The Harriet Lane Handbook: The Johns Hopkins Hospital

Cover
PEDIATRIC PARAMETERS AND EQUIPMENT
THE HARRIET LANE HANDBOOK
Copyright
Dedication
Preface
Content
1 - Emergency and Critical Care Management
	I. APPROACH TO THE UNRESPONSIVE CHILD
		A. Circulation1-­3,5-­10
		B. Airway and Breathing1,7,11-­17
	II. MANAGEMENT OF SHOCK3,5,7,11
		A. Definition: Physiologic state characterized by inadequate oxygen and nutrient delivery to meet tissue demands
		B. Etiology: Categorized into four basic types
		C. Management
	III. MANAGEMENT OF COMMON EMERGENCIES
		A. Anaphylaxis18
		B. Upper Airway Obstruction
		C. Status Asthmaticus24-­28
		D. Pulmonary Hypertensive Crisis11,29
		E. Hypertensive Crisis11,30
		F. Hypercyanotic Crisis (“Tet spell”)20,31
		G. Altered Level of Consciousness20,32
		H. Status Epilepticus33-­34
		I. Increased Intracranial Pressure35-­37
	IV. CRITICAL CARE REFERENCE DATA
	REFERENCES
	REFERENCES
2 - Traumatic Injuries
	I. COMPONENTS OF THE TRAUMA ASSESSMENT
		A. Primary Survey
		B. Secondary Survey (Fig. 2.1)
	II. HEAD AND NECK TRAUMA
		A. Head Imaging
		B. Cervical Spine and Neck Imaging
		C. Specific Imaging Studies
	III. CONCUSSION
		A. Concussion Evaluation
		B. Return-­to-­school and Return-­to-­play Guidelines (Table 2.1)
	IV. THORACIC AND ABDOMINAL TRAUMA EVALUATION18
		A. Physical Exam
		B. Laboratory Studies to Consider
		C. Imaging Studies to Consider
	V. ORTHOPEDIC/LONG BONE TRAUMA
		A. Physical Exam
		B. Imaging
		C. Fractures Unique to Children
		D. Fractures Requiring Urgent Orthopedic Surgeon Consultation
		E. Fractures That Are Appropriate to Manage Acutely With Outpatient Referral to Orthopedics (Table 2.2)
	VI. DENTAL TRAUMA
		A. Components of a Tooth (Fig. 2.3)
		B. Differences Between Primary and Permanent Teeth (Fig. 2.4)
		C. Dental Injuries
		D. Anticipatory Guidance Following Dental Trauma
	VII. OPHTHALMOLOGIC TRAUMA26
		A. Chemical Injury to the Eye18
		B. Ruptured Globe
		C. Corneal Abrasion
		D. Superglue to the Eye28
		E. Eyelid Laceration
		F. Orbital Floor Fractures
		G. Other Instances Requiring Ophthalmologic Consultation
	VIII. ANIMAL BITES
		A. Wounds at the Highest Risk of Infection
		B. Decision to Suture
		C. Antibiotic Prophylaxis29
		D. Tetanus Postexposure Prophylaxis: See Chapter 16
		E. Rabies Postexposure Prophylaxis: See Chapter 16
	IX. BURNS
		A. Burns That Should Prompt Consideration of Elective Intubation
		B. Estimation of the Surface Area of Burns
		C. Estimation of the Depth of Burns (Table 2.5)
		D. Fluid Resuscitation in Patients With Burns (Fig. 2.6)
		E. Indications for Transfer to a Burn Center30
		F. Management of Burns Not Referred to Burn Center
		G. Other Special Considerations With Burns
		H. Other Types of Burns
	X. NONACCIDENTAL TRAUMA
		A. Physical Abuse
		B. Sexual Abuse
	XI. RESOURCES
		A. Acute Concussion Evaluation Forms for Emergency Department and Physician/Clinician Office: https://www.cdc.gov/headsup/provid...
