Pierre Loredo's Pediatric Board Review

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Top Pediatric Literature

Pulse ox utility for testicular torsion. Ultrasound remains standard of care for diagnosis.

Delaying vaccines (alternate scheduling) more than doubles risk of seizure.

Sinusitis -amoxicillin if soft call; otherwise, augmentin

New Guidelines for Otitis Media released. Key recommendations:
*Clinicians should diagnose AOM in children who present with moderate to severe bulging of the tympanic membrane (TM) or new onset of otorrhea not due to acute otitis externa. Clinicians may diagnose AOM in children who present with mild bulging of the TM and recent (<48 hours) onset of ear pain (holding, tugging, rubbing of the ear in a nonverbal child) or intense erythema of the TM.
· Clinicians should not diagnose AOM in children who do not have middle ear effusion (MEE) based on pneumatic otoscopy and/or tympanometry).
· The management of AOM should include an assessment of pain. If pain is present, the clinician should recommend treatment to reduce pain.
· The clinician should prescribe antibiotic therapy for AOM (bilateral or unilateral) in children aged 6 months and older with severe signs or symptoms (ie, moderate or severe otalgia or otalgia for at least 48 hours or temperature =39°C (102.2°F). The clinician should prescribe antibiotic therapy for bilateral AOM in children aged 6 months to 23 months without severe signs or symptoms (ie, mild otalgia for <48 hours and temperature <39°C ).
· The clinician should either prescribe antibiotic therapy or offer observation with close follow-up based on joint decision-making with the parent(s)/caregiver for unilateral AOM in children aged 6 months to 23 months of age without severe signs or symptoms. When observation is used, a mechanism must be in place to ensure follow-up and begin antibiotic therapy if the child worsens or fails to improve within 48 to 72 hours of onset of symptoms.
· Clinicians should prescribe amoxicillin for AOM when a decision to treat with antibiotics has been made and the child has not received amoxicillin in the past 30 days or the child does not have concurrent purulent conjunctivitis or the child is not allergic to penicillin.
· Clinicians should prescribe an antibiotic with additional beta-lactamase coverage for AOM when a decision to treat with antibiotics has been made, and the child has received amoxicillin in the last 30 days or has concurrent purulent conjunctivitis, or has a history of recurrent AOM unresponsive to amoxicillin.
· Clinicians should not prescribe prophylactic antibiotics to reduce the frequency of episodes of AOM in children with recurrent AOM.
· Clinicians may offer tympanostomy tubes for recurrent AOM (3 episodes in 6 months or 4 episodes in 1 year with 1 episode in the preceding 6 months).
· Clinicians should recommend pneumococcal conjugate vaccine and the influenza vaccine to all children according to the schedule of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, American Academy of Pediatrics (AAP), and American Academy of Family Physicians (AAFP).

Clinical article on Scoliosis helps clarify decision as to what to do (follow up, repeat x-rays, refer) at which pubertal stage and at which cobb angle.   

The Academy recommends infants have their hearing tested by one month of age. Most newborns are tested (hearing screen) before discharge, but with c-section deliveries it's best to test after 2 days of age.

Newborn screening for critical congenital heart disease.

Rate of serious bacterial infection in infants aged 22 to 28 days found to be no higher than in infants aged 29 to 90 days for young infants with fever. Is it time to change current standard of care for infants < 28 days with fever?

Revised UTI guidelines, VCUG after first UTI not required in all cases. Also, compared with parenteral therapy, oral antimicrobial therapy is as effective in treating UTI. Finally, voiding cystourethrography (VCUG) shows vesicoureteral reflux (VUR), antimicrobial prophylaxis is not recommended to prevent febrile UTI.

Methicillin-resistant Staphylococcus aureus (MRSA) guidelines.  Drainage alone of abscesses less than 5 centimeters (cm) is as effective as drainage plus antibiotics. Drain, culture and use antibiotics if 1. Abscesses greater than 5 cm 2. ill appearing child (as evidenced by fever, etc.) 3. abscess site that is difficult to drain (e.g., genitalia, face, hands) 4. children with co-morbidities (e.g., chronic underlying disease, immunosuppressed) 5. rapidly advancing disease 6. failure of simple drainage.

Cephalexin and Clindamycin showed no significant difference in the treatment of uncomplicated (Exclusion-immune deficent, hospitalization on initial visit, surgical wound/hard ware from surgery, currently on antibiotics) skin and soft tissue infection (Abscess with/without surrounding cellulitis, furuncle, or carbuncle). Yes, even if bug was CA-MRSA. Note: Wound care (including drainage) and follow up still very important.

Intranasal Midazolam and rectal diazepam have no difference in efficacy for terminating seizures at home.

Probiotics reduce severity of diarrhea (infectious), also reduces length of hospital stay.

ACOG changes guidelines. First cervical cancer screen (and pelvic exam) now delayed until age 21, even if sexually active earlier.

Top FREE Pediatric Online Lectures

Outpatient Liver function tests



Food Allergy

Pediatric patient centered medical home

Allergic Rhinitis


PEDS ID Lecture

Sports Concussion Update

Pediatric Musculoskeletal Exam: Shoulder, Knee and Ankle

More Pediatric Musculoskeletal care

Musculoskeletal: Lower extremity

Lower extremity(Some more)

Pediatric Acne Guidelines

Congenital Heart Disease Screening: Policy, Politics and Practice

Respiatory Distress Lecture

Recurrent illness

Grand Rounds: Development Delays

Lipid screening

This site is dedicated to the Love of my life.
Thank you Elizabeth for everything you do.

Pierre Loredo, M.D, was born and raised in Miami, Florida.
He graduated from Cornell University during which time he interned with the
Children’s Health Fund and assisted with research on the Yale school of medicine mobile medical van.
Following college he taught anatomy and physiology for one year before finishing medical school and residency in Florida.
Today, he practices in Fort Myers, Fl where he is happily married to Elizabeth Layton
Loredo. Dr. Loredo is board certified in Pediatrics.

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