scholarly journals Paranasal Mass in a Healthy Male Toddler

2021 ◽  
pp. 014556132110079
Author(s):  
Melonie Anne Phillips ◽  
Meredith Lind ◽  
Gerd McGwire ◽  
Diana Rodriguez ◽  
Suzanna Logan
Keyword(s):  
Differential Diagnosis ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Age Group ◽  
Significant Morbidity ◽  
Healthy Male ◽  
Neck Tumors ◽  
Complete Surgical Resection ◽  
Maxilla And Mandible ◽  
Benign Mass

Head and neck tumors are rare in pediatric patients but should be kept in the differential when a patient presents with a new swelling or mass. One of these tumors is a myxoma, which is an insidiously growing, benign mass originating from the mesenchyme. They most commonly arise in the myocardium but can also develop in facial structures, particularly in the maxilla and mandible. When arising in facial structures, ocular, respiratory, and digestive systems can be affected based on local invasion. Complete surgical resection is curative but can lead to significant morbidity as well. Here, we present a case of a 15-month-old toddler presenting with a paranasal mass, which was ultimately diagnosed as a maxillary myxoma. This tumor is very rare in the pediatric population, especially in the toddler age-group, reminding clinicians to broaden the differential diagnosis when a patient’s course is atypical.

scholarly journals Opioid Prescribing Patterns for Low Back Pain Among Commercially Insured Children

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tej D Azad ◽  
Michael D Harries ◽  
Daniel Vail ◽  
Yi Jonathan Zhang ◽  
John K Ratliff
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Prescribing Patterns ◽  
Low Back ◽  
Age Group ◽  
Newly Diagnosed ◽  
Opioid Prescription ◽  
Opioid Prescribing

Abstract INTRODUCTION Low back pain (LBP) may affect up to 20% of the pediatric population. No specific guidelines exist regarding pharmacotherapy for acute LBP in the pediatric population. Given this observation and the lack of data available regarding pharmacotherapy for pediatric LBP, we sought to characterize patterns of opioid prescribing in the pediatric population. METHODS We used a national database to identify pediatric patients (age 5-17) with newly diagnosed with LBP between 2008 and 2015 who did not have a red flag diagnosis, had not received an opioid prescription in the 6 mo prior to diagnosis, and had 12-mo of continuous enrollment after diagnosis. We used logistic regression to model the association between sex, geographic region, categorical age, and our primary outcome, receipt of an opioid prescription in the year following diagnosis. RESULTS Our sample included 268 228 opioid-naïve pediatric patients diagnosed with LBP between 2008 and 2015. We observed that 47 631 (17.8%) patients received physical therapy, 29 903 (11.2%) patients received chiropractic manipulative therapy, 658 (0.25%) patients received epidural steroid injection, and 281 (0.10%) patients received surgery. A total of 35 274 (13.2%) pediatric LBP patients were prescribed opioids within 12 mo from their diagnosis. Opioid prescribing decreased in all age groups over the study period age group 5 to 9 decreased from 4.2% to 2.7%, age group 10 to 14 decreased from 10.3% to 7.7%, and age group 15 to 18 yr decreased from 20.9% to 17.1%. Female pediatric patients were more likely than male patients to receive an opioid prescription (OR, 1.12, P < .0001). Patients ages 10 to 14 (OR, 2.89, P < .0001) and 15 to 18 (OR, 6.98, P < .0001) were significantly more likely to be prescribed opioids compared to patients in the youngest age group. CONCLUSION To our knowledge, we report the first observational cohort study of opioids and LBP in the pediatric population. Our findings indicate that opioids are being used for newly diagnosed LBP and receipt of opioids are associated with patient demographic factors.

