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Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
[News in paediatrics]
Insights
Pediatricians should evaluate vertebral skin lesions for spinal dysraphism and recognize that bruises and fractures in young children may indicate non-accidental injury. Isotonic solutions are recommended for pediatric maintenance infusions to prevent hyponatremia.
Area of Science:
- Pediatric medicine
- Neonatology
- Emergency medicine
Context:
- Skin lesions near the vertebral column in infants require careful assessment to rule out spinal dysraphism.
- Non-accidental injury is a significant concern in young children, often presenting with bruises or fractures.
- Current trends in pediatric care favor isotonic over hypotonic solutions for maintenance infusions.
Purpose:
- To provide a practical algorithm for evaluating neonatal skin lesions for spinal dysraphism.
- To highlight the importance of investigating suspicious injuries in infants and toddlers for non-accidental trauma.
- To advocate for the preferential use of isotonic solutions in pediatric maintenance hydration.
Summary:
- A diagnostic algorithm aids pediatricians in identifying spinal dysraphism associated with vertebral skin lesions, preventing complications like meningeal infection or tethered cord.
- Bruises and fractures in young children warrant thorough investigation for non-accidental injury.
- Isotonic maintenance infusions are recommended for children to mitigate hyponatremia risks.
Impact:
- Improved diagnostic accuracy for spinal dysraphism in newborns.
- Enhanced detection and management of non-accidental injury in pediatric patients.
- Reduced incidence of iatrogenic hyponatremia in hospitalized children.
Abstract:
Every pediatrician will be confronted with newborns oryoung infants with skin lesions in proximity of the vertebral column. It is important not to miss a spinal dysraphism because of the risk of meningeal infection or of the possible presence of a tethered cord. A practical algorithm is presented. Non-accidental injury in young infants and toddlers is not rare but difficult to detect. Bruises and fractures are highly suspicious for non-accidental injury and should trigger specific investigations. Emergency departments and hospitals are switching from hypotonic to isotonic solutions as maintenance infusions of children. They reduce the risk of hyponatremia without increasing that of hypernatremia, and they should be used preferentially in the majority of pediatric clinical settings.
