The MCG Pediatric Podcast

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

Feedback with Dr. Lisa Leggio

Feedback with Dr. Lisa Leggio

Participants

• Jameson Kenerly (MS4)
• Jessica Davis, DO
• Lisa Leggio, MD
• Zachary Hodges, MD

Peer review by Dr. Andy Albritton and the MCG Pediatric Podcast Committee

About our guest:

Dr. Lisa Leggio is a professor of pediatrics here at the Medical College of Georgia and a practicing general pediatrician at the Children’s Hospital of Georgia. She is the director of the pediatric clerkship which is commonly voted as a favorite rotation by our medical students. Individually, she is a very successful medical educator and has been recognized as the educator of the year multiple times here at our institution.

Learning Objectives:

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

1. Recognize and overcome barriers to giving feedback
2. Recognize and overcome barriers to receiving feedback
3. Describe and use 4 techniques for giving feedback

FREE CME Credit (requires sign-in): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8420

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:

• Armson H, Lockyer JM, Zetkulic M, Könings KD, Sargeant J. Identifying coaching skills to improve feedback use in postgraduate medical education. Med Educ. 2019 May;53(5):477-493. doi: 10.1111/medu.13818. Epub 2019 Feb 18. PMID: 30779210.
• Baldie D et al. Exploring the impact and use of patients’ feedback about their care experiences in general practice settings – a realist synthesis.  Family Practice, 2018; 35(1):13-21.
• Boehler ML, Rogers DA, Schwind CJ, Mayforth R, Quin J, Williams RG, Dunnington G. An investigation of medical student reactions to feedback: a randomised controlled trial. Med Educ. 2006 Aug;40(8):746-9. doi: 10.1111/j.1365-2929.2006.02503.x. PMID: 16869919.
• Brown, B. (2018). Dare to lead: Brave work. Tough conversations. Whole hearts.New York: Random House.
• Dweck, C.S. (2008). Mindset: the New Psychology of Success.  New York:  Random House.
• Ende J. Feedback in clinical medical education. JAMA. 1983 Aug 12;250(6):777-81. PMID: 6876333.
• Fainstad T, Mcclintock A A, Van Der Ridder M J, et al. (December 11, 2018) Feedback Can Be Less Stressful: Medical Trainee Perceptions of Using the Prepare to ADAPT (Ask-Discuss-Ask-Plan Together) Framework . Cureus 10(12): e3718. doi:10.7759/cureus.3718
• Gigante, J., Dell, M., & Sharkey, A. (2011). Getting beyond "Good job": how to give effective feedback. Pediatrics, 127(2), 205–207. https://doi.org/10.1542/peds.2010-3351
• Sargeant J. Future Research in Feedback: How to Use Feedback and Coaching Conversations in a Way That Supports Development of the Individual as a Self-Directed Learner and Resilient Professional. Acad Med. 2019 Nov;94(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 58th Annual Research in Medical Education Sessions):S9-S10. doi: 10.1097/ACM.0000000000002911. PMID: 31365395.
• Stone, D. and Heen, S. (2014). Thanks for the Feedback: the Science and Art of Receiving Feedback Well* even when it is off base, unfair, poorly delivered, and, frankly, you’re not in the mood. New York:  Penguin Books.

Juvenile Idiopathic Arthritis (JIA) with Dr. Julisa Patel

Juvenile Idiopathic Arthritis (JIA)

Participants

• Christina Cho (MS3)
• Julisa Patel, MD
• Zachary Hodges, MD

Peer review by pediatric rheumatologist Dr. Rita Jerath and the MCG Pediatric Podcast committee.

About our guest:

Dr. Julisa Patel is an Associate Professor of Pediatrics and practicing pediatric rheumatologist here at MCG.

 

Learning Objectives:

By the end of listening to this episode, learners should be able to:

1. Recognize the common signs and symptoms associated with juvenile idiopathic arthritis (JIA).
2. Formulate a differential diagnosis for a child with arthritis.
3. Understand the general diagnostic approach for a patient with likely JIA.
4. Recognize the role but limitations of the laboratory evaluation for JIA.
5. Initiate appropriate first-line therapy for JIA.
6. Recall both the short- and long-term complications of JIA.