Analysis of Warfarin Therapy in Pediatric Patients: A Prospective Cohort Study of 319 Patients

Blood ◽  
1999 ◽  
Vol 94 (9) ◽  
pp. 3007-3014 ◽  
Author(s):  
W. Streif ◽  
M. Andrew ◽  
V. Marzinotto ◽  
P. Massicotte ◽  
A.K.C. Chan ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Warfarin Therapy ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
International Normalized Ratio ◽  
Target Range ◽  
Age Group ◽  
Older Children ◽  
Effect Of Age ◽  
Fontan Patients

Abstract This study details warfarin use in a large pediatric population followed in a central anticoagulation clinic. A prospective, consecutive cohort of nonselected children were studied. Patients were divided into groups by age, target international normalized ratio (INR) range, disease, medications, and vitamin K supplemented enteral nutrition use. Groups were analyzed on multiple aspects of warfarin therapy using multivariate methods. A total of 319 patients received 352 warfarin courses representing 391 treatment years. Age independently influenced all aspects of therapy. When compared with all older children, the ≤1 year of age group required increased warfarin doses, longer overlap with heparin, longer time to achieve target INR ranges, more frequent INR testing and dose adjustments, and fewer INR values in the target range. Although significantly different than children ≤1 year, children 1 to 6 years of age showed the same findings when compared with 7- to 18-year-olds. Fontan patients required 25% decreased dosage as compared with other congenital heart disease patients. Children on corticosteroids had less INRs in the target range and children on phenobarbital/carbamazepine required increased maintenance dosages of warfarin. Also, patients receiving enteral nutrition required increased dosages of warfarin. Serious bleeding occurred in 2 children (0.5% per patient year). Recurrent thromboembolic events (TEs) occurred in 8 children. Two children had recurrences while receiving warfarin (1.3% per patient year). This study outlines the profound effect of age and relative complexity of clinical management of warfarin therapy in children.

scholarly journals Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions

2008 ◽  
Vol 24 (2) ◽  
pp. E16 ◽  
Author(s):  
Anand Veeravagu ◽  
Raphael Guzman ◽  
Chirag G. Patil ◽  
Lewis C. Hou ◽  
Marco Lee ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Moyamoya Disease ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Small Populations ◽  
Age Group ◽  
Radiological Findings ◽  
Advantages And Disadvantages ◽  
Pediatric Age Group ◽  
Revascularization Procedures

✓Neurosurgical interventions for moyamoya disease (MMD) in pediatric patients include direct, indirect, and combined revascularization procedures. Each technique has shown efficacy in the treatment of pediatric MMD; however, no single study has demonstrated the superiority of one technique over another. In this review, the authors explore the various studies focused on the use of these techniques for MMD in the pediatric population. They summarize the results of each study to clearly depict the clinical outcomes achieved at each institution that had utilized direct, indirect, or combined techniques. In certain studies, multiple techniques were used, and the clinical or radiological outcomes were compared accordingly. Direct techniques have been shown to aid a reduction in perioperative strokes and provide immediate revascularization to ischemic areas; however, these procedures are technically challenging, and not all pediatric patients are appropriate candidates. Indirect techniques have also shown efficacy in the pediatric population but may require a longer period for revascularization to occur and perfusion deficits to be reversed. The authors concluded that the clinical efficacy of one technique over another is still unclear, as most studies have had small populations and the same outcome measures have not been applied. Authors who compared direct and indirect techniques noted approximately equal clinical outcomes with differences in radiological findings. Additional, larger studies are needed to determine the advantages and disadvantages of the different techniques for the pediatric age group.

Analysis of Warfarin Therapy in Pediatric Patients: A Prospective Cohort Study of 319 Patients

Blood ◽  
1999 ◽  
Vol 94 (9) ◽  
pp. 3007-3014 ◽  
Author(s):  
W. Streif ◽  
M. Andrew ◽  
V. Marzinotto ◽  
P. Massicotte ◽  
A.K.C. Chan ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Warfarin Therapy ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
International Normalized Ratio ◽  
Target Range ◽  
Age Group ◽  
Older Children ◽  
Effect Of Age ◽  
Fontan Patients

