The MCG Pediatric Podcast

The Limping Child

Children frequently are brought to the emergency room for difficulty walking. In some cases, the cause is easily identified, but in others, the cause can be a sign of a more serious condition.  Dr. George Hsu, a Pediatric Emergency Physician, joins Dr. Ohmed Khilji and Pediatric Resident Kristen Schmidbauer to discuss the evaluation and management of children presenting with a limp. Specifically, they will:

• Review common history and physical exam findings associated with conditions causing children to limp
• Discuss initial diagnostic approach, as well as selecting appropriate labs, imaging, and treatment options
• Diagnoses discussed: septic arthritis, toddler’s fracture, osteomyelitis, Perthes disease, malignancy, non-accidental trauma, slipped capital femoral epiphysis, transient synovitis and more

Special thanks to Dr. Rebecca Yang and Dr. Melissa Allen for peer reviewing this episode.

FREE CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=10783

Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu

Remember that all content during this episode is intended for educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support!

References:

• Flynn JM, Widmann RF. The limping child: evaluation and diagnosis. J Am Acad Orthop Surg. 2001; 9(2): 89-98
• The Limping Child. Martin J. Herman, Melissa Martinek. Pediatrics in Review May 2015, 36 (5) 184-197; DOI:1542/pir.36-5-184
• Herring  J, Birch  J. The limping child. In: Herring J, ed. Pediatric Orthopaedics. 5th ed. Philadelphia, PA: Saunders; 2014:79–89

Autism Spectrum Disorder

Welcome to the MCG Pediatric Podcast! Dr. April Hartman, an associate professor of Pediatrics and the Division Chief of General Pediatric and Adolescent Medicine at the Children’s Hospital of Georgia, is joined by Medical Student, Kayla Cooper to discuss pertinent topics surrounding individuals living with Autism with a pediatric lens. Specifically, they will:

• Define, Explain the prevalence of, and discuss clinical symptoms of autism spectrum disorder
• Explain the diagnostic evaluation of autism spectrum disorder
• Discuss the screening and surveillance of autism spectrum disorder
• Evaluate the management of co-occurring conditions with autism spectrum disorder
• Define Current Interventions for patients within this community
• Explain advocacy and partnership with families of patients

FREE CME Credit (requires sign-in): 

https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=9857

Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support!

References:

1. Evans B. How autism became autism: The radical transformation of a central concept of child development in Britain. Hist Human Sci. 2013;26(3):3-31. doi:10.1177/0952695113484320
2. Identification, Evaluation, and Management of Children with Autism Spectrum Disorder. Susan L. Hyman, Susan E. Levy, Scott M. Myers, COUNCIL ON CHILDREN WITH DISABILITIES, SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS. Pediatrics Jan 2020, 145 (1) e20193447; DOI: 10.1542/peds.2019-3447
3. https://www.cdc.gov/ncbddd/autism/data.html. Accessed on 12/23/20
4. The American Academy of Pediatrics (AAP). Identifying and Caring for Children with Autism Spectrum Disorder A course for Pediatric Clinicians. [Online Course]. Pedialink. http://asd.pedialink.courses.aap.org/course/
5. https://www.cdc.gov/ncbddd/autism/addm-community-report/documents/addm-community-report-2020-h.pdf
6. Timing of the Diagnosis of Autism in African American Children. John N. Constantino, Anna M. Abbacchi, Celine Saulnier, Cheryl Klaiman, David S. Mandell, Yi Zhang, Zoe Hawks, Julianna Bates, Ami Klin, Paul Shattuck, Sophie Molholm, Robert Fitzgerald, Anne Roux, Jennifer K. Lowe, Daniel H. Geschwind. Pediatrics Sep 2020, 146 (3) e20193629; DOI: 10.1542/peds.2019-3629

Lead Toxicity in Children

Lead toxicity continues to be a major public health concern in the United States. Children are particularly vulnerable to the potential toxicity of lead. Nicole Bisel, a medical student at the Medical College of Georgia is joined by pediatricians Dr. Tyrone Bristol and Dr. Rebecca Yang to to discuss the risk, evaluation and management of lead toxicity in children.