 

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.    

Free CME Credit: https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8419

References

• Shenoi S. Juvenile Idiopathic Arthritis - Changing Times, Changing Terms, Changing Treatments. Pediatr Rev. 2017 May;38(5):221-232. doi: 10.1542/pir.2016-0148. PMID: 28461613.
• Ringold S, Angeles-Han ST, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care Res (Hoboken). 2019 Jun;71(6):717-734. doi: 10.1002/acr.23870. Epub 2019 Apr 25. PMID: 31021516; PMCID: PMC6561125.

 

Trisomy 13 & 18 Family Perspective with Wiley and Jenny Purcell (Part 2)

Trisomy 13 & 18—Family Perspective Wiley and Jenny Purcell

Participants

• Wiley and Jenny Purcell
• Zachary Hodges

All participants have no financial conflicts of interest to disclose.

Peer review by Dr. Paul Mann and the MCG Pediatric Podcast Committee

About our guests:

Wiley and Jenny Purcell have been gracious to share their story of their son Samul and their family’s experience with his diagnosis of trisomy 13. We are very excited to share their story!

Learning Objectives:

After listening to this podcast, learners should be able to better understand a family’s experience with:

1. A prenatal diagnosis of a life-limiting genetic disease
2. A newborn baby requiring neonatal intensive care.
3. Bringing a baby with complex medical needs home from the NICU.
4. Daily life with an infant with special needs.

 

Links mentioned:

SOFT—Support Organization for Trisomy; www.trisomy.org  

String of Pearls: http://www.stringofpearlsonline.org/

Cuddle Cot: https://www.cuddlingangels.com/

 

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. We look forward to speaking to you on our next episode of the MCG Pediatric Podcast.  

Trisomy 13 & 18 Family Perspective with Wiley and Jenny Purcell (Part 1)

Trisomy 13 & 18—Family Perspective Wiley and Jenny Purcell

Participants

• Wiley and Jenny Purcell
• Zachary Hodges

All participants have no financial conflicts of interest to disclose.

Peer review by Dr. Paul Mann and the MCG Pediatric Podcast Committee

About our guests:

Wiley and Jenny Purcell have been gracious to share their story of their son Samul and their family’s experience with his diagnosis of trisomy 13. We are very excited to share their story!

Learning Objectives:

After listening to this podcast, learners should be able to better understand a family’s experience with:

1. A prenatal diagnosis of a life-limiting genetic disease
2. A newborn baby requiring neonatal intensive care.
3. Bringing a baby with complex medical needs home from the NICU.
4. Daily life with an infant with special needs.

 

Links mentioned:

SOFT—Support Organization for Trisomy; www.trisomy.org  

String of Pearls: http://www.stringofpearlsonline.org/

Cuddle Cot: https://www.cuddlingangels.com/

 

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. We look forward to speaking to you on our next episode of the MCG Pediatric Podcast.  

Trisomy 13 & 18 Cardiac Surgery with Dr. James St. Louis

Trisomy 13 & 18 Cardiac Surgery with Dr. James St. Louis

Participants:

• James St. Louis, MD
• Zachary Hodges, MD

Peer review by Dr. Pushpa Shivaram and the MCG Pediatric Podcast Committee

About our Guest:

Dr. James St. Louis is the J. Harold Harrison, MD Distinguished Chair in Pediatrics, Surgery and Cardiothroacic Surgery at the Medical College of Georgia. He is the Chief of Pediatric Cardiothoracic and Congenital Cardiac Surgery at the Children’s Hospital of Georgia. 

