guideline for the inpatient care of children with pyelonephritis

Febrile urinary tract infections and pyelonephritis are common in children and frequently lead to hospitalization for management, especially in the child who appears toxic. The American Academy of Pediatrics [AAP] practice parameter on the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children provides experience and evidence-based guidelines for the practitioner caring for children between the ages of 2 months to 2 years. No established guideline exists for older children and the AAP guideline does not specifically focus on inpatient care. We conducted a comprehensive review of recently published literature and practice guidelines to develop a consensus on the inpatient diagnosis and management of children with pyelonephritis. Eight recommendations are proposed for the diagnosis and management, including revised guidelines for the imaging studies postpyelonephritis on the basis of current best evidence. Proper diagnosis of pyelonephritis, timely initiation of appropriate therapy and identification of children at risk for renal injury will help to reduce immediate as well as long-term complications due to chronic kidney disease

Gastric immature teratoma

Gastric teratoma [GT] is a rare neoplasm which accounts for less than 1% of all teratomas in children. Little more than 100 cases of GT are reported in the literature out of which, about a dozen cases are of immature variety. We present a case of immature gastric teratoma in a 7-month-old male baby

Ambbulatory blood pressure monitoring. A pediatric review

Hypertension is one of the major contributors to cardiovascular, renal and central nervous system morbidity and mortality. Although it is more prevalent in the adult population, hypertension and its sequelae are being seen in the pediatric population with increasing frequency. Blood pressure [BP] is not a static phenomenon. It is highly variable, changing constantly in response to various activities, stimuli, and stresses. Consideration of all of these factors make intermittent clinic BP measurements less effective in accounting for BP rhythmicity so ambulatory BP monitoring has emerged as a useful tool to give a detailed analysis of BP patterns during the day and night. It is becoming more and more evident that ABPM could be a useful tool in evaluation of white coat hypertension, apparent drug resistant hypertension, to evaluate efficacy of medications for control of hypertension, in evaluation of borderline hypertension, to further elaborate on chronology of hypertension and above all to assess the end organ damage risk as measurement of 24 hour BP parameters do correlate with hypertensive end organ injury