Our findings provide additional support for the new guideline recommendations to provide respiratory syncytial virus prophylaxis only for children ≤12 months old with congenital heart disease.

In today's modern world of high technology imaging and sophisticated laboratory examinations, medicine has come to rely on technology much more than in the past. So much so that at times we forget about the power of a thorough physical exam in detecting medical issues. In this article we will explore the normal newborn examination, discuss the importance of knowing normal versus abnormal findings and discuss some common and not so common findings on the newborn examination. In healthy babies, 15% to 20% will have at least one minor anomaly with an associated 3% chance of having a major anomaly. Two, three, or more minor anomalies are found in 0.8% and 0.5% of healthy babies, respectively. In these cases the chances of major anomalies rises to 10% and 20%, respectively [1].Newborn infants may present to the emergency department for a variety of reasons. Almost all of these derive from the parent's perception that something is wrong. In each of these cases, the role of the emergency physician is to recognize abnormality and, if no abnormality exists, to alleviate concerns of the parent. Mostly, parental concern stems from conditions that are self-limited or are variants without physiologic consequence. Less common are that these concerns are the presentation of a medical condition that has the potential to worsen or represents underlying illness. Detection of the latter can be life saving. Unfortunately, illness in the newborn is often subtle and difficult to detect. The primary difficulty lies in that the daily activities of a newborn and the newborn's interaction with the environment are extremely limited. It is therefore imperative that the emergency physician becomes familiar and comfortable with performing a newborn exam.

Torsades de Pointes (TdP) is a life-threatening ventricular arrhythmia that can be associated with metabolic abnormalities, exposure to arrhythmogenic medications, and congenital long-QT syndrome. This report describes a patient with ALL and multiple complications of therapy who developed TdP. The patient had no evidence of congenital long-QT syndrome, but a constellation of factors appears to have led to QT prolongation, ventricular ectopy, and TdP. Although the patient suffered cardiac arrest, rapid recognition of TdP and prompt defibrillation resulted in an excellent outcome.

Acute hemorrhagic leukoencephalitis (AHLE) is a rare demyelinating disease of the central nervous system that typically follows a viral or bacterial respiratory infection. We report the first described case of AHLE following influenza A (H3N2) in an otherwise healthy 15-year-old girl with no relevant past medical history who initially presented to the emergency department (ED) by emergency medical services (EMS) with decorticate posturing and right gaze deviation after being found unresponsive at home. Subsequent testing for Influenza A H3N2 via viral polymerase chain reaction (PCR) was positive. Clinical correlation and brain MRI confirmed AHLE. At follow-up three months after discharge, she was found to have intellectual functioning in the extremely low range and she still had deficits in motor skills eight months after discharge. While the patient was reportedly up-to-date on her routine scheduled childhood vaccinations, she had not received her annual influenza vaccination that year. Pediatric infectious disease physicians and neurologists should consider the diagnosis of AHLE in unvaccinated, previously healthy patients with new and rapid onset of neurological symptoms following influenza infection.