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a LANGE medical book
CURRENT
Diagnosis & Treatment
Pediatrics
TWENTY-FOURTH EDITION
Edited by
William W. Hay, Jr., MD Robin R. Deterding, MD
Professor, Department of Pediatrics Professor, Department of Pediatrics
Section of Neonatology and Chief, Section of Pediatric Pulmonary Medicine
Division of Perinatal Medicine University of Colorado School of Medicine and
University of Colorado School of Medicine Children’s Hospital Colorado
and Children’s Hospital Colorado Medical Director, Breathing Institute Children’s
Hospital Colorado
Myron J. Levin, MD
Professor, Departments of Pediatrics and Medicine Mark J. Abzug, MD
Section of Pediatric Infectious Diseases Professor, Department of Pediatrics
University of Colorado School of Medicine Section of Pediatric Infectious Diseases
and Children’s Hospital Colorado Associate Vice Chair for Academic Affairs,
Department of Pediatrics
University of Colorado School of Medicine and
Children’s Hospital Colorado
and Associate Authors
The Department of Pediatrics at the University of Colorado School of Medicine

is affiliated with Children’s Hospital Colorado.
New York Chicago San Francisco Athens London Madrid Mexico City Milan
New Delhi Singapore Sydney Toronto
Hay_FM_pi-xxxii.indd 1 30/03/18 11:40 AM

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Contents
Authors xix Esophageal Atresia & Tracheoesophageal
Preface xxix Fistula 48
Selected Highlighted Topics in the Intestinal Obstruction 49
24th Edition of CDT-P xxxi Abdominal Wall Defects 50
Diaphragmatic Hernia 51
1. Advancing the Quality Gastrointestinal Bleeding 51
& Safety of Care 1 Gastroesophageal Reflux 51
Infections in the Newborn Infant 52
Daniel Hyman, MD Bacterial Infections 52
Introduction 1 Fungal Sepsis 55
Current Context 1 Congenital Infections 56
Strategies & Models for Perinatally Acquired Infections 58
Quality Improvement (QI) 4 Hematologic Disorders in the Newborn Infant 59
Principles of Patient Safety Bleeding Disorders 59
(Incident Reporting, Just Culture, Anemia 60
Disclosure, FMEA, RCA, Polycythemia 61
Reliability, Checklists) 7 Renal Disorders in the Newborn Infant 62
Renal Failure 62
2. The Newborn Infant 10 Urinary Tract Anomalies 62
Renal Vein Thrombosis 63
Danielle Smith, MD Neurologic Problems in the Newborn Infant 63
Theresa Grover, MD Seizures 63
Introduction 10 Intracranial Hemorrhage 64
The Neonatal History 10 Metabolic Disorders in the Newborn Infant 65
Assessment of Growth & Gestational Age 10 Hyperglycemia 65
Examination at Birth 12 Hypocalcemia 65
Examination in the Nursery 13 Inborn Errors of Metabolism 66
Care of the Well Neonate 15 Quality Assessment & Improvement
Feeding the Well Neonate 15 in the Newborn Nursery & NICU 66
Early Discharge of the Newborn Infant 17
Hearing Screening 18 3. Child Development & Behavior 67
Common Problems in the Term Newborn 18
Neonatal Jaundice 18 Edward Goldson, MD
Hypoglycemia 25 Ann Reynolds, MD
Respiratory Distress in the Term Introduction 67
Newborn Infant 26 Normal Development 67
Heart Murmurs 28 The First 2 Years 67
Birth Trauma 28 Ages 2–4 Years 73
Infants of Mothers Who Abuse Drugs 29 Early School Years: Ages 5–7 Years 74
Multiple Births 31 Middle Childhood: Ages 7–11 Years 74
Neonatal Intensive Care 32 Behavioral & Developmental Variations 74
Perinatal Resuscitation 32 Normality & Temperament 74
The Preterm Infant 36 Enuresis & Encopresis 75
The Late Preterm Infant 45 Enuresis 75
Cardiac Problems in the Newborn Infant 46 Encopresis 76
Structural Heart Disease 46 Common Developmental Concerns 77
Persistent Pulmonary Hypertension 47 Colic 77
Arrhythmias 48 Feeding Disorders in Infants &
Gastrointestinal & Abdominal Surgical Young Children 79
Conditions in the Newborn Infant 48 Sleep Disorders 80
iii

