Pediatric hospitalists demonstrated their leadership and ownership of clinical hospital medicine on this year’s pediatric track at HM11.
Joel Tieder, MD, MPH, advocated for a balanced and risk-based approach to apparent life-threatening events (ALTEs). Although the differential for this observer-defined symptom remains broad, a link to perhaps the most worrisome outcome, sudden infant death syndrome (SIDS), has not been borne out in the medical literature. Testing seldom offers conclusive answers, Dr. Tieder said in his review.
Thus, a risk-based approach to guide work-up is prudent. Young age and a history of recurrent events are two factors that could signify risk for worrisome underlying pathology, to include infection and nonaccidental trauma. Dr. Tieder has worked with SHM to organize and lead an expert panel that hopes to release a white paper on this topic in the future.
John Pope, MD, Kris Rehm, MD, and Brian Alverson, MD, collectively presented an update on the top articles of the year relevant to pediatric HM.
- The potential utility of the Pediatric Early Warning Score in identifying clinical deterioration;
- A reduction in symptoms in patients with irritable bowel syndrome given Lactobacillus GG;
- The positive impact of an antimicrobial stewardship program on vancomycin usage;
- The utility of the clinical examination in deciding whether a lumbar puncture is warranted to evaluate for bacterial meningitis in patients presenting with complex febrile seizures; and
- The adequacy of short-term IV antibiotic therapy in young infants with UTIs.
Dr. Alverson provided an update on the development of clinical practice guidelines for community-acquired pneumonia in children, highlighting his participation on a committee cosponsored by the Pediatric Infectious Disease Society and the Infectious Disease Society of America. Laboratory and radiographic data rarely clarify the diagnosis of clinical pneumonia and are not as useful in the outpatient setting but may be justified to look for complications in children who are hospitalized, he reported.
Other take-home points:
- Antimicrobial therapy in uncomplicated pneumonia should primarily target pneumococcus;
- Ampicillin and amoxicillin penetrate lung tissue well, and in high dosages can overcome most pneumococcal resistance; and
- Management of mycoplasma in children remains controversial and requires further investigation.
- The final guidelines are expected to be published sometime toward the end of the year.
Dr. Shen is pediatric editor of The Hospitalist.