		B. Acute Concussion Evaluation Care Plans for Work and School: https://www.cdc.gov/headsup/providers/discharge-­materials.html
	REFERENCES
	REFERENCES
Color Plates
3 - Toxicology
	I. INITIAL EVALUATION
		A. History
		B. Workup and Laboratory Investigation
		C. Clinical Diagnostic Aids (Table EC 3.A)
	II. TOXIDROMES
	III. INGESTIONS AND ANTIDOTES
		A. Decontamination
		B. Enhanced Removal
		C. Other Considerations
	IV. ACETAMINOPHEN OVERDOSE7
		A. Four Phases of Intoxication
		B. Treatment Criteria
		C. Antidote: N-­Acetylcysteine (See Formulary)
	V. LEAD POISONING8
		A. Definition
		B. Sources of Exposure
		C. Overview of Symptoms by Blood Lead Level
		D. Management
	VI. WEB RESOURCES
	REFERENCES
	REFERENCES
4 - Procedures
	I. General Guidelines
		A. Consent
		B. Risks
		C. Documentation
		D. Attending to the Needs of a Fearful Child
	II. Ultrasound for Procedures
		A. Introduction to Ultrasound
		B. Ultrasound Basics
	III. Neurologic Procedures: Lumbar Puncture2,3
		A. Indications
		B. Complications
		C. Cautions and Contraindications
		D. Procedure
		E. A video on lumbar punctures is available on the New England Journal of Medicine’s website
	IV. Otolaryngologic Procedures
		A. Cerumen Impaction Removal4,5
		B. Foreign Body Removal from Ear6
		C. Foreign Body Removal from Nose6,7
		D. Management of Epistaxis6,8
	V. Cardiovascular Procedures
		A. Vagal Maneuvers for Supraventricular Tachycardia (SVT)9,10,11
		B. Heelstick and Fingerstick12
		C. Peripheral Intravenous Access
		D. External Jugular Puncture and Catheterization (see Section XI, Online Content)
		E. Radial Artery Puncture and Catheterization2,3
		F. Posterior Tibial and Dorsalis Pedis Artery Puncture
		G.Intraosseous (IO) Access2,3 (Fig. 4. 4)
		H. Umbilical Artery and Umbilical Vein Catheterization2
	VI. Pulmonary Procedures
		A. Use of Metered-­Dose Inhalers and Spacer6
		B. Needle Cricothyrotomy6,14
		C. Needle Thoracostomy2,15
	VII. Gastrointestinal Procedures
		A. Nasogastric Tube Placement6,16
		B. Gastrostomy Tube Replacement6,17
	VIII. Genitourinary Procedures
		A. Urinary Bladder Catheterization3,6,18
		B. Suprapubic Bladder Aspiration2
	IX. Musculoskeletal Procedures
		A. Basic Splinting2
		B.Selected Splints and Indications (Fig. 4. 8)
		C. Radial Head Subluxation (Nursemaid’s Elbow) Reduction19
		D. Finger/Toe Dislocation Reduction2
		E. Knee Arthrocentesis2
		F. Hematoma Blocks20
	X. Skin/Dermatologic Procedures
		A. Immunization and Medication Administration3
		B. Basic Laceration Repair2
		C. Incision and Drainage (I&D) of Abscess2
		D. Soft Tissue Aspiration25
		E. Tuberculin Skin Test Placement26
		F. Tick Removal27
	References
	XI. Online Content
		A. Ultrasound-­Guided Lumbar Puncture
		B. External Jugular Puncture and Catheterization2
	References
5 - Adolescent Medicine
	I. ADOLESCENT HEALTH MAINTENANCE
	II. SEXUAL HEALTH
	REFERENCES
6 - Analgesia and Procedural Sedation
	I. Pain Assessment
		A. Infant1
		B. Preschooler
		C. School-­Age and Adolescent
	II. Analgesics1
		A. Safety
		B. Nonopioid Analgesics
		C.Opioids (Table 6. 2)
		D. Local Anesthetics9–12
		E. Nonpharmacologic Measures of Pain Relief13,14
	III. Patient-­Controlled Analgesia (PCA)
		A. Definition
		B. Indications
		C. Routes of Administration
		IVor epidural
		D.Agents (Table 6. 5)
		E. Adjuvants
		F. Side Effects of Opioid Patient-­Controlled Analgesia
	IV. Opioid Tapering
		A. Indications
		B. Withdrawal
		C. Recommendations for Tapering
		D. Examples
	V. Procedural Sedation1,9–12,19–21
		A. Definitions
		B. Preparation
		C. Monitoring
		D. Pharmacologic Agents
		E. Discharge Criteria20
	VI. Web Resources
	References
	References
7 - Cardiology
	I. Physical Examination
		A. Heart Rate
		B. Blood Pressure
		C. Heart Sounds
		D. Systolic and Diastolic Sounds
		E. Murmurs4
	II. Electrocardiography
		A. Basic Electrocardiography Principles
		B. ECG Abnormalities
		C.ECG Findings Secondary to Electrolyte Disturbances, Medications, and Systemic Illnesses (Table 7. 10)7,9
		D. Long QT
		E. Hyperkalemia
	III. Congenital Heart Disease
		A. Pulse Oximetry Screening for Critical Congenital Heart Disease
		B.Common Syndromes Associated with Cardiac Lesions (Table 7. 11)
		C. Acyanotic Lesions (Table 7.12)
		D.Cyanotic Lesions (Table 7. 13)
	IV. Acquired Heart Disease
		A.Myocardial Infarction (MI) in Children (Box 7.4; Fig. 7. 8)
		B. Endocarditis
		C. Bacterial Endocarditis Prophylaxis
		D. Myocardial Disease
