2022 Flashcards by JQ B

What adverse outcomes are PDAs associated with in preterm infants?

prolonged assisted ventilation
pulmonary hemorrhage
CLD
NEC
IVH
death

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What prophylactic COX-1 drug can be used in ELBW/extreme prem infants to close the PDA?

Indomethacin IV
Note: there is insufficient evidence for ibuprofen or acetaminophen prophylaxis in this age/wt group.

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What investigation should be done to confirm the presence of a PDA?

Echo

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List examples of conservative management of a PDA.

diuretics
increase PEEP

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What medication is preferred for the management of symptomatic PDAs in infants >26 weeks?

Ibuprofen
Note: can do high dose if the baby is >3-5 days old (Day 1: 15-20 mg/kg, Day 2-3: 7.5-10 mg/kg)

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When should you consider procedural PDA closure (cath or surgery)?

If the infant has a persistent and symptomatic PDA with echo findings of a large shunt and pulmonary overcirculation after having 2 rounds of pharmacotherapy (or less if pharmacotherapy was contraindicated).

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Should you refer an infant to cardiology if they have a persistent PDA at discharge?

Yes

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By what age does infantile GER typically resolve?

1 yo

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List the recommended non-pharmacological strategies to address infantile GERD.

Thickened feeds
Avoiding cow’s milk protein - should only be trialled if 2 weeks of thickened feeds failed to show symptom improvement.

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Is infant re-positioning recommended as a non-pharmacological management of GERD?

No.
There is weak evidence to support any improvement in GERD symptoms. In addition, there is strong evidence that flat, back to sleep prevents SIDS in infants.

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For what clinical symptoms is acid-suppression recommended as treatment for GERD?

Symptoms of Erosive Esophagitis
1. Hematemesis
2. Failure to feed
3. Failure to Thrive

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Are prokinetics recommended in the management of infantile GERD?

No.
Limited evidence and significant negative side effects.

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List 5 general risk factors for reduced bone mass.

chronic inflammation
reduced physical activity or low muscle mass
pubertal delay
poor nutritional status (either from inadequate intake or absorption)
certain medications
Obesity

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Define pediatric osteoporosis

≥1 vertebral fracture in the absence of local disease or high-energy trauma
OR
≥2 long bone fractures by 10 yo OR ≥3 long bone fractures at any age until 19yo WITH a reduced BMD Z-score ≤2.0

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What details will you ask a patient when obtaining an osteoporosis-specific history?

personal and family fracture history
back pain
diet (Ca sources)
physical activity
sun exposure, sunscreen use
onset of puberty

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List examples of osteotoxic medications

steroids
traditional AEDs (phenytoin, PHB, carbamazepine, valproate)
GnRH agonists
medroxyprogesterone
calcineurin inhibitors
antiretrovirals
anticoagulants
loop diuretics
high dose methotrexate

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What is the recommended dietary allowance (RDA) of Vitamin D in children ≥1yo?

600 IU

What is the recommended dietary allowance (RDA) of Calcium in children aged 1-3yo, 4-8yo, and 9-18yo?

1-3yo: 700 mg
4-8yo: 1000 mg
9-18yo: 1300 mg

List things to assess for on physical exam of a child being evaluated for osteoporosis.

growth charts, BMI
signs of nutritional deficiency (rachitic signs, widened metaphyses, limb pain, limb deformities)
vertebral fractures (palpate the spine for tenderness), - Tanner staging
signs of primary osteoporosis (blue sclera for osteogenesis imperfecta, joint laxity in collagen disorders)

When is a DEXA scan indicated in pediatric osteoporosis?

used in patients with fragility fractures who are being considered for bisphosphonate therapy
can also be considered for patients with vertebral fractures

What investigations should you consider for evaluating a patient with osteoporosis?

25-OH-D if evaluating for rickets or low-trauma fracture
spine XR - for vertebral fractures
wrist XR - for rickets
DEXA scan - for fragility fractures who are being considered for bisphosphonate treatment. Can also be considered in vertebral fractures.

List non-pharmacological suggestions you can give patients to improve their bone health.

adequate RDA of Calcium and Vitamin D (diet preferred over supplements)
encourage weight-bearing activities

What is the most common presentation of COVID in children?

mild URTI or asymptomatic

List risk factors for developing severe COVID

obesity
chronic neuro conditions
chronic lung disease (other than asthma)
chronic cardiac disease
immunodeficiency
multiple comorbidities

What is the most common adverse effect of the COVID vaccine?

local pain/swelling

What age group and demographic is most affected by post-COVID vaccine myocarditis/pericarditis?

