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Welcome to the September 17 edition of The Differential. Created by physicians for physicians, this high-quality pediatrics briefing is designed to be quick (skim it in just a few minutes) and thorough (all the information you need is in this email).

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Single-Sentence Summaries

1. The AAP recommends pregnant and breastfeeding women abstain from marijuana due to both lack of safety evidence and strong theoretical justification for adverse outcomes for offspring. Pediatrics, Aug. 2018

2. Antibiotics account for 46% of pediatric ED visits for adverse drug events resulting from systemic medication. Journal of the Pediatric Infectious Diseases Society, Aug. 2018

3. Limiting repeat head CT imaging in children with traumatic epidural hematoma (EDH) to those with concerning neurologic findings or mass effect on initial exam could reduce unnecessary imaging by more than half. Pediatrics, Aug. 2018

4. Lithium monotherapy appears to be a reasonably safe and effective treatment for bipolar disorder in children and adolescents. European Psychiatry, Aug. 2018

5. While obese girls are 44% more likely to be depressed than normal-weight girls, there is no correlation between obesity and depression in boys. Archives of Disease in Childhood, July 2018

Clinical Quiz

A full-term infant develops increased work of breathing, expiratory grunting, and nasal flaring within two hours of birth. Examination reveals mild cyanosis and subcostal chest retractions. Her respiratory rate is 70 breaths per minute and arterial blood gas measurements show moderate hypoxemia. A chest X-ray demonstrates increased lung volumes with flat diaphragms, perihilar streaking, and fluid in the interlobar fissures. Which of the following is a risk factor for this patient’s most likely diagnosis?

A. Maternal obesity
B. Caesarean delivery
C. Maternal drug use
D. Multiple pregnancy

Answer at the bottom of this email, or click here to see the full case and discussion on Figure 1.

Editor’s Pearl

This week’s pearl comes from Dave Beard, BSN, RN and was originally shared by Clinical Advisor. “When swabbing your patient’s throat, have the patient ‘pant like a dog’ while you’re getting the swab. Breathing that fast prevents the gag reflex from taking over and you’ll get an accurate swab and a laugh from your patients, especially the pediatric patients. It’s a fun trick to show off and you’ll get better results.”

CLINICAL QUIZ ANSWER:

C. Cesarean delivery 

This patient’s presentation is characteristic of transient tachypnea of the newborn, a condition caused by a delayed clearance of fetal lung fluid. Appearing shortly after birth, this self-limited condition typically resolves with supportive treatment within 72 hours. Normally, during the labor process, maternal stress hormones stimulate alveolar fluid resorption in preparation for delivery. When the natural hormonal labor processes are interrupted or absent during cesarean deliveries, infants are at a higher risk of developing this condition.

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