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New Orleans, LA, United States

Hauser A.,New Orleans Childrens Hospital | Fogarasi S.,Ochsner Medical Center
Pediatrics in Review | Year: 2010

• Eyelid swelling is a common pediatric complaint and must be evaluated expeditiously by a pediatrician. • Based primarily on consensus and observational studies, differentiation of periorbital and orbital cellulitis must be attempted through thorough history taking, including predisposing factors, and physical examination focused on the eye. (5) • CT scan scanning may aid in the diagnosis, according to primarily consensus and observational studies. (3) • Based primarily on consensus and observational studies, simple periorbital cellulitis may be treated empirically with oral antibiotic therapy and close follow-up. (10) • Consensus and observational studies suggest that early recognition and treatment of orbital cellulitis is essential. (2) • When a patient presents with ophthalmoplegia and proptosis, consensus and observational studies recommend initiation of appropriate empiric antibiotic therapy targeted at MRSA and Streptococcus. (6) • Based primarily on consensus and observational studies, the patient's clinical course must be monitored closely, with clinical deterioration or lack of improvement possibly requiring imaging to look for underlying complications and determine the need for surgical intervention.

Edwards S.,Childrens Mercy Hospital and Clinics | Davis A.M.,University of Kansas Medical Center | Davis A.M.,Center for Childrens Healthy Lifestyles and Nutrition | Bruce A.,University of Kansas Medical Center | And 8 more authors.
Journal of Parenteral and Enteral Nutrition | Year: 2016

Enteral nutrition is the practice of delivering nutrition to the gut either orally or through a tube or other device. Many children are reliant on enteral feedings to either supplement their nutrition or as a complete source of their nutrition. Managing children on tube feedings requires a team of providers to work through such dilemmas as feeding schedules, weaning from tube feeding, sensory implications of tube feeding, treatment of pain or nausea associated with eating, oral-motor issues, and behavioral issues in the child and family. The purpose of the current review is to summarize the multidisciplinary aspects of enteral feeding. The multidisciplinary team consists of a variable combination of an occupational therapist, speech-language pathologist, gastroenterologist, psychologist, nurse, pharmacist, and dietitian. Children who have minimal oral feeding experience and are fed via a nasogastric or gastrostomy tube often develop oral aversions. Limited data support that children with feeding disorders are more likely to have sensory impairment and that early life pain experiences contribute to feeding refusal. There are inpatient and outpatient programs for weaning patients from tube feeding to eating. The parent-child interaction is an important part of the assessment and treatment of the tube-fed child. This review also points out many information gaps, including data on feeding schedules, blenderized tube feedings, the best methods for weaning children off enteral feedings, the efficacy of chronic pain medications with tube-fed children, and, finally, the necessity of the assessment of parental stress among all parents of children who are tube fed. © The American Society for Parenteral and Enteral Nutrition.

Davis A.M.,University of Kansas Medical Center | Davis A.M.,Center for Childrens Healthy Lifestyles and Nutrition | Dean K.,Center for Childrens Healthy Lifestyles and Nutrition | Mousa H.,University of California at San Diego | And 7 more authors.
Journal of Pediatrics | Year: 2016

Objective To assess the role of amitriptyline in the effectiveness of an outpatient protocol for weaning medically complicated children from tube to oral feeding. Study design Twenty-one children seen in multidisciplinary outpatient feeding teams across 4 sites were recruited to a randomized placebo-controlled trial of a 6-month outpatient treatment protocol with behavioral, oral-motor, nutrition, and medication components. Results All of the children who completed the 6-month program (73%) were weaned to receive only oral feeding, regardless of group assignment. The transition from tube to oral feeding resulted in decreases in body mass index percentile and pain, some improvements in quality of life, and no statistically significant changes in cost. Conclusions Amitriptyline is not a key component of this otherwise effective outpatient, interdisciplinary protocol for weaning children from tube to oral feeding. © 2016 Elsevier Inc.

Estacion M.,Yale University | Estacion M.,Rehabilitation Research Center | O'Brien J.E.,University of Michigan | Conravey A.,New Orleans Childrens Hospital | And 6 more authors.
Neurobiology of Disease | Year: 2014

Rare de novo mutations of sodium channels are thought to be an important cause of sporadic epilepsy. The well established role of de novo mutations of sodium channel SCN1A in Dravet Syndrome supports this view, but the etiology of many cases of epileptic encephalopathy remains unknown. We sought to identify the genetic cause in a patient with early onset epileptic encephalopathy by whole exome sequencing of genomic DNA. The heterozygous mutation c. 2003C>T in SCN8A, the gene encoding sodium channel Nav1.6, was detected in the patient but was not present in either parent. The resulting missense substitution, p.Thr767Ile, alters an evolutionarily conserved residue in the first transmembrane segment of channel domain II. The electrophysiological effects of this mutation were assessed in neuronal cells transfected with mutant or wildtype cDNA. The mutation causes enhanced channel activation, with a 10mV depolarizing shift in voltage dependence of activation as well as increased ramp current. In addition, pyramidal hippocampal neurons expressing the mutant channel exhibit increased spontaneous firing with PDS-like complexes as well as increased frequency of evoked action potentials. The identification of this new gain-of-function mutation of Nav1.6 supports the inclusion of SCN8A as a causative gene in infantile epilepsy, demonstrates a novel mechanism for hyperactivity of Nav1.6, and further expands the role of de novo mutations in severe epilepsy. © 2014 The Authors.

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