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E/M Medical Decision Making

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8721. Fever Without a Focus (Treatment)

children presenting with fever and leukopenia are also a concern, consider leukocytosis and leukopenia in making decisions about empiric antibiotic therapy. According to a recent study by Gomez et al, isolated leukopenia, especially in children without leukocyturia suggestive of a UTI, may not be a significant risk factor for SBI and viral etiologies may be considered more strongly. [ ] Patients aged 2-36 months may not require admission if they meet the following criteria: Patient was healthy prior (...) . Pediatrics . 2012 Dec. 130(6):e1455-62. . . Watt K, Waddle E, Jhaveri R. Changing epidemiology of serious bacterial infections in febrile infants without localizing signs. PLoS One . 2010 Aug 27. 5(8):e12448. . . Craig JC, Williams GJ, Jones M, Codarini M, Macaskill P, Hayen A, et al. The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ . 2010 Apr 20. 340:c1594. . . Mazzi E, Bartos

2014 eMedicine Pediatrics

8722. External Auditory Canal Atresia (Treatment)

of Dallas, University of Texas Southwestern Medical Center John E McClay, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Chief Editor Ravindhra G Elluru, MD, PhD Professor, Wright State University, Boonshoft School of Medicine; Pediatric Otolaryngologist, Department of Otolaryngology, Dayton Children's Hospital Medical Center Ravindhra G Elluru, MD, PhD is a member of the following medical societies: , , , , , , , , Disclosure: Nothing to disclose (...) binaural hearing and sound lateralization. [ , ] Interestingly, the actual anatomic configurations of the EAC have been demonstrated to affect the gain distribution and contribution to audition. [ ] Not all patients with unilateral atresia require surgery. Hearing, learning, and social issues must be considered for audiologic and surgical decision making. Additional amplification measures include a bone-anchored hearing aid (BAHA), [ ] a percutaneous device that conducts sound via bone. [ , ] A group

2014 eMedicine Pediatrics

8723. Ethical Issues in Neonatal Care (Treatment)

as they make decisions. Clinical practice guidelines have gained broad acceptance by healthcare managers and many clinicians in the past several years. Existing guidelines Medical futility or futile care Several US regions have developed clinical ethics guidelines to address this issue, including Houston, Texas; Charleston, South Carolina; Denver, Colorado; Sacramento, California; and the state of Georgia. Their appropriateness and applicability must be determined in the context of each individual case (...) of ethical import include the following: President's Commission for the Study of Ethical Problems in Medicine, and Biomedical and Behavioral Research. Seriously ill newborns. In: Deciding to Forego Life-Sustaining Treatment: A Report on the Ethical, Medical and Legal Issues in Treatment Decisions. Washington, DC: US Government Printing Office. 1983. [ ] The Hastings Center. Guidelines on the termination of life-sustaining treatment and the care of the dying. Washington, DC; 1987. [ ] American Academy

2014 eMedicine Pediatrics

8724. Hydrops Fetalis (Treatment)

antiarrhythmic medications (eg, digoxin) for fetal arrhythmia, and in-utero surgery (eg, fetal thoracocentesis/paracentesis, surgical resection). Decisions about fetal treatment are often uncertain and difficult, because the necessary evidence for a diagnosis as well as for balancing the risks against the benefits of a specific treatment is not available. Although many anecdotal approaches are found in the literature, no properly designed clinical trials are available for the clinician concerned (...) be associated with hydrops and are managed accordingly. Drainage of the pleural and abdominal cavities of pleural and ascitic fluid, respectively, may be necessary to adequately ventilate the infant. Next: Consultations Fetal hydrops should be considered a medical emergency that requires urgent referral to a maternal-fetal medicine specialist, allowing for detailed and comprehensive ultrasonographic examination and early identification of any treatable causes. Referral to a geneticist is also essential

2014 eMedicine Pediatrics

8725. Human Immunodeficiency Virus Infection (Treatment)

immune function Maximally and durably suppressing viral replication Minimizing drug-related toxicity Maintaining normal physical growth and neurocognitive development Improving quality of life The following are several important factors to consider in making treatment decisions about when to initiate antiretroviral therapy: Severity of HIV disease Risk of disease progression Laboratory assessments (eg, CD4 + count, plasma HIV RNA levels) Availability of appropriate and palatable drug formulations (...) be compliant. Such a device also is useful for nutritional supplementation. This option must be planned in advance because the potentially tenuous condition of children with advanced HIV can make surgical procedures risky. A home visiting nurse or a family member experienced in healthcare may be able to assist and instruct primary caregivers in giving medications. Previous Next: Deterrence/Prevention The risk of vertical transmission may be reduced. Most children are infected by means of vertical

