CPS Statements Flashcards
Imaging the term neonatal brain: what area does US not visualize well?
The convex surfaces and the posterior fossa.
Imaging the Term Neonatal Brain: What is another con of US modality to image the term neonatal brain?
It may miss some subtle grey and white matter anomalies if the operator is less experienced.
Imaging the Term Neonatal Brain: When is it appropriate to get a CT head on a neonate?
When the infant is too sick to have an MRI with the length of time that it requires for the MRI or in trauma situation to look for fractures.
Comprehensive care of the ambulatory child with cerebral palsy (GMFCS I and II): A Canadian perspective: What is the definition of CP?
- heterogeneous group of:
1. non-progressive
2. neurodevelopment conditions characterized by impairments in motor function that limit activity, and are
3. caused by a disturbance to the developing fetal or infant brain
4. associated with altered sensation or perception, intellectual disability, communication and behavioral difficulties, seizure disorders, and musculoskeletal complications.
Comprehensive care of the ambulatory child with cerebral palsy (GMFCS I and II): A Canadian perspective: What are the common early warning signs that should trigger further evaluation for CP include?
- Hand preference before 12 months
- Stiffness or tightness in the legs before 12 months
- Inability to sit by 9 months
- Persistent fisting of hands beyond 4 months
- Delays or asymmetry in movement or posture
Comprehensive care of the ambulatory child with cerebral palsy (GMFCS I and II): A Canadian perspective: what is the GMFCS for I and II?
I: walk without limitations and only experience difficulties with speed, balance, and coordinating more advanced motor skills.
II: walk well on flat and familiar surfaces but require support when navigating uneven surfaces, crowded areas, and long distances
Comprehensive care of the ambulatory child with cerebral palsy (GMFCS I and II): A Canadian perspective: What are the 9 categories (Clinical Pearls) to monitor for children with CP with GMFCS I and II?
- Pain:
- Seizures
- Nutrition and Feeding
- Vision
- Hip Surveillance
- Scoliosis
- Hypertonia
- Developmental Surveillance
- Wellness Participation
function, family, fitness, fun, friends, and future
Non-IgE-mediated food allergy: Evaluation and management. What are the 2 most common types of non -IgE mediated food allergy?
- food protein-induced enterocolitis syndrome (FPIES) = 0.34%
- food protein induced allergic proctocolitis (FPIAP) = 0.16%
What is the underlying pathophysiology related to FPIES or FPIAP?
- T-cell mediated inflammation (but poorly understood)
what are the FPIES Clinical manifestations (7 points)
- ages of onset 2-7 months (often with introduction of solids or formula into the diet)
- acute: profuse, repetitive vomiting, with pallor or lethargy, 1-4 hours after ingesting a trigger food
- can be on first exposure or after a period of tolerance
- diarrhea can occur 5-10 hours later (more severe cases)
- rare and severe cases: hypothermia, LOC, hypotonia, acidemia, methemoglobinemia
- no skin or resp findings (as not IgE mediated)
- chronic FPIES may be on the differential of FTT, chronic diarrhea, malabsoroption syndromes
What are the clinical manifestations of FPIAP? (3 points)
- intermittent slow onset hematochezia in an otherwise healty growing infant, in the first 6 months of life.
- typical onset is 1-4 weeks post delivery
- no associated emesis, diarrhea, or FTT
Acute Management for FPIES?
Acute Management?
- typical management for dehydration
- mention of ondansetron if minimum weight 8 kg
- consider IV methylpred 1 mg/kg, no studies demonstrating efficacy
- No acute management needed for FPIAP
What are the most common Food triggers in FPIES?
- milk - 67%
- Soy - 41%
- Grains (rice> oat> wheat> corn> barely) 25.3%
- Egg - 11%
- Meats/fish < 10%
- Vegtetables
- Fruits
- Peanuts/tree nuts
What is the Long term Management of FPIES?
- eliminating the trigger food! relying largely on clinical history
- oral Food challenge by allergist (Second line)
- An OFC would only be recommended if the infant’s history is unclear, such as in the absence of a clear trigger food, an atypical symptom time course, or lack of symptom resolution with trigger food elimination
- can also do an OFC to assess if the FPIES has been outgrown
- not recommended: stool testing, endoscopy, radiography
- Do not need to avoid warning labels for foods or carry epi-pen
What bout multiple food triggers in FPIES?
- occurring in about 30% of patients with FPIES
in a patient with FPIES, should we avoid other common trigger foods?
In the absence of a history of reaction, however, avoiding common FPIES triggers during infancy is not recommended
- Because IgE-mediated food allergy is more prevalent and generally more difficult to outgrow, the risk of developing an IgE-mediated allergy to foods such as peanut or egg outweighs the benefit of delayed introduction to manage or prevent FPIES
- Introducing commonly allergenic solids at around 6 months of age (and not before 4 months), especially if the child is at risk for IgE-mediated allergy, is recommended
Treatment of Cows milk FPIES? (3 points)
- cow’s milk FPIES, extensively hydrolyzed formula should be considered as a feeding alternative
- cross-reactivity between cow’s milk and soy-based formulas is low, such that soy-based formula can be considered as an alternative for feeding infants over 6 months of age
- some infants may require an amino acid-based formula
Treatment of Grain-induced FPIES?
- rice or oats have high cross-reactivity, avoid both!
- reasonable to introduce other grains
- growth and nutrition must be closely monitored
FPIAP long term management
- typically resolves with the elimination of Cows milk protein (and often soy)
- next steps are egg and corn to eliminate
- or changes to extensively hydrolyzed formula
What is the prognosis of FPIES and FPIAP?
- FPIES: high spontaneous rate of resolution, often in early childhood.
- 35% by 2 years of age,
- 70% by 3 years of age, and
- 85% by 5 years of age
- solid food related FPIES may resolve later than cows milk or soy FPIES
- Medically supervised OFCs may be considered as early as 12 to 18 months after the most recent reaction
- FPIAP: typically resolves by 1 year of age, can then introduce both one at a time, consider slow reintroduciton
When do we refer to an allergist in non-IgE mediated food allergy?
- young children with FPIES should be referred to an allergist who can offer OFCs for evaluation, especially before reintroducing a trigger food into the diet.
- or if family is hesitant to introduce new foods
- skin prick tests are a second line reason for referral, high false positive rate. (measuers food specific IgE levels for a trigger food, can have prognostic implications)
- for FPIAP, if trigger can not be identified, or symptoms are not responding to typical food eliminations
Non-IgE-mediated food allergy: Evaluation and management . Practice Pointss
- Acute management of FPIES includes fluid resuscitation or IV/IM ondansetron (or both). No acute management of FPIAP is necessary.
- Long-term management of both FPIES and FPIAP involves eliminating the trigger food from the infant’s diet.
- Avoiding cross-reactive foods and precautionary labelling are generally not required.
- Using an epinephrine autoinjector is not required for FPIES or FPIAP.
- Closely monitoring nutrition and growth, especially when there are multiple trigger foods or food avoidances, is essential.
- Both FPIAP and FPIES have high rates of resolution in early childhood. Reintroducing a trigger food at home can occur with FPIAP. For FPIES, reintroduction should occur under medical supervision.
Timing of introduction of allergenic solids for infants at high risk: CPS statement
What is the incidence of food allergy in Canada?
2-10%
What are the most common food that cause allergies in children in Canada?
cow’s milk, egg, peanut, tree nuts, fish, shellfish, wheat and soy
