Front Cover
IFC
Pediatric Parameters and Equipment
Title Page
The Harriet Lane Handbook, 23rd edition
Copyright
Dedication
Preface
Contents
I - PEDIATRIC ACUTE CARE
1. Emergency and Critical Care Management
I. Approach to the Unresponsive Child
A Circulation1-3,5-11
B Airway and Breathing1,7,8,13-19
II. Management of Shock3,5,7,12,13
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 Anaphylaxis20
B Upper Airway Obstruction
C Status Asthmaticus26-31
D Pulmonary Hypertensive Crisis13,32
E Hypertensive Crisis13,33
F Pulmonary Embolism34
G Hypercyanotic Crisis (“Tet Spell”)22,35
H Altered Level of Consciousness22,36
I Status Epilepticus37-38
J Increased Intracranial Pressure39-41
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)
C Labs/Workup to Consider in the Emergent Setting
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. Intrathoracic, Abdominal, and Pelvic Trauma16
A Assessment and Management Pearls
B Imaging Studies to Consider
V. Limb and Long Bone Trauma16
A Assessment and Management Pearls
B Imaging
C Traumatic Fractures in 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. 2.4)
B Differences Between Primary and Permanent Teeth (Fig. 2.5)
C Dental Injuries
D Anticipatory Guidance Following Dental Trauma
VII. Ophthalmologic Trauma16
A Chemical Injury to the Eye
B Ruptured Globe
C Corneal Abrasion
D Eyelid Glued Shut due to Cyanoacrylate (Superglue)
E Eyelid Laceration
F Orbital Floor Fractures
G Other Instances Requiring Ophthalmologic Consultation
VIII. Animal Bites16
A Risk of Infection and Antibiotic Prophylaxis
B Physical Exam Assessment
C Imaging
D Decision to Suture and Infection Risk
IX. Burns27,28
A First Aid and Emergency Management
B Other Special Considerations With Burns
X. Nonaccidental Trauma16
A Physical Abuse
B Sexual Abuse32
References
References
Color Plates Chapter 2
3. Toxicology
I. Initial Evaluation
A History
B Workup and Laboratory Investigation
C Clinical Diagnostic Aids: Table With Clinical Signs and Possible Intoxicants (eTable 3.1)
II. Toxidromes
III. Ingestions and Antidotes
A Decontamination
B Enhanced Removal
C Other Considerations
IV. Acetaminophen Overdose8
A Four Phases of Intoxication
B Treatment Criteria
C Antidote: N-Acetylcysteine (See Formulary in Chapter 30)
D Consider Referral to Liver Transplant Center if Patient Meets King’s College Criteria
V. Lead Poisoning9
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 Documentation
C Risks
D Attending to the Needs of a Fearful Child2
II. Ultrasound for Procedures2a
A Introduction to Ultrasound
B Ultrasound Basics
III. Neurologic Procedures: Lumbar Puncture3-5
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 Removal6,7
B Foreign Body Removal From Ear3,8
C Foreign Body Removal From Nose9,10,3
D Management of Epistaxis9,11
V. Cardiovascular procedures
A Vagal Maneuvers for Supraventricular Tachycardia (SVT)12-14
B Heelstick and Fingerstick15
C Peripheral Intravenous Access15
D External Jugular Puncture and Catheterization (See Section XI [Online Content])
F Intraosseous (IO) Access3,4,17 (Fig. 4.4)
G Umbilical Artery and Umbilical Vein Catheterization3,18
VI. Pulmonary Procedures
A Use of Metered-Dose Inhalers and Spacers9
B Needle Cricothyrotomy9,19
C Needle Thoracostomy3,20
D Bag-Valve-Mask Ventilation21,22
E Endotracheal intubation: Please refer to Chapter 1