Specifically, they will:

• Why lead toxicity continues to be an issue today
• Discuss sources of how humans are exposed to lead
• Review Risk Factors & Consequences of lead toxicity
• And finally discuss screening, management, and treatment for children with lead toxicity

FREE CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=9855

Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu

Remember that all content during this episode is intended for educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support!

References:

1. American Academy of Pediatrics. Council of Environmental Health. Prevention of Childhood Lead Toxicity. Pediatrics. 2016;38(1)e20161493 – August 01, 2017 https://pediatrics.aappublications.org/content/138/1/e20161493
2. American Academy of Pediatrics. Childhood Lead Exposure Infographic. In: American Academy of Pediatrics Health Initiatives Lead Exposure and Lead Poisoning. American Academy of Pediatrics Website. https://www.aap.org/en-us/ImagesGen/Lead_infographic.jpg. Accessed February 6, 2021.
3. PEHSU: Pediatric Environmental Health Specialty Units. Lead and Drinking Water: Information for Health Professionals Across the United States. American Academy of Pediatrics Website. https://www.pehsu.net/_Library/facts/LeadandDrinkingWater_62116_final.pdf. Accessed February 6, 2021.
4. American Academy of Pediatrics. Lead Exposure in Children. American Academy of Pediatrics Website. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/lead-exposure/Pages/Lead-Exposure-in-Children.aspx. Accessed February 6, 2021.
5. Centers for Disease Control and Prevention. Childhood Lead Poisoning Prevention. Childhood Lead Poisoning Prevention Program Website. https://www.cdc.gov/nceh/lead/. Accessed February 6, 2021.
6. Mayans L. Lead Poisoning in Children. American Family Physician. 2019; 100(1):24-30. https://www.aafp.org/afp/2019/0701/p24.html. Accessed February 13, 2021.
7. Hanna-Attisha M, LaChance J, Sadler RC, Schnepp AC. Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response. American Journal of Public Health. 2016; 106(2): 283-290. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985856/#__ffn_sectitle. Accessed February 13, 2021.
8. Council on Environmental Health. Prevention of Childhood Lead Toxicity. Pediatrics. 2016; 138(1):e20161493. https://pediatrics.aappublications.org/content/138/1/e20161493%20. Accessed February 13, 2021.
9. Sanders T, Liu Y, Buchner V, Tchounwou PB. Neurotoxic Effects and Biomarkers of Lead Exposure: A Review. Rev Environ Health. 2009; 24(1): 15-45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858639/#__ffn_sectitle. Accessed February 13, 2021.
10. American Academy of Pediatrics. Detection of Lead Poisoning. American Academy of Pediatrics Website. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/lead-exposure/Pages/Detection-of-Lead-Poisoning.aspx. Accessed March 7, 2021
11. American Academy of Pediatrics. Treatment of Lead Poisoning. American Academy of Pediatrics Website. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/lead-exposure/Pages/Treatment-of-Lead-Poisoning.aspx. Accessed March 7, 2021.
12. Zahran S, McElmurry SP, Sadler RC. Four Phases of Flint Water Crisis: Evidence from Blood Lead Levels in Children. Environ Res. 2017; 157: 160-172. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538017/. Accessed February 13, 2021.
13. https://www.cdc.gov/nceh/lead/advisory/acclpp/actions-blls.htm. Accessed March 14, 2021.
14. https://www.cdc.gov/nceh/lead/advisory/acclpp/actions-blls.htm. . Accessed Nov 14, 2021.

 

Sickle Cell Disease, Part 2

We are back with more information about Sickle Cell Disease with emphasis on adolescent health. Dr. Nnenna Badamosi, a Pediatric Hematologist, joins Dr. Zachary Hodges and Second Year Medical Student Kayla Cooper to discuss the important aspects that every pediatrician should know when treating patients with Sickle cell disease. Specifically, they will:

• Recognize the important complications of SCD in adolescence & young adulthood.
• Generally, recall the required routine health maintenance for adolescents and young adults with SCD.
• Recognize the complexity of chronic pain in SCD and the necessity for multidisciplinary care.
• Identify risk factors associated with increased health care utilization and mortality in young adults with SCD.
• Understand the goals of a structured transition process for young adults with SCD.
• Recognize the quality indicators of a successful transition of care in SCD.