iv Contents
Parasomnias 81 Predicting the Progression from

Insomnia 81 use to Abuse 148
Sleep-Disordered Breathing 82 Evaluation of Substance Abuse 149
Restless Legs Syndrome & Periodic Treatment & Referral 152
Limb Movement Disorder 82 Prevention 154
Temper Tantrums & Breath-Holding Spells 83 References 155
Well-Child Surveillance & Screening 85
Developmental Disorders 85 6. Eating Disorders 156
Attention-Deficit/Hyperactivity Disorder 87
Autism Spectrum Disorders 89 Eric J. Sigel, MD
Intellectual Disability 93 Introduction 156
Specific Forms of Intellectual Disability & Etiology 156
Associated Treatment Issues 95 Incidence 157
References 97 Predisposing Factors & Clinical Profiles 157
Anorexia Nervosa 157
4. Adolescence 98 Bulimia Nervosa 163
Binge-Eating Disorder 165
Amy E. Sass, MD, MPH Avoidant/Restrictive Food Intake Disorder 166
Molly J. Richards, MD Prognosis, Quality Assessment,
Introduction 98 & Outcomes Metrics 166
Epidemiology 98 Resources for Practitioners & Families 167
Mortality Data 98
Morbidity Data 98 7. Child & Adolescent Psychiatric
Providing a Medical Home for Adolescents 99 Disorders & Psychosocial Aspects
Relating to the Adolescent Patient 100 of Pediatrics 168
The Structure of the Visit 101
Guidelines for Adolescent Preventive Services 107 Adam Burstein, DO
Adolescent Screening 107 Kimberly Kelsay, MD
Promoting Healthy Behaviors 108 Ayelet Talmi, PhD
Transition to Adult Care 112 Introduction 168
Growth & Development 114 Models of Care Encompassing
Puberty 114 Behavioral Health in the
Physical Growth 114 Primary Care Setting 169
Sexual Maturation 114 Prevention, Early Identification, &
Psychosocial Development 115 Developmental Context 170
Adolescent Gynecology & Lifestyle Recommendations 171
Reproductive Health 117 Identification & Assessment During Health
Breast Examination 117 Supervision Visits 171
Breast Masses 118 Psychiatric Disorders of Childhood
Nipple Discharge & Galactorrhea 119 & Adolescence 180
Gynecomastia 120 Anxiety Disorders 181
Gynecologic Disorders in Adolescence 122 Obsessive-Compulsive & Related Disorders 189
Contraception 132 Attention-Deficit/Hyperactivity Disorder 192
Pregnancy 139 Mood Disorders 196
Suicide in Children & Adolescents 202
5. Adolescent Substance Abuse 142 Disruptive, Impulse-Control
& Conduct Disorders 204
Paritosh Kaul, MD High-Risk Patients & Homicide 205
Scope of the Problem 142 Somatic Symptom & Related Disorders 207
Morbidity Data 147 Adjustment Disorders 209
Psychotic Disorders 209
Other Psychiatric Conditions 212

Contents v
8. Child Abuse & Neglect 213 Vaccination in Special Circumstances 254

Hepatitis B Vaccination 255
Antonia Chiesa, MD Rotavirus Vaccination 258
Andrew P. Sirotnak, MD Diphtheria-Tetanus-Acellular
Introduction 213 Pertussis Vaccination 259
Prevention 214 Haemophilus Influenzae Type B
Clinical Findings 214 Vaccination 261
Differential Diagnosis 220 Pneumococcal Vaccination 262
Treatment 220 Poliomyelitis Vaccination 264
Prognosis 221 Influenza Vaccination 265
Measles, Mumps, & Rubella Vaccination 266
9. Ambulatory & Office Pediatrics 222 Varicella Vaccination 268
Hepatitis A Vaccination 270
Meghan Treitz, MD
Meningococcal Vaccination 271
Daniel Nicklas, MD
Tetanus-Reduced Diphtheria-Acellular
Maya Bunik, MD, MSPH
Pertussis Vaccination
David Fox, MD
(Adolescents & Adults) 273
Introduction 222 Human Papillomavirus Vaccination 273
Pediatric History 222 Vaccinations for Special Situations 274
Pediatric Physical Examination 224 Rabies Vaccination 274
Health Supervision Visits 225 Typhoid Fever Vaccination 276
Developmental & Behavioral Assessment 225 Cholera Vaccination 277
Growth Parameters 228 Japanese Encephalitis Vaccination 277
Blood Pressure 229 Tuberculosis Vaccination 277
Vision & Hearing Screening 230 Yellow Fever Vaccination 278
Anticipatory Guidance 234 Passive Prophylaxis 278
Nutrition Counseling 235
Counseling About Television & 11. Normal Childhood Nutrition
Other Media 236 & Its Disorders 280
Immunizations 237
Acute-Care Visits 237 Matthew A. Haemer, MD, MPH
Prenatal Visits 238 Laura E. Primak, RD, CNSD
Sports Physicals 238 Nancy F. Krebs, MD, MS
Chronic Disease Management 238 Nutritional Requirements 280
Medical Home 239 Nutrition & Growth 280
Mental & Behavioral Health 239 Energy 280
Telephone Management & Web-Based Protein 281
Information 240 Lipids 282
Advocacy & Community Pediatrics 240 Carbohydrates 283
Common General Pediatric Issues 241 Major Minerals 284
Fever 241 Trace Elements 284
Growth Deficiency 243 Vitamins 284
Infant Feeding 288
10. Immunization 245 Breast-Feeding 288
Special Dietary Products for Infants 295
Matthew F. Daley, MD
Nutrition for Children 2 Years & Older 296
Sean T. O’Leary, MD, MPH
Pediatric Undernutrition 297
Ann-Christine Nyquist, MD, MSPH
Pediatric Overweight & Obesity 298
Standards for Pediatric Immunization Nutrition Support 302
Practices 246 Enteral 302
Routine Childhood & Adolescent Immunization Parenteral Nutrition 303
Schedules 247 Nutrient Requirements & Delivery 304
Vaccine Safety 247

