2010 September » Easy Pediatrics » Page 2

Apnea in New Born

Sep 092010

Apnea is a common problem in preterm infants that may be due to prematurity or an associated illness. In term infants, apnea is always worrisome and demands immediate diagnostic evaluation. Periodic breathing must be distinguished from prolonged apneic pauses because the latter may be associated with serious illnesses.

Apnea is a feature of many primary diseases that affect neonates . These disorders produce apnea by direct depression of the central nervous system’s control of respiration (hypoglycemia, meningitis, drugs, hemorrhage, seizures), disturbances in oxygen delivery (shock, sepsis, anemia), or ventilation defects (pneumonia, RDS, persistent pulmonary hypertension of the newborn [PPHN], muscle weakness).

Idiopathic apnea of prematurity occurs in the absence of identifiable predisposing diseases. Apnea is a disorder of respiratory control and may be obstructive, central, or mixed.

Obstructive apnea (pharyngeal instability, neck flexion, nasal occlusion) is characterized by absent airflow but persistent chest wall motion. Pharyngeal collapse may follow the negative airway pressures generated during inspiration, or it may result from incoordination of the tongue and other upper airway muscles involved in maintaining airway patency.

In central apnea, which is caused by decreased central nervous system (CNS) stimuli to respiratory muscles, airflow and chest wall motion are absent. Gestational age is the most important determinant of respiratory control, with the frequency of apnea being inversely related to gestational age. The immaturity of the brainstem respiratory centers is manifested by an Continue reading »

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Radiographic Findings in Slipped Capital Femoral Epiphysis

Musculoskeletal System No Responses »

Sep 032010

Plain Radiography

Plain radiography in anteroposterior and lateral views is the primary and often the only imaging study needed to evaluate a slipped epiphysis. Common radiographic findings include widening and irregularity of the physis, a decrease in epiphyseal height in the center of the acetabulum, a crescent-shaped area of increased density in the proximal portion of the femoral neck, and the “blanch sign of Steel” corresponding to the double density created from the anteriorly displaced femoral neck overlying the femoral head.

In an unaffected patient, the Klein line, a straight line drawn along the superior cortex of the femoral neck on anteroposterior radiograph, intersects the lateral capital epiphysis. As progressive displacement of the epiphysis occurs in SCFE, the amount of the Klein line that intersects the epiphysis decreases, compared with the uninvolved hip, and eventually the line fully misses intersection with the proximal femoral epiphysis . A true lateral (cross-table lateral) radiographic view of the hip better defines the extent of posterior displacement of the femoral epiphysis.

Computed Tomography.

CT can be used to confirm epiphyseal displacement and accurately measure the amount of Continue reading »

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Slipped Capital Femoral Epiphysis

Musculoskeletal System No Responses »

Sep 032010

Slipped Capital Femoral Epiphysis is a hip disorder that affects adolescents, most often between 12 and 15 yr of age, and involves the displacement of the CFE from the metaphysis through the zone of hypertrophy layer of the physeal plate.

CLASSIFICATION

SCFE may be classified temporally, according to onset of symptoms (acute, chronic, acute-on-chronic); functionally, according to patient’s ability to bear weight (stable or unstable); or morphologically, as the extent of displacement of the femoral epiphysis relative to the neck (mild, moderate, or severe), as estimated by measurement on radiographic or CT images.

An acute SCFE has been characterized as one occurring in a patient with prodromal symptoms for ?3 wk and should be distinguished from a purely traumatic separation of the epiphysis in a previously normal hip . The patient with an acute slip will usually have some prodromal pain in the groin, thigh, or knee and will usually report a relatively minor injury (a twist or fall) that normally is not as sufficiently violent as to produce an acute fracture of this severity.

Chronic SCFE is the most frequent form of presentation. Typically, an adolescent presents with a few-month history of vague groin, upper thigh, or lower thigh pain and a limp.

The children with acute-on-chronic SCFE may have features of both ends of the spectrum. Prodromal symptoms have been present for >3 wk with a sudden exacerbation of pain.

The stability classification separates patients based on their ability to ambulate and is more useful in predicting prognosis and establishing a treatment plan. The SCFE is considered “stable” when the child is able to walk with or without crutches. A child with an “unstable” SCFE is unable to walk with or without crutches. Patients with unstable SCFEs have a much higher prevalence of Continue reading »

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