		E. Pericardial Disease
		F. Kawasaki Disease19
		G. Rheumatic Heart Disease
	V. Imaging
	VI. Procedures
		A. Cardiac Surgery (Fig. 7.11, Table 7.14)
		B. Cardiac Catheterization13,14
	VII. Common Cardiac Complaints
		A. Non-­Traumatic Chest Pain20
		B. Syncope21
	VIII. Exercise Recommendations for Patients With Congenital Heart Disease
	IX. Lipid Monitoring Recommendations
		A. Screening of Children and Adolescents23
		B. Goals for Lipid Levels in Childhood23
	X. Cardiovascular Screening
		A. Sports24
		B. Attention–Deficit/Hyperactivity Disorder (ADHD)27
	XI. Web Resources
	References
	References
8 - Dermatology
	I. Evaluation and Clinical Descriptions of Skin Findings
		A. Primary Skin Lesions
		B. Secondary Skin Lesions
		C. Shapes and Arrangements
	II. Vascular Anomalies1
		A. Vascular Tumors
		B. Vascular Malformations
	III. Infections
		A. Viral
		B. Parasitic
		C.Fungal (Figs. 8.12–8. 16, Color Plates)
		D. Bacterial
	IV.Hair Loss (Figs. 8.18–8. 20, Color Plates)
		A.Telogen Effluvium (see Fig. 8. 18, Color Plates)
		B.Alopecia Areata (see Fig. 8. 19, Color Plates)
		C.Traction Alopecia (see Fig. 8. 20, Color Plates)
		D. Trichotillomania and Hair Pulling
	V. Acne Vulgaris
		A. Pathogenetic Factors
		B. Risk Factors
		C. Clinical Presentation
		D.Treatment14–16 (Table 8. 2)
	VI.Common Neonatal Dermatologic Conditions (Fig. 8.21; Figs. 8.22–8. 30, Color Plates)
		A.Erythema Toxicum Neonatorum (see Fig. 8. 22, Color Plates)
		B.Transient Neonatal Pustular Melanosis (see Figs. 8.23–8. 24, Color Plates)
		C.Miliaria (Heat Rash) (see Fig. 8. 25, Color Plates)
		D.Milia (see Fig. 8. 26, Color Plates)
		E.Neonatal Acne (see Fig. 8. 27, Color Plates)
		F.Seborrheic Dermatitis (Cradle Cap) (see Figs. 8.28–8. 29, Color Plates)
		G. Congenital Dermal Melanocytosis (formerly known as Mongolian Spots)
		H.Diaper Dermatitis19 (see Fig. 8. 30, Color Plates)
	VII.Autoimmune and Allergic Dermatologic Conditions (Figs. 8.31–8. 38, Color Plates)
		A. Contact Dermatitis
		B.Atopic Dermatitis (Eczema) (See Figs. 8.33–8. 37, Color Plates)
		C.Papular Urticaria (See Fig. 8. 38, Color Plates)
		D. Stevens-­Johnson Syndrome and Toxic Epidermal Necrolysis
		E. Autoimmune Bullous Diseases: See Section X, Online Content
	VIII. Nail Disorders28: see Section X, Online Content
	IX. Disorders of Pigmentation: see Section X, Online Content
	REFERENCES
	X. Online Content
		A. Autoimmune and Allergic Lesions
		B. Nail Disorders28
		C. Disorders of Pigmentation30
	References
Color Plates
9 - Development, Behavior, and Developmental Disability
	I. Developmental Definitions1,2
		A. Developmental Streams
		B. Developmental Quotient (DQ)
		C. Abnormal Development
	II. Guidelines for Normal Development and Behavior
		A.Developmental Milestones (Table 9. 1)
		B.Age-­Appropriate Behavioral Issues in Infancy and Early Childhood: See Table 9. 2
	III. Developmental Screening and Evaluation of Developmental Disorders
		A. Developmental Surveillance and Screening Guidelines
		B.Commonly Used Developmental Screening and Assessment Tools: See Table 9. 3
		C.Identification of Developmental “Red Flags”: See Table 9. 4
		D. Evaluation of Abnormal Development
	IV. Specific Disorders of Development
		A. Overview
		B. Intellectual Disability
		C. Communication Disorders
		D. Learning Disabilities4
		E. Cerebral Palsy (CP)
		F. Autism Spectrum Disorders
		G. Attention Deficit/Hyperactivity Disorder: See Chapter 24
	V. Longitudinal Care of Children With Developmental Disorders and Disabilities
		A. Interdisciplinary Involvement
		B. Relevant Laws and Regulation
	VI. Transitions From Pediatric to Adult Care for Youth With Developmental Disabilities
		A. The Need
		B. The Role of the Pediatric Provider
		C. Transition Domains
	VII. Web Resources
	References
	References
10 - Endocrinology
	I. Diabetes
		A. Diagnosis of Diabetes Mellitus1-­3
		B. Definition of Increased Risk (Prediabetes)
		C. Interpreting Hemoglobin A1c1,2
		D. Etiology: Distinguishing Between Types of Diabetes Mellitus1,2
		E. Screening for Type 2 Diabetes Mellitus1,6
		F. Additional Testing in New-­Onset Diabetes
		G. Management of Diabetes6-­8
		H. Diabetes-­Related Devices9,10
		I. Monitoring6,8,9,11
		J. Diabetic Emergencies12,13
	II. Thyroid Gland14-­16
		A. Thyroid Tests15,17,18
		B. Hypothyroidism
		C. Hyperthyroidism
	III. Parathyroid Gland and Vitamin D22-­24
		A. Parathyroid Hormone Function
		B. Distinguishing Between Abnormalities Related to Parathyroid Hormone and Vitamin D
