5. Prescribing competence of junior doctors: does it add up? L Kidd, Arch Dis Child 2010;95:219 undergraduate training both at a national level following GMC guidance General Medical Council. Tomorrow’s doctors. London: General Medical Council, 2003. http://www.gmc-uk.org/education/undergraduate/GMC_tomorrows_doctors.pdf

20. Abuso IL BAMBINO BATTUTO

22. Nonaccidental Head Injury Is the Most Common Cause of Subdural Bleeding in Infants <1 Year of Age Matschke Pediatrics 2009;124:1587 % OF CASES WITH SUBDURAL BLEEDING 82.4% 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 5.2% 8.0% NON-ACCIDENTAL HEAD INJURY OTHER CAUSES OF DEATH UNEXPLAINED CT scan

27. Bruising Characteristics Discriminating Physical Child Abuse From Accidental Trauma Pierce Pediatrics 2010;125:67 Comparison of cumulative numbers of bruises for patients with abusive versus accidental trauma. Several bruises are present in case of abuse

28. Bruising Characteristics Discriminating Physical Child Abuse From Accidental Trauma Pierce Pediatrics 2010;125:67 Bruise distribution for patients with abusive and accidental trauma. * Indicates regions significantly predictive of abusive trauma * * * * * *

34. FEVER CONTROL

37. PAIN CONTROL

62. In the Lowest Quartile (<15 ng/ml) vs the Highest Quartile (>26 ng/ml) OR for 2.36 LOW HIGH-DENSITY LIPOPROTEIN CHOLESTEROL HYPERTENSION HYPERGLICEMIA 4 – 3 – 2 – 1 – 0 1.54 3.88 2.54 METABOLIC SY Vitamin D Status and Cardiometabolic Risk Factors in the United States Adolescent Population Reis Pediatrics 2009; 124:e371

69. OR FOR VIT D DEFICIENCY (<15 ng/mL) 1.16 DRANK MILK LESS THAN ONCE A WEEK OLDER GIRLS 5 – 4 – 3 – 2 – 1 – 0 1.6 4.9 1.9 OBESE 21.9 1.9 BLACK >4 HOURS OF TELEVISION VIDEO OR COMPUTER/DAY 0.4 VITAMIN D SUPPLEMEN-TATION Prevalence and Associations of 25-Hydroxyvitamin D Deficiency in US Children: NHANES 2001-2004 Kumar Pediatrics 2009;124;e362

78. CARDIOLOGY

81. Delayed Recognition of Initial Stroke in Children: Need for Increased Awareness Srinivasan Pediatrics 2009;124;e227

88. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement of American Heart Association Newburger Pediatrics 2004;114:1708 Classic clinical criteria of Kawasaki Disease Fever persisting at least 5 days Presence of at least 4 principal features: 1) Changes in extremities Acute: Erythema of palms, soles; edema of hands, feet Subacute: Periungual peeling of fingers, toes in weeks 2 and 3 2) Polymorphous exanthem 3) Bilateral bulbar conjunctival injection without exudate 4) Changes in lips and oral cavity: Erythema, lips cracking, strawberry tongue, diffuse injection of oral and pharyngeal mucosae 5) Cervical lymphadenopathy (1.5-cm diameter), usually unilateral

89. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement of American Heart Association Newburger Pediatrics 2004;114:1708 Classic clinical criteria of Kawasaki Disease Fever persisting at least 5 days Presence of at least 4 principal features: 1) Changes in extremities Acute: Erythema of palms, soles; edema of hands, feet Subacute: Periungual peeling of fingers, toes in weeks 2 and 3 2) Polymorphous exanthem 3) Bilateral bulbar conjunctival injection without exudate 4) Changes in lips and oral cavity: Erythema, lips cracking, strawberry tongue, diffuse injection of oral and pharyngeal mucosae 5) Cervical lymphadenopathy (1.5-cm diameter), usually unilateral Patients with fever of at least 5 days and < 4 principal criteria can be diagnosed with Kawasaki disease when coronary artery abnormalities are detected by 2-dimensional echocardiography or angiography.

90. Laboratory findings in acute Kawasaki disease * (Thrombocytopenia in sone infants) *

91. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Newburger JW, Pediatrics. 2004 Dec;114:1708-33.

94. Refractory pneumonia and high fever Falcini, Lancet 2010;373:1818 (A) Frontal view showing marked pleural effusion on the right. (B) After therapy with IVIg and methylprednisolone

110. Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus Lonneke G.M. Bode. NEJM 2010 (362): 9-17 Background Nasal carriers of Staphylococcus aureus are at increased risk for health care–associated infections with this organism. Decolonization of nasal and extranasal sites on hospital admission may reduce this risk.