2014 eMedicine Pediatrics

8726. Gaucher Disease (Treatment)

. Glucosylsphingosine is a reliable response biomarker in Gaucher disease. Am J Hematol . 2018 Jun. 93 (6):E140-E142. . Sidransky E, Pastores GM, Mori M. Dosing enzyme replacement therapy for Gaucher disease: older, but are we wiser?. Genet Med . 2009 Feb. 11(2):90-1. . . Cerdelga (eliglustat) prescribing information. [package insert]. IDA Industrial Park, Old Kilmeaden Road, Waterford, Ireland: Genzyme Ireland, Ltd. August 2014. Lowes, R. Medscape Medical News. FDA Clears Eliglustat (Cerdelga) for Gaucher Disease (...) . Available at . Harrison L. Evidence Mounting for Eliglustat in Gaucher's Disease. Medscape Medical News. Available at . Accessed: November 10, 2014. Zimran A, Altarescu G, Phillips M, Attias D, Jmoudiak M, Deeb M. Phase I/II and extension study of velaglucerase alfa (Gene-ActivatedTM human glucocerebrosidase) replacement therapy in adults with type 1 Gaucher disease: 48-month experience. Blood . 2010 Mar 18. . Sidransky E, Pastores GM, Mori M. Dosing enzyme replacement therapy for Gaucher disease: older

2014 eMedicine Pediatrics

8727. Genital Anomalies (Treatment)

):180-6. . Valentini AL, Giuliani M, Gui B, Laino M, Zecchi V, Rodolfino E, et al. Persistent Urogenital Sinus: Diagnostic Imaging for Clinical Management. What Does the Radiologist Need to Know?. Am J Perinatol . 2016 Apr. 33 (5):425-32. . Hendren WH. Management of cloacal malformations. Semin Pediatr Surg . 1997 Nov. 6(4):217-27. . Hendren WH. Urogenital sinus and cloacal malformations. Semin Pediatr Surg . 1996 Feb. 5(1):72-9. . Media Gallery Agenesis of scrotum in 6-month-old child. Agenesis (...) of Surgery, Virginia Commonwealth University School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond Harry P Koo, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief Editor Marc Cendron, MD Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston Marc Cendron, MD is a member of the following medical societies: , , , , , , Disclosure

2014 eMedicine Pediatrics

8728. Gonorrhea (Treatment)

Bennett, MB, BCh, PhD, is a member of the following medical societies: and Disclosure: Nothing to disclose. John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance John L Brusch, MD, FACP is a member of the following medical societies: and Disclosure: Nothing to disclose. David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department (...) and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University Joseph Domachowske, MD is a member of the following medical societies: , , , , , and Disclosure: Nothing to disclose. Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York Dirk M Elston, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Renuka Heddurshetti, MD Fellow in Infectious Diseases, Department of Internal Medicine

2014 eMedicine Pediatrics

8729. Genital Anomalies (Overview)

):180-6. . Valentini AL, Giuliani M, Gui B, Laino M, Zecchi V, Rodolfino E, et al. Persistent Urogenital Sinus: Diagnostic Imaging for Clinical Management. What Does the Radiologist Need to Know?. Am J Perinatol . 2016 Apr. 33 (5):425-32. . Hendren WH. Management of cloacal malformations. Semin Pediatr Surg . 1997 Nov. 6(4):217-27. . Hendren WH. Urogenital sinus and cloacal malformations. Semin Pediatr Surg . 1996 Feb. 5(1):72-9. . Media Gallery Agenesis of scrotum in 6-month-old child. Agenesis (...) of Surgery, Virginia Commonwealth University School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond Harry P Koo, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief Editor Marc Cendron, MD Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston Marc Cendron, MD is a member of the following medical societies: , , , , , , Disclosure

2014 eMedicine Pediatrics

8730. Fragile X Syndrome (Overview)

, Lachiewicz A, Barbouth D, et al. Fragile X syndrome: a review of associated medical problems. Pediatrics . 2014 Nov. 134 (5):995-1005. . . Lachiewicz AM, Dawson DV, Spiridigliozzi GA. Physical characteristics of young boys with fragile X syndrome: reasons for difficulties in making a diagnosis in young males. Am J Med Genet . 2000 Jun 5. 92(4):229-36. . Yrigollen CM, Durbin-Johnson B, Gane L, et al. AGG interruptions within the maternal FMR1 gene reduce the risk of offspring with fragile X syndrome (...) SL, Finucane B, et al. Newborn, carrier, and early childhood screening recommendations for fragile x. Pediatrics . 2012 Dec. 130(6):1126-35. . Bailey DB Jr, Raspa M, Bishop E, Holiday D. No change in the age of diagnosis for fragile x syndrome: findings from a national parent survey. Pediatrics . 2009 Aug. 124(2):527-33. . de Vries BB, Halley DJ, Oostra BA, Niermeijer MF. The fragile X syndrome. J Med Genet . 1998 Jul. 35(7):579-89. . Hagerman RJ, Berry-Kravis E, Kaufmann WE, Ono MY, Tartaglia N