Young, adult males Typically within 1 week after the second dose

Which brand of vaccine is preferable to prevent post-COVID vaccine myocarditis/pericarditis?

Pfizer Allow 8 weeks between doses

What investigations would you order for a child who presents with chest pain, SOB, or palpitations after the COVID vaccine?

ECG, troponins, CRP, ESR Consult cardio and get an echo if the ECG or troponins are abnormal.

What COVID immunization recommendations do you give to patients who are unimmunized or partially immunized for COVID, but have had a previous COVID infection?

- If no previous vaccine or only 1 dose -> give vaccine 8 wks after symptom onset or COVID+ test result - If immunocompromised -> give vaccine 4-8 wks after symptom onset or COVID+ test result - If completed first series, but has not had booster series -> give vaccine 3mo after symptom onset or COVID+ test result; OR 6 mo after first series, whichever is longer - If had MIS-C -> give vaccine when recovered or 90 days from the onset of MIS-C, whichever is longer

Is it recommended for patients with moderate-severe immunocompromise to receive a 2-dose or 3-dose COVID vaccine series?

3-dose

Are COVID antibodies post-vaccine passed through the placenta and breastmilk?

Yes - Covid protective antibodies can last in breastmilk for 6 weeks after vaccine administration - Vaccine antibodies can also pass through the placenta

In which circumstances are COVID immunizations contraindicated?

1. Anaphylactic allergy to previous COVID vaccine 2. If myocarditis occurred within 6 weeks of a previous COVID vaccine 3. If pericarditis with abnormal ECG or echo findings occurred. In this circumstance, wait 3 months to vaccinate.

Can COVID vaccination alter TB skin test and IGRA results?

Yes, mRNA vaccines temporarily diminish cellular immunity. - If doing a TB skin test or IGRA, ensure this is done before COVID vaccine administration OR 4 weeks after vaccination

What COVID vaccine brand and timing of series is recommended for children aged 5-11 yo?

- Pfizer - 8 weeks between doses

What COVID vaccine brand and timing of series is recommended for children aged >/ 12 yo?

- Pfizer or Moderna - 8 weeks between doses

Are booster COVID vaccine doses recommended for all children?

Yes. But specifically they are recommended for all children at higher risk for severe COVID. This includes: - Immunocompromised, live in congregate settings, belong to communities disproportionately affected by COVID - cancer on active treatment, CKD, CLD, uncontrolled asthma, CF, neuro conditions, diabetes, Down syndrome, CHD, chronic liver disease, obesity, pregnancy, sickle cell, thalassemia, substance use, medically fragile

Should macrolide antibiotics be prescribed for their anti-inflammatory effect in common infections (PNA, AOM, etc)?

No Macrolides are only indicated for atypical PNA or life-threating beta-lactum allergy.

List the recommended first-line, second-line, and additional antibiotics for the treatment of Uncomplicated PNA? Include duration of antibiotic. I

Duration = 5 days o 1st line Amoxicillin o 2nd line Amox-Clav o Life-threatening amox allergy OR atypical PNA-> (1) clarithromycin, (2) azithromycin o Non-life threatening amox allergy -> cefprozil or cefuroxime

List the recommended first-line, second-line, and additional antibiotics for the treatment of AOM. Include duration of antibiotic.

Duration = 10 days if <2yo; 5 days if >/ 2yo o 1st line Amoxicillin o 2nd line Amox-Clav o Life-threatening amox allergy OR atypical PNA-> (1) clarithromycin, (2) azithromycin o Non-life threatening amox allergy -> cefprozil or cefuroxime o Other: Penicillin VK

List the recommended first-line, second-line, and additional antibiotics for the treatment of GAS pharyngitis. Include duration of antibiotic.

GAS: treat for 10 days o 1st line Penicillin VK or Amoxicillin o Non-life threatening amox allergy -> Cephalexin o Life-threatening amox allergy OR atypical PNA-> (1) clarithromycin, (2) azithromycin (5 days

List the recommended antibiotics for the treatment of uncomplicated UTIs. Include duration of antibiotic.

uncomplicated and afebrile, treat for 3 days. Uncomplicated and febrile, treat for 7-10 days. o Septra, Cefixime, Amox/Clav, Ciprofloxacin o If choosing cephalexin, then always 7 days