117. Chronic fatigue syndrome

123. 2 – 1 – 0 1.4 2.1 2.0 1.8 1.7 1.8 1.9 SLEEP PROBLEMS BLURRED VISION PAIN IN ARMS OR LEGS BACK PAIN COSTIPATION MEMORY DEFICITS HOT AND COLD SPELLS OR FOR PERSISTENCE Risk Factors for Persistent Fatigue With Significant School Absence in Children and Adolescent Robert Pediatrics 2009;124;e89

135. FREQUENT MEDICAL ABSENCES IN SECONDARY SCHOOL STUDENTS: SURVEY AND CASE–CONTROL STUDY Jones Arch Dis Child 2009;94:763 ADHD , attention deficit hyperactivity disorder; DISC , Diagnostic Interview Schedule for Children; OCD , obsessive compulsive disorder; OR , odds ratio; PTSD , post-traumatic stress disorder; SDQ , Strengths and Difficulties Questionnaire for SDQ

136. Dermatology

138. Propranolol for Severe Infantile Hemangiomas: Follow-Up Report Sans Pediatrics 2009;124:e423 1) Infantile hemangiomas (IHs) are the most-common soft-tissue tumors of infancy, occurring in 4% to 10% of children 1 year of age , with a clear female predominance. 2) At birth , IHs may not be apparent or may appear as flat circumscribed lesions with telangiectatic vessels on the surface. Within the first weeks of life, IHs enter a phase of rapid growth with superficial and/or deep components, which lasts usually 3 to 6 months and sometimes up to 24 months . 3) A period of stabilization for a few months follows, and spontaneous involution usually occurs in several years. 4) Regression is complete for 60% of 4-year-old patients and 76% of 7-year-old patients .

139. Propranolol for Severe Infantile Hemangiomas: Follow-Up Report Sans Pediatrics 2009;124:e423 A) 10% of IHs require treatment during the proliferative phase, because of life-threatening locations , local complications , or cosmetic/functional risks . B) IHs can be life-threatening when present in upper airways and liver, inducing acute respiratory failure and congestive heart failure, respectively. C) Local complications such as hemorrhage, ulceration, and necrosis can be very painful and may lead to scars that are difficult to repair. D) IHs in some locations can impair sensory functions; for example, IHs of the upper eyelid can induce anisometropia, astigmatism, and amblyopia. IHs in other locations, such as the lip, nasal tip, or ear, may lead to permanent deformities.

140. Propranolol for Severe Infantile Hemangiomas: Follow-Up Report Sans Pediatrics 2009;124:e423 A) 10% of IHs require treatment during the proliferative phase, because of life-threatening locations , local complications , or cosmetic/functional risks . B) IHs can be life-threatening when present in upper airways and liver, inducing acute respiratory failure and congestive heart failure, respectively. C) Local complications such as hemorrhage, ulceration, and necrosis can be very painful and may lead to scars that are difficult to repair. D) IHs in some locations can impair sensory functions; for example, IHs of the upper eyelid can induce anisometropia, astigmatism, and amblyopia. IHs in other locations, such as the lip, nasal tip, or ear, may lead to permanent deformities. We observed serendipitously that propranolol , a well-tolerated, nonselective, β -adrenergic receptor blocker commonly used for cardiologic indications in young children, can control the growth of IHs efficiently.

141. Propranolol for Severe Infantile Hemangiomas: Follow-Up Report Sans Pediatrics 2009;124:e423 Patient with palpebral occlusion. A, Palpebral occlusion at 2 months of age, after 1 week of systemic steroid treatment (2 mg/kg per day) and 1 day before treatment with propranolol. B, Spontaneous eye reopening after 7 days of propranolol treatment at 2 mg/kg per day. C, Further improvement after 2 months of propranolol treatment while prednisone treatment was tapered progressively. D, Residual telangiectases at 12 months of age, after cessation of propranolol treatment. Time 0 7 days after 2 months 12 months

142. Propranolol for Severe Infantile Hemangiomas: Follow-Up Report Sans Pediatrics 2009;124:e423 Patient with a painful ulcerated IH. Standard treatment with wound care dressings and analgesics was also used. A, At 5 months of age, 1 day before treatment with propranolol. B, Beginning of healing after 2 weeks of propranolol treatment at 2 mg/kg per day. C, Limited ulceration relapse at 8 months of age, after 3 months of propranolol treatment. Complete healing was achieved after the propranolol dosage was increased to 3 mg/kg per day. After 2 weeks

143. Propranolol for Severe Infantile Hemangiomas: Follow-Up Report Sans Pediatrics 2009;124:e423 Patient at risk of cosmetic disfigurement and ulceration because of a large IH of the inferior lip. A, At 4 months of age, 1 day before treatment with propranolol. B, After 2 months of propranolol treatment at 2 mg/kg per day. C, After 3 months of propranolol treatment at 2 mg/kg per day. D, After 5 months of propranolol treatment at 2 mg/kg per day.

