Therapy varies with the extent of the collapse and the nature and severity of the underlying disease.

A tension pneu mothorax may emergently require drainage by needle thoracostomy. A small or even moderate-sized pneumothorax in an otherwise normal child may resolve without specific treatment, usually within about 1 wk. A small (<5%) pneumothorax complicating asthma may also resolve spontaneously.

Administering 100% oxygen may hasten resolution. Patients with chronic hypoxemia should be monitored closely during the administration of supplemental oxygen. Pleural pain deserves analgesic treatment. If there is >5% collapse or if the pneumothorax is recurrent or under tension, chest tube drainage is necessary.

Pneumothoraces complicating CF frequently recur, and definitive treatment may be justified with the 1st episode, even with <5% collapse.

Closed thoracotomy (simple insertion of a chest tube) and drainage of the trapped air through a catheter, the external opening of which is kept in a dependent position under water, is adequate to re-expand the lung in most patients; pigtail catheters are frequently used.

When there have been previous pneumothoraces, it may be indicated to induce the formation of Continue reading »

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Myocarditis refers to inflammation, necrosis, or myocytolysis and may be caused by many infectious, connective tissue, granulomatous, toxic, or idiopathic processes affecting the myocardium with or without associated systemic manifestations of the disease process or involvement of the endocardium or pericardium.

Etiology:

The most common causative agents in children are adenovirus, coxsackievirus B, and other enteroviruses, although most known viral agents have been implicated.

Pathophysiology:

Acute viral myocarditis may produce a fulminant inflammatory process characterized by cellular infiltrates, cell degeneration and necrosis, and subsequent fibrosis. Viral myocarditis may also become a chronic process with persistence of viral RNA or DNA (but not infectious virus particles) in the myocardium.In addition, some viral proteins may share antigenic epitopes with host cells, which results in autoimmune damage to the antigenically related myocyte.

The net final result of chronic viral-associated inflammation is often dilated cardiomyopathy.

Clinical Manifestations:

Signs and symptoms depend on the patient’s age and the acute or chronic nature of the infection. A neonate may initially have fever, severe heart failure, respiratory distress, cyanosis, distant heart Continue reading »

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The regular response of iron-deficiency anemia to adequate amounts of iron is an important diagnostic and therapeutic feature.

Oral Iron:

Oral administration of simple ferrous salts (e.g., sulfate, gluconate, fumarate) provides inexpensive and satisfactory therapy. No evidence shows that addition of any trace metal, vitamin, or other hematinic substance significantly increases the response to simple ferrous salts. One problem encountered with administration of oral iron to young children is that liquid FeSO4has an unpleasant taste, but sometimes the taste can be camouflaged by mixing with flavored syrup. Other, better-tasting preparations are available over the counter, but these are much more expensive than simple liquid FeSO4. Aside from the unpleasant taste, intolerance to oral iron is uncommon in young children, although older children and adolescents sometimes have gastrointestinal complaints. Problems with constipation can be minimized by increasing water and fiber intake. For some children, abdominal discomfort can be minimized by administering iron with food, recognizing that this may decrease iron absorption to some extent.

The therapeutic dose should be calculated in terms of elemental iron; ferrous sulfate is 20% elemental iron by weight. A daily total dose of 4–6 mg/kg of elemental iron in 3 divided doses Continue reading »

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