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Welcome to the July 30 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). Today’s Differential is edited by Dr. Daniel Flanders, a pediatrician and adjunct lecturer at the University of Toronto.

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Single-Sentence Summaries

1. Teenagers who have high digital media usage rates are more likely to display symptoms of attention deficit disorder. JAMA, July 17, 2018

2. Patients who underwent CT scans as children had a 47% higher chance of developing certain types of brain cancer later in life. Journal of the National Cancer Institute, July 2018

3. Children raised by same-sex parents tend to have positive social and mental health outcomes. Journal of Developmental and Behavioral Pediatrics, May 2018

4. As part of a policy statement on food additives and child health, the AAP recommends reducing exposure to these chemicals by hand washing, avoiding certain plastic containers/liners, and prioritizing consumption of fresh or frozen fruits and vegetables. American Academy of Pediatrics, July 2018

5. Zika virus infection shows promise as a treatment for childhood neuroblastoma. PLoS ONE, July 2018

Clinical Quiz

An 11-month-old male with a two-day history of irritability and lethargy is brought to the emergency department by his mother. She reports that he has vomited four times today and has had fewer wet diapers than usual. He is up to date with his vaccinations. On examination, he is febrile, and a slight bulging of his anterior fontanel and neck stiffness are noted. Laboratory tests demonstrate a serum glucose of 75 mg/dL, and blood cultures and a lumbar puncture are performed. Analysis of the cerebrospinal fluid (CSF) reveals a predominance of neutrophils. Which additional CSF finding is most likely?

A. Glucose of 50mg/dL
B. Protein of 98 mg/dL
C. Glucose of 18mg/dL
D. White blood cell count of 90/microL

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 — The Pediatric Airway — comes from EMDocs.net. More details here.

  1. Position the child with the aid of rolled bed-sheets in order to align the oropharyngeal and tracheal axes.
  2. Both the Miller and Macintosh Blades are acceptable. Use what you are comfortable with.
  3. Although un-cuffed endotracheal tubes are generally used in children under eight years of age, cuffed tubes may be used in children one year and older, but probably should not be used in neonates.
  4. Recognize that children have both anatomic and physiologic differences relative to adults.
  5. For a difficult pediatric airway, consider jet insufflation.

CLINICAL QUIZ ANSWER:

B. Glucose of 18mg/dL

This patient’s findings are consistent with a diagnosis of meningitis, an inflammatory disease of the tissues surrounding the brain and spinal cord. The cloudiness of his CSF and the predominance of neutrophils present are suggestive of bacterial meningitis. Although there is some overlap in CSF findings for the different causes of meningitis, the CSF in bacterial meningitis typically has a low glucose concentration and a serum to glucose ratio less than 0.6.

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