2014 eMedicine Pediatrics

8731. Fever Without a Focus (Overview)

signs. PLoS One . 2010 Aug 27. 5(8):e12448. . . Craig JC, Williams GJ, Jones M, Codarini M, Macaskill P, Hayen A, et al. The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ . 2010 Apr 20. 340:c1594. . . Mazzi E, Bartos AE, Carlin J, Weber MW, Darmstadt GL. Clinical signs predicting severe illness in young infants (J Trop Pediatr. 2010 Oct. 56(5):307-16. . McCarthy PL (...) , MD, FAAP Director, Pediatric Lyme and Tick-Borne Diseases Center, Department of Pediatrics, Division of Pediatric Infectious Diseases, Stony Brook Children’s Hospital; Assistant Professor of Clinical Pediatrics, Department of Pediatrics, Division of Pediatric Infectious Diseases, Stony Brook University School of Medicine Saul R Hymes, MD, FAAP is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Specialty Editor Board Mary L Windle, PharmD Adjunct Associate

2014 eMedicine Pediatrics

8732. Human Milk and Lactation (Overview)

in Breastfeeding Medicine (2007). [ ] Below are the highlights of just some of many known immune properties and functions of human milk. Human milk immunoglobulins Human milk contains all of the different antibodies (M, A, D, G, E), but secretory immunoglobulin A (sIgA) is the most abundant. Milk-derived sIgA is a significant source of passively acquired immunity for the infant during the weeks before the endogenous production of sIgA occurs. During this time of reduced neonatal gut immune function, the infant (...) mother and newborn may be a strong factor; however, stronger cultural or societal barriers may result in the decision to formula feed. Such issues must be understood for successful counseling. The mother makes her decision regarding breastfeeding prior to delivery in more than 90% of cases; therefore, her choice of infant nutrition should be discussed starting in the second trimester and continue as part of an ongoing dialogue during each obstetric visit. This article reviews the development

2014 eMedicine Pediatrics

8733. Hydrops Fetalis (Overview)

, and idiopathic forms. Hematologic causes Hematologic causes that lead to profound anemia and have been recognized to trigger hydrops fetalis are summarized below. Isoimmunization (hemolytic disease of the newborn, erythroblastosis) includes the following: Rh (most commonly D; also C, c, E, e) Kell (K, k, Kp, Js[B]) ABO MNSs (M, to date) Duffy (Fy b ) Other hemolytic disorders include the following: Glucose phosphate isomerase deficiency (autosomal recessive) Pyruvate kinase deficiency (autosomal recessive (...) , glucose phophate isomerase deficiency), and their association with fetal hydrops is limited to one or two reports. G-6-PD deficiency is a more common, X-linked recessive disorder; however, G-6-PD has been infrequently associated with fetal hydrops. Making the diagnosis is important in these rare conditions, because they are compatible with a relatively normal life and fetal transfusions should be effective. Fetal RBC hemolysis from placental transfer of maternal immunoglobulin (Ig) G antibody against

2014 eMedicine Pediatrics

8734. History of Pediatric Liver Transplantation (Overview)

: , , , , , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Stuart M Greenstein, MD Professor of Surgery, Albert Einstein College of Medicine; Consulting Surgeon, Department of Surgery, Division of Transplantation, Montefiore Medical Center Stuart M Greenstein, MD (...) grafts. Ann Surg . 2004 Feb. 239(2):272-80. . Volk ML, Biggins SW, Huang MA, Argo CK, Fontana RJ, Anspach RR. Decision making in liver transplant selection committees: a multicenter study. Ann Intern Med . 2011 Oct 18. 155(8):503-8. . . United Network for Organ Sharing. Liver Transplantation. MELD/PELD Calculator. Available at . Bucuvalas JC, Ryckman FC. Long-term outcome after liver transplantation in children. Pediatr Transplant . 2002 Feb. 6(1):30-6. . McDiarmid SV. Management of the pediatric

2014 eMedicine Pediatrics

8735. Heterotaxy, Asplenia (Overview)

site. The duodenum heads to the left, the duodenal-jejunal junction is to the left of the spine (opposite to what would be expected for situs inversus totalis), and the jejunum (J) stays left-sided. of 6 Tables Contributor Information and Disclosures Author Alvin J Chin, MD Emeritus Professor of Pediatrics, University of Pennsylvania School of Medicine Disclosure: Nothing to disclose. Specialty Editor Board Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center (...) College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College Julian M Stewart, MD, PhD is a member of the following medical societies: , , Disclosure: Received research grant from: Lundbeck Pharmaceuticals
Received grant/research funds from Lundbeck Pharmaceuticals for none. Chief

