Pediatrics
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Influenza and other winter respiratory viruses cause substantial morbidity among children. Previous estimates of the burden of illness of these viruses have neglected to include the emergency department, where a large number of patients seek acute care for respiratory illnesses. This study provides city- and statewide population estimates of the burden of illness attributable to respiratory viruses for children receiving emergency department-based care for respiratory infections during the winter months. ⋯ There is a high incidence of emergency department visits for infectious respiratory illnesses among children. This important component of health care use should be included in estimates of the burden of illness attributable to influenza and other winter respiratory viruses.
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Case Reports
Insect bite-induced hypersensitivity and the SCRATCH principles: a new approach to papular urticaria.
Insect bites and the associated hypersensitivity reactions known as papular urticaria account for a significant number of all referrals from pediatricians and dermatologists to our pediatric dermatology clinic. Unfortunately, children affected by these eruptions are frequently misdiagnosed and often subject to expensive evaluations including invasive and unnecessary procedures. ⋯ On the basis of our clinical findings and experience with this patient population, we propose a set of principles (termed "SCRATCH") as clinical features to aid clinicians in making an early and accurate clinical diagnosis. We conclude that a more appropriate term for future study and diagnosis of this entity is insect bite-induced hypersensitivity.
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Here we report the reversal of cholestasis in 2 infants with intestinal failure and parenteral nutrition-associated liver disease. Treatment involved the substitution of a conventional intravenous fat emulsion with one containing primarily omega-3 fatty acids. ⋯ This suggests that fat emulsions made from fish oils may be an effective means of treating and preventing this often-fatal condition. A randomized, controlled trial is necessary to study the efficacy of this new approach to parenteral nutrition-associated liver disease.
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The purpose of this research was to describe hospital use patterns of HIV-infected children in the United States. ⋯ Infections account for the majority of hospitalizations of HIV-infected children in the United States, although nutritional deficiencies, anemia and other hematologic disorders, gastrointestinal and renal disorders, and complications of medical care are also more common among hospitalized children with HIV than among those without HIV.
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Performance measures are essential components of public reporting and quality improvement. To date, few such measures exist to provide a comprehensive assessment of the quality of emergency department services for children. ⋯ Using a structured panel process, data on emergency department use, and literature review, it was possible to define indicators of emergency department care for children. The feasibility of these indicators will depend on the availability of high-quality data.