Small bowel perforation: an unusual presentation for child abuse.

Hollow viscus perforation due to inflicted blunt abdominal injury is uncommon. Diagnosis is frequently delayed because of inaccurate or absent history, nonspecific or delayed physical findings or both, and laboratory tests with low sensitivity. Computed tomographic scanning of the abdomen is the best diagnostic test available. A high index of suspicion is essential to diagnose visceral perforation early, as significant morbidity and mortality results from diagnostic delay.

Otitis media in infants aged 0-8 weeks: frequency of associated serious bacterial disease.

OBJECTIVE: To determine the frequency of serious bacterial infection in well appearing infants aged 0-8 weeks with isolated otitis media (OM). METHODS: Infants with confirmed OM underwent tympanocentesis with middle ear fluid (MEF) culture and complete sepsis evaluation. Enrolled infants were admitted to the hospital for parenteral antibiotics until blood, urine, and CSF cultures were negative for 48 hours. RESULTS: Forty non-toxic appearing infants were enrolled between January 1994 and April 1995, of whom 15 (38%) had a documented rectal temperature > or =38 degrees C. Bacterial pathogens were isolated from MEF cultures in 25 (62.5%) infants. All afebrile infants had negative blood, urine, and cerebrospinal fluid cultures (upper limit (UL) 95% CI 0.11). Only two febrile infants had positive cultures from sites other than the MEF (UL 95% CI 0.36). CONCLUSION: In our study population, previously healthy, non-toxic appearing afebrile infants aged 2-8 weeks and having isolated OM infrequently have an associated serious bacterial infection, suggesting that outpatient treatment with oral antibiotics and close follow-up may be an option. Further studies with large numbers of infants are necessary to confirm this conclusion.

Congenital diaphragmatic hernia with gastric volvulus presenting as an acute tension gastrothorax.

This report describes a 3-month-old infant with acute severe respiratory distress in whom a diagnosis of congenital diaphragmatic hernia with tension gastrothorax and gastric volvulus was made. A review of the pathophysiology, clinical presentation, differential diagnosis, diagnostic evaluation, and treatment of congenital diaphragmatic hernia is presented.

Evaluation of the febrile infant younger than 3 months of age with no source of infection.

Because of the subtlety of their localizing signs, relative immunologic immaturity, and increased risk of SBI, young infants with fever traditionally have been admitted to the hospital. Recent literature indicates that the outpatient management of a select low-risk subset of these febrile infants between the ages of 28 and 90 days who meet appropriate screening criteria is possible with good follow-up care. Baker et al indicate that a lumbar puncture is warranted as part of the screening criteria for outpatient management in the 28-to-60-day age group. Until further large prospective studies are available, use of the Rochester criteria including lumbar puncture has been shown to provide the best screening method for selecting a low risk subset of febrile infants between the ages of 28 and 60 days who may be managed as outpatients. Management of infants between 60 and 90 days of age may be based on the Rochester screening criteria. Current studies that are ongoing may eventually define a similar subset of infants younger than 28 days of age who may be managed as outpatients. However, at the present time, management as an outpatient of low-risk infants younger than 28 days has not been recommended.

Training, attitudes, and income profiles of pediatric emergency physicians: the results of a 1993 survey of the American Academy of Pediatrics Section on Pediatric Emergency Medicine.

In late 1993, 562 questionnaires were sent to members of the Emergency Medicine Section of the American Academy of Pediatrics; of the questionnaires sent, 65% (365) were returned. Data were collected on 280 full-time practicing pediatric emergency physicians (PEPs). Eighty-two percent of these full-time PEPs have been practicing pediatric emergency medicine for less than 10 years, and two thirds of them are males. The majority work in pediatric emergency departments, devoting 28.1 clinical hours per week to their specialty. Ninety-nine percent of these full-time PEPs are board certified in pediatrics, and 61.5% are board certified in pediatric emergency medicine, whereas less than one quarter are fellowship trained. Approximately two thirds of these physicians feel that board certification in pediatric emergency medicine is a prerequisite for practicing; only one quarter feel that a fellowship in pediatric emergency medicine is required at this time. Average annual gross income for full-time PEPs was $111,000 per year; 62.8% of these physicians make more than $100,000 per year. PEPs indicated that diversity of their clinical practice and the medical acuity of their patients were the most desirable aspects of pediatric emergency medicine, whereas scheduling and the shift work nature of the profession, along with lack of follow-up in hospital practice, were seen as the least desirable aspects of the subspecialty.

Varicella-associated acute supraglottitis.

Acute bacterial supraglottitis is a well-recognized pediatric entity. There are reports in the literature of numerous supraglottic infections not limited to the usual organism, Haemophilus influenzae type b. We present a case of acute supraglottitis that is associated with varicella infection.