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Measuring the fluid in the stomachs of vomiting infants may cost-effectively indicate the likely cause and reduce the need for diagnostic imaging tests. Researchers treated 89 children aged 11-120 days who were fasted and vomiting. A nasogastric tube was used to collect fluid from the stomach. Children with more than 5 ml of fluid were more likely to have a stomach obstruction, and were then examined by ultrasound. Children with less than 5 ml of fluid underwent upper gastrointestinal examination. Both imaging tests were only necessary in 7% of children. The use of gastric volume measurement to guide the diagnosis prevented 62 unnecessary imaging tests., Objective. To develop a cost- and time-effective algorithm for differentiating hypertrophic pyloric stenosis (HPS) from other medical causes of emesis in infants referred from community-based pediatricians and family practitioners to the imaging department of a tertiary children's care facility. Methods. Eighty-nine vomiting infants (22 females, 67 males) between the ages of 11 and 120 days (mean, 43.5 days) had received nothing by mouth for at least 1 hour before the study. Each child was assessed for duration of vomiting, status of body weight, time and volume of last ingestion, and time of last emesis. A #8 French (Sherwood Medical, St Louis, MO) nasogastric feeding tube was placed in the child's stomach. The contents were aspirated and measured to determine likelihood of HPS. An aspirated volume [is greater than or equal to] 5 mL implicated gastric outlet obstruction, and ultrasonography (US) was performed. If this study was positive for HPS, the patient was referred for surgery. If US was negative, an upper gastrointestinal series (UGI) was performed. An aspirated stomach contents volume [is less than] 5 mL suggested a medical cause for the emesis, and UGI was performed. Pediatric surgeons with no knowledge of the volume results palpated the abdomens of 73 of 89 infants (82%). Results. Twenty-three of 89 patients (25%) had HPS. The aspirate criteria for HPS had a sensitivity of 91%, a specificity of 88%, and an accuracy of 89%. Of the false-positive studies (total = 8), six were related to recent significant ingestion (within 2 hours of the study), and two were attributable to antral dysmotility. The surgeons palpated the mass in 10 of 19 patients (53%). Sensitivity and specificity were 53% and 93%, respectively. Only 6 of 139 infants (7%) required both US and UGI to determine the etiology of the nonbilious vomiting. By performing the UGI in 66 patients, it was also found that 14% had slow gastric emptying and 79% had gastroesophageal reflux. Eighty-one percent of the gastroesophageal reflux was significant. Conclusion. The volumetric method of determining the proper imaging study is cost- and time-effective in the evaluation of the nonbilious vomiting infant for pyloric stenosis. If US was performed initially in all patients referred for imaging, two studies would have been performed in 68 of 89 patients (76%) to define the etiology of the emesis. Because we used the volumetric method, 62 fewer imaging studies were performed, representing a savings of $4464 and 30 hours of physician time. If children are given nothing by mouth for 3 to 4 hours before gastric aspiration, the specificity of the volumetric method improves to 94%, and the accuracy improves to 96%. Pediatrics 1999;103:1198-1202; cost-effectiveness, gastroesophageal reflux, infantile emesis, pyloric stenosis radiography, ultrasonography., ABBREVIATIONS. HPS, hypertrophic pyloric stenosis; UGI, upper gastrointestinal series; US, ultrasonography; GER, gastroesophageal reflux; RVU, relative value units. Infantile hypertrophic pyloric stenosis (HPS) is a common diagnosis of infants [is [...]

Informed consent should be seen as an essential part of health care practice; parental permission and childhood assent is an active process that engages patients, both adults and children, in health care. Pediatric practice is unique in that developmental maturation allows, over time, for increasing inclusion of the child's and adolescent's opinion in medical decision-making in clinical practice and research. [ABSTRACT FROM AUTHOR]

Human embryonic stem cell research has emerged as an important platform for the understanding and treatment of pediatric disease; From its inception, however, it has raised ethical concerns based not on the use of stem cells themselves but on objections to the source of the cells-specifically, the destruction of preimplantation human embryos. Despite differences in public opinion on this issue, a large majority of the public supports continued research using embryonic stem cells. Given the possible substantial benefit of stem cell research on child health and development, the American Academy of Pediatric believes that funding and oversight for human embryo and embryonic stem cell research should continue. [ABSTRACT FROM AUTHOR]