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Red flags in the evaluation of infants with jaundice

Informative algorithm.

Phototherapy indications in full and preterm infants.

Arthrogryposis, also called arthrogryposis multiplex congenita (AMC), is a term used to describe a variety of conditions involving multiple joint contractures (or stiffness).

A 12-month-old boy is seen in the emergency department for cough, fever, and decreased oral intake for the past 2 days. He has had the normal number of wet diapers and no diarrhea. He has a history of hypoplastic left heart syndrome (HLHS), which was initially palliated with a Norwood-type repair and at 5 months of age with a bidirectional Glenn procedure (cavopulmonary anastomosis). The boy has been doing well since his last surgery and receives consistent cardiologic follow-up. The cardiologist had no concerns at the last clinic visit. His vital signs are as follows: temperature, 38 °C; heart rate, 170 beats/min; respiratory rate, 50 breaths/min; blood pressure, 95/50 mm Hg; and oxygen saturation, 67% in room air (average of 80%-85% since last surgery). He is alert and interactive, with mildly increased work of breathing without acute distress. On lung auscultation, air movement is adequate and equal bilaterally, with mild wheezing and without stridor. He has well-healed surgical scars. Capillary re ll time is 2 to 3 seconds. The remainder of his examination ndings are normal.

#Prep_pearls The rst line of treatment for preschool-aged children with attention-de cit/hyperactivity disorder is behavioral management. For those who continue to have a moderate to severe level of impairment with behavioral interventions, medication can be considered.

Age-­Related Causes of Respiratory Distress.

The correct answer is pulmonary arteriovenous malformation The girl in the vignette has asymptomatic cyanosis, digital clubbing, hypoxia, and a left upper lobe density on chest radiography. These findings are most consistent with a pulmonary arteriovenous malformation (AVM). Chest computed tomography with intravenous contrast confirmed an AVM in the same area as the left upper lobe density.  All of the other response choices could produce cyanosis and digital clubbing, but they would involve additional signs, symptoms, or both. The girl has no chronic wet cough or diffuse radiographic changes to suggest bronchiectasis. She has normal growth and no symptoms of malabsorption or chronic cough to suggest cystic fibrosis (CF). Congenital cyanotic heart disease is unlikely with no symptoms of cardiovascular compromise, normal cardiac examination findings, and no radiographic evidence of a cardiac abnormality.