Enteral feeding in patients receiving VAs is associated with no difference in GI outcomes and a tendency towards lower mortality. Prospective studies are required to confirm the safety of enteral feedings in patients receiving VAs.

Key Clinical MessageIntravenous immunoglobulin therapy should be considered in pediatric acute hemorrhagic leukoencephalitis that is refractory to steroid and plasmapheresis.

Acute ischemic stroke (AIS) in children is rare with almost 40% diagnosed as cryptogenic. One possible mechanism associated with AIS is an elevated Lipoprotein (a) [Lp(a)] level. Here, we discuss the case of an 11-year old boy who presented with multiple thrombotic strokes secondary to elevated Lp(a), which was identified as the only risk factor and immediately treated with lipoprotein apheresis (LA). Eighteen months post-AIS, he is still receiving LA treatments and has made remarkable progress in his recovery without another cerebrovascular event.

Key Clinical MessageGiant cell myocarditis should be considered in all pediatric patients with refractory ventricular arrhythmia. Endomyocardial biopsy should be obtained to confirm the diagnosis of giant cell myocarditis.

Severe pediatric ARDS remains a significant challenge for clinicians, and management strategies are essentially limited to lung protective ventilation strategies, and adjunct approaches such as prone positioning, steroids, surfactant, and inhaled nitric oxide in unique situations. Inhaled nitric oxide produces pulmonary vasodilation in ventilated regions of the lung, shunting blood away from poorly ventilated areas and thus optimizing the ventilation perfusion ratio. A subset of patients with ARDS are known to be non-responders to nitric oxide, and selective pulmonary vasodilators such as Epoprostenol can be useful as rescue therapy in such cases. We describe a case of severe pediatric ARDS in the setting of pre-existing pulmonary hypertension and Trisomy 21, whose clinical course improved remarkably once inhaled Epoprostenol was initiated.