VII. Gastrointestinal Procedures
A Nasogastric Tube Placement3,9,23
B Gastrostomy Tube Replacement3,9,24
VIII. Genitourinary Procedures
A Urinary Bladder Catheterization9,25
B Suprapubic Bladder Aspiration3,4
IX. Musculoskeletal Procedures
A Basic Splinting3
B Selected Splints and Indications (Fig. 4.8)
C Radial Head Subluxation (Nursemaid’s Elbow) Reduction26,27
D Finger/Toe Dislocation Reduction3
E Knee Arthrocentesis3
F Hematoma Blocks28
X. Skin/Dermatologic Procedures
A Immunization and Medication Administration9,29
B Basic Laceration Repair3,9
C Incision and Drainage (I&D) of Abscess3
D Tuberculin Skin Test Placement37
E Tick Removal38,39
References
XI. Online Content
A Ultrasound-Guided Lumbar Puncture
B External Jugular Puncture and Catheterization3
References
II - DIAGNOSTIC AND THERAPEUTIC INFORMATION
5. Adolescent Medicine
I. Theory of Adolescence/Introduction
II. Structural Factors Impacting Adolescents and Their Health
A Examples
B Role Clinicians Can Play5
III. Confidentiality
A Consent Laws
B Breach of Confidentiality
C Documentation and Billing
IV. Health Maintenance Elements Unique to the Adolescent Patient
A History (HEEADSSS Assessment) and Screenings15
B Physical Examination Elements Unique to the Adolescent46,47
V. Sexual Health
A Sexually Transmitted Infection Screening Guidelines by Sexual Behaviors15,52-55
B Sexually Transmitted Infection Evaluation and Management (Tables 5.5 to 5.7)52
C Contraception60,61
D Pregnancy92,93
VI. Transitioning Adolescents into Adult Care94
VII. Web Resources
A Websites for Clinicians
B Websites for Patients
References
References
6. Analgesia and Procedural Sedation
I. Types of Pain
A Definition
B Types of Pain: Table 6.1
II. Pain Assessment
A Infant5
B Preschooler
C School-Age and Adolescent
D Children With Significant Neurological Impairment (SNI)4
III. Analgesics5
A Medications to Avoid in Children
B Nonopioid Analgesics
C Opioids (Table 6.5)
D Local Anesthetics14–17
E Nonpharmacologic Measures of Pain Relief19,20
IV. Patient-Controlled Analgesia (PCA)
A Definition
B Indications
C Routes of Administration
D Agents (Table 6.8)
E Adjuvants
F Side Effects of Opioid Patient-Controlled Analgesia
V. Opioid Tapering
A Indications
B Withdrawal
C Recommendations for Tapering
VI. Procedural Sedation5,14–17,25–27
A Definitions
B Preparation
C Monitoring31
D Pharmacologic Agents
E Discharge Criteria26
F Examples of Sedation Protocols (Table 6.12 and eTable 6.1)
VII. Web Resources
References
References
7. Cardiology
I. Physical Examination
A Heart Rate
B Blood Pressure
C Heart Sounds
D Systolic and Diastolic Sounds
E Murmurs
II. Electrocardiography
A Basic Electrocardiography Principles
B ECG Abnormalities
C ECG Findings Secondary to Electrolyte Disturbances, Medications, and Systemic Illnesses (Table 7.8)5,7
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 7.9)
C Acyanotic Lesions (Table 7.10)
D Cyanotic Lesions (Table 7.11)
IV. Acquired Heart Disease
A Myocardial Infarction (MI) in Children (Box 7.4; Fig. 7.9)
B Endocarditis
C Bacterial Endocarditis Prophylaxis
D Myocardial Disease
E Pericardial Disease
F Kawasaki Disease17
G Multisystem Inflammatory Syndrome in Children
H Rheumatic Heart Disease
V. Imaging
A Chest Radiograph (Fig. 7.11)
B Echocardiography (eTable 7.3)
VI. Procedures
A Cardiac Surgery (Fig. 7.12, Table 7.12)