		C. Vitamin D Supplementation
	IV. Adrenal Gland25-­29
		A. Adrenal Insufficiency
		B. Adrenal Cortex Hormone Excess29
		C. Adrenal Medulla Hormone Excess: Pheochromocytoma32-­34
	V. Disorders of So dium and Water Regulation35
		A.Distinguishing Between Disorders of Sodium and Water Regulation: See Table 10. 16
		B. Correction of Hypo-­ and Hypernatremia: See Chapter 11
		C. Conducting a Water Deprivation Test
		D.Interpretation of Water Deprivation Test Results: See Table 10. 17
		E. Differentiating Between Central Versus Nephrogenic Causes of Diabetes Insipidus
	VI. Growth35-­37
		A. Assessing Height
		B. Short Stature
	VII. Sexual Development39-­45
		A. Puberty
		B. Lab Evaluation
		C. Polycystic Ovarian Syndrome48
		D. Ambiguous Genitalia49
		E. Cryptorchidism50
	VIII. Neonatal Hypoglycemia Evaluation51,52
		A. Definition
		B. Treatment Goals
		C. Management
		D. Further Work-­up
		E. Interpretation of Results
		F. Hyperinsulinemia
	IX. Additional Normal Values
	X. Web Resources
		A.Children with Diabetes (www.childrenwithdiabetes. com)
		B.American Diabetes Association (www.diabetes. org)
		C.International Society for Pediatric and Adolescent Diabetes (www.ispad. org)
		D.Pediatric Endocrine Society (www.lwpes. org)
		E.The Endocrine Society (www.endocrine. org)
		F.American Thyroid Association (www.thyroid. org)
	REFERENCES
		A complete list of references can be found online at www.expertconsult.com
	References
11 - Fluids and Electrolytes
	I. Introduction
	II. Fluid Resuscitation
		A. Calculating Maintenance Fluid Volume
		B. Calculating Fluid Loss
		C. Maintenance Fluid Choice in Hospitalized Children
		D. Volume Replacement Strategy7,12,13
	III. Electrolyte Management
		A. Serum Osmolality and Tonicity2,7,14
		B. Sodium
		C. Potassium
		D. Calcium
		E. Magnesium
		F. Phosphate
	IV. Algorithm for Evaluating Acid-­Base Disturbances7,17,18
		A. Determine the pH
		B. Calculate the anion gap (AG)
		C. Calculate the delta gap (DG)20
		D. Calculate the osmolal gap
		E.Calculate expected compensatory response: (Table 11. 14)
		F. Determine the likely etiology
		G.If there is not appropriate compensation, consider an additional acid-­base derangement (Fig. 11. 2)
	References
		A complete list of references can be found online at www.expertconsult.com
	References
12 - Gastroenterology
	I. Gastrointestinal Emergencies
		A. Gastrointestinal Bleeding
		B. Acute Abdomen2
	II. Conditions of the Gastrointestinal Tract
		A. Vomiting
		B. Gastrointestinal Reflux Disease3
		C. Eosinophilic Esophagitis6,7
		D. Celiac Disease9
		E. Inflammatory Bowel Disease (EoE)10,11
		F. Constipation17
		G. Diarrhea18
	III. Conditions of the Liver
		A.Liver Laboratory Studies: Table 12. 6
		B. Acute Liver Failure24,25
		C. Nonalcoholic Fatty Liver Disease26
		D. Hyperbilirubinemia27-­29
	IV. Pancreatitis30-­32
		A. Acute Pancreatitis33
		B. Chronic Pancreatitis34,35
	V. Web Resources
	REFERENCES
	References
13 - Genetics: Metabolism and Dysmorphology
	I. METABOLISM1-­7
		A. Clinical Presentation of Metabolic Disease (Box 13.1)
		B. Evaluation
		C. Categories of Metabolic Disorders
		D. Management of Metabolic Crisis
		E. Commonly Used Medications
	II. NEWBORN METABOLIC SCREENING7
		A. Timing
14 - Hematology
	I. Anemia
		A. Screening for Anemia
		B. Definition of Anemia
		C. Causes of Anemia
		D. Evaluation of Anemia
		E. Management of Anemia
	II. Neutropenia
		A. Definition of Neutropenia
		B. Causes and Evaluation of Neutropenia11
		C. Management of Neutropenia
	III. Thrombocytopenia and Impaired Platelet Function
		A. Definition of Thrombocytopenia
		B. Bleeding Risk with Thrombocytopenia
		C. Evaluation of Thrombocytopenia15,16
		D. Causes of Thrombocytopenia and Impaired Platelet Function
		E. Management of Thrombocytopenia
	IV. Coagulation
		A. Evaluation of Coagulation and Platelet Function
		B. Definition of Abnormal Coagulation
		C. Causes and Management of Coagulopathy
		D. Causes of Hypercoagulability
		E. Thrombus Management
	V. Blood Component Replacement
		A.Calculating Estimated Blood Volume (Table 14. 16)
		C.Diagnosis and Management of Transfusion Reactions (Table 14. 18)
	VI. Additional Resources
		A.Medications to avoid with G6PD Deficiency: http://g6pddeficiency. org/wp/living-­with-­g6pd-­deficiency/drugs-­to-­avoid-­list
	REFERENCES
	VII. Online Content
		A. Specific PRBC Types
		B. Directed Donor Transfusions
	References