FREE CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=9854

Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu

Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support!

References:

• Field, Joshua J. “Five lessons learned about long-term pain management in adults with sickle cell disease.”  American Society of Hematology. Education Programvol. 2017,1 (2017): 406-411. doi:10.1182/asheducation-2017.1.406
• https://www.gottransition.org/six-core-elements/

Sickle Cell Disease, Part 1

We all have heard of Sickle cell disease, but have we discussed care across the lifespan for patients with this condition? Dr. Nnenna Badamosi, a Pediatric Hematologist, joins Dr. Zachary Hodges and Second Year Medical Student Kayla Cooper to discuss the important aspects that every pediatrician should know when treating patients with Sickle cell disease. Specifically, they will:

• Recognize newborn screening results that are consistent with sickle cell disease
• Recognize the need for additional routine vaccines for meningococcal and streptococcal pneumonia disease in children with sickle cell disease.
• Understand the indications and initiate appropriate antibiotic prophylaxis for infants and young children with sickle cell disease.
• Recognize the risk of early acute complications of sickle cell disease including dactylitis, splenic sequestration and invasive bacterial infections
• Recognize the benefits and risks of disease-modifying therapy with hydroxyurea early in childhood.
• Recognize the importance of primary stroke prevention with transcranial doppler screening and treatment with chronic transfusions.
• Recognize the importance of screening for end organ disease including cardiac dysfunction, retinopathy and kidney disease.

Peer Reviewed by MCG Pediatric Podcast Committee

FREE CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=9853

Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu

Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thanks again for your support!

 

References:

1. Minkovitz, Cynthia S et al. “Newborn Screening Programs and Sickle Cell Disease: A Public Health Services and Systems Approach.” American journal of preventive medicine 51,1 Suppl 1 (2016): S39-47. doi:10.1016/j.amepre.2016.02.019
2. https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease
3. Cober MP, Phelps SJ. Penicillin prophylaxis in children with sickle cell disease. J Pediatr Pharmacol Ther. 2010;15(3):152-159.
4. Adams RJ, McKie VC, Hsu L, Files B, Vichinsky E, Pegelow C, Abboud M, Gallagher D, Kutlar A, Nichols FT, Bonds DR, Brambilla D. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med. 1998 Jul 2;339(1):5-11. doi: 10.1056/NEJM199807023390102. PMID: 9647873.

Online Technology Use for Children

We are living in a technology saturated world as we rely on smart devices for virtual learning, entertainment, completing work, and connecting with others. But how much is too much for our children? What are risks and benefits of technology use for children? And what is the pediatrician’s role in helping to educate their patients and parents?

Join Dr. Jacob Eichenberger and Dr. Kathryn Peralta as they discuss the impact of technology use on children and how pediatricians can counsel families on appropriate use to ensure healthy development and wellbeing.

Learning Objectives:

• Review the epidemiology of screen media use in children and adolescents
• Identify age-appropriate types and duration of use for various technology
• Discuss risk factors for excessive or problematic use in children and what physical and emotional outcomes may be associated with excessive media use.
• Discuss impact of social media, cyberbullying, and risks of exploitation of children from technology use.
• Identify benefits of screen media as well as tips to help parents navigate this complex topic

Peer Reviewers: Dr. Rebecca Yang, Dr. Zachary Hodges

Free CME Credit:  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8632

References:

1. Rideout, V., & Robb, M. B. (2020). The Common Sense census: Media use by kids age zero to eight, 2020. San Francisco, CA: Common Sense Media.
2. Rideout, V., and Robb, M. B. (2019). The Common Sense census: Media use by tweens and teens, 2019. San Francisco, CA: Common Sense Media.
3. Rideout, V., Foehr, U., Roberts, D., GENERATION M2 Media in the Lives of 8- to 18-Year-Olds. A Kaiser Family Foundation Study JANUARY 2010.
4. Reid Chassiakos Y,  Radesky  J,  Christakis  D,  et  ,  AAP  COUNCIL  ON  COMMUNICATIONS  AND  MEDIA.  Children and Adolescents and Digital Media. Pediatrics. 2016;138(5):e20162593
5. Hoge, E., Bickham, D., Cantor, J. Digital Media, Anxiety, and Depression in Children. Pediatrics Volume 140, number s2, November 2017:e20161758
6. AAP COUNCIL ON COMMUNICATIONS AND MEDIA. Media and Young Minds. Pediatrics. 2016;138(5):e20162591
7. Radesky J, Chassiakos Y, LR, Ameenuddin N, et al. AAP COUNCIL ON  COMMUNICATION  AND    Digital Advertising to Children. Pediatrics. 2020;146(1):e20201681
8. Technology and Interactive Media as Tools in Early Childhood Programs Serving Children from Birth through Age 8. (2012, January). Retrieved from https://www.naeyc.org/sites/default/files/globally-shared/downloads/PDFs/resources/topics/PS_technology_WEB.pdf
9. Jennifer S. Saul, Rachel F. Rodgers, Adolescent Eating Disorder Risk and the Online World, Child and Adolescent Psychiatric Clinics of North America, Volume 27, Issue 2, 2018, Pages 221-228,
10. Jasmine Fardouly, Lenny R. Vartanian, Social Media and Body Image Concerns: Current Research and Future Directions, Current Opinion in Psychology, Volume 9, 2016, Pages 1-5
11. Saunders, J., and Eaton, A. Snaps, Selfies, and Shares: How Three Popular Social Media Platforms Contribute to the Sociocultural Model of Disordered Eating Among Young Women. CYBERPSYCHOLOGY, BEHAVIOR, AND SOCIAL NETWORKING Volume 21, Number 6, 2018
12. Hill, D. Social Media: Anticipatory Guidance. Pediatrics In Review Volume 41, Number 3. March 2020 Pages 112-117.
13. D’Angelo, J; Moreno, M. Screening for Problematic Internet Use. PEDIATRICS Volume 145, number s2, May 2020:e20192056F
14. Steinberg, S. Sharenting: Children’s Privacy in the Age of Social Media. University of Florida Levin College of Law Legal Studies Research Paper Series Paper No. 16-41
15. Richdel, M. (2021, January 16). Children’s Screen Time Has Soared in the Pandemic, Alarming Parents and Researchers. The New York Times.
16. Haelle, T. (2016, October 28). Do Parents Invade Children's Privacy When They Post Photos Online? NPR
17. Maheshwari, S. (2017, November 4). On YouTube Kids, Startling Videos Slip Past Filters. The New York Times
18. The Impact of Social Media on Children, Adolescents, and Families. Gwenn Schurgin O'Keeffe, Kathleen Clarke-Pearson, Council on Communications and Media. Pediatrics Apr 2011, 127 (4) 800-804; DOI:1542/peds.2011-0054
19. https://www.stopbullying.gov/. Accessed 6/19/21. Google

Resources For Providers

• Clinic for Interactive Media and Internet Disorders (CIMAID)at Boston Children’s Hospital
• Digital Wellness Lab (Contains Screening Tools and Anticipatory Guidance)
• https://digitalwellnesslab.org/cimaid/clinician-toolkit/
• Internet Addiction Assessment
• https://psychology-tools.com/test/internet-addiction-assessment
• Problematic and Risky Internet Use Screening Scale (PRIUSS) accessed from https://doi.org/10.1016/j.acap.2015.07.001

Resources for Parents

• Reviews of Digital Media. org
• Creating a Digital Media Plan: https://www.healthychildren.org/English/news/Pages/Managing-Media-We-Need-a-Plan.aspx

Palliative Care with Dr. Sharon Beall (Part 2)

Palliative Care with Dr. Sharon Beall

Free CME Credit:  Click Here

Participants:

• Rachel Vaizer, MD
• Sharon Beall, MD
• Zachary Hodges, MD

Peer review by the MCG Pediatric Podcast Committee

About our guest:

Dr. Sharon Beall is an Associate Professor of Pediatrics at the Medical College of Georgia and the medical director for the Children’s Hospital of Georgia palliative care and hospice program.

