Approximately one fourths of infant fractures are due to abuse. Recognition of abuse is important to avoid further morbidity/mortality. There is limited knowledge regarding how frequently pediatric emergency department clinicians consider abuse in infants with fractures. Our primary objective was to estimate the percentage of infants with fractures for whom abuse was considered, and to examine characteristics associated with abuse consideration. We performed a retrospective review of infants <1 year of age presenting to a pediatric emergency department. Our primary outcome variable was consideration of abuse. Our secondary outcome measures were identification of predictor variables associated with consideration of abuse. We identified 509 infants meeting study criteria. Pediatric emergency physicians considered abuse in approximately two thirds of infants with fractures. Consideration was more likely to occur in younger infants, in the presence of no history or unwitnessed injury mechanism, when evaluated by male physicians, and emergency department encounters from 12 am to 6 am.

Background and aims The PI3K pathway is frequently activated during tumourigenesis through deletion of the tumour suppressor PTEN. In contrast, increased PTEN expression in adipose tissue results in an increase in UCP1 expression and provides metabolic protection from tumourigenesis. This intrinsic protection normally arises from interscapular brown adipose tissue (iBAT) but may also arise from 'beiging' of inguinal white adipose tissue (iWAT). The aim of this study was to see if an association existed between UCP1 expression in adipose tissue and paediatric brain tumour growth through elevated PTEN levels. Methods Two types of medulloblastoma (WNT and group 4) and ependymoma tumour cells were orthotopically xenografted into mice. iBAT and iWAT samples were extracted from tumour and non-tumour bearing mice to examine UCP1 and PTEN expression through QRT-PCR and Western blotting. Haematoxylin and eosin staining and UCP1 antibody immunohistochemistry (IHC) was also used to determine BAT activity in adipose tissue. Thermogenic activity of the adipose tissue was indirectly measured by thermal imaging of mice. Results iWAT from ependymoma tumour-bearing mice had evidence of beiging and increased UCP1 expression through histology and IHC, while UCP1 expression in iBAT remained high in all mice. An increase in UCP1 gene expression and thermogenesis was observed with spinal metastasis. PTEN expression did not relate to UCP1 expression. Conclusion Our data indicated mice implanted with aggressive tumours had increased UCP1 expression in iWAT. In conclusion, this pilot study suggests rapidly growing and metastatic brain tumours stimulate metabolic protection via an increase UCP1 expression in iWAT. Background and aims To evaluate the diagnostic usefulness of biomarkers in the management of children with fever at risk of serious bacterial infections (SBI) at the emergency department (ED). Paediatric Emergency Medicine IIMethods In this prospective observational study previously healthy children with fever, aged 1 month to 16 years, attending the EDs of a university hospital and a teaching hospital (Rotterdam, the Netherlands) between 2009 and 2012 were included. Standardised information on clinical signs and symptoms, Creactive protein (CRP), procalcitonin (PCT), neutrophil CD64 expression and urinalysis were collected prospectively. Logistic multivariable regression analysis was used to assess diagnostic performance.Results 1,084 children were included, median age was 1.6 years (interquartile range: 0.8-3.5), 170 children (16%) had SBI. CRP (receiver operating characteristic curve (ROC-area) 0.77 (95% confidence interval (CI) 0.69-0.85)) and PCT (ROC-area 0.75 (95% CI 0.67-0.83)) were both strong predictors of SBI. CD64 lacked diagnostic strength (ROC-area 0.62 (95% CI 0.54-0.70)). A score containing PCT and CRP together with urinalysis, the Lab-score, performed well (ROC-area 0.79 (95% CI 0.72-0.87)), but thresholds performed similar to often used cut-offs of single biomarkers. Combined with clinical signs and symptoms b...

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Newborn screening programs were established in the United States in the early 1960s. Newborn screening programs were then developed by states and have continued to be the responsibility of the state. All states require a newborn screening, but what is required of these programs and screening panels has differed greatly by state. Historically, the most commonly screened disorders are the following: congenital hypothyroidism, congenital adrenal hyperplasia, sickle cell disease and associated hemoglobinopathies, biotinidase deficiency, galactosemia, cystic fibrosis and phenylketonuria, maple syrup urine disease, and homocystinuria. However, under new guidelines in 2006 and with new advances in technology, the scope of newborn screening programs has expanded to include at a minimum 9 organic acidurias, 5 fatty acid oxidation disorders, 3 hemoglobinopathies, and 6 other conditions. This CME article reviews the logistics of newborn screening and explores the effect of new technology and recent policy on state screens and what that means for providers. This article also highlights several of the disorders most relevant to emergency room physicians and discusses future considerations of newborn screening.