15 - Immunology and Allergy
	I. Allergic Rhinitis1–6
		A. Epidemiology
		B. Diagnosis
		C. Differential Diagnosis
		D. Treatment
	II. Food Allergy7–12
		A. Epidemiology
		B. Manifestations of Food Allergy
		C.Diagnosis of Food Allergy (Fig. 15. 1)
		D. Differential Diagnosis
		E. Treatment
		F. Natural History
	III. Drug Allergy13,14
		A. Definition
		B. Diagnosis
		C.Management (Fig. 15. 2)
	IV. Evaluation of Suspected Immunodeficiency
	V. Immunoglobulin Therapy22–25
		A. Intravenous Immunoglobulin (IVIG)
		B. Intramuscular Immunoglobulin (IMIG)
		C. Subcutaneous Immunoglobulin
		D. Specific Immunoglobulins
		E. Vaccination Timing
	VI. Immunologic Reference Values
		A.Serum IgG, IgM, IgA, and IgE Levels (Table 15. 3)
	REFERENCES
	References
16 - Immunoprophylaxis
	I. Immunization Schedules
		A. Immunizations for Children Ages 0 to 18
		B. Nonroutine Vaccines Used in the United States3
	II. Immunization Guidelines
		A. Vaccine Informed Consent
		B. Vaccine Administration
		C. Live, Attenuated Vaccines
		D. Timing and Spacing of Vaccine Doses
		E. Contraindications and Precautions6
	III.Postexposure Prophylaxis (Table 16. 5)
	IV. Special Patient Populations7
		A. Altered Immunocompetence8,9
		B. Disease-­Specific Considerations
		C. Preterm Infants
		D. Pregnant Women
		E. Immigration, Emigration, and Travel
	V. Counseling and Communication about Vaccines16-­26
		A. Vaccine Hesitancy
		B. Countering Vaccine Hesitancy
	VI. Web Resources27-­33
	REFERENCES
	VII. Online Content
		A. Additional Vaccine Recommendations
		B. The 3C Model: Key Barriers to Vaccine Use Worldwide16
		C. Strategies to Address Vaccine Hesitancy18-­19,22-­26
		D. Provider Resources for Vaccine Communication
	References
17 - Microbiology and Infectious Disease
	I. Common Neonatal and Pediatric Infections: Guidelines for Diagnosis and Initial Management
		A.Congenital, Perinatal, and Neonatal Infections (Table 17. 1)
		B.Pediatric Infections by System (Table 17. 2)
		C.Pediatric Viral Illnesses (Table 17. 3)
		D.Pediatric Tick-­Borne Diseases (Table 17. 4)
		E.Tuberculosis: Diagnosis and Treatment (Boxes 17.1 and 17. 2)1,2
		F. Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome
	II. Microbiology
		A. Collection of Specimens for Blood Culture
		B.Rapid Microbiologic Identification of Common Aerobic Bacteria (Fig. 17.4) and Anaerobic Bacteria (Fig. 17. 5)
	III.Spectra of Activity for Commonly Used Antibiotics (Fig. 17. 6)
	IV. Exposures to Blood Borne Pathogens and Prophylaxis
		A. General Practice46
		B. Disease-­Specific Post-Exposure Management
	References
	References
18 - Neonatology
	I. Newborn resuscitation
		A.Algorithm for Neonatal Resuscitation (Fig. 18. 1)
		B.Endotracheal Tube Size and Depth of Insertion (Table 18. 1)
		C. Vascular Access (See Chapter 4 for Umbilical Venous/Artery Catheter Placement)
	II. Routine Newborn Care of a Term Infant
		A. General Care for the Full-­Term Healthy Newborn with Uncomplicated Delivery
		B. Prior to Discharge7
	III. Newborn Assessment
		A. Vital Signs and Birth Weight
		B.APGAR Scores (Table 18. 2)
		C. Gestational Age Estimation
		D. Birth Trauma
		E. Selected Anomalies, Syndromes, and Malformations (see Chapter 13 for genetic disorders)
	IV. Fluids, Electrolytes, and Nutrition
		A. Fluids
		B. Glucose
		C. Electrolytes, Minerals, and Vitamins
		D. Nutrition
	V. Cyanosis in the Newborn
		A. Differential Diagnosis
		B. Evaluation
	VI. Respiratory Diseases
		A. General Respiratory Considerations
		B. Respiratory Distress Syndrome
		C. Persistent Pulmonary Hypertension of the Newborn
		D. Transient Tachypnea of the Newborn
		E. Pneumothorax
	VII. Apnea and Bradycardia
		A. Apnea15
		B. Bradycardia without Central Apnea
	VIII. Cardiac Diseases
		A. Patent Ductus Arteriosus
		B. Cyanotic Heart Disease (See Chapter 7)
	IX. Hematologic Diseases
		A. Unconjugated Hyperbilirubinemia in the Newborn23
		B. Conjugated Hyperbilirubinemia (See Chapter 12)
		C. Polycythemia
	X. Gastrointestinal Diseases
		A. Necrotizing Enterocolitis
		B. Bilious Emesis
		C.Abdominal Wall Defects (Table EC 18. D)
		D. Gastroesophageal Reflux Disease (See Chapter 12)
	XI. Neurologic Diseases
		A. Neonatal Hypoxic-­Ischemic Encephalopathy
		B. Intraventricular Hemorrhage
		C. Periventricular White Matter Injury
		D. Neonatal Seizures (See Chapter 20)
		E. Neonatal Abstinence Syndrome
		F. Peripheral Nerve Injuries
	XII. Urologic Disorders
		A. Lower Urinary Tract Obstruction