Learning Objectives:

After listening to this podcast, learners should be able to:

1. Understand the value of palliative care as well as an overview of palliative care principles and practices.
2. Recognize the need for expertise in the assessment and treatment of patient symptom burden, functional status and quality of life.
3. Recognize the burden of serious illness and the role of palliative care in screening, assessing and treating psychological and psychiatric illnesses.
4. Recognize the social limitations in caring for the seriously ill and have a guide for screening for access to social support, food, housing, transportation and adaptive equipment.
5. Recognize the importance of spiritual and cultural beliefs in patient and family decision making.
6. Understand the importance of screening and assessment of patients and their family’s spiritual needs.
7. Recognize when a referral to hospice is indicated.
8. Manage the physical symptoms nearing the end of life (pain dyspnea, nausea, agitation, delirium, terminal secretions).
9. Recognize palliative care’s role the family and caregivers in post-death bereavement care.

Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu

Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios.We look forward to speaking to you on our next episode of the MCG Pediatric Podcast.  

 

References:                                                               

• Bergstraesser, E. (2013). Pediatric palliative care—when quality of life becomes the main focus of treatment. European journal of pediatrics, 172(2), 139-150.
• Ferrell BR, Twaddle ML, Melnick A, Meier DE. National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition. J Palliat Med. 2018 Dec;21(12):1684-1689. doi: 10.1089/jpm.2018.0431. Epub 2018 Sep 4. PMID: 30179523.
• Hsiao, J. L., Evan, E. E., & Zeltzer, L. K. (2007). Parent and child perspectives on physician communication in pediatric palliative care. Palliative & Supportive Care, 5(4), 355.
• Jones, B. L., Contro, N., & Koch, K. D. (2014). The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring. Pediatrics, 133(Supplement 1), S8-S15.
• Linebarger, J., & Moreno, M. A. (2019). Pediatric palliative care. JAMA pediatrics, 173(11), 1115-1115.

Palliative Care with Dr. Sharon Beall (Part 1)

Palliative Care with Dr. Sharon Beall

Participants:

• Rachel Vaizer, MD
• Sharon Beall, MD
• Zachary Hodges, MD

Peer review by the MCG Pediatric Podcast Committee

Free CME Credit:  Click Here

About our guest:

Dr. Sharon Beall is an Associate Professor of Pediatrics at the Medical College of Georgia and the medical director for the Children’s Hospital of Georgia palliative care and hospice program.

Learning Objectives:

After listening to this podcast, learners should be able to:

1. Understand the value of palliative care as well as an overview of palliative care principles and practices.
2. Recognize the need for expertise in the assessment and treatment of patient symptom burden, functional status and quality of life.
3. Recognize the burden of serious illness and the role of palliative care in screening, assessing and treating psychological and psychiatric illnesses.
4. Recognize the social limitations in caring for the seriously ill and have a guide for screening for access to social support, food, housing, transportation and adaptive equipment.
5. Recognize the importance of spiritual and cultural beliefs in patient and family decision making.
6. Understand the importance of screening and assessment of patients and their family’s spiritual needs.
7. Recognize when a referral to hospice is indicated.
8. Manage the physical symptoms nearing the end of life (pain dyspnea, nausea, agitation, delirium, terminal secretions).
9. Recognize palliative care’s role the family and caregivers in post-death bereavement care.

Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu

Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios.We look forward to speaking to you on our next episode of the MCG Pediatric Podcast.  