B Cardiac Catheterization9,10 (Table 7.13)
VII. Common Cardiac Complaints
A Nontraumatic Chest Pain18
B Syncope19
VIII. Exercise Recommendations for Patients with Congenital Heart Disease
IX. Lipid Monitoring Recommendations
A Screening of Children and Adolescents28
B Goals for Lipid Levels in Childhood28
X. Cardiovascular Screening
A Sports29,30
B Attention–Deficit/Hyperactivity Disorder (ADHD)31
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. 8.15 to 8.19, Color Plates)
D Bacterial
IV. Hair Loss (Fig. 8.22, Color Plates )
A Telogen Effluvium
B Alopecia Areata
C Traction Alopecia (Fig. 8.22, 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. 8.23 To 8.30, Color Plates)
A Erythema Toxicum Neonatorum (Fig. 8.23, Color Plates)
B Transient Neonatal Pustular Melanosis (Figs. 8.24 to 8.25, Color Plates)
C Miliaria (Heat Rash) (Fig. 8.26, Color Plates)
D Milia (Fig. 8.27, Color Plates)
E Neonatal Acne (Fig. 8.28, Color Plates)
F Seborrheic Dermatitis (Figs. 8.29 to 8.30, Color Plates)
G Congenital Dermal Melanocytosis
H Diaper Dermatitis19
VII. Autoimmune and Allergic Dermatologic Conditions (Figs. 8.32 To 8.38, Color Plates)
A Contact Dermatitis
B Atopic Dermatitis (Eczema) (Figs. 8.33 to 8.36, Color Plates)
C Papular Urticaria (Fig. 8.37, Color Plates)
D Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
VIII. Nail Disorders28
IX. Disorders of Pigmentation29
X. Rashes of Unknown or Inflammatory Etiology
References
XI. Online Content
A Autoimmune and Allergic Lesions
References
Color Plates Chapter 8
9. Development, Behavior, and Developmental Disability
I. Developmental Definitions1,2
A Developmental Streams
B Developmental Quotient
C Abnormal Development
II. Guidelines for Normal Development and Behavior
A Developmental Milestones
B Age-Appropriate Behavioral Issues in Infancy and Early Childhood: See Table 9.2
III. Developmental Screening and Evaluation of Developmental Disorders
A Developmental Screening 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 (ID)
C Communication Disorders
D Learning Disability9
E Cerebral Palsy (CP)
F Autism Spectrum Disorder (ASD)
G Attention Deficit/Hyperactivity Disorder (ADHD): See Chapter 24
V. Longitudinal Care of Children with Developmental Disorders and Disabilities
A Interdisciplinary Involvement
B Relevant Laws and Regulation
C Head Start and Early Head Start
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. Social Determinants of Health and Adversity Significantly Impact Child Development, Attainment of Developmental Milestones, ...
A Social Determinants of Health (SDOHs)
B Adverse Childhood Experiences (ACEs)
E Relationship Between Adversity and Resilience
F Diversity and Equity in Adversity and Resilience
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 Management Devices9
I Monitoring6,8-10
J Diabetic Emergencies11,12
II. Thyroid Gland13-15
A Thyroid Tests14,16,17
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 Sodium 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
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 Workup
E Interpretation of Results
F Hyperinsulinemia
IX. Additional Normal Values
X. Web Resources
References
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 Strategy9,15,16
III. Fluid Removal
A Diuretics
B Indications for Acute Dialysis: Please refer to Chapter 19, Section IX.