		B. Bladder Exstrophy-­Epispadias-­Cloacal Exstrophy Complex
	XIII. Retinopathy of Prematurity34
		A. Definition
		B. Etiology
		C. Diagnosis
		D. Timing35
		E. Classification
		F. Management34-­35
	XIV. Commonly Used Medications in the Neonatal Intensive Care Unit
	XV. Web Resources
	REFERENCES
	XVI. Online Content
	I. Prenatal Assessment of Fetal Health
		A. Fetal Anomaly Screening
		B. Fetal Health
		C. Estimation of Gestational Age
	References
19 - Nephrology
	I.Urinalysis1: Table 19. 1
	II. Kidney Function Tests
		A. Tests of Glomerular Function
		B. Tests of Kidney Tubular Function
	III. Chronic Hypertension5-­7
		A. Definition
		B. Measurement of Blood Pressure in Children
		C.Etiologies of Hypertension in Neonates, Infants, and Children (Table 19. 5)
		D. Evaluation of Chronic Hypertension
		E.Classification and Treatment of Hypertension (Table 19. 6)
		F. Antihypertensive Drugs for Outpatient Management of Primary Hypertension in Children 1 to 17 Years of Age
	IV. Urinary Tract Infections8-­13
		A. History
		B. Physical Examination
		C. Risk Factors
		D. Methods of Urine Collection
		E. Diagnosis
		F. Classification
		G. Imaging
		H. Treatment of Culture-­Positive Urinary Tract Infection
	V. Proteinuria14–16
		A. Definitions
		B. Methods of Detection
		C.Etiologies (Box 19. 1)
		D. Evaluation15
		E. Nephrotic Syndrome16
	VI. Hematuria18
		A. Definition
		B. Etiologies: See Table 19.9
		C.Evaluation (Fig. 19. 2)
		D. Management (Fig. 19.3)
	VII. Acute Kidney Injury19,20
		A. Definition
		B.Etiology (Table 19. 10)
		C. Clinical Presentation
		D. Acute Tubular Necrosis
		E. Treatment Considerations
		F. Complications
		G. Radiographic Imaging Considerations in AKI/CKD
	VIII. Chronic Kidney Disease23
		A. Definition
		B. Etiology
		C. Clinical Manifestations (Table 19.12)
		D. General Management
	IX. Dialysis
		A. Indications for Acute Dialysis
		B. Techniques
		C. Complications
	X. Tubular Disorders
		A.Renal Tubular Acidosis (Table 19. 13)26
		B. Fanconi Syndrome
		C. Nephrogenic Diabetes Insipidus
	XI. Nephrolithiasis27-­30
		A. Risk Factors
		B. Presentation
		C. Diagnostic Imaging
		D. Management
		E. Workup
		F. Prevention
	XII. Web Resources
		A.International Pediatric Nephrology Association: www.ipna-­online. org
		B. National Kidney Disease Education Program: https://www.niddk.nih.gov/health-­information/communication-­programs/nkdep
		C. National Kidney Foundation: www.kidney.org
	REFERENCES
	References
20 - Neurology
	I. NEUROLOGIC EXAMINATION
	II. HEADACHES1–11
	III. SEIZURES12–25
	IV. HYDROCEPHALUS26–28
	V. ATAXIA29,30
	VI. STROKE31–33
	VII. ENCEPHALOPATHY/ALTERED MENTAL STATUS34–37
	VIII. NEUROMUSCULAR DISORDERS38–45
	IX. WEB RESOURCES
	REFERENCES
21 - Nutrition and Growth
	I. ASSESSMENT OF GROWTH
		A. Types of Growth Charts
		B. Interpretation of Growth Charts11,12
		C. General Guidelines Regarding Appropriate Growth13,14
	II. MANAGEMENT OF OVERWEIGHT AND OBESE CHILDREN
		A. AAP Recommendations for the Prevention of Obesity15-­17
		B. Prevention and Management of Obesity in the Primary Care Setting (Table 21.1)
		C. Conditions Associated with Obesity15
	III. MALNUTRITION IN INFANTS AND CHILDREN
		A. Defining Malnutrition16
		B. Classifying the Degree to Which a Patient Is Malnourished (Table 21.2)17
		C. Resources for Determining Z-­scores18
		D. Differential Diagnosis of Malnutrition19
		E. Physical Exam Findings Consistent with Malnutrition23-­25
		F. Diagnostic Evaluation of Malnutrition26-­29
		G. Red Flags That Suggest a Medical Cause of Malnutrition20
		H. Approach to the Management of Malnourished Patients21,22 (Box 21.1)
	IV. RE-­FEEDING SYNDROME
		A. Patients at Risk of Developing Re-­Feeding Syndrome23
		B. Management of Re-­Feeding Syndrome24
	V. NUTRITIONAL NEEDS OF HEALTHY CHILDREN
		A. Dietary Allowances for Carbohydrates and Protein (Table 21.3)
		B. Fat Requirements (Table 21.4)
		C. Vitamin Requirements (Tables 21.5 and 21.6)
		D. Mineral Requirements (Table 21.7)
		E. Fiber Requirements (Table 21.8)
	VI. BREASTFEEDING AND THE USE OF HUMAN MILK
		A. Benefits of Breast Milk31
		B. Contraindications to Breastfeeding32,33 (Box 21.2)
		C. Use of Milk Bank Donor Human Milk34
		D. Safe Handling of Breast Milk35
		E. Breastfeeding Challenges
	VII. ENTERAL NUTRITION
		A. Feeding the Healthy Infant
		B. Available Formulas for Patients with Specific Clinical Conditions or for Those Requiring Special Diets (Tables 21.12 and 21.1...