 

References:                                                               

• Bergstraesser, E. (2013). Pediatric palliative care—when quality of life becomes the main focus of treatment. European journal of pediatrics, 172(2), 139-150.
• Ferrell BR, Twaddle ML, Melnick A, Meier DE. National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition. J Palliat Med. 2018 Dec;21(12):1684-1689. doi: 10.1089/jpm.2018.0431. Epub 2018 Sep 4. PMID: 30179523.
• Hsiao, J. L., Evan, E. E., & Zeltzer, L. K. (2007). Parent and child perspectives on physician communication in pediatric palliative care. Palliative & Supportive Care, 5(4), 355.
• Jones, B. L., Contro, N., & Koch, K. D. (2014). The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring. Pediatrics, 133(Supplement 1), S8-S15.
• Linebarger, J., & Moreno, M. A. (2019). Pediatric palliative care. JAMA pediatrics, 173(11), 1115-1115.

Cystic Fibrosis- Nutrition and Exercise Considerations

Hosts:

• Medical Student: Brooke Pace Quertermous
• Faculty: Katie McKie, MD
• Faculty: Ryan Harris, Ph.D

Peer Review: Rebecca Yang, MD; Janelle McGill, MD

During this episode, you will learn that Cystic Fibrosis is more than just a lung disease. Individuals with CF are also at risk for malabsorption, maldigestion, intestinal obstruction, exercise intolerance, and other systemic abnormalities.

Dr. Katie McKie, Director of Pediatric Pulmonology at Augusta University, joins Dr. Ryan Harris, Founder and Director of the LIVEP and CF researcher, and Medical Student Brooke Quertermous to discuss the impact of nutrition and exercise on children with CF.

Specifically, they will: 

1. Explain the mechanism by which CF affects digestion and absorption of nutrients
2. Acknowledge the importance of frequent growth monitoring for children with CF.
3. Understand the role of nutrient supplementation for children with CF, and when enteral nutrition is required.
4. Describe why exercise intolerance occurs in CF and the necessity of regular exercise for these patients.

FREE CME Credit (requires sign-in): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8631

Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu

Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenariosWe look forward to speaking to you on our next episode of the MCG Pediatric Podcast.  

References:

