Challenging Cases in Pediatric Hospital Medicine

297 Pages·2020·3.56 MB·English

by  Daniel A. Rauch MD (editor), Dr. Snezana Nena Osorio MD MS (editor)

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Challenging Cases in Pediatric l Challenging Cases in
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Hospital Medicine in
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C Pediatric
Editors a
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Daniel A. Rauch, MD, SFHM, FAAP • Snezana Nena Osorio, MD, MS, FAAP e
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Associate Editors
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Jennie G. Ono, MD, MS, FAAP • Jennifer Oshimura, MD

P
e Hospital Medicine
Written by pediatric hospitalists and clinician-educators, this valuable
d
reference and learning tool features 50 real-life case studies to guide you i
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expertly through the types of cases (both common and rare) encountered by t
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practicing pediatric hospitalists. i
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Each chapter begins with the patient presentation. Next, the chapter steps H
through the patient hospital course and the case workup and management, o Editors
s Daniel A. Rauch, MD, SFHM, FAAPﾠ●ﾠSnezana Nena Osorio, MD, MS, FAAP
as well as the patient outcome and follow-up. Chapters conclude with the p
clinical competencies that were addressed, followed by valuable pearls— it Associate Editors
discussions of aspects of care that do not just cover disease management a Jennie G. Ono, MD, MS, FAAPﾠ●ﾠJennifer Oshimura, MD
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but truly refl ect the scope of pediatric hospital medicine. Recommended M
readings round out each chapter. e
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With its case-based format, this book is both a valuable clinical tool and a superb i
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learning and training aid for various levels of learners on a medical team. i
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Chapters include e
• Asthma Care Challenges in Adolescents
• Prolonged Fever and Rash
• Intentional Ingestion
• Persistent Neonatal Jaundice
• Cough and Chest Pain
• Unintentional Lead Poisoning
• Recurrent Pancreatitis Ra
u
• Extreme Infl ammatory Response c
h
• And much more • O
s
o
For other pediatric resources, visit the American Academy r
io
of Pediatrics at shop.aap.org.
AAP
Challenging Cases in
Pediatric
Hospital Medicine
Editors
Daniel A. Rauch, MD, SFHM, FAAP • Snezana Nena Osorio, MD, MS, FAAP
Associate Editors
Jennie G. Ono, MD, MS, FAAP • Jennifer Oshimura, MD
Challenging Cases in Hospital Med_Book.indb 1 07/08/20 9:26 AM
American Academy of Pediatrics Publishing Staff
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Linda Smessaert, MSIMC, Senior Marketing Manager, Professional Resources
Mary Louise Carr, MBA, Marketing Manager, Clinical Publications
Published by the American Academy of Pediatrics
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Telephone: [phone]
Facsimile: 847/434-8000
www.aap.org
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians,
pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and
well-being of infants, children, adolescents, and young adults.
The recommendations in this publication do not indicate an exclusive course of treatment
or serve as a standard of medical care. Variations, taking into account individual circumstances, may
be appropriate.
Statements and opinions expressed are those of the authors and not necessarily those of the
American Academy of Pediatrics.
Any websites, brand names, products, or manufacturers are mentioned for informational
and identification purposes only and do not imply an endorsement by the
American Academy of Pediatrics (AAP). The AAP is not responsible for the content of
external resources. Information was current at the time of publication.
This publication has been developed by the American Academy of Pediatrics. The contributors are
expert authorities in the field of pediatrics. No commercial involvement of any kind has been solicited
or accepted in the development of the content of this publication. Disclosures: Dr Rauch disclosed a
consultant relationship with the American Board of Pediatrics; Dr Kenny (Chapter 16) disclosed a board
of directors position with Cardinal Health.
Every effort has been made to ensure that the drug selection and dosage set forth in this text are
in accordance with the current recommendations and practice at the time of publication. It is the
responsibility of the health care professional to check the package insert of each drug for any change in
indications and dosage and for added warnings and precautions.
Every effort is made to keep Challenging Cases in Pediatric Hospital Medicine consistent with the most recent
advice and information available from the American Academy of Pediatrics.
Please visit www.aap.org/errata for an up-to-date list of any applicable errata for this publication.