		C. Use of Enteral Tube Feeds37
		D. Features of the Most Common Oral Rehydration Solutions (Table 21.14)
	VIII. PARENTERAL NUTRITION
		A. Indications for the Use of Parenteral Nutrition38
		B. Starting and Advancing Parenteral Nutrition (Table 21.15)
		C. Frequency of Monitoring Growth Parameters and Laboratory Studies in Patients on Parenteral Nutrition (Table 21.16)
		D. Recommended Formulations of PN (Table 21.17)
	IX. WEB RESOURCES
		A. Professional and Government Organizations
		B. Infant and Pediatric Formula Company Websites
		C. Breastfeeding Resources
	REFERENCES
	REFERENCES
22 - Oncology
	I. OVERVIEW OF PEDIATRIC MALIGNANCIES1-4
		A. Epidemiology
		B. Presenting Signs and Symptoms
	II. PEDIATRIC HEMATOLOGIC MALIGNANCIES1-­2 (TABLE 22.1)
	III. PEDIATRIC SOLID TUMOR MALIGNANCIES1-­2 (TABLE 22.2)
	IV. PEDIATRIC CENTRAL NERVOUS SYSTEM (CNS) TUMORS1-­2,5-­8(TABLE 22.3)
		A. Epidemiology
		B. Clinical Presentation
		C. Initial Workup
		D. Management Principles
	V. ONCOLOGIC EMERGENCIES2,9-­16
		A. Fever and Neutropenia (Fig 22.1)
		B. Hyperleukocytosis/Leukostasis
		C. Tumor Lysis Syndrome
		D. Spinal Cord Compression
		E. Increased Intracranial Pressure (ICP)
		F. Other Neurologic Emergencies: Cerebrovascular Accident (CVA), Seizures
		G. Superior Vena Cava Syndrome/Superior Mediastinal Syndrome
		H. Typhlitis (Neutropenic Enterocolitis)
		I. Cytokine Release Syndrome
	VI. COMMONLY USED CHEMOTHERAPEUTIC DRUGS AND ASSOCIATED ACUTE TOXICITIES (TABLE 22.4)
	VII. COMMON CHEMOTHERAPY COMPLICATIONS AND SUPPORTIVE CARE1,11
		A. Cytopenias: Anemia, Thrombocytopenia, Neutropenia
		B. Mucositis
		C. Nausea and Emesis
	VIII. ANTIMICROBIAL PROPHYLAXIS IN ONCOLOGY PATIENTS (TABLE 22.6)17-­19
	IX. HEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT)1,2,20
		A. Goal
		B. Preparative Regimens
		C. Types of HSCT
		D. Engraftment
	X. COMPLICATIONS OF HSCT1,2,20-­22
		A. Graft-­Versus-­Host Disease
		B. Sinusoidal Obstructive Syndrome (SOS); Veno-­Occlusive Disease (VOD)
	XI. CANCER SURVIVORSHIP3,23-­25
		A. Understand the Diagnosis
		B. Monitoring
		C. Vaccinations in Oncology and HSCT Patients: see Chapter 16
	XII. WEB RESOURCES
	REFERENCES
	XIII. ONLINE CONTENT
		A. Complications of HSCT1,2,19-­21,25-­29
	REFERENCES
23 - Palliative Care
	I. INTRODUCTION TO HOSPICE AND PALLIATIVE MEDICINE
		A. Definition of Palliative Care1,2
		B. Definition of Hospice
		C. Team Composition
	II. COMMUNICATION AND DECISION MAKING
		A. Decision-­Making Tools3
		B. Structuring Family Meetings4
		C. Breaking Bad News5
		D. Other Tools for Difficult Conversations
	III. CARE OF THE DYING CHILD
		A. Limiting Interventions
		B. Involving the Child in Conversations About Death8-­11
		C. Supporting Patients Throughout the Dying Process
		D. Pronouncing Death14
		E. Explaining Autopsies15
		F. Organ Donation
		G. Completing Death Certificates14
		H. Interacting with Loved Ones After a Child’s Death
	IV. WEB RESOURCES
		A. Center to Advance Palliative Care—capc.org
		C. The American Academy of Hospice and Palliative Medicine—www.aahpm.org
	REFERENCES
	REFERENCES
24 - Psychiatry
	I. OVERVIEW
		A. Epidemiology and General Approach
		B. Mental Status Exam
	II. POSTPARTUM DEPRESSION
		A. Epidemiology4: Prevalence in most studies is between 10% and 15%
		B. Screening
		C. Diagnosis
		D. Treatment
	III. COMMON PSYCHIATRIC CONDITIONS IN CHILDREN (2 TO 12 YEARS)
		A. Attention-­Deficit/Hyperactivity Disorder
		B. Anxiety Disorders
		C. Oppositional Defiant Disorder (ODD)17
	IV. COMMON PSYCHIATRIC CONDITIONS IN ADOLESCENTS
		A. Depressive Disorders
		B. Substance Use Disorders
		C. Eating Disorders
	V. PSYCHIATRIC EMERGENCIES
		A. Suicide
		B. Agitation31,32
	VI. WEB RESOURCES