2014 eMedicine Pediatrics

8736. Molluscum Contagiosum (Overview)

Dermatology, Department of Dermatology, Northwestern University, The Feinberg School of Medicine; Medical Director for Dermatologic Research, Director of Dermatologic, Laser and Cosmetic Surgery, Oak Dermatology Ashish C Bhatia, MD, FAAD, FACMS is a member of the following medical societies: , , , , , Disclosure: Nothing to disclose. Chief Editor Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine Dirk M (...) ; Director of Dermatologic Surgery and Dermatology, The Dermatology Institute of DuPage Medical Group Ashish C Bhatia, MD, FAAD is a member of the following medical societies: , , , , , , and Disclosure: Nothing to disclose. David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic David F Butler, MD is a member of the following medical societies

2014 eMedicine Pediatrics

8737. Motor Skills Disorder (Overview)

. [ ] Previous Next: Patient Education Children aged 6-7 years can be positively counseled to make modifications in school and in social situations to make the best of their limitations in motor tasks. Acknowledging these limitations and helping the children understand that this problem is not voluntary on their part and not due to lack of effort or intellectual skill is important. As with other chronic medical conditions, the patient can be helped to understand the nature of the condition, to live (...) . [Developmental coordination disorder: relations between deficits in movement and cognition]. Klin Padiatr . 2010 Jan-Feb. 222(1):26-34. . Bax M, Hart H, Jenkins SM. Developmental disorders. Child Development, Child Health . Blackwell Scientific; 1990. 106-48, 229-68. Gillberg C, Kadesjo B. Why bother about clumsiness? The implications of having developmental coordination disorder (DCD). Neural Plast . 2003. 10(1-2):59-68. . . Kopp S, Beckung E, Gillberg C. Developmental coordination disorder and other motor

2014 eMedicine Pediatrics

8738. Mitral Valve Insufficiency (Overview)

for management decision-making in patients with left-sided valvular regurgitation. Eur Heart J . 1996 Feb. 17(2):272-80. . Media Gallery Acute stage of mitral regurgitation (MR) (mitral valve insufficiency). Chronic compensated stage of mitral regurgitation (MR) (mitral valve insufficiency). Chronic decompensated stage of mitral regurgitation (MR) (mitral valve insufficiency). Dilated cardiomyopathy with significant mitral regurgitation (MR) (mitral valve insufficiency) by transthoracic echocardiogram (...) of the following medical societies: , , , , , Disclosure: Nothing to disclose. Specialty Editor Board Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College Julian M Stewart, MD, PhD is a member

2014 eMedicine Pediatrics

8739. Ethical and Legal Considerations in Pediatric Surgery (Overview)

as they make decisions. Clinical practice guidelines have gained broad acceptance by healthcare managers and many clinicians in the past several years. Existing guidelines Medical futility or futile care Several US regions have developed clinical ethics guidelines to address this issue, including Houston, Texas; Charleston, South Carolina; Denver, Colorado; Sacramento, California; and the state of Georgia. Their appropriateness and applicability must be determined in the context of each individual case (...) of ethical import include the following: President's Commission for the Study of Ethical Problems in Medicine, and Biomedical and Behavioral Research. Seriously ill newborns. In: Deciding to Forego Life-Sustaining Treatment: A Report on the Ethical, Medical and Legal Issues in Treatment Decisions. Washington, DC: US Government Printing Office. 1983. [ ] The Hastings Center. Guidelines on the termination of life-sustaining treatment and the care of the dying. Washington, DC; 1987. [ ] American Academy

2014 eMedicine Pediatrics

8740. Evaluation of the Pediatric Surgical Patient (Overview)

other symptoms, the character of pain, and the amount of blood loss. In addition, information on past medical and surgical history, medications, allergies, and immunization status, if available, may influence management decisions. Also, note the time when the child last ate or drank. Always keep the possibility of child abuse in mind. Have a high index of suspicion for nonaccidental injury if the pattern of injuries is inconsistent with the described mechanism or if several injuries of various (...) inherent in providing medical care for children. [ , , , ] Establishing a healthy and trusting relationship with the child, as well as the child’s parents or guardian, is essential. This article describes the general approach to treating the pediatric surgical patient. Care must be individualized; the approach may differ for newborns, infants, children, and adolescents and depends on the overall health of the patient. Parental considerations Complete care of the pediatric surgical patient includes

2014 eMedicine Pediatrics

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