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© 2021 American Academy of Pediatrics
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Printed in the United States of America
9-456/0920 1 2 3 4 5 6 7 8 9 10
MA0996
ISBN: 978-1-61002-456-3
eBook: 978-1-61002-457-0
Cover and publication design by Peg Mulcahy
Library of Congress Control Number: 2020932855
Challenging Cases in Hospital Med_Book.indb 2 07/08/20 9:26 AM
Contributors
Editors
Daniel A. Rauch, MD, SFHM, FAAP Snezana Nena Osorio, MD, MS, FAAP
Professor of Pediatrics Professor of Clinical Pediatrics
Tufts University School of Department of Pediatrics
Medicine Weill Cornell Medicine
Chief of Pediatric Hospital New York-Presbyterian Komansky
Medicine Children’s Hospital
Floating Hospital for Children at New York, NY
Tufts Medical Center
Boston, MA
Associate Editors
Jennie G. Ono, MD, MS, FAAP Jennifer Oshimura, MD
Medical Director, Inpatient Formerly of Children’s Healthcare
Pediatrics of Atlanta at Scottish Rite
Assistant Professor of Clinical Atlanta, GA
Pediatrics
Weill Cornell Medicine
New York-Presbyterian Komansky
Children’s Hospital
New York, NY
Challenging Cases in Hospital Med_Book.indb 3 07/08/20 9:26 AM
iv Contributors
Authors
Sarah T. Adams, MD, IBCLC, FAAP Kathleen Bradford, MD
Assistant Professor of Pediatrics Professor of Pediatrics
Division of Hospital Pediatrics University of North Carolina
University of North Carolina Chapel Hill, NC
Chapel Hill, NC 20: Unintentional Lead Poisoning
12: Altered Mental Status April O. Buchanan, MD, FAAP
Namrata Ahuja, MD Associate Dean for Curriculum
Assistant Professor of Clinical and Pediatric Hospitalists
Pediatrics University of South Carolina
Division of Hospital Medicine School of Medicine Greenville
Children’s Hospital Los Angeles Prisma Health Children’s Hospital
University of Southern California Greenville, SC
Los Angeles, CA 7: Chronic Leg Pain
15: Failure to Thrive Beyond Lisa Capra, MD
Infancy Medical Director, Newborn
Sarah Bauer, MD Nursery
Assistant Professor, Hospital Division of Pediatric Hospitalist
Medicine Medicine
Medical College of Wisconsin Floating Hospital for Children at
Milwaukee, WI Tufts Medical Center
37: Incomplete Maternal History Boston, MA
Confounding the Diagnosis 32: A Newborn With Black Stools
Julia Beauchamp-Walters, MD, Megan Cardoso, MD, FAAP
FAAP Attending Pediatrician,
Clinical Professor of Pediatrics Chelmsford Pediatrics
Division of Pediatric Hospital Pediatric Medical Director,
Medicine Wellforce Medicaid ACO
University of California San Diego Dunstable, MA
San Diego, California 14: Fever and Refusal to Walk
23: Developmental Regression and Sonia Chaudhry, MD, FAAP
Transaminitis Assistant Professor of Pediatrics
Bo Borch-Christensen, MD , FAAP Division of Neonatology
Pediatric Hospital Medicine University of Connecticut School
Phoenix Children’s Hospital of Medicine
Phoenix, AZ Connecticut Children’s Medical
24: Food Allergy in Infancy Center
Hartford, CT
33: Diabetic Ketoacidosis
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Contributors v
Margaret A. Connolly, MD, FAAP Sandra Gage, MD, PhD, SFHM,
Assistant Professor of Clinical FAAP
Pediatrics Associate Division Chief of Hospital
Renaissance School of Medicine at Medicine
Stony Brook University Phoenix Children’s Hospital
Division of Pediatric Hospital Associate Professor of Pediatrics
Medicine University of Arizona College of
Stony Brook Children’s Hospital Medicine – Phoenix
Stony Brook, NY Phoenix, AZ
45: Infant With Fever 24: Food Allergy in Infancy
Ami Doshi, MD, FAAP 26: Severe Headaches
Associate Professor of Pediatrics 30: Extreme Inflammatory Response
Division of Hospital Medicine 35: Recurrent Stridor
University of California San Diego 39: “Direct” Hyperbilirubinemia in
Director of Inpatient Palliative a Newborn
Care 50: Cardiac Arrest
Rady Children’s Hospital Laurie Gordon, MD, MA, FAAP
San Diego, CA Pediatric Hospitalist
9: Palliative Care in Hospital Associate Professor of Clinical
Medicine Pediatrics