Learning Objectives:

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

1. Recognize the prevalence of congenital heart disease in children with Trisomy 13 & 18.
2. Recall the limited access to cardiac surgery historically offered to children with Trisomy 13 & 18.
3. Describe the general recent trends in pediatric cardiothoracic surgery for children with Trisomy 13 & 18, specifically increased access to surgical repair of relative low complexity lesions.
4. Describe which cardiac abnormalities are increasingly being offered surgical repair by some centers.
5. Recognize key factors or comorbidities that might guide the decision to offer or withhold corrective surgery for children with Trisomy 13 & 18.
6. Generally, recognize which complex and multi-stage procedures are currently not being offered to children with Trisomy 13 & 18.
7. Recognize the current variability of surgical options being offered between different centers.
8. Describe what types of cardiac surgery are being offered to children with Trisomy 13 & 18 here at the Medical College of Georgia.

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.  

Free CME Credit: https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8278

References:

1. McCaffrey MJ. Trisomy 13 and 18: Selecting the road previously not taken. Am J Med Genet C Semin Med Genet. 2016;172(3):251-256. doi:10.1002/ajmg.c.31512 
2. Bajinting A, Munoz-Abraham AS, Osei H, Kirby AJ, Greenspon J, Villalona GA. To operate or not to operate? Assessing NSQIP surgical outcomes in trisomy 18 patients [published online ahead of print, 2020 Jun 5]. J Pediatr Surg. 2020;S0022-3468(20)30369-9. doi:10.1016/j.jpedsurg.2020.05.037 
3. Neubauer K, Boss RD. Ethical considerations for cardiac surgical interventions in children with trisomy 13 and trisomy 18. Am J Med Genet C Semin Med Genet. 2020;184(1):187-191. doi:10.1002/ajmg.c.31767 
4. Nelson KE, Rosella LC, Mahant S, Guttmann A. Survival and Surgical Interventions for Children With Trisomy 13 and 18 [published correction appears in JAMA. 2017 May 2;317(17 ):1803]. JAMA. 2016;316(4):420-428. doi:10.1001/jama.2016.9819 

Breastfeeding

Did you know that in the U.S., only 50% of infants are being exclusively breastfed at 3 months of age or that breastmilk helps reduce the incidence of otitis media and sudden infant death syndrome? Dr. Rebecca Pierce, a general pediatrician and international board certified lactation consultant at the Children’s Hospital of Georgia is joined by pediatric resident Nicole Lock to discuss the importance of breastfeeding.

Specifically, they will:

• Review guidelines and recommendations for breastfeeding
• Discuss breastfeeding benefits and contraindications
• Recognize common problems in breastfeeding and discuss practical solutions
• Discuss barriers to breastfeeding
• Review appropriate resources for breastfeeding mothers and providers
• Highlight current research on antibodies in breastmilk after Covid-19 vaccination or infection

Special thanks to Dr. Kathryn Mcleod, Dr. Amy Thompson, and Dr. Rebecca Yang for peer reviewing this episode.

For Show Notes:  Follow the linkhttps://www.augusta.edu/mcg/pediatrics/residency/podcast-episodes.php

Free CME Credit: https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8277

References:

• Breastfeeding and the Use of Human Milk. SECTION ON BREASTFEEDING. Pediatrics Mar 2012, 129 (3) e827-e841; DOI: 10.1542/peds.2011-3552
• La Leche League International, https://www.llli.org/breastfeeding-info/
• Your Guide to Breastfeeding. Office on Women’s Health, US Department of Health and Human Services. https://www.womenshealth.gov/files/your-guide-to-breastfeeding.pdf
• Mitchell EA, Blair PS, L'Hoir MP. Should pacifiers be recommended to prevent sudden infant death syndrome? Pediatrics. 2006 May;117(5):1755-8. doi: 10.1542/peds.2005-1625. PMID: 16651334.
• Perl et al. SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women. JAMA. April 2021.
• Wymore et al, Persistence of Δ-9-Tetrahydrocannabinol in Human Breast Milk. JAMA Pediatrics, March 2021; DOI: 10.1001/jamapediatrics.2020.6098

 

Trisomy 13 & 18 Ethical Considerations with Dr. Paul Mann

Trisomy 13 & 18 Ethical Considerations with Dr. Paul Mann

PARTICIPANTS:

• Paul Mann, MD
• Zachary Hodges, MD

About Our Guest:

Dr. Paul Mann is an Associate Professor of Pediatrics, Chief of the Division of Neonatology and practicing neonatologist at the Medical College of Georgia. He also is the Director of Clinical Ethics for the Augusta University Center for Bioethics and Health Policy.