vi Contents
12. Emergencies & Injuries 309 Barbiturates & Benzodiazepines 342

Belladonna Alkaloids (Atropine, Jimsonweed,
Kevin P. Carney, MD Potato Leaves, Scopolamine, Stramonium) 342
Kelley Roswell, MD b-Blockers & Calcium Channel Blockers 343
Introduction to Pediatric Carbon Monoxide 343
Emergencies & Injuries 309 Caustics 344
Initial Approach to the Acutely Ill Central a2-Adrenergic Agonist 344
Infant or Child 309 Cocaine 345
The ABCs of Resuscitation 310 Cosmetics & Related Products 345
Management of Shock 314 Cyclic Antidepressants 345
Summary of Initial Approach to the Digitalis & Other Cardiac Glycosides 346
Acutely Ill Infant or Child 315 Diphenoxylate with Atropine
Emergency Pediatric Drugs 316 (Lomotil) & Loperamide (Imodium) 346
Approach to the Pediatric Trauma Patient 316 Disinfectants & Deodorizers 347
Mechanism of Injury 317 Disk-Shaped “Button” Batteries 347
Initial Assessment & Management 317 Ethylene Glycol & Methanol 348
Primary Survey 317 g-Hydroxybutyrate, g-Butyrolactone,
Secondary Survey 319 Butanediol, Flunitrazepam, & Ketamine 348
Head Injury 321 Hydrocarbons (Benzene, Charcoal
Burns 323 Lighter Fluid, Gasoline, Kerosene,
Thermal Burns 323 Petroleum Distillates, Turpentine) 349
Electrical Burns 325 Ibuprofen 349
Disorders due to Extremes of Environment 326 Insect Stings (Bee, Wasp, & Hornet) 349
Heat-Related Illnesses & Heat Stroke 326 Insecticides 349
Hypothermia 326 Iron 350
Submersion Injuries 327 Lead 351
Lacerations 328 Magnets 352
Animal & Human Bites 329 Marijuana 352
Dog Bites 329 Mushrooms 352
Cat Bites 330 Nitrites, Nitrates, Aniline,
Human Bites 330 Pentachlorophenol, & Dinitrophenol 353
Pain Management & Procedural Sedation 330 Opioids & Opiates 353
Oral Anti-Diabetics
13. Poisoning 332 (Sulfonylureas, Metformin) 354
Antipsychotics (Typical & Atypical) 355
Richard C. Dart, MD, PhD
Plants 355
Barry H. Rumack, MD
Psychotropic Drugs 355
George Sam Wang, MD
Salicylates 357
Introduction 332 Scorpion Stings 358
Pharmacologic Principles of Toxicology 332 Serotonin Reuptake Inhibitors 358
Preventing Childhood Poisonings 333 Snakebite 358
General Treatment of Poisoning 333 Soaps & Detergents 359
Initial Telephone Contact 333 Spider Bites 360
Initial Emergency Department Contact 336 Vitamins 360
Definitive Therapy of Poisoning 336 Warfarin (Coumadin) & Newer Oral
Management of Specific Common Poisonings 337 Anticoagulants (NOAC) 361
Acetaminophen (Paracetamol) 337
Alcohol, Ethyl (Ethanol) 339
Amphetamines & Related Drugs
(Stimulants, Methamphetamine, MDMA) 340
Anesthetics, Local 340
Antihistamines & Cough & Cold
Preparations 341

