Why does newborn jaundice occur?
Newborns have increased rates of bilirubin production due to RBC's with shorter life spans, and a decreased rate of bilirubin elimination due to decreased ability of the neonatal liver to conjugate bilirubin

What percentage of newborns will become clinically jaundiced?
About <em><span style="text-decoration:underline;"><strong>60%</strong></span></em> of newborns will become clinically jaundiced

What day of life do bilirubin levels peak in newborns?
Bilirubin levels peak at <span style="text-decoration:underline;"><strong>4 days of life</strong></span>,  and may not decline before day 7

When should you admit and treat a jaundiced newborn?
Admission and treatment should be considered urgently when <span style="text-decoration:underline;"><strong>serum total bilirubin &gt;25mg/dL</strong></span>, with <span style="text-decoration:underline;"><strong>exchange transfusion if it is &gt;30mg/dL or the infant has signs of kernicterus.
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There are nomograms which plot the bilirubin level according to the infant's age in hours to determine if an infant is at risk for being at toxic levels.<span style="text-decoration:underline;"><strong>
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Most pathologic etiologies of newborn jaundice are due to:
Increased bilirubin production: blood-group incompatibilities, RBC-enzyme deficiency, and RBC structural defects

When jaundice occurs between days 4 and 7, strongly consider:
Sepsis, UTI, congenital infection (syphilis, CMV, etc)

True or False:  All pediatric burn blisters should be debrided.
<answer>
A common debate on the topic of pediatric burns is whether or not blisters should be debrided.  <span style="text-decoration:underline;"><strong>ALL PEDIATRIC BURN BLISTERS SHOULD BE DEBRIDED. </strong></span> 

There are two reasons for this:
1. Without debridement of burn blisters, the depth of a burn cannot be assessed, and such an assessment will certainly affect treatment and disposition.
2. There is conflicting (poor) evidence that blister fluid provides both protective and damaging properties, however, there is excellent evidence that ruptured blisters, or large blisters which are likely to rupture, carry a higher risk of infection if not debrided. 

Therefore, all blisters should be debrided. 

Sargent, RL. Management of blisters in the partial-thickness burn: an integrative research review. J Burn Care Res 2006; 27:66.

Alsbjorn, B, Gilbert, P, Hartmann, B, et al. Guidelines for the management of partial-thickness burns in a general hospital or community setting--recommendations of a European working party. Burns 2007; 33:155.</answer>

Pediatric Ethanol Ingestion Pearls
<answer>
Infants and young children who have ingested enough ethanol to cause a peak serum level<span style="text-decoration:underline;"><strong> &ge;50 mg/dL (11 mmol/L) are at risk for profound hypoglycemia</strong></span>, in addition to the other effects of alcohol seen in adults 

The key is that the dangerous serum level is MUCH lower in children than in adults, and children require FAR smaller volume than what may be considered dangerous by adults.

Supportive care is the key to good outcomes, with particular focus on treating <strong><span style="text-decoration:underline;">hypoglycemia</span></strong> - check your D-sticks early and often.

Consider child protective services involvement in every case of pediatric intoxication, and consider measurement of serum acetaminophen levels as well as other possible toxic ingestion candidates.

Activated charcoal cannot adsorb ethanol and should only be used if other substances are being considered.

Children who are asymptomatic for six hours, and have a safe home environment, may be discharged.</answer>

Most Common Cause of Low Platelets in Children:
<strong><span style="text-decoration:underline;">Idiopathic Thrombocytopenic Purpura (ITP)</span></strong>

What is ITP?
I<strong><span style="text-decoration:underline;">mmune-mediated</span></strong> destruction of circulating platelets

Peak Incidence of Acute ITP (age range)?
<strong><span style="text-decoration:underline;">2-5 years of age</span></strong>

Peak Incidence of Chronic ITP (age)?
<span style="text-decoration:underline;"><strong>Adolescence</strong></span>

True or False: In ITP, a recent history (1-6 weeks) of viral infection or recent immunization is common.
<span style="text-decoration:underline;"><strong>TRUE</strong></span>

True or False:  Hepatosplenomegaly is common in ITP?
<span style="text-decoration:underline;"><strong>FALSE</strong></span>; there is NO hepatosplenogmegaly in ITP.

What is a typical Hg and blood smear in a patient with ITP?
<answer>
<span style="text-decoration:underline;"><strong>Low platelets</strong></span> with <strong><span style="text-decoration:underline;">megathrombocytes </span></strong>on smear

<strong><span style="text-decoration:underline;">Normal hemoglobin</span></strong> (which differentiates from TTP, HUS, and DIC)</answer>

True or False:  In ITP, nearly 90% of children will have normal platelet counts in 6 months.
<span style="text-decoration:underline;"><strong>TRUE</strong></span>

When do you treat ITP (at what platelet count)?
Treatment reserved for <strong><span style="text-decoration:underline;">platelet counts &lt;20,000 OR</span> <span style="text-decoration:underline;">significant bleeding</span></strong>

What do you treat ITP with?
<span style="text-decoration:underline;"><strong>-IVIG</strong></span> (best response rate of 95%)
<span style="text-decoration:underline;"><strong>-Corticosteroids</strong></span> (79% resposne rate)
<span style="text-decoration:underline;"><strong>-Anti-rH (D) immunoglobulin</strong></span> (82% reesponse reate)

In a pediatric patient with a possible caustic ingestion, what symptoms would make you pursue an EGD to evaluate risk of perforation or stricture formation?
<answer>
If the child displays 2 or more of the following symptoms there is enough evidence from case series that there will be a clinically signficant lesion found on EGD:

<span style="text-decoration:underline;"><strong>-Vomiting </strong></span>
<span style="text-decoration:underline;"><strong>-Drooling</strong></span>
<span style="text-decoration:underline;"><strong>-Stridor</strong></span>
<strong><span style="text-decoration:underline;">-Presence of Oropharyngeal Burns</span></strong>

That being said, many clinicians would elect for EGD and assessment of airway with stridor alone.  Do not be fooled into thinking if you see no oral lesions that there is no way the child ingested the caustic.  Each case series showed a lack of correlation of physical exam findings to EGD findings.</answer>

What is the main side effect of oral ondansetron when used in the setting of pediatric gastroentiritis?
The main side effect of ondansetron in this setting appears to be an <strong><span style="text-decoration:underline;">i</span><span style="text-decoration:underline;"><strong>n</strong>creased frequency of diarrhea after administration</span></strong> (Emerg Med J, 11/09, pg 785).