American Academy of Pediatrics

Acute compartment syndrome (ACS) results from increased intracompartmental pressure in the extremities of adult and pediatric patients. When identified, it must be addressed urgently to prevent devastating consequences from the disruption of vascular blood flow to various aspects of an enclosed space. If left untreated, ACS may result in tissue ischemia, along with nerve and muscle injury, making it a surgical emergency requiring prompt evaluation and a high index of suspicion.

The incidence of diabetes in children and adolescents has increased during the past decades, with a 1.9% increase per year in type 1 diabetes mellitus (T1DM). Patients with diabetes have a greater risk of hospitalizations compared with those without diabetes. Clear evidence has emerged in the past decade that supports appropriate glycemic control in the hospital setting to improve clinical outcomes and reduce the risk of hospital complications and mortality. Determining the appropriate insulin regimen in patients with T1DM in the hospital depends on the clinical status, type of outpatient insulin regimen (multiple daily injections versus pump therapy), glycemic control before admission, nutritional status, procedures, and enteral versus parenteral nutrition. Due to the complexity of the inpatient management of diabetes, institutions should have an inpatient diabetes management team that includes dietitians, diabetes educators, nurses, pharmacists, social workers, and endocrinologists. The use of inpatient diabetes teams has been demonstrated to be beneficial in the management of patients with T1DM.

A 7-year-old previously healthy girl presents to the pediatric emergency department with left leg weakness and inability to bear weight. Yesterday the patient awoke with left leg “numbness,” which has not resolved, and mild weakness. The family noticed a limp, but the patient was still able to ambulate independently. Today, the patient is unable to move her left leg or bear weight. She describes diffuse muscular aching of the left leg but denies any focal areas of pain. The parents also report 1 week of fevers (to 101.1°F [38.4°C]), cough, congestion, rhinorrhea, bilateral ear pain, headaches, and 1 episode of nonbilious emesis. She denies vision changes, facial and neck pain, and urinary or gastrointestinal changes/incontinence. The patient’s sister also had symptoms of fever, cough, and congestion, but her illness resolved within a few days.

In 2017, tisagenlecleucel (Kymriah®; Novartis Pharmaceuticals Corp, East Hanover, NJ) became the first chimeric antigen receptor (CAR) T-cell therapy approved by the Food and Drug Administration (FDA) as a novel immunotherapy that specifically targets the B-cell antigen CD19. It was approved for use in pediatric and young adult patients with pre–B-cell acute lymphoblastic leukemia (ALL) whose leukemia was either refractory to standard chemotherapy or in second or greater relapse. Tisagenlecleucel made history by providing long-term cures to many patients who have historically experienced high mortality. In the years since, multiple other CAR T-cell products have become FDA approved for other indications.

A 15-year-old girl with a medical history significant for eczema, food allergies, and allergic rhinitis presents with 8 months of worsening lower lip swelling. The lip swelling was initially mild and would seem to wax and wane over a few days but became more significant and persistent with eventual involvement of the upper lip. She does not experience worsening of the swelling with any oral trauma. Review of systems is negative for fever, pruritus, facial numbness, joint pain, and respiratory or gastrointestinal symptoms. She has no history of anaphylaxis or facial swelling outside of her lips. She has known food allergy to fish and nuts but had no exposures to these triggers, and there is no known association with other foods or medications. Previous treatments included antihistamines, which did not help her symptoms; a short course of oral corticosteroids, which helped temporarily but was associated with recurrence on cessation; and...

The definition of pulmonary hypertension changed in 2018 to an elevation of the mean pulmonary artery pressure to greater than 20 mm Hg in children older than 3 months at sea level. As of 2022, pulmonary arterial hypertension consists of a pulmonary vascular resistance index greater than 2 Woods units and pulmonary capillary wedge pressure less than 15 mm Hg. Pediatric pulmonary hypertension is a complex disease that requires regular multidisciplinary monitoring and care, and it is a condition that physically and emotionally affects pediatric patients.

Fetal alcohol spectrum disorders (FASDs) encompass a group of conditions that can develop from prenatal exposure to alcohol. In the United States, the quoted prevalence of FASD ranges from 1% to 5%, although it is likely higher, with an increased risk seen among children with lower socioeconomic backgrounds, those in foster care, and those who have gone through the adoption process.

An 8-year-old boy admitted for multisystem inflammatory syndrome in children (MIS-C) presents with altered mental status and hypertension on hospital day 8. He has a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection 4 weeks earlier. He initially presented to the emergency department with fever for 4 consecutive days, headache, abdominal pain, vomiting, and diarrhea. On physical examination, his vital signs were within normal limits and his BMI was within normal range. He was nontoxic appearing, with bilateral conjunctival injection, cracked lips, and strawberry tongue. His examination was negative for cardiac murmur, rash, edema and erythema of his hands and feet, and lymphadenopathy. His laboratory values on admission demonstrated normocytic anemia (hemoglobin level, 10.9 g/dL [109 g/L] [reference range, 11.5–15.5 g/dL (115–155 g/L)]); elevated cardiac enzyme levels (troponin, 1.35 ng/mL [1.35 µg/L] [<0.045 ng/mL (<0.045 µg/L)]; brain natriuretic peptide level, 248 pg/mL [248 ng/L] [reference range, <100.0 pg/mL...

Despite the American Academy of Pediatrics guidelines for the evaluation, treatment, and management of urinary tract infections (UTIs), UTI diagnosis and management remains challenging for clinicians. Challenges with acute UTI management stem from vague presenting signs and symptoms, diagnostic uncertainty, limitations in laboratory testing, and selecting appropriate antibiotic therapy in an era with increasing rates of antibiotic-resistant uropathogens. Recurrent UTI management remains difficult due to an incomplete understanding of the factors contributing to UTI, when to assess a child with repeated infections for kidney and urinary tract anomalies, and limited prevention strategies. To help reduce these uncertainties, this review provides a comprehensive overview of UTI epidemiology, risk factors, diagnosis, treatment, and prevention strategies that may help pediatricians overcome the challenges associated with acute and recurrent UTI management.

A 2-and-a-half-year-old girl with sickle cell disease (SCD) of homozygous hemoglobin S presents with left-sided weakness. After waking up from a 6-hour nap at home, she experiences a brief episode of shaking in her left arm and subsequently is unable to move her left arm or leg. She usually takes a 2-hour-long nap daily. Her mother recalls no previous illnesses or injuries in the past month. On further history, she was born at term gestation with no neonatal problems. Her newborn screen revealed hemoglobin S with absence of hemoglobin A (FS pattern), consistent with SCD. She receives daily prophylaxis with penicillin and has received all vaccines recommended for her age, including the pneumococcal polysaccharide vaccine 5 months before presentation. Her steady-state hemoglobin level is 8.5 g/dL (85 g/L). Her follow-up with her hematologist is poor, and she has not received annual transcranial Doppler screening for vasculopathy. She has no medical...