IV. Electrolyte Management
A Serum Osmolality and Tonicity2,9,17
B Sodium
C Potassium
D Calcium
E Magnesium
F Phosphate
V. Algorithm for Evaluating Acid-Base Disturbances9,20,21
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
References
12. Gastroenterology
I. Gastrointestinal Emergencies
A Gastrointestinal Bleeding
B Acute Abdomen4
II. Conditions of the Gastrointestinal Tract
A Vomiting
B Gastrointestinal Reflux Disease5
C Eosinophilic Esophagitis8,9 (EOE)
D Celiac Disease11
E Inflammatory Bowel Disease13,14
F Constipation22,23
G Diarrhea24
III. Conditions of the Liver
A Liver Laboratory Studies: Table 12.6
B Acute Liver Failure30,31
C Nonalcoholic Fatty Liver Disease32
D Hyperbilirubinemia33-35
IV. Pancreatitis36-38
A Acute Pancreatitis39
B Chronic Pancreatitis40,41
V. Web Resources
References
References
13. Genetics: Metabolism and Conditions With Distinctive Appearance
I. Metabolism1-8
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
B Abnormal Result
C Results Affected by Transfusion
III. Dysmorphology7,11-14
A History
B Family History
C Physical Examination
D Workup: Tailor to individual patient and existing information, including effective chart review, prior genetic testing, and ...
IV. Patterns of Genetic Conditions with Distinctive Appearance11,14
A Cardiac Conditions
B Ciliopathies
C Cleft Lip and Palate (CLP)
D Connective Tissue Disorders
E Developmental Delay, Intellectual Disability
F Deafness, Hard of Hearing
G Hypotonia
H Limb and Stature Conditions
I Liver Disease
J Oncologic Conditions19
K Overgrowth
L Conditions Associated With Seizures
M Skin Pigmentation Alterations
N Vascular Anomalies
V. Etiologies of Dysmorphic Features (FIG. 13.4)11,14,29
A Aneuploidy
B Copy Number Variation (Deletions and Duplications)
C Disorders of Methylation/Epigenetics
D Repeat Expansion
E Mendelian/Single Gene Disorders
F Teratogen Exposure (Table 13.10)
G In utero Forces25
VI. Consent and Disclosure of Genetic Testing
A Ethics of Genetic Testing in Pediatrics
B Informed Consent
C Professional Disclosure of Familial Genetic Information
D Disclosure of Incidental Findings
VII. Web Resources
A Specific Genetic Disorders
B Guidelines for Genetic Conditions
C Molecular Testing Resources
D Teratogen Evaluation
References
VIII. Online Content
A Patterns of Inheritance
References
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. Erythrocytosis12,48
A Definition of Erythrocytosis
B Causes of Erythrocytosis
C Evaluation of Erythrocytosis
D Management of Erythrocytosis
III. Neutropenia
A Definition of Neutropenia
B Causes and Evaluation of Neutropenia11
C Management of Neutropenia
IV. Leukocytosis12
A Definition of Leukocytosis
B Causes of Neutrophilia
C Causes of Eosinophilia
D Causes of Monocytosis
E Causes of Basophilia
V. 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
VI. Thrombocytosis12
A Definition of Thrombocytosis
B Causes of Thrombocytosis
C Evaluation of Thrombocytosis
D Management of Thrombocytosis
VII. 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
VIII. Blood Component Replacement
A Calculating Estimated Blood Volume (Table 14.17)
B Indications for and Expected Response Following Blood Transfusions
C Diagnosis and Management of Transfusion Reactions (Table 14.19)
D Infectious Risks of Blood Transfusion
IX. Additional Resources
C Anemia Algorithm App: Created for Adult Patients but Provides Useful Framework for Anemia Differential
References
X. 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 Management
II. Food Allergy7-18
A Epidemiology
B Diagnosis (Fig. 15.1)
C Differential Diagnosis
D Management
E Natural History
F Prevention
III. Drug Allergy19-21
A Definition
B Diagnosis
C Management (Fig. 15.2)
IV. Immunodeficiency22-27
A Clinical Presentation
B Evaluation (Table 15.2)
V. Immunoglobulin Therapy28-34
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)
B Serum IgG, IgM, IgA, and IgE Levels for Low Birth Weight Preterm Infants (Table 15.4)
C Lymphocyte Enumeration (Table 15.5)
D Serum Complement Levels (Table 15.6)
16. Immunoprophylaxis
I. Common Types of Vaccines Administered to Children1
A Inactivated Vaccines
B Live, Attenuated Vaccines
C Subunit, Recombinant, Polysaccharide, and Conjugate Vaccines
D Toxoid Vaccines
E mRNA Vaccines2,3
II. Immunization Schedules
A Routine Vaccines for Children in the United States
B Nonroutine Vaccines for Children in the United States6
III. Immunization Guidelines
A Vaccine Informed Consent
B Vaccine Administration
C Live, Attenuated Vaccines
D Timing and Spacing of Vaccine Doses
E Contraindications and Precautions
IV. Postexposure Prophylaxis (Table 16.5)
V. Special Patient Populations9
A Altered Immunocompetence10,11
B Disease-Specific Considerations
C Preterm Infants
D Pregnant Women
E Immigration, Emigration, and Travel
VI. Counseling and Communication About Vaccines22-34
A Vaccine Hesitant versus Vaccine Refusal33
B Countering Vaccine Hesitancy26
VII. Web Resources35-40
References
VIII. Online Content
A Additional Vaccine Information
B The 3C Model: Key Barriers to Vaccine Use Worldwide22
C Provider Resources for Vaccine Communication: See eBox 16.2.