Contents vii
14. Critical Care 362 Fungal Infections of the Skin 409

Viral Infections of the Skin 410
Todd C. Carpenter, MD Virus-Induced Tumors 411
Amy Clevenger, MD, PhD Insect Infestations 412
Angela S. Czaja, MD, MSc Dermatitis (Eczema) 412
Eva N. Grayck, MD Common Skin Tumors 415
Cameron F. Gunville, DO Papulosquamous Eruptions 416
Leslie Ridall, DO Hair Loss (Alopecia) 417
Carleen Zebuhr, MD Reactive Erythemas 418
Introduction 362 Miscellaneous Skin Disorders Seen
Respiratory Critical Care 362 in Pediatric Practice 418
Acute Respiratory Failure 362
Conventional Mechanical Ventilation 366 16. Eye 420
Other Modes of Respiratory Support 369
Major Respiratory Diseases in the Jennifer Lee Jung, MD
Pediatric ICU 370 Rebecca Sands Braverman, MD
Acute Respiratory Distress Syndrome 370 Introduction 420
Status Asthmaticus 373 Common Nonspecific Signs & Symptoms 420
Cardiovascular Critical Care 376 Red Eye 420
Shock 376 Tearing 420
Sepsis 379 Discharge 420
Neurocritical Care 383 Pain & Foreign Body Sensation 420
Traumatic Brain Injury 383 Photophobia 420
Hypoxic-Ischemic Encephalopathy 387 Leukocoria 421
Acute Kidney Injury & Renal Replacement Refractive Errors 421
Therapy 388 Myopia (Nearsightedness) 422
Fluid Management & Nutritional Support Hyperopia (Farsightedness) 422
of the Critically Ill Child 389 Astigmatism 422
Sedation & Analgesia in the Pediatric ICU 391 Ophthalmic Examination 422
End-of-Life Care & Death in the PICU 395 History 422
Quality Improvement Initiatives Visual Acuity 422
in the PICU 398 External Examination 423
Pupils 424
15. Skin 399 Alignment & Motility Evaluation 424
Ophthalmoscopic Examination 425
Lori D. Prok, MD Ocular Trauma 426
Carla X. Torres-Zegarra, MD Ocular Foreign Bodies 426
General Principles 399 Corneal Abrasion 427
Diagnosis of Skin Disorders 399 Intraocular Foreign Bodies & Perforating
Treatment of Skin Disorders 399 Ocular Injuries 428
Disorders of the Skin in Newborns 401 Blunt Orbital Trauma 429
Transient Diseases in Newborns 401 Lacerations 429
Pigment Cell Birthmarks, Nevi, Burns 430
& Melanoma 402 Hyphema 431
Melanocytic Nevi 402 Abusive Head Trauma & Nonaccidental
Vascular Birthmarks 403 Trauma 432
Epidermal Birthmarks 404 Prevention of Ocular Injuries 432
Connective Tissue Birthmarks Disorders of the Ocular Structures 433
(Juvenile Elastoma, Collagenoma) 404 Diseases of the Eyelids 433
Hereditary Skin Disorders 405 Viral Eyelid Disease 434
Common Skin Diseases in Infants, Miscellaneous Eyelid Infections 435
Children, & Adolescents 406 Eyelid Ptosis 435
Acne 406 Horner Syndrome 436
Bacterial Infections of the Skin 408 Eyelid Tics 437