1. Gajbhiye, R., et al., Cystic fibrosis transmembrane conductance regulator (CFTR) gene abnormalities in Indian males with congenital bilateral absence of vas deferens & renal anomalies. Indian J Med Res, 2016. 143(5): p. 616-23. AND Elborn, J.S., Cystic fibrosis. Lancet, 2016. 388(10059): p. 2519-2531.)
2. (Kuk, K. and J.L. Taylor-Cousar, Lumacaftor and ivacaftor in the management of patients with cystic fibrosis: current evidence and future prospects. Ther Adv Respir Dis, 2015. 9(6): p. 313-26.)
3. (Farrell et al, Siret el al, Sims et al).
4. Sullivan, J. S., & Mascarenhas, M. R. (2017). Nutrition: Prevention and management of nutritional failure in cystic fibrosis. Journal of Cystic Fibrosis, 16. doi:10.1016/j.jcf.2017.07.010
5. Committee On Practice And Ambulatory Medicine, & Workgroup, B. (2020, March 01). 2020 recommendations for Preventive Pediatric health care. Retrieved March 22, 2021, from https://pediatrics.aappublications.org/content/145/3/e20200013
6. Cystic Fibrosis Foundation, et al. Cystic Fibrosis Foundation evidence-based guidelines for management of infants with cystic fibrosis, J Pediatr 2009; 155(6 Suppl):S73-93.)
7. (Nutrition Prevention and Management Article)
8. (Mattar AC, Leone C, Rodrigues JC, Adde FV. Sweat conductivity: an accurate diagnostic test for cystic fibrosis? J Cyst Fibros. 2014 Sep;13(5):528-33. doi: 10.1016/j.jcf.2014.01.002. Epub 2014 Jan 31. PMID: 24485874.)
9. Ameet Daftary, James Acton, James Heubi, Raouf Amin, Fecal elastase-1: Utility in pancreatic function in cystic fibrosis, Journal of Cystic Fibrosis, Volume 5, Issue 2, 2006, Pages 71-76,ISSN 1569-1993,
10. Walkowiak, D. Sands, A. Nowakowska, R. Piotrowski, K. Zybert, K.H. Herzig, et al. Early decline of pancreatic function in cystic fibrosis patients with class 1 or 2 CFTR mutations J Pediatr Gastroenterol Nutr, 40 (2) (2005), pp. 199-201
11. Witt, H. (2003). Chronic pancreatitis and cystic fibrosis. Gut, 52(90002), 31ii-41. doi:10.1136/gut.52.suppl_2.ii31
12. Fielding, J., Brantley, L., Seigler, N., McKie, K. T., Davison, G. W., & Harris, R. A. (2015). Oxygen uptake kinetics and exercise capacity in children with cystic fibrosis. Pediatric Pulmonology, 50(7), 647-654. doi:10.1002/ppul.23189
13. Orenstein, D. (2018). The Relationship between CFTR Genotype and Exercise Tolerance in Cystic Fibrosis.. AnnalsATS, 15(2), 166.
14. Marcotte JE, Canny GJ, Grisdale R, Desmond K, Corey M, Zinman R, Levison H, Coates AL. Effects of nutritional status on exercise performance in advanced cystic fibrosis. Chest. 1986 Sep;90(3):375-9. doi: 10.1378/chest.90.3.375. PMID: 3743150.
15. Pastré, J., Prévotat, A., Tardif, C., Langlois, C., Duhamel, A., & Wallaert, B. (2014). Determinants of exercise capacity in cystic fibrosis patients with mild-to-moderate lung disease. BMC pulmonary medicine, 14(1), 1-8.
16. Hulzebos, Erik H. J.1; Bomhof-Roordink, Hanna1,3; van de Weert-van Leeuwen, Pauline B.2; Twisk, Jos W. R.3; Arets, H. G. M.2; van der Ent, Cornelis K.2; Takken, Tim1 Prediction of Mortality in Adolescents with Cystic Fibrosis, Medicine & Science in Sports & Exercise: November 2014 - Volume 46 - Issue 11 - p 2047-2052 doi: 10.1249/MSS.0000000000000344
17. Ding S., Zhong C. (2020) Exercise and Cystic Fibrosis. In: Xiao J. (eds) Physical Exercise for Human Health. Advances in Experimental Medicine and Biology, vol 1228. Springer, Singapore. https://doi.org/10.1007/978-981-15-1792-1_26
18. Moorcroft AJ, Dodd ME, Morris J, Webb AK. Individualised unsupervised exercise training in adults with cystic fibrosis: a 1 year randomised controlled trial. Thorax. 2004 Dec;59(12):1074-80. doi: 10.1136/thx.2003.015313. PMID: 15563708; PMCID: PMC1746905.
19. Pianosi P, Leblanc J, Almudevar A. Peak oxygen uptake and mortality in children with cystic fibrosis. Thorax. Jan 2005;60(1):50-54.

LIVEP Contact: Reva Crandall at 706-721-5483.

 

Neonatal Opioid Withdrawal Syndrome

Join medical student Rilee Racine and Dr. Brian Stansfield, a neonatologist at the Children's Hospital of Georgia discuss Neonatal Opioid Withdrawal Syndrome, also known as NOWS. 

After listening to this podcast, learners should be able to:

• Define neonatal opioid withdrawal syndrome
• Apply knowledge of signs and symptoms of NOWS to recognize these infants early
• Demonstrate general understanding of non-pharmacologic vs. pharmacologic management indications
• Recall the long term effects of NOWS and utilize this information to care for these infants long-term
• Educate families on clinical symptoms, management, and potential complications of NOWS

Peer Review by Dr. Rebecca Yang and Dr. Amy Thompson

Free CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8575 

Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu. Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios.