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 Tickborne Diseases (Table 17.4)
E Pediatric Parasitic Infections (Table 17.5)
F Pediatric Fungal Infections (Table 17.6)
G Febrile Infants
H Tuberculosis: Diagnosis and Treatment2,3
I Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome6
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. Antibiotic Therapy And Stewardship
A Spectra of Activity for Commonly Used Antibiotics (Fig. 17.6)
References
B. Antibiotic Stewardship
C. Resistance in Common Organisms
IV. Exposures to Bloodborne Pathogens and Prophylaxis
A General Practice23
B Disease-Specific Postexposure Management
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 Discharge6
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 (RDS)
C Persistent Pulmonary Hypertension of the Newborn (PPHN)
D Transient Tachypnea of the Newborn
E Pneumothorax
VII. Apnea and Bradycardia
A Apnea
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 Newborn15,16
B Conjugated Hyperbilirubinemia (See Chapter 12)
C Polycythemia
X. Gastrointestinal Diseases
A Necrotizing Enterocolitis
B Bilious Emesis
C Abdominal Wall Defects (Table 18.10)
D Gastroesophageal Reflux Disease (See Chapter 12)
XI. Neurologic Diseases
A Neonatal Hypoxic-Ischemic Encephalopathy
B Intraventricular Hemorrhage
C Periventricular White Matter Injury24
D Neonatal Seizures (See Chapter 20)
E Neonatal Abstinence Syndrome26
F Peripheral Nerve Injuries
XII. Urologic Disorders
A Lower Urinary Tract Obstruction
B Bladder Exstrophy-Epispadias-Cloacal Exstrophy Complex
XIII. Retinopathy of Prematurity29
A Definition
B Etiology
C Diagnosis
D Timing of Screening30
E Classification
F Management29-30
XIV. Commonly Used Medications in the Neonatal Intensive Care Unit
XV. Web Resources
References
XVI. Prenatal Assessment of Fetal Health
A Fetal Anomaly Screening
B Fetal Health
C Estimation of Gestational Age
References
19. Nephrology
I. Urinalysis1: See Table 19.1
II. Kidney Function Tests
A Tests of Glomerular Function
B Tests of Kidney Tubular Function
III. Blood Pressure (BP) and Chronic Hypertension6-11
A Definition
B Measurement of Blood Pressure in Children
C Etiologies of Hypertension in Neonates, Infants, and Children (Table 19.7)
D Evaluation of Chronic Hypertension
E Classification and Treatment of Hypertension (Table 19.8)
F Antihypertensive Drugs for Outpatient Management of Primary Hypertension in Children 1 to 17 Years of Age
IV. Urinary Tract Infections12-17
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. Proteinuria19-21
A Definitions
B Methods of Detection
C Etiologies (Box 19.1)
D Evaluation20
E Nephrotic Syndrome21
VI. Hematuria19,24
A Definition
B Etiologies: See Table 19.11
C Evaluation (Fig. 19.2)
D Management (Fig. 19.3)
VII. Acute Kidney Injury25,26
A Definition
B Etiology (Table 19.12)
C Clinical Presentation
D Acute Tubular Necrosis
E Treatment Considerations
F Complications
G Radiographic Imaging Considerations in AKI/CKD
VIII. Chronic Kidney Disease32,33
A Definition
B Etiology
C Clinical Manifestations (Table 19.14)
D General Management
IX. Dialysis34-36
A Indications for Acute Dialysis
B Techniques
C Complications (Table 19.15)
X. Tubular Disorders
A Renal Tubular Acidosis (Table 19.16)37