viii Contents
Disorders of the Nasolacrimal System 437 17. Oral Medicine & Dentistry 466
Nasolacrimal Duct Obstruction 437
Congenital Dacryocystocele 438 Ulrich Klein, DMD, DDS, MS
Dacryocystitis 438 Roopa P. Gandhi, BDS, MSD
Diseases of the Conjunctiva 439 Camille V. Gannam, DMD, MS
Ophthalmia Neonatorum 439 Issues in Pediatric Oral Health 466
Bacterial Conjunctivitis 440 Oral Examination of Children 467
Viral Conjunctivitis 440 Eruption of the Teeth 469
Allergic Conjunctivitis 441 Dental Caries 471
Mucocutaneous Diseases 442 Periodontal Disease 473
Disorders of the Iris 443 Dental Emergencies 474
Iris Coloboma 443 Special Patient Populations 475
Aniridia 444 Orthodontic Referral 477
Albinism 444
Miscellaneous Iris Conditions 445 18. Ear, Nose, & Throat 478
Glaucoma 445
Patricia J. Yoon, MD
Uveitis 445
Melissa A. Scholes, MD
Anterior Uveitis/Iridocyclitis/Iritis 446
Norman R. Friedman, MD
Posterior Uveitis 446
Intermediate Uveitis 447 The Ear 478
Disorders of the Cornea 448 Infections of the Ear 478
Cloudy Cornea 448 Acute Trauma to the Middle Ear 488
Viral Keratitis 448 Ear Canal Foreign Body &
Corneal Ulcers 449 Cerumen Impaction 488
Disorders of the Lens 450 Auricular Hematoma 489
Cataracts 450 Congenital Ear Malformations 489
Dislocated Lenses/Ectopia Lentis 450 Identification & Management of
Disorders of the Retina 451 Hearing Loss 489
Retinal Hemorrhages in the Newborn 451 The Nose & Paranasal Sinuses 492
Retinopathy of Prematurity 451 Acute Viral Rhinitis 492
Retinoblastoma 452 Rhinosinusitis 493
Retinal Detachment 453 Choanal Atresia 495
Diabetic Retinopathy 454 Recurrent Rhinitis 495
Diseases of the Optic Nerve 454 Epistaxis 496
Optic Neuropathy 454 Nasal Infection 497
Optic Nerve Hypoplasia 455 Nasal Trauma 497
Papilledema 456 Foreign Bodies in the Nose 497
Optic Neuritis 457 The Throat & Oral Cavity 497
Optic Atrophy 458 Acute Stomatitis 497
Diseases of the Orbit 458 Pharyngitis 498
Periorbital & Orbital Cellulitis 458 Peritonsillar Cellulitis or Abscess (Quinsy) 501
Craniofacial Anomalies 459 Retropharyngeal Abscess 501
Orbital Tumors 459 Ludwig Angina 501
Nystagmus 460 Acute Cervical Adenitis 502
Amblyopia 461 Snoring, Mouth Breathing, & Upper Airway
Strabismus 462 Obstruction 503
Unexplained Decreased Vision Tonsillectomy & Adenoidectomy 505
in Infants & Children 464 Disorders of the Lips 506
Learning Disabilities & Dyslexia 464 Disorders of the Tongue 506
Halitosis 506
Salivary Gland Disorders 507
Congenital Oral Malformations 507

Contents ix
19. Respiratory Tract & Mediastinum 509 Congenital Malformations

of the Lung Parenchyma 529
Monica J. Federico, MD Pulmonary Agenesis & Hypoplasia 529
Christopher D. Baker, MD Pulmonary Sequestration 530
Emily M. Deboer, MD Congenital Lobar Overinflation 531
Ann C. Halbower, MD Congenital Pulmonary Airway Malformation
Oren Kupfer, MD (Cystic Adenomatoid Malformation) 532
Stacey L. Martiniano, MD Acquired Abnormalities of the Lung
Scott D. Sagel, MD Parenchyma 533
Paul Stillwell, MD Bronchopulmonary Dysplasia 533
Edith T. Zemanick, MD Community-Acquired Bacterial Pneumonia 534
Michelle Caraballo, MD Parapneumonic Effusion & Empyema 536
Stephen Hawkins, MD, DO Atypical Pneumonias 537
Respiratory Tract 509 Viral Pneumonia 537
Growth & Development 509 Bronchiolitis 538
Diagnostic Aids 510 Mycoplasma Pneumonia 539
Physical Examination of the Aspiration Pneumonia 540
Respiratory Tract 510 Pneumonia in the Immunocompromised
Pulmonary Function Tests 510 Host 541
Assessment of Oxygenation & Ventilation 511 Lung Abscess 542
Diagnosis of Respiratory Tract Infections 512 Bronchiolitis Obliterans 543
Imaging of the Respiratory Tract 514 Children’s Interstitial Lung Disease
Laryngoscopy & Bronchoscopy 515 Syndrome 544
General Therapy for Pediatric Lung Diseases 515 Hypersensitivity Pneumonitis 545
Oxygen Therapy 515 Diseases of the Pulmonary Circulation 546
Inhalation of Medications 516 Pulmonary Hemorrhage 546
Airway Clearance Therapy 516 Pulmonary Embolism 548
Avoidance of Environmental Hazards 517 Pulmonary Edema 549
Disorders of the Conducting Airways 517 Congenital Pulmonary Lymphangiectasia 549
Laryngomalacia & Congenital Disorders Disorders of the Chest Wall 550
of the Extrathoracic Airway 518 Scoliosis 550
Laryngomalacia 518 Pectus Carinatum 550
Other Causes of Congenital Extrathoracic Pectus Excavatum 550
Obstruction 518 Neuromuscular Disorders & Lung Disease 551
Acquired Disorders of the Disorders of the Pleura & Pleural Cavity 551
Extrathoracic Airway 519 Hemothorax 552
Foreign Body Aspiration in the Chylothorax 552
Extrathoracic Airway 519 Pneumothorax & Related Air Leak
Croup Syndromes 520 Syndromes 552
Vocal Fold Immobility 522 Mediastinum 553
Subglottic Stenosis 522 Mediastinal Masses 553
Congenital Causes of Intrathoracic Airway Sleep-Disordered Breathing 554
Obstruction 523 Obstructive & Central Sleep Apnea 554
Malacia of Airways 523 Apparent Life-Threatening Events 555
Vascular Rings & Slings 524 Sudden Unexpected Infant Death &
Bronchogenic Cysts 524 Sudden Infant Death Syndrome 558
Acquired Causes of Intrathoracic Quality Assessment & Outcomes Metrics 559
Airway Obstruction 525
Foreign Body Aspiration in the
Intrathoracic Airway 525
Disorders of Mucociliary Clearance 525
Cystic Fibrosis 526
Primary Ciliary Dyskinesia 527
Bronchiectasis 528