Free CME Credit: https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=7772

Learning Objectives:

By the end of listening to this episode, learners should be able to:

1. Recognize aneuploidies as a common cause of genetic abnormalities in pregnancy.
2. Recognize the historically pessimistic counseling given to families of children with trisomy 13 and 18 and how this might continue to influence our counseling today.
3. Recall how most babies are prenatally diagnosed with trisomy 13 and 18.
4. Describe the life-limiting malformations associated with trisomy 13 and 18.
5. Recognize the recent improvement in prognosis of children with trisomy 13 and 18 as they are being selectively offered more intensive and surgical care.
6. Sensitively counsel families about the general prognosis of newborns with trisomy 13 and 18 while avoiding inaccurate and problematic language such as “lethal and incompatible with life.”

       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.  

 

Peer Reviewers: Amy Thompson, MD & MCG Pediatric Podcast Committee

 

References:

1. Kett JC. Who Is the Next "Baby Doe?" From Trisomy 21 to Trisomy 13 and 18 and Beyond. Pediatrics. 2020;146(Suppl 1):S9-S12. doi:10.1542/peds.2020-0818D
2. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics; Committee on Genetics; Society for Maternal–Fetal Medicine. Practice Bulletin No. 162: Prenatal Diagnostic Testing for Genetic Disorders. Obstet Gynecol. 2016;127(5):e108-e122. doi:10.1097/AOG.0000000000001405
3. Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs. Stamford, Conn: Appleton & Lange, 1999. Print.
4. McCaffrey MJ. Trisomy 13 and 18: Selecting the road previously not taken. Am J Med Genet C Semin Med Genet. 2016;172(3):251-256. doi:10.1002/ajmg.c.31512
5. Bajinting A, Munoz-Abraham AS, Osei H, Kirby AJ, Greenspon J, Villalona GA. To operate or not to operate? Assessing NSQIP surgical outcomes in trisomy 18 patients [published online ahead of print, 2020 Jun 5]. J Pediatr Surg. 2020;S0022-3468(20)30369-9. doi:10.1016/j.jpedsurg.2020.05.037
6. Neubauer K, Boss RD. Ethical considerations for cardiac surgical interventions in children with trisomy 13 and trisomy 18. Am J Med Genet C Semin Med Genet. 2020;184(1):187-191. doi:10.1002/ajmg.c.31767
7. Wightman A, Kett J, Campelia G, Wilfond BS. The Relational Potential Standard: Rethinking the Ethical Justification for Life-Sustaining Treatment for Children with Profound Cognitive Disabilities. Hastings Cent Rep. 2019;49(3):18-25. doi:10.1002/hast.1003
8. Nelson KE, Rosella LC, Mahant S, Guttmann A. Survival and Surgical Interventions for Children With Trisomy 13 and 18 [published correction appears in JAMA. 2017 May 2;317(17 ):1803]. JAMA. 2016;316(4):420-428. doi:10.1001/jama.2016.9819

Congenital Hypothyroidism

TITLE: Congenital Hypothyroidism 

Last Updated: April 30, 2021 

PARTICIPANTS: 

• Host: Dr. Zachary Hodges 
• Learner: Dr. John Baek 
• Specialist: Dr. Jacqueline Chan 

PEER REVIEWERS: 

• Dr. Christopher Houk 
• MCG Pediatric Podcast Committee

Free CME Credit: https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=7771

Learning Objectives: 

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

1. Recall the incidence of and risk factors associated with congenital hypothyroidism. 
2. Understand the importance of early diagnosis and the harms of delayed treatment. 
3. Understand the normal hypothalamic-pituitary-thyroid axis. 
4. Understand the methods of newborn screening for congenital hypothyroidism and interpret abnormal results. 
5. Create a differential diagnosis for the potential causes of congenital hypothyroidism.  
6. Recognize findings on physical exam that would support the diagnosis of congenital hypothyroidism. 
7. Interpret confirmatory testing required to diagnose congenital hypothyroidism. 
8. Recognize that interpreting thyroid function tests should be considered in the context of special circumstances (i.e., premature infants). 
9. Initiate appropriate treatment for suspected congenital hypothyroidism. 
10. Understand the prognosis, need for continued close follow-up and common methods of weaning thyroid replacement therapy.  

