheezing and develop asthma-predictive tools. ⋯ Heterogeneity of wheezing phenotypes may account for different responses to treatment and varied outcomes. Overlap in phenotypes and instability over time also add additional challenges to defining discrete groups of children with specific outcomes. Further studies are needed to determine combinations of variables that may improve phenotype designation with the goal of improving asthma prevention and treatment as well as predicting outcomes and understanding the pathogenesis of asthma.
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We review recommendations from recent publications on the management of fever with antipyretics, the classification and diagnosis of fevers of unknown origin (FUO), and the evaluation of fever in infants under 90 days of age. ⋯ Pediatricians should spend more time educating parents about fever and antipyretic use. Not all persistent fever is FUO, and testing should be targeted to the child's clinical condition. Existing low-risk criteria should be used to identify febrile infants who can be managed without extensive work-up and antibiotics. Adherence to evidence-based recommendations will lessen the morbidity and mortality associated with febrile illnesses in children.
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This review will examine the current evidence regarding pediatric blunt abdominal trauma and the physical exam findings, laboratory values, and radiographic imaging associated with the diagnosis of intra-abdominal injuries (IAI), as well as review the current literature on pediatric hollow viscus injuries and emergency department disposition after diagnosis. ⋯ Although the FAST exam is not recommended as the sole screening tool to rule out IAI in hemodynamically stable trauma patients, it may be used in conjunction with the physical exam and laboratory findings to identify children at risk for IAI. Children with a normal physical exam and normal abdominal CT may not require routine hospitalization after blunt abdominal trauma.