x Contents
20. Cardiovascular Diseases 561 Cardiac Transplantation 611

Quality Improvement for Pediatric Heart
Pei-Ni Jone, MD Transplantation 612
Johannes VonAlvensleben, MD Pulmonary Hypertension 613
Dale Burkett, MD Disorders of Rate & Rhythm 614
Jeffrey R. Darst, MD Disorders of the Sinus Node 614
Kathryn K. Collins, MD Premature Beats 615
Shelley D. Miyamoto, MD Supraventricular Tachycardia 616
Introduction 561 Ventricular Tachycardia 620
Diagnostic Evaluation 561 Long QT Syndrome 621
History 561 Sudden Death 621
Physical Examination 561 Disorders of Atrioventricular Conduction 621
Electrocardiography 564 Syncope (Fainting) 623
Chest Radiograph 566 Introduction 623
Echocardiography 567 Diagnostic Evaluation 624
Magnetic Resonance Imaging 568 Vasovagal/Neurocardiogenic Syncope 624
Cardiopulmonary Stress Testing 568
Arterial Blood Gases 568 21. Gastrointestinal Tract 626
Cardiac Catheterization & Angiocardiography 569
Perinatal & Neonatal Circulation 570 Edward J. Hoffenberg, MD
Heart Failure 571 Glenn T. Furuta, MD
Genetic Basis of Congenital Heart Disease 573 Gregory Kobak, MD
Acyanotic Congenital Heart Disease 574 Thomas Walker, MD
Defects in Septation 574 Jason Soden, MD
Patent (Persistent) Ductus Arteriosus 578 Robert E. Kramer, MD
Right-Sided Obstructive Lesions 580 David Brumbaugh, MD
Left-Sided Lesions 582 Disorders of the Esophagus 626
Diseases of the Aorta 586 Gastroesophageal Reflux & GERD 626
Coronary Artery Abnormalities 587 Eosinophilic Esophagitis 628
Cyanotic Congenital Heart Disease 588 Achalasia of the Esophagus 629
Tetralogy of Fallot 588 Caustic Burns of the Esophagus 630
Pulmonary Atresia with Ventricular Foreign Bodies in the Alimentary Tract 631
Septal Defect 590 Disorders of the Stomach & Duodenum 633
Pulmonary Atresia with Intact Hiatal Hernia 633
Ventricular Septum 590 Pyloric Stenosis 633
Tricuspid Atresia 592 Gastric & Duodenal Ulcer 634
Hypoplastic Left Heart Syndrome 593 Congenital Diaphragmatic Hernia 635
Transposition of the Great Arteries 594 Congenital Duodenal Obstruction 636
Total Anomalous Pulmonary Disorders of the Small Intestine 637
Venous Return 596 Intestinal Atresia & Stenosis 637
Truncus Arteriosus 597 Intestinal Malrotation 638
Quality Improvement in Congenital Short Bowel Syndrome 638
Heart Disease 598 Intussusception 640
Acquired Heart Disease 599 Inguinal Hernia 640
Rheumatic Fever 599 Umbilical Hernia 641
Kawasaki Disease 601 Patent Omphalomesenteric Duct 641
Infective Endocarditis 602 Meckel Diverticulum 641
Pericarditis 604 Acute Appendicitis 642
Cardiomyopathy 605 Duplications of the Gastrointestinal Tract 643
Myocarditis 608 Disorders of the Colon 643
Preventive Cardiology 609 Congenital Aganglionic Megacolon
Hypertension 609 (Hirschsprung Disease) 643
Atherosclerosis & Dyslipidemias 609 Constipation 644
Chest Pain 610 Anal Fissure 646