Julie A. Dunbar, MD, FAAP Weill Cornell Medicine
Division of Pediatric Hospital New York, NY
Medicine 36: Sickle Cell Disease and
The Children’s Hospital at Cognitive Biases
Montefiore Cori Green, MD, MS, FAAP
Assistant Professor of Pediatrics Director of Behavioral Health
Albert Einstein College of Education and Integration in
Medicine Pediatrics
Bronx, NY Associate Professor of Clinical
34: Ventriculoperitoneal Shunt Pediatrics
Complications Weill Cornell Medical Center
New York, NY
19: Hypotonia and Poor Feeding
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vi Contributors
Matt Grisham, MD, FAAP Maheshwor Kafle, MD
Clinical Assistant Professor of Pediatric Hospitalist
Pediatrics Phoenix Children’s Hospital
Division of General Pediatrics Assistant Professor of Child Health
Prisma Health/University of South University of Arizona
Carolina School of Medicine Phoenix, AZ
Greenville 39: “Direct” Hyperbilirubinemia in
Greenville, SC a Newborn
17: Intentional Ingestion Michelle Katzow, MD, MS, FAAP
Jennifer S. Hall, MD, FAAP Diplomate of the American Board
Pediatric Hospital Medicine Fellow of Obesity Medicine
Phoenix Children’s Hospital Cohen Children’s Medical Center
Phoenix, AZ Northwell Health
50: Cardiac Arrest New Hyde Park, NY
Patricia Hametz, MD, MPH, FAAP 8: Right Upper Quadrant Pain in an
Chief, Division of Pediatric Adolescent
Hospital Medicine Gregory Kenny, MD
Associate Professor of Pediatrics Department of Pediatrics
Albert Einstein College of Elmhurst Hospital Center, NYC
Medicine/The Children’s Health + Hospitals
Hospital at Montefiore Assistant Professor of Pediatrics
Bronx, NY Icahn School of Medicine at Mount
34: Ventriculoperitoneal Shunt Sinai
Complications New York, NY
Katherine Harer, MD 16: Breastfeeding Difficulties
Floating Hospital for Children at Manaswitha Khare, MD
Tufts Medical Center Clinical Assistant Professor of
Boston, MA Pediatrics
44: Unusual Bruising in an Active Division of Pediatric Hospital
Child Medicine
Vanessa L. Hill, MD, FAAP Rady Children’s Hospital
Associate Professor of Pediatrics University of California San Diego
Section of Pediatric Hospital San Diego, CA
Medicine 38: Recurrent Pancreatitis
Baylor College of Medicine
The Children’s Hospital of San
Antonio
San Antonio, TX
3: Thinking Beyond Bronchiolitis
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Contributors vii
Anika Kumar, MD, FHM, FAAP Daniel M. Lercher, DM
Clinical Assistant Professor of Assistant Professor, Pediatric
Pediatrics Critical Care Medicine
Department of Pediatric Hospital Department of Pediatrics
Medicine University of North Carolina
Cleveland Clinic Children’s Chapel Hill, NC
Cleveland Clinic Lerner College 20: Unintentional Lead Poisoning
of Medicine of Case Western Michael Levy, MD
Reserve University Assistant Professor of Pediatrics
Cleveland, OH Division of Hospital Medicine
11: Managing Eating Disorders in Rady Children’s Hospital
the Hospital San Diego, CA
Janelle Laudone, MD, FAAP 6: Pelvic Pain
Assistant Professor of Pediatrics Huay-ying Lo, MD, FAAP
Division of Pediatric Hospital Assistant Professor of Pediatrics
Medicine Pediatric Hospital Medicine
Tufts University School of Medicine Texas Children’s Hospital and
Boston, MA Baylor College of Medicine
33: Diabetic Ketoacidosis Houston, TX
Dassi Leader, MD 27: Hand Swelling After an Animal
Associate Chair for Clinical Bite
Services, Pediatrics Department Christopher Lops, MD, MA, FAAP
Director, Inpatient Pediatrics Clinical Instructor of Pediatrics
Staten Island University Hospital, Tufts University School of Medicine
Northwell Health Division of Pediatric Hospital
Assistant Professor, Donald and Medicine
Barbara Zucker School of Cape Cod Hospital
Medicine at Hofstra/Northwell Hyannis, MA
41: Abdominal Pain After a 48: Urinary Tract Infection
Resolved Splenic Pseudocyst
David Lyczkowski, MD, FAAP
Vivian Lee, MD, FAAP Medical Director, Inpatient
Assistant Professor of Clinical Pediatrics
Pediatrics Newton-Wellesley Hospital
USC Keck School of Medicine Newton, MA