References:

• Anbalagan S, Mendez MD. Neonatal Abstinence Syndrome. 2020 Oct 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 31855342.
• Armbruster, Debra PhD, APRN-CNP, NNP-BC, CPNP-PC, C-ELBW; Schwirian, Caitlyn PharmD; Mosier, Ashley MS, RN, CNL; Tam, Wai-Yin Mandy PharmD, BCPS, BCCCP; Prusakov, Pavel PharmD, BCPS, BCPPS Neonatal Abstinence Syndrome and Preterm Infants, Advances in Neonatal Care: March 05, 2021 - Volume Publish Ahead of Print - Issue - doi: 10.1097/ANC.0000000000000858
• Finnegan LP. Neonatal abstinence syndrome: assessment and pharmacotherapy. In: Nelson N, editor. Current therapy in neonatal-perinatal medicine. 2 ed. Ontario: BC Decker; 1990.
• Jansson, Lauren M. MD. Neonatal abstinence syndrome. Uptodate. (2020).
• Johnson MR, Nash DR, Laird MR, Kiley RC, Martinez MA. Development and implementation of a pharmacist-managed, neonatal and pediatric, opioid-weaning protocol. J Pediatr Pharmacol Ther. 2014 Jul;19(3):165-73. doi: 10.5863/1551-6776-19.3.165. PMID: 25309146; PMCID: PMC4187529.
• Maguire, Denise J, PhD,R.N., C.N.L., Taylor, Susan, MSW,L.C.S.W.-C., C.M.A., Armstrong, K., PhD., Shaffer-Hudkins, E., Germain, A. M., M.D., Brooks, Sandra S,M.D., M.P.H., . . . Clark, L. (2016). Long-term outcomes of infants with neonatal abstinence syndrome: NN. Neonatal Network, 35(5), 277-286. doi:http://dx.doi.org/10.1891/0730-0832.35.5.277
• Mangat, A. K., Schmölzer, G. M., & Kraft, W. K. (2019). Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS). Seminars in fetal & neonatal medicine, 24(2), 133–141. https://doi.org/10.1016/j.siny.2019.01.009
• Merhar SL, Ounpraseuth S, Devlin LA, Poindexter BB, Young LW, Berkey SD, Crowley M, Czynski AJ, Kiefer AS, Whalen BL, Das A, Fuller JF, Higgins RD, Thombre V, Lester BM, Smith PB, Newman S, Sánchez PJ, Smith MC, Simon AE; EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT NEONATAL RESEARCH NETWORK AND THE NIH ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES (ECHO) PROGRAM INSTITUTIONAL DEVELOPMENT AWARDS STATES PEDIATRIC CLINICAL TRIALS NETWORK. Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome. Pediatrics. 2021 Mar;147(3):e2020017830. doi: 10.1542/peds.2020-017830. PMID: 33632932; PMCID: PMC7919109.
• Protecting Our Infants Act of 2015, H.R, 1462, 114th Cong. (2015-2016). 
• Sarka Lisonkova, Lindsay L. Richter, Joseph Ting, Giulia M. Muraca, Qi Wen, Azar Mehrabadi, Sheona Mitchell-Foster, Eugenia Oviedo-Joekes and Janet Lyons. Pediatrics August 2019, 144 (2) e20183664; DOI: https://doi.org/10.1542/peds.2018-3664
• Siegler R., Saffran J., Eisenberg N., Deloache, J., & Gershoff, E. (2017). How Children Develop (5th ed.). NY, NY, USA: Macmillan Learning. 
• Stephen W. Patrick, Wanda D. Barfield, Brenda B. Poindexter and COMMITTEE ON FETUS AND NEWBORN, COMMITTEE ON SUBSTANCE USE AND PREVENTION. Neonatal Abstinence Withdrawal Syndrome. Pediatrics November 2020, 146 (5) e2020029074; DOI: https://doi.org/10.1542/peds.2020-029074
• Patrick SW, Barfield WD, Poindexter BB; COMMITTEE ON FETUS AND NEWBORN, COMMITTEE ON SUBSTANCE USE AND PREVENTION. Neonatal Opioid Withdrawal Syndrome. Pediatrics. 2020 Nov;146(5):e2020029074. doi: 10.1542/peds.2020-029074. PMID: 33106341.
• Zimmermann, U., Rudin, C., Duò, A. et al. Treatment of opioid withdrawal in neonates with morphine, phenobarbital, or chlorpromazine: a randomized double-blind trial. Eur J Pediatr 179, 141–149 (2020). https://doi.org/10.1007/s00431-019-03486-6