Contents xi
Congenital Anorectal Anomalies 646 Pancreatic Disorders 708

Clostridium Difficile Infection in Children 647 Acute Pancreatitis 708
Disorders of the Peritoneal Cavity 648 Chronic Pancreatitis 710
Peritonitis 648 Gastrointestinal & Hepatobiliary
Chylous Ascites 648 Manifestations of Cystic Fibrosis 711
Gastrointestinal Tumors & Malignancies 649 Syndromes with Pancreatic
Juvenile Polyps 649 Exocrine Insufficiency 711
Cancers of the Esophagus, Small Isolated Exocrine Pancreatic
Bowel, & Colon 651 Enzyme Defect 714
Mesenteric Cysts 651 Pancreatic Tumors 714
Intestinal Hemangiomas & References 715
Vascular Malformations 651
Major Gastrointestinal Symptoms & Signs 652 23. Fluid, Electrolyte, & Acid-Base
Acute Diarrhea 652 Disorders & Therapy 716
Chronic Diarrhea 653
Gastrointestinal Bleeding 655 Melisha G. Hanna, MD, MS
Vomiting 658 Margret Bock, MD, MS
Abdominal Pain 660 Regulation of Body Fluids, Electrolytes,
Acute Abdomen 661 & Tonicity 716
Malabsorption Syndromes 661 Acid-Base Balance 717
Inflammatory Bowel Disease 665 Fluid & Electrolyte Management 717
Dehydration 719
22. Liver & Pancreas 669 Hyponatremia 721
Hypernatremia 722
Ronald J Sokol, MD, FAASLD Potassium Disorders 722
Michael R. Narkewicz, MD Acid-Base Disturbances 724
Shikha S Sundaram, MD, MSCI Metabolic Acidosis 724
Cara L. Mack, MD Metabolic Alkalosis 725
Liver Disorders 669 Respiratory Acidosis 725
Neonatal Cholestatic Jaundice 669 Respiratory Alkalosis 725
Intrahepatic Cholestasis 669
Extrahepatic Neonatal Cholestasis 678 24. Kidney & Urinary Tract 726
Other Neonatal Hyperbilirubinemic
Conditions (Noncholestatic Melissa A. Cadnapaphornchai, MD
Nonhemolytic) 680 Gary M. Lum, MD
Hepatitis A 683 Evaluation of the Kidney & Urinary Tract 726
Hepatitis B 685 History 726
Hepatitis C 687 Physical Examination 726
Hepatitis D (Delta Agent) 688 Laboratory Evaluation of Renal Function 726
Hepatitis E 688 Laboratory Evaluation of Immunologic
Other Hepatitis Viruses 688 Function 730
Acute Liver Failure 689 Radiographic Evaluation 730
Autoimmune Hepatitis 690 Renal Biopsy 730
Nonalcoholic Fatty Liver Disease 692 Congenital Anomalies of the Urinary Tract 730
a1-Antitrypsin Deficiency Liver Disease 693 Renal Parenchymal Anomalies 730
Wilson Disease (Hepatolenticular Distal Urinary Tract Anomalies 731
Degeneration) 694 Hematuria & Glomerular Disease 732
Drug-Induced Liver Disease 696 Microhematuria 732
Cirrhosis 696 Glomerulonephritis 732
Portal Hypertension 698 Tubulointerstitial Disease 734
Biliary Tract Disease 701 Acute Interstitial Nephritis 734
Pyogenic & Amebic Liver Abscess 705 Proteinuria & Renal Disease 734
Liver Tumors 706 Congenital Nephrosis (Finnish Type) 735
Liver Transplantation 708