B Fanconi Syndrome
C Nephrogenic Diabetes Insipidus
XI. Nephrolithiasis38-44
A Risk Factors
B Presentation
C Diagnostic Imaging
D Management
E Workup
F Prevention
XII. Web Resources
References
References
20. Neurology
I. Neurologic Examination
A Mental Status: Alertness, Orientation (Person, Place, Time, Situation), Language, Cognition
B Cranial Nerves (eTable 20.1)
C Motor
D Sensory
E Reflexes
F Coordination and Gait
II. Neurologic Emergencies
A Stroke1-4
B Status Epilepticus and Breakthrough Seizures
C Encephalopathy7-10
D Hydrocephalus with Increased Intracranial Pressure11-13
E Weakness
F Ataxia19,20
III. Chronic Or Gradually Progressive Conditions
A Headaches21-33
B Seizures5,6,34-48
C Neuromuscular Disorders49-57
D Functional Neurologic Disorders (FNDs)59-62
IV. Web Resources
References
References
21. Nutrition and Growth
I. Assessment of Growth
A Types of Growth Charts
B Interpretation of Growth Charts9,10
C General Guidelines Regarding Appropriate Growth12,13
II. Management of Overweight and Obese Children
A AAP Recommendations for the Prevention of Obesity14-16
B Prevention and Management of Obesity in the Primary Care Setting (Table 21.1)
C Conditions Associated With Obesity14
III. Malnutrition in Infants and Children
A Defining Malnutrition15
B Classifying the Degree to Which a Patient Is Malnourished (Table 21.2)16
C Resources for Determining Z-scores17
D Differential Diagnosis of Malnutrition18
E Physical Exam Findings Consistent With Malnutrition19-21
F Diagnostic Evaluation of Malnutrition23-26
G Red Flags That Suggest a Medical Cause of Malnutrition27
H Approach to the Management of Malnourished Patients28,29 (Box 21.1)
IV. Re-Feeding Syndrome
A Patients at Risk of Developing Re-feeding Syndrome19
B Management of Re-feeding Syndrome20
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 Breastfeeding31 (Box 21.2)
C Use of Milk Bank Donor Human Milk32
D Safe Handling of Breast Milk33
E Breastfeeding Resources
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 21.13)
C Use of Enteral Tube Feeds35
D Features of the Most Common Oral Rehydration Solutions (Table 21.14)
VIII. Parenteral Nutrition
A Indications for the Use of Parenteral Nutrition36-38
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 Parenteral Nutrition (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. Nonspecific Symptoms in the Primary Care Setting (TABLE 22.1)1,2
II. Pediatric Hematologic Malignancies (TABLE 22.2)3-4
III. Pediatric Solid Tumor Malignancies (TABLE 22.3)3-4
IV. Pediatric Central Nervous System (CNS) Tumors3-4,7-10 (TABLE 22.4)
A Epidemiology
B Clinical Presentation
C Initial Workup
D Management Principles
V. Oncologic Emergencies4,11-18,19
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 (CRS)
VI. Commonly Used Chemotherapeutic Drugs, Associated Acute and Long-Term Toxicities (TABLE 22.5)
VII. Common Chemotherapy Complications and Supportive Care3,13
A Cytopenias: Anemia, Thrombocytopenia, Neutropenia
B Mucositis
C Nausea and Emesis
VIII. Antimicrobial Prophylaxis in Oncology Patients20-22 (TABLE 22.7)
IX. Hematopoietic Stem Cell Transplantation (HSCT) (Also Called Bone Marrow or Stem Cell Transplantation)3,4,23
A Goal
B Preparative Regimens
