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Welcome to the August 20th 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 CDC’s 2018 mid-year measles report found 107 cases in the U.S., nearly as many as in all of 2017. CDC, August 15, 2018

2. Acute gastroenteritis outbreaks are frequently reported at youth sleepaway camps, with norovirus, salmonella, and E.coli as the most commonly identified etiologies. Journal of the Pediatric Infectious Disease Society, Aug. 2, 2018

3. Girls exposed to secondhand smoke had increased odds of developing rheumatoid arthritis later in life. Rheumatology, Aug. 14, 2018

4. Children of mothers who received the prenatal tetanus, diphtheria, acellular pertussis (Tdap) vaccination had a reduced incidence of autism spectrum disorder (3.78 diagnosed with autism per 1,000 person-years with vaccination, 4.05 without vaccination). Pediatrics, 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 male is born to a healthy 32-year-old female. Newborn examination reveals generalized hypotonia, a distended abdomen with visible peristalsis and thin wrinkled skin, and an empty scrotum. A sweep along the inguinal canals bilaterally indicates that both testes are present. Which of the following is this patient most likely to develop?

A. Wilms tumor
B. Cecal volvulus
C. Chronic kidney disease
D. Rectal prolapse

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 @MikeGinnyMD, a pediatrician on Figure 1. In response to this case featuring a 17-year-old’s attempted overdose, he said: “In general, young men are more likely to actually try suicide with intent. Young women are more likely to ’gesture.’ Certainly not something to hang your hat on, but a general fact.”

CLINICAL QUIZ ANSWER:

C. Chronic kidney disease

This patient’s clinical findings are indicative of prune-belly syndrome (PBS), a rare congenital disorder characterized by the partial or complete absence of abdominal wall muscles, bilateral cryptorchidism in males, and urinary tract abnormalities. Gastrointestinal, musculoskeletal, and cardiopulmonary anomalies may also be present. Of the patients that survive infancy, approximately 50% will develop chronic kidney disease in childhood or adolescence. Bilateral kidney abnormalities on imaging, a serum creatinine concentration greater than 0.7 mg/dL (62 mcmol/L), and episodes of clinical pyelonephritis may be early indicators of an eventual diagnosis of chronic kidney disease.

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