xii Contents
Idiopathic Nephrotic Syndrome Acute Ataxias of Childhood 794

of Childhood 735 Chronic & Episodic Ataxias 797
Focal Segmental Glomerulosclerosis 736 Movement Disorders 797
Membranous Nephropathy Cerebral Palsy 800
(Membranous Glomerulonephritis) 736 Infections & Inflammatory Disorders
Diseases of the Renal Vessels 736 of the Central Nervous System 801
Renal Vein Thrombosis 736 Bacterial Meningitis 802
Renal Arterial Disease 737 Brain Abscess 803
Hemolytic-Uremic Syndrome 737 Viral Infections 804
Renal Failure 738 Encephalopathy of Human
Acute Kidney Injury 738 Immunodeficiency Virus Infection 804
Chronic Renal Failure 741 Other Infections 805
Hypertension 742 Noninfectious Inflammatory Disorders
Inherited or Developmental of the Central Nervous System 805
Defects of the Kidneys 745 Multiple Sclerosis 806
Disorders of the Renal Tubules 746 Syndromes Presenting as Acute
Cystinosis 746 Flaccid Weakness 807
Oculocerebrorenal Syndrome Disorders of Childhood Affecting Muscles 810
(Lowe Syndrome) 747 Benign Acute Childhood Myositis 817
Hypokalemic Alkalosis (Bartter Syndrome, Myasthenic Syndromes 817
Gitelman Syndrome, & Liddle Syndrome) 747 Peripheral Nerve Palsies 819
Nephrogenic Diabetes Insipidus (NDI) 747 Chronic Polyneuropathy 820
Nephrolithiasis 748 Miscellaneous Neuromuscular Disorders 821
Urinary Tract Infections 749 Floppy Infant Syndrome 821
QA/QI in Pediatric Nephrology 750
26. Orthopedics 824
25. Neurologic & Muscular Disorders 752
Jason Rhodes, MD, MS
Teri L. Schreiner, MD, MPH Mark A. Erickson, MD, MMM
Michele L. Yang, MD Alex Tagawa, BS
Jan A. Martin, MD Cameron Niswander, BA
Ricka Messer, MD, PhD Disturbances of Prenatal Origin 824
Scott Demarest, MD Congenital Amputations &
Diana Walleigh, MD Limb Deficiencies 824
Neurologic Assessment & Neurodiagnostics 752 Deformities of the Extremities 825
History & Examination 752 Common Foot Problems 825
Diagnostic Testing 752 Genu Varum & Genu Valgum 827
Pediatric Neuroradiologic Procedures 754 Tibial Torsion & Femoral Anteversion 828
Disorders Affecting the Nervous System Developmental Dysplasia of the Hip Joint 828
in Infants & Children 758 Slipped Capital Femoral Epiphysis 830
Altered States of Consciousness (Coma) 758 Common Spine Conditions 831
Seizures & Epilepsy 761 Torticollis 831
Sleep Disorders 773 Scoliosis 832
Headaches 774 Kyphosis 832
Pseudotumor Cerebri (Idiopathic Inflammatory Conditions 833
Intracranial Hypertension) 777 Arthritis & Tenosynovitis 833
Cerebrovascular Disease 779 Syndromes with Musculoskeletal Involvement 834
Congenital Malformations of the Arthrogryposis Multiplex Congenita
Nervous System 782 (Amyoplasia Congenita) 834
Abnormal Head Size 785 Klippel-Feil Syndrome 834
Neurocutaneous Dysplasias 787 Neurologic Disorders Involving the
Central Nervous System Degenerative Musculoskeletal System 836
Disorders of Infancy & Childhood 794 Trauma 837
Ataxias of Childhood 794 Traumatic Subluxations & Dislocations 839

Contents xiii
Fractures 840 30. Hematologic Disorders 898

Infections of the Bones & Joints 842
Vascular Lesions & Avascular Necrosis Daniel R. Ambruso, MD
(Osteochondroses) 845 Rachelle Nuss, MD
Neoplasia of the Musculoskeletal System 846 Michael Wang, MD
Miscellaneous Diseases of Bone & Joint 848 Normal Hematologic Values 898
Fibrous Dysplasia 848 Bone Marrow Failure 898
Bone Cysts, Baker Cyst, & Ganglions 849 Constitutional Aplastic Anemia
Quality Assurance/Improvement Initiatives (Fanconi Anemia) 898
in Orthopedics 849 Acquired Aplastic Anemia 900
Anemias 901
27. Sports Medicine 850 Approach to the Child with Anemia 901
Pure Red Cell Aplasia 903
Katherine S. Dahab, MD, FAAP, CAQSM Nutritional Anemias 904
Kyle B. Nagle, MD, MPH, FAAP, CAQSM Anemia of Chronic Disorders 906
Armando Vidal, MD Congenital Hemolytic Anemias:
Basic Principles 850 Red Cell Membrane