C Types of HSCT
D Engraftment
X. Complications of HSCT3,4,23-26
A Graft-Versus-Host Disease (GVHD)
B Sinusoidal Obstructive Syndrome (SOS); Previously Known as Venoocclusive Disease (VOD)
XI. Cancer Survivorship5,27-29
A Understand the Diagnosis
B Monitoring
A. Vaccinations in Oncology and HSCT Patients: See Chapter 16
XII. Fertility Preservation30
A. Resources for Patients and Families
XIII. Web Resources
References
XIV. Online Content
A Complications of HSCT3,4,22-24,29-35
References
23. Palliative Care
I. Introduction to Hospice and Palliative Medicine
A Definition of Palliative Care1,2
B Definition of Hospice
C Concurrent Care for Children3
D Team Composition
E Timing of Palliative Care Consults
II. Communication and Decision-Making
A Decision-Making Tools4
B Structuring Family Meetings5
C Breaking Bad News6
D Other Tools for Difficult Conversations
III. Care of the Dying Child
A Limiting Interventions
B Involving the Child in Conversations About Death9-12
C Outpatient Care
D Supporting Patients Throughout the Dying Process13-16, 22
E Pronouncing Death17
F Explaining Autopsies18
G Organ Donation
H Completing Death Certificates17
I Interacting with Loved Ones After a Child’s Death
IV. Web Resources
24. Psychiatry
I. Overview
A General Approach
B Mental Status Exam
C Behavioral Interventions
II. Postpartum Depression
A Diagnosis
B Epidemiology
C Evaluation
D Management
III. Common Psychiatric Conditions of Children and Adolescents
A Attention-Deficit/Hyperactivity Disorder (ADHD)
B Oppositional Defiant Disorder (ODD)
C Anxiety Disorders
D Depressive and Mood Disorders
E Eating Disorders
F Substance Use Disorders
IV. Psychiatric Emergencies
A Suicide
B Aggression or Impulsivity26,27
V. Web Resources
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)16,17
III. Asthma12-13,19
A Definition
B Clinical Presentation
C Treatment
D Prevention of Exacerbations19
IV. Bronchiolitis20-27
A Definition
B Clinical Presentation
C Treatment
V. Bronchopulmonary Dysplasia (BPD)28-33
A Definition
B Clinical Presentation
C Diagnosis
D Treatment
VI. Cystic Fibrosis (CF)34-46
A Definition
B Clinical Manifestations (Fig. 25.9)
C Diagnosis (Fig. 25.10)
D Treatment
VII. Obstructive Sleep Apnea Syndrome (OSAS)47-53
A Definition
B Clinical Presentation
C Diagnosis
D Treatment
VIII. Infant and Child Sleep53-54
A Sleep Duration
B Sleep-Related Infant Death55-58
IX. Brief Resolved Unexplained Event (BRUE)58-59
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
26. Radiology
I. General Pediatric Principles
A Use Imaging Judiciously
B Terminology
II. Choosing the Right Study
III. Head
A Head Trauma
B CSF Shunt Malfunction
C Orbital Cellulitis
IV. Neck and Airway
A Normal Anatomy
B Cervical Spine Trauma
C Classic Findings of Upper Airway Conditions on Conventional Radiographs
D Foreign Body
E Tracheoesophageal Fistula and Esophageal Atresia
F Vascular Rings, Aortic Arch Variants, and Pulmonary Sling
V. Chest
A Normal Anatomy (Fig. 26.4 and eFig. 26.6)
B Pulmonary Infections
C Neonatal Lung Disease
D Mediastinal Masses
VI. Heart
VII. Abdomen
A Normal Abdominal X-Ray and Bowel Gas Pattern
B Pneumoperitoneum (Free Intraperitoneal Air)
C Neonatal Enterocolitis (NEC, see Chapter 18)
D Neonatal Intestinal Obstruction