This study details warfarin use in a large pediatric population followed in a central anticoagulation clinic. A prospective, consecutive cohort of nonselected children were studied. Patients were divided into groups by age, target international normalized ratio (INR) range, disease, medications, and vitamin K supplemented enteral nutrition use. Groups were analyzed on multiple aspects of warfarin therapy using multivariate methods. A total of 319 patients received 352 warfarin courses representing 391 treatment years. Age independently influenced all aspects of therapy. When compared with all older children, the ≤1 year of age group required increased warfarin doses, longer overlap with heparin, longer time to achieve target INR ranges, more frequent INR testing and dose adjustments, and fewer INR values in the target range. Although significantly different than children ≤1 year, children 1 to 6 years of age showed the same findings when compared with 7- to 18-year-olds. Fontan patients required 25% decreased dosage as compared with other congenital heart disease patients. Children on corticosteroids had less INRs in the target range and children on phenobarbital/carbamazepine required increased maintenance dosages of warfarin. Also, patients receiving enteral nutrition required increased dosages of warfarin. Serious bleeding occurred in 2 children (0.5% per patient year). Recurrent thromboembolic events (TEs) occurred in 8 children. Two children had recurrences while receiving warfarin (1.3% per patient year). This study outlines the profound effect of age and relative complexity of clinical management of warfarin therapy in children.

scholarly journals Stepwise School Opening Online and Off-line and an Impact on the Epidemiology of COVID-19 in the Pediatric Population

2020 ◽  
Author(s):  
Yoonsun Yoon ◽  
Kyung-Ran Kim ◽  
Hwanhee Park ◽  
So young Kim ◽  
Yae-Jean Kim
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Family Members ◽  
Press Release ◽  
School Closure ◽  
Older Age ◽  
Age Group ◽  
School Students ◽  
Younger Age ◽  
The Press

Background Data on SARS-CoV-2 transmission from a pediatric index patient to others at the school setting are limited. Epidemiologic data on pediatric COVID-19 cases after school opening is warranted. Methods We analyzed data of the pediatric patients with COVID-19 collected from the press release of the Korea Centers for Disease Control and Prevention. Information on the school opening delay and re-opening policies were achieved from the press release from Korean Ministry of Education. Findings The school openings were delayed three times in March 2020. Online classes started from April 9, and off-line classes started from May 20 to June 8 at four steps in different grades of students. There was no sudden increase in pediatric cases after the school opening, and the proportion of pediatric cases remained around 7.0% to 7.1%. As of July 11, 45 children from 40 schools and kindergartens were diagnosed with COVID-19 after off-line classes started. More than 11,000 students and staff were tested; only one additional student was found to be infected in the same classroom. Among those 45, 32 (71.1%) patients had available information for the source of infection. Twenty-five (25/45, 55.6%) were infected by the family members. The proportions of pediatric patients without information on infection sources were higher in older age group (middle and high school students) than in younger age group (kindergarten and elementary school students) (47.6% vs 12.5%, p=0.010). In the younger age group, 79.1% of children were infected by family members, while only 28.6% of adolescents in the older age group were infected by family members (p<0.001). Interpretation Korea had a successful transition from school closure to re-opening with online and off-line classes. Although partial, off-line school opening did not cause significant school-related outbreak among pediatric population although young children and adolescents may have different epidemiologic features.

Prevalence of Unique Pediatric Pathologies Encountered by Paramedic Students Across Age Groups

2016 ◽  
Vol 31 (4) ◽  
pp. 386-391 ◽  
Author(s):  
Eric V. Ernest ◽  
Tom B. Brazelton ◽  
Elliot D. Carhart ◽  
Jonathan R. Studnek ◽  
Patricia L. Tritt ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Saint Paul ◽  
Age Groups ◽  
Age Group ◽  
Pediatric Age ◽  
Provider Education ◽  
Publication Type ◽  
One Year

