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OBJECTIVE: Our study assessed the reliability of a transcutaneous hemoglobin (tcHgb) measurement as compared to a standard capillary hemoglobin (cHgb) measurement in screening for iron deficiency anemia in a single university-based pediatric outpatient clinic. METHODS: Study participants included all pediatric patients requiring a hemoglobin (Hgb) assessment from July 2019 to June 2020. A tcHgb measurement was attempted on all children who received a cHgb measurement. Additional variables evaluated were age, visit type, gender, insurance type, weight, BMI percentile and presence of comorbid conditions. RESULTS: Of 777 attempts, both cHgb and tcHgb were obtained in 196 children aged 9 months to 21 years. Attempts were most successful in children > 2 years of age due to finger size and ability to remain still for one to two minutes. The mean cHgb was 12.5 ± 1.5g/dL, mean tcHgb value 13.1 ± 2.1g/dL, and the mean difference was 0.6 ± 2.1g/dL (tcHgb-cHgb). An intraclass correlation coefficient was 0.29. There were no differences with regards to age, visit type, gender, insurance type, weight, BMI percentile and presence of comorbid conditions. Bland-Altman analysis displayed a lack of agreement between the tcHgb and cHgb measurements and tcHgb tended to over-estimate Hgb values when the cHgb was low. CONCLUSIONS: The measurement of a transcutaneous Hgb is less invasive for pediatric patients but has significant limitations. Smaller children (probe specifications) and movement limited the ability to obtain a tcHgb measurement in ~75% of children tested. Falsely normal tcHgb values occurred due to overestimation of hemoglobin when compared to the traditional cHgb device. The suboptimal sensitivity of the tcHgb device may cause providers to miss a diagnosis of anemia. Future research should compare both methods of Hgb assessment to the gold standard laboratory-analyzed complete blood count and use a smaller probe for children under 2, once available.

Graves' disease is the most common form of hyperthyroidism in the pediatric population. While the most prevalent symptoms seen in children with Graves' disease include goiter and excessive sweating (Minamitani et al., 2017), diagnosis is frequently delayed due to presentation with non-specific symptoms (Léger et al., 2018). This case report is of a 12-year-old female who presented to her pediatrician with a one month history of episodes of tachycardia both with physical exertion and at rest. Notably, these episodes were discovered on her electronic smartwatch by its heart rate monitoring feature. Further pertinent positives elicited in the patient's review of systems included increasing anxiety, diaphoresis, intermittent hand tremors, and recent weight loss. These findings led to further workup that included thyroid studies, culminating in a diagnosis of Graves' disease. Indeed, this patient's smartwatch aided in her initial presentation to her physician and allowed for prompt workup and diagnosis. There exist limited studies to date on the use of smartwatches to detect cardiac-related conditions in children, which may be due to the absence of Food and Drug Administration approval for certain cardiac-related smartwatch features in this patient population.

When evaluating pediatric patients with hyperpigmented lesions on the plantar aspect of the feet, the differential diagnosis should include talon noir, acral melanoma, and verruca with thrombosis. Talon noir are asymptomatic brown-black pigmented macules formed by intraepidermal hemorrhages of the feet caused by shear-force injury. Spontaneous resolution of talon noir typically occurs within 2-3 weeks. Clinicians should ensure that their patients who participate in sports have appropriately fitting shoes, which may prevent these lesions from occurring. This case report highlights a unique case of talon noir occurring in a young baseball player with an atypical distribution of plantar macules.

1. Malcolm M. Kates, BS/BA* 2. Jaclyn Otero, MD† 3. Molly Posa, MD† 1. *College of Medicine, University of Florida, Gainesville, FL 2. †Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL A 13-year-old girl presents to an outpatient pediatric clinic with a bilateral frontal headache and “dark spots” on her eyes over the last 3 days. The spots initially appeared red to her but are now described as dark in color. The lesions are not painful, but she has been tearful for the past week, purportedly in anticipation of an upcoming surgical procedure for an osteochondroma diagnosed 3 months ago. She reports biweekly mild frontal headaches that have not changed in severity or frequency during the past 3 months and have been attributed to skipping meals. She denies changes in vision, photophobia, double vision, eye pain, eye drainage, ocular trauma, fever, nausea, or vomiting. Neither the patient nor her pediatrician noticed any ocular dark spots at her health supervision visit 2 months before this visit. She …

While the FilmArray Respiratory Panel EZ has been proven to reduce inappropriate antibiotic use in the outpatient pediatric setting, it is unclear whether its implementation will also reduce downstream health costs such as provider visits and telephone calls. This analysis will help pediatricians make more informed decisions on the implementation and judicious use of the Respiratory Panel EZ in their clinical practice.

Intussusception is one of the most frequent causes of intestinal obstruction in infants. Rotavirus vaccination has been associated with intussusception in the medical literature. We report a case of a 4-month-old female with intussusception requiring hemicolectomy one week following rotavirus vaccination. We review the pathophysiology, presentation, and management of intussusception with a distinct focus on the history of rotavirus vaccination and risks of intussusception associated with timing of rotavirus vaccine administration. The discussion makes a strong case for rotavirus vaccine counseling regarding signs of intestinal obstruction and the importance of early recognition.

A previously healthy 10-year-old female presented to a local emergency department following three days of nausea and vomiting diagnosed with a solid pseudopapillary tumor. Solid pseudopapillary neoplasms are a rare form of pancreatic cystic neoplasm that typically presents in young females in their 20–30s and are very rare in children. These neoplasms often present as an asymptomatic tumor found on incidental imaging. When symptomatic they most commonly present with abdominal pain and can also cause a palpable abdominal mass, weight loss, gastrointestinal obstruction, and nausea and vomiting. Timely diagnosis of this rare neoplasm is very important because complete resection of the tumor is the definitive treatment and leads to an excellent long-term survival.

A term female newborn infant was delivered to a 39-year-old, gravida 3, para 3 mother by spontaneous vaginal delivery. Both parents were of Hispanic descent. The family history was unremarkable for congenital anomalies. The mother’s antenatal history was without concerns except for advanced maternal age. There was no maternal history of smoking or alcohol or substance abuse during the pregnancy. The pregnancy was complicated by gestational diabetes controlled with diet and echogenic bowel found on 16-week prenatal ultrasonography. The mother declined any follow-up ultrasonography or genetic testing. All maternal serologic test results were negative except group B streptococcal perineal culture. Because of group B streptococcal positivity, the mother received 3 doses of ampicillin before an uncomplicated, vaginal delivery. The infant’s Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. At birth the infant was appropriate for gestational age with regard to weight (3,314 g), length (47 cm), and head circumference (34 cm). On physical examination, she was noted to have an abnormal tissue projection from her vaginal orifice (Figure). On inspection of the child’s vaginal opening, a pedunculated mass was appreciated to be extending from the vagina. The lesion measured 30 mm long, 1 to 2 mm wide proximally, and 4 mm wide at the distal ovoid segment. Careful visual inspection of the genital area with lighted magnification tracked the lesion to an origin within the vagina. The lesion originated from an area …