E Pyloric Stenosis
F Intussusception
G Ileus
H Bowel Obstruction
I Appendicitis
J Esophageal Foreign Bodies
K Abdominal Trauma
L Gallbladder Disease
M Pancreatitis
VIII. Genitourinary Tract
A Urinary Tract Infection
B Nephrolithiasis/Urolithiasis
C Testicular Pathology
D Ovarian Pathology
E Congenital Hydronephrosis
IX. Musculoskeletal
A Fractures and Trauma
B Osteomyelitis
C Hip Disorders
D Scoliosis
E Bone Lesions
F Skeletal Survey in Suspected Nonaccidental Trauma
X. Confirming Tube Placement and Line Insertion
A Central Venous Catheter
B Umbilical Lines (Fig. 26.12)
C Nasogastric Tube
D Nasoduodenal Tube
E Endotracheal Tube
XI. Web Resources
27. Rheumatology
I. Brief Overview of Clinical Characteristics of Rheumatologic Diseases
A Juvenile Idiopathic Arthritis (JIA)1-4
B Systemic Lupus Erythematosus (SLE)1,2,7-10
C Drug-Induced SLE11
D Neonatal SLE12-14
E Vasculitis1,2,15,16
F Sarcoidosis2,26,27
G Scleroderma2,28
H Sjögren Syndrome2,29
I Juvenile Dermatomyositis (JDM)2,30
J Other Rheumatologic Disorders2,31,32
K Multisystem Inflammatory Syndrome in Children (MIS-C)33-35
II. Interpretation of Lab Studies Used In The Diagnosis and Monitoring of Rheumatologic Disorders1
A Acute Phase Reactants: Indicate presence of inflammation when elevated. Elevation is nonspecific and can result from trauma ...
B Autoantibodies (See Table 27.3 for Association With Rheumatologic Diseases)36,39-43
C Complement: The complement system is composed of a series of plasma proteins and cellular receptors that function together ...
III. Medications: Mechanisms of Action, Toxicities, and Recommended Surveillance2 (SEE TABLE 27.4)
IV Primary Care Management of Rheumatologic Diseases54-57
A. Vaccination (See Chapter 16)
B Weight Management
C Bone and Skin Health
D Reproductive Health
E Ophthalmologic
F Laboratory Monitoring
References
References
III - REFERENCE
28. Blood Chemistry and Body Fluids
I. Reference Values
II. Evaluation of Body Fluids
A Evaluation of Cerebrospinal Fluid: See Table 28.2.
B Evaluation of Urine: See Table 28.3.
C Evaluation of Transudate/Exudate: See eTable 28.1.
D Evaluation of Synovial Fluid: See eTable 28.2.
III. Conversion Formulas
A Temperature
B Length and Weight
References
References
29. Biostatistics and Evidence-Based Medicine
I. Biostatistics and Evidence-Based Medicine (EBM)1-3
II. Biostatistics and Epidemiology
A Statistical Tests
B Statistical Terminology
C Types of Study Designs9 (see Table 29.2)
D Measurement of Disease Occurrence and Treatment Effects5
E Measurements of Test Performance5
III. Web Resources
A Evidence-Based Resources
B Biostatistics and Epidemiology Resources
References
References
IV - FORMULARY
30. Drug Dosages
I. Note to Reader
II. Sample Entry
III. Explanation of Breastfeeding Categories
IV. Explanation of Pregnancy Categories
V. Nomogram and Equation for Body Surface Area
VI. Drug Index
References
31. Drugs in Kidney Failure
I. Dose Adjustment Methods
A Maintenance Dose
B Dialysis
C Glomerular Filtration Rate Estimation
II. Antimicrobials Requiring Adjustment in Kidney Failure
III. Non-Antimicrobials Requiring Adjustment in Kidney Failure
References
References
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
IBC