144. Propranolol for Severe Infantile Hemangiomas: Follow-Up Report Sans Pediatrics 2009;124:e423 Patient with a life-threatening laryngeal IH. The improvement of the cutaneous component should be noted. A, At 2 months of age, 1 day before treatment with propranolol. B, Seven days after initiation of propranolol treatment at 2 mg/kg per day, with a change in color from intense red to purple and palpable softening. C, Further improvement after 2 months of propranolol treatment at 2 mg/kg per day. D, Residual telangiectases at 11 months of age, 1 month after cessation of propranolol treatment.

145. Propranolol for Severe Infantile Hemangiomas: Follow-Up Report Sans Pediatrics 2009;124:e423 α ) Propranolol is a nonselective β -adrenergic receptor blocker. β ) Capillary endothelial cells express β 2 -adrenergic receptors , which modulate the release of nitric oxide, causing endothelium-dependent vasodilatation. γ ) β -Adrenergic receptor stimulation can induce modifications of signal transduction pathways of angiogenic factors such as VEGF or bFGF.

149. Emergency Department

153. gastroenterology

157. The Applicability and Efficacy of Guidelines for the Management of Acute Gastroenteritis (AGE) in Outpatient Children: A Field-Randomized Trial on Primary Care Pediatricians Albano J Pediatr 2010;156:226 The pediatricians in group A were instructed to adhere to 4 major recommendations in the guidelines: 1) rapid oral rehydration for 3-4 hours with hypoosmolar solution (Na 60 mmol/L); 2) rapid refeeding after 4 hours of rehydration with the child’s normal diet, including solids, full-strength milk, or formula, with no restriction of lactose intake; 3) avoidance of unnecessary medications; 4) avoidance of microbiological investigations.

179. Rectal Sensory Threshold for Pain is a Diagnostic Marker of Irritable Bowel Syndrome and Functional Abdominal Pain in Children U Halac, J Ped 2010;156:60

183. The multiple muscle ASR (response probability, 0% to 100%), for the 8 repetitive stimuli, is significantly enlarged in patients with abdominal pain (n = 20) compared with control subjects (n = 23) but not compared with patients with anxiety disorder (n = 25). Increased Auditory Startle Reflex in Children with Functional Abdominal Pain Bakker J Pediatr 2010;156:285 The multiple muscle ASR (EMG magnitude), for the 8 repetitive stimuli, is significantly enlarged in patients with abdominal pain (n = 20) compared with control subjects (n = 23) but not compared with patients with anxiety (n = 25).

184. The multiple muscle ASR (response probability, 0% to 100%), for the 8 repetitive stimuli, is significantly enlarged in patients with abdominal pain (n = 20) compared with control subjects (n = 23) but not compared with patients with anxiety disorder (n = 25). Increased Auditory Startle Reflex in Children with Functional Abdominal Pain Bakker J Pediatr 2010;156:285 The multiple muscle ASR (EMG magnitude), for the 8 repetitive stimuli, is significantly enlarged in patients with abdominal pain (n = 20) compared with control subjects (n = 23) but not compared with patients with anxiety (n = 25). Children with abdominal pain–related functional gastrointestinal disorders may have a generalized hypersensitivity of the central nervous system.

192. Objectives: To determine the benefits of Lactobacillus rhamnosus GG (LGG) in an extensively hydrolyzed casein formula (EHCF) in improving hematochezia and fecal calprotectin over EHCF alone. Study design: Fecal calprotectin was compared in 30 infants with hematochezia and 4 weeks after milk elimination with that of a healthy group. We also compared fecal calprotectin and hematochezia on 26 formula-fed infants randomly assigned to EHCF with LGG (Nutramigen LGG) (EHCF + LGG) or without (Nutramigen) (EHCF - LGG) and on 4 breastfed infants whose mothers eliminated dairy. Lactobacillus GG Improves Recovery in Infants with Blood in the Stools and Presumptive Allergic Colitis Compared with Extensively Hydrolyzed Formula Alone Baldassarre J Pediatr 2010;156:397

194. Lactobacillus GG Improves Recovery in Infants with Blood in the Stools and Presumptive Allergic Colitis Compared with Extensively Hydrolyzed Formula Alone Baldassarre J Pediatr 2010;156:397

209. 52% % PATIENTS SURVIVING 60 – 50 – 40 – 30 – 20 – 10 - 0 10.3% APPROPRIATE INAPPROPRIATE INITIAL T