Division of Hospital Medicine 46: Staphylococcal Skin Abscess
Children’s Hospital Los Angeles
Molly Maenchen, MD, FAAP
Los Angeles, CA
Resident Physician
29: Fever of Unknown Origin in a
Phoenix Children’s Hospital
Child Who Has Immigrated
Phoenix, AZ
50: Cardiac Arrest
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viii Contributors
Candice Maietti Foy, MD, FAAP Jorge Masuello, MD, FAAP
Assistant Professor of Clinical Academic Pediatric Hospitalist
Pediatrics Phoenix Children’s Hospital
Division of Hospital Medicine Clerkship Director
Stony Brook Children’s Hospital University of Arizona College of
Stony Brook, NY Medicine – Phoenix
43: Newborn Screening and Failure Clinical Assistant Professor
to Thrive Department of Child Health
Leah Mallory, MD, FAAP University of Arizona
Associate Professor of Pediatrics Phoenix, AZ
Tufts University School of Medicine 26: Severe Headaches
Pediatric Hospitalist Jessica S. Meyer, MD, FAAP
The Barbara Bush Children’s Assistant Professor of Pediatrics
Hospital Pediatric Hospitalist
Maine Medical Center University of Virginia Children’s
Portland, ME Hospital
5: Cough and Chest Pain Charlottesville, VA
Jennifer Maniscalco, MD, MPH, 2: Prolonged Fever and Rash
MAcM, FAAP Jennifer Murzycki, MD, PhD,
Assistant Professor of Pediatrics FAAP
Johns Hopkins University School of Assistant Professor of Pediatrics
Medicine Tufts University School of Medicine
Baltimore, MD Division of Pediatric Hospital
Designated Institutional Official Medicine
Johns Hopkins All Children’s Floating Hospital for Children at
Hospital Tufts Medical Center
St Petersburg, FL Boston, MA
15: Failure to Thrive Beyond 22: Newborn With In Utero
Infancy Polysubstance Exposure
Michelle Marks, DO, SFHM, FAAP Jennifer Orr Vincent, MD
Clinical Associate Professor of Assistant Professor of Pediatrics
Pediatrics Division of Hospital Pediatrics
Cleveland Clinic Lerner College of University of North Carolina
Medicine Chapel Hill, NC
Chair, Pediatric Hospital Medicine 18: Convulsive-like Movements
Cleveland Clinic Children’s Hospital Jennifer Oshimura, MD
Cleveland, OH Formerly of Children’s Healthcare
11: Managing Eating Disorders in of Atlanta at Scottish Rite
the Hospital Atlanta, GA
1: Asthma Care Challenges in
Adolescents
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Contributors ix
Andrew Papez, MD Lindsay Rogozinski, MS, RN,
Director, Pediatric Cardiology PPCNP-BC
Fellowship Program Pediatric Hospital Medicine
Phoenix Children’s Hospital Complex Care Service, Lead
Phoenix, AZ Nurse Practitioner
50: Cardiac Arrest Pediatric General Care Units, Lead
Steven Pattishall, MD, FAAP Advanced Practice Provider
Pediatric Hospitalist Pediatric Hospital Medicine
Nemours Children’s Specialty Care University of Rochester
Jacksonville, FL Rochester, NY
4: Apnea in Infancy 28: Care of Medically Complex
Patients
Timothy Porter, MD, FAAP
Clinical Assistant Professor of Melanie Rudnick, MD, FAAP
Pediatrics Assistant Professor of Pediatrics,
Tufts University School of Medicine University of Connecticut
Pediatric Hospitalist School of Medicine
Floating Hospital for Children at Assistant Professor of Pediatrics,
Tufts Medical Center Frank H. Netter MD School of
Boston, MA Medicine
13: Persistent Neonatal Jaundice Division of Pediatric Hospital
Medicine, Connecticut
MacKenzi Preston, MD, MS
Children’s
Assistant Professor of Pediatrics
Hartford, CT
Division of General Academic
29: Fever of Unknown Origin in a
Pediatrics
Child Who Has Immigrated
Weill Cornell Medicine
New York, NY Amanda Sandford, MD, FAAP
25: Attention-Seeking Behavior of Director, Neonatal Hospitalist
Parents Program
Division of Neonatology
Jeffrey Riese, MD, FAAP
Beth Israel Deaconess Hospital
Pediatric Hospitalist
Boston, MA
Hasbro Children’s Hospital
47: Neonatal Hypoglycemia
Providence, RI
42: Agitation in an Adolescent Lori Singleton, MD, FAAP
Associate Professor of Pediatrics
Morehouse School of Medicine
Atlanta, GA
10: Nutrition and Autism Spectrum
Disorder
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