 

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:

• Alejandro Diaz and Elizabeth G. Lipman Diaz. Hypothyroidism. Pediatrics in Review August 2014, 35 (8) 336-349; DOI: https://doi.org/10.1542/pir.35-8-336
• Agrawal P, Philip R, Saran S, et al. Congenital hypothyroidism. Indian J Endocrinol Metab. 2015;19(2):221-227. doi:10.4103/2230-8210.131748
• Bowden SA, Goldis M. Congenital Hypothyroidism. [Updated 2020 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558913/ 
• Gammons S, Presley BK, White PC. Referrals for Elevated Thyroid Stimulating Hormone to Pediatric Endocrinologists. J Endocr Soc. 2019;3(11):2032-2040. Published 2019 Sep 16. doi:10.1210/js.2019-00244
• Alejandro Diaz and Elizabeth G. Lipman Diaz. Hypothyroidism. Pediatrics in Review August 2014, 35 (8) 336-349; DOI: https://doi.org/10.1542/pir.35-8-336

Childhood Obesity

Did you know that 1 out of 5 children in the United States ages 6 to 19 are overweight or obese?

Dr. Jamie Lawson, a Pediatric Hospitalist, joins Pediatric Resident Ashley Miller to discuss the evaluation and management pediatric obesity. Specifically, they will:

• Review the key history and physical exam findings associated with obesity.
• Discuss the initial diagnostic approach to obesity
• Identify associated co-morbidities of patients with obesity
• Guide pediatricians on how to initiate appropriate therapy for children who are overweight or obese
• Advise on strategies to counsel patients and their families

Special thanks to Dr. Rebecca Yang and Dr. April Hartman who peer reviewed today’s episode. 

Free CME Credit Available: https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=7596

References:

Alizadeh, Zahra, et al. “Obese and Overweight Children and Adolescents: an Algorithmic Clinical Approach.” Iranian Journal of Pediatrics, Tehran University of Medical Sciences, Dec. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC4025117/. 

Barlow, Sarah E. “Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report.” Pediatrics, vol. 120, no. Supplement 4, 2007, doi:10.1542/peds.2007-2329c. 

Cuda, Suzanne E., and Marisa Censani. “Pediatric Obesity Algorithm: A Practical Approach to Obesity Diagnosis and Management.” Frontiers in Pediatrics, vol. 6, 2019, doi:10.3389/fped.2018.00431. 

“Defining Childhood Obesity.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 July 2018, www.cdc.gov/obesity/childhood/defining.html. 

Flegal, Katherine M, et al. “Characterizing Extreme Values of Body Mass Index–for-Age by Using the 2000 Centers for Disease Control and Prevention Growth Charts.” The American Journal of Clinical Nutrition, vol. 90, no. 5, 2009, pp. 1314–1320., doi:10.3945/ajcn.2009.28335. 

Gulati, A. K., et al. “Clinical Tracking of Severely Obese Children: A New Growth Chart.” PEDIATRICS, vol. 130, no. 6, 2012, pp. 1136–1140., doi:10.1542/peds.2012-0596. 

Lang, Jason E., et al. “Being Overweight or Obese and the Development of Asthma.” Pediatrics, vol. 142, no. 6, 2018, doi:10.1542/peds.2018-2119. 

Ludwig, David S. “Epidemic Childhood Obesity: Not Yet the End of the Beginning.” Pediatrics, vol. 141, no. 3, 2018, doi:10.1542/peds.2017-4078. 

“Overweight & Obesity.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 29 Oct. 2020, www.cdc.gov/obesity/index.html. 

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