AbstractIntroductionTraditionally, Emergency Medical Services (EMS) educators have divided the pediatric population into age groups to assist in targeting their clinical and didactic curriculum. Currently, the accrediting body for paramedic training programs requires student exposure to pediatric patients based entirely on age without specifying exposure to specific pathologies within each age stratification. Identifying which pathologies are most common within the different pediatric age groups would allow educators to design curriculum targeting the most prevalent pathologies in each age group and incorporating the physiologic and psychological developmental milestones commonly seen at that age.HypothesisIt was hypothesized that there are unique clusterings of pathologies, represented by paramedic student primary impressions, that are found in different age groups which can be used to target provider education.MethodsThis is a retrospective review of prospectively collected data documented by paramedic students in the Fisdap (Field Internship Student Data Acquisition Project; Saint Paul, Minnesota USA) database over a one-year period. For the purposes of this study, pediatric patients were defined arbitrarily as those between the ages of 0-16 years. All paramedic student primary impressions recorded in Fisdap for patients aged 0-16 years were abstracted. Primary impression by age was calculated and graphed. The frequency of primary impression was then assessed for significance of trend by age with an alpha ≤.05 considered significant.ResultsThe following primary impressions showed clinically and statistically significant variability in prevalence among different pediatric age groups: respiratory distress, medical-other, abdominal pain, seizure, overdose/poisoning, behavioral, and cardiac. In patients less than 13 years old, respiratory and other-medical were the most common two primary impressions and both decreased with age. In patients 5-16 years old, the prevalence of abdominal pain and behavioral/psych increased. Bimodal distributions for overdose were seen with one spike in the toddler and another in the adolescent population. Seizures were most common in the age group associated with febrile seizure. Sepsis was seen most often in the youngest patients and its prevalence decreased with age.ConclusionThere are statistically significant variations in the frequency of paramedic student primary impressions as a function of age in the pediatric population. Emphasizing paramedic student exposure to the most common pathologies encountered in each age group, in the context of the psychological and physiological milestones of each age, may improve paramedic student pediatric practice.ErnestEV, BrazeltonTB, CarhartED, StudnekJR, TrittPL, PhilipGA, BurnettAM. Prevalence of unique pediatric pathologies encountered by paramedic students across age groups. Prehosp Disaster Med. 2016; 31(4):386–391.

scholarly journals Lethality by COVID-19 in children: an integrative review

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Márcia Andrade ◽  
Joel Lamounier ◽  
Taynara Paiva ◽  
Priscila Leite ◽  
Emylle Silva
Keyword(s):  
Heart Disease ◽  
Literature Review ◽  
Full Text ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Publication Date ◽  
Age Group ◽  
Inclusion Criteria ◽  
Keywords Children ◽  
Epidemiological Characteristics

OBJECTIVES: To characterize the clinical and epidemiological characteristics of deceased pediatric patients with COVID-19. METHODS: It was performed an integrative literature review with the keywords “children”, “COVID-19” and “death” and the boolean “AND” on the databases SciELO, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Embase and ScienceDirect. The results were filtered by publication date (January 1st to June 30th) and by language (Portuguese, English and Spanish). The inclusion criteria were: articles with proven or probable pediatric COVID-19 cases and full text in Portuguese, English or Spanish. Articles with no full text available in the above-mentioned languages, non-pediatric population and editorials were excluded. Brazilian data were analyzed based on epidemiological reports from each state of the country. RESULTS: 24 articles were analyzed, with a total of 17 deaths among pediatric COVID-19 patients. There was no data available about age of 9 patients and about comorbidities of 14 patients. Brazil had 357 pediatric deaths and 182 of them were on the age group 0-9 years. The most frequent comorbidities were heart disease and diabetes. CONCLUSIONS: Despite the low distribution of deaths among pediatric COVID-19 patients, it is important to point out that they are still carriers of the disease.

Pediatric Lymphangiography: Imaging to Intervention

2019 ◽  
Vol 03 (03) ◽  
pp. 203-213
Author(s):  
Shimwoo Lee ◽  
Aarti P. Luhar ◽  
Edward Wolfgang Lee ◽  
Sanjay Sinha ◽  
Ravi N. Srinivasa
Keyword(s):  
Fluid Transport ◽  
Pediatric Patients ◽  
Lymphatic System ◽  
Pediatric Population ◽  
Immune Recognition ◽  
Significant Morbidity ◽  
Resonance Imaging ◽  
Lymphatic Malformations ◽  
Lymphatic Flow ◽  
Image Guided

AbstractThe lymphatic system plays a crucial role in fluid transport as well as facilitating immune recognition. Disruption of lymphatic flow can lead to significant morbidity and mortality in the pediatric population, manifesting as lymphatic malformations and lymphatic leaks. There has been rising interest in developing minimally invasive image-guided approaches to diagnose and treat lymphatic disorders in pediatric patients. Notably, magnetic resonance imaging of the lymphatic system has emerged as a promising diagnostic tool. Moreover, interventions such as sclerotherapy and thoracic duct embolization for treatment of lymphatic malformations and leaks have come forth as safe and effective alternatives to surgery. The aim of this article is to review various pediatric lymphatic disorders and discuss advances in image-guided diagnostic and therapeutic options for these entities.