	REFERENCES
	REFERENCES
25 - Pulmonology and Sleep Medicine
	I. EVALUATION OF PULMONARY GAS EXCHANGE
		A. Pulse Oximetry1-­3
		B. Capnography4,5
		C. Blood Gases6-­8
		D. Analysis of Acid-­Base Disturbances9-­11
	II. PULMONARY FUNCTION TESTS (PFT)
		A. Peak Expiratory Flow Rate (PEFR)12,13
		B. Maximal Inspiratory and Expiratory Pressures14,15
		C. Spirometry (for Children 6 Years of Age or Above)16,17
	III. ASTHMA12,18
		A. Definition
		B. Clinical Presentation
		C. Treatment
		D. Prevention of Exacerbations
	IV. BRONCHIOLITIS19-­23
		A. Definition
		B. Clinical Presentation
		C. Treatment
	V. BRONCHOPULMONARY DYSPLASIA (BPD)24-­27
		A. Definition
		B. Clinical Presentation
		C. Diagnosis
		D. Treatment
	VI. CYSTIC FIBROSIS28-­37
		A. Definition
		B. Clinical Manifestations (Fig. 25.9)
		C. Diagnosis
		D. Treatment
	VII. OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS)38-­42
		A. Definition
		B. Clinical Presentation
		C. Diagnosis
		D. Treatment
		I.History
		II.Physical examination
	VIII. INFANT AND CHILD SLEEP43-­46
		A. Sleep Duration
		B. Sleep-­Related Infant Death
	IX. BRIEF RESOLVED UNEXPLAINED EVENT (BRUE)47,48
		A. Definition
		B. Differential Diagnosis
		C. Management
	X. WEB RESOURCES
	REFERENCES
	XI. ONLINE CONTENT
		A. Evaluation of Pulmonary Gas Exchange
		B. Asthma
		C. Childhood Sleep Disorders44,45
	REFERENCES
26 - Radiology
	I. GENERAL PEDIATRIC PRINCIPLES
	II. CHOOSING THE RIGHT STUDY
	III. HEAD
	IV. NECK AND AIRWAY
	V. CHEST
	VI. HEART (SEE CHAPTER 7)
	VII. ABDOMEN
27 - Rheumatology
	I. BRIEF OVERVIEW OF CLINICAL CHARACTERISTICS OF RHEUMATOLOGIC DISEASES
		A. Juvenile Idiopathic Arthritis (JIA)1–­5
		B. Reactive Arthritis6–­8
		C. Systemic Lupus Erythematosus (SLE)1,9–­11
		D. Drug-­Induced Systemic Lupus Erythematosus1,6,9
		E. Neonatal Systemic Lupus Erythematosus1,12
		F. Vasculitis (Table 27.2)1,6,13–­23
		G. Sarcoidosis6,14,24–­26
		H. Scleroderma6,14,27
		I. Sjögren Syndrome1,6,14,28
	II. INTERPRETATION OF LABORATORY STUDIES USED IN THE DIAGNOSIS AND MONITORING OF RHEUMATOLOGIC DISEASES
		A. Acute-­Phase Reactants
		B. Autoantibodies (Table 27.3)14
		C. Complement1,5
	III. PRIMARY CARE MANAGEMENT OF RHEUMATOLOGIC DISEASES36,38,39
		A. Vaccination
		B. Weight Management
		C. Bone and Skin Health
		D. Reproductive Health
		E. Other Aspects of Primary Care Coordination
		F. Laboratory Monitoring
	IV. WEB RESOURCES
	REFERENCES
	REFERENCES
28 - Blood Chemistry and Body Fluids
	I. REFERENCE VALUES
	II. EVALUATION OF BODY FLUIDS
		A. Evaluation of Cerebrospinal Fluid
		B. Evaluation of Urine
		C. Evaluation of Transudate/Exudate
		D. Evaluation of Synovial Fluid
	III. CONVERSION FORMULAS
		A. Temperature
		B. Length and Weight
	REFERENCES
	REFERENCES
29 - Biostatistics and Evidence-Based Medicine
	I. EVIDENCE-BASEDMEDICINE
		A. Formulate the Clinical Question (PICO Process)
		B. Search for the Evidence to Answer the Question
		C. Critically Appraise the Evidence
		D. Apply the Evidence to the Clinical Question
	II. BIOSTATISTICS AND EPIDEMIOLOGY
		A. Statistical Tests
		B. Statistical Terminology
		C. Types of Study Designs7 (see Table 29.2)
		D. Measurement of Disease Occurrence and Treatment Effects2
		E. Measurements of Test Performance2
	III. WEB RESOURCES
		A. Evidence-BasedResources
		B. Biostatistics and Epidemiology Resources
		REFERENCES
		REFERENCES
31 - Drugs in Renal Failure
	I. DOSE ADJUSTMENT METHODS
		A. Maintenance Dose
		B. Dialysis
	II. ANTIMICROBIALS REQUIRING ADJUSTMENT IN RENAL FAILURE (TABLE 31.1)
	III. NONANTIMICROBIALS REQUIRING ADJUSTMENT IN RENAL FAILURE (TABLE 31.2)
	REFERENCES
	REFERENCES
Pediatric BLS Health Care Providers
Pediatric Tachycardia
Pediatric Bradycardia
Pediatric Cardiac Arrest