Hypoxemia without Respiratory Distress: Hereditary Hemorrhagic Telangiectasia in a Child

2020 ◽  
Author(s):  
Michael D. McCann ◽  
Claire Newlon ◽  
Conrad Krawiec
Keyword(s):  
Hereditary Hemorrhagic Telangiectasia ◽  
Arteriovenous Malformations ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Genetic Disorder ◽  
Significant Morbidity ◽  
Younger Patients ◽  
Life Threatening ◽  
Symptoms And Signs ◽  
Over Time

AbstractHereditary hemorrhagic telangiectasia (HHT) is an underrecognized genetic disorder of vascular development in pediatric patients. Its presentation can range from mild cutaneous findings to life-threatening hemorrhage from arteriovenous malformations. Clinical diagnosis can be challenging in the pediatric population as disease manifestations evolve over time and may be difficult to identify in younger patients. This case highlights how nonspecific symptoms and signs in the preanesthesia period can be misleading, potentially placing a patient with unrecognized HHT at risk for significant morbidity and mortality.

Suitability of the Subaxial Cervical Laminae for Laminar Screws in the Pediatric Population: A Radiologic Anatomical Study

2021 ◽  
pp. 1-7
Author(s):  
Feyza Karagoz Guzey ◽  
Ilker Gulec ◽  
Burak Eren
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Spinous Process ◽  
Age Groups ◽  
Anatomical Study ◽  
Age Group ◽  
Safety And Efficacy ◽  
Laminar Screw ◽  
Significant Difference ◽  
Laminar Thickness

<b><i>Introduction:</i></b> The laminar screw method was popularized during recent years. Since no data exist in the literature on its suitability for subaxial levels in the pediatric population, a radiologic anatomical study was planned to evaluate the suitability of the laminae for laminar screws in children. <b><i>Methods:</i></b> The laminar thicknesses from C3 to C7 were measured in axial sections in 120 pediatric patients using computed tomography. The patients were divided into 3 age-groups: ages 4–6, 7–9, and 10–12. Each age-group consisted of 20 boys and 20 girls. The suitability of the laminae was evaluated for 3.5-mm-thick commercially available screws and also for the 3-mm screws that could be produced in the future. If the height of the base of the spinous process is ≥ 9 mm, the segment was accepted as suitable for the bilateral screw, and ≥5 mm is for the unilateral screw. Additionally, laminar thickness and length were measured for possible short screws longer than 15 mm in the laminae that were distally thin but proximally thick. <b><i>Results:</i></b> The C4 and C5 levels had the thinnest (2.77 ± 0.6 mm and 2.81 ± 0.6 mm, respectively) and C7 had the thickest laminae (4.66 ± 0.6 mm) in all age-groups. No significant differences were found between boys and girls and right and left laminae. According to the age-groups, an increase in laminar thickness was possible by growing, but only C7 laminae thickness was statistically different between 10–12 and 4–6 age-groups (<i>p</i> &#x3c; 0.001). The last rate of the suitability was 9.1% for the 3.5-mm-thick screws and 13.75% for the 3-mm-thick screws after deletion of the bilateral insertion due to the short base of the spinous process and adding the possible short screws in the distally thin but proximally thick laminae. The rates increased with age, but the only statistically significant difference was found between 4–6- and 10–12-year-old age-groups (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Laminar screws may be suitable for some levels of C7, C6, and C3 even in the young pediatric population. The use of thinner screws (3 mm) may increase the suitability rate. Therefore, laminar screw choice may be considered as a salvage method in pediatric patients, and all laminae may be evaluated individually for suitability. This study did not evaluate the safety and efficacy of the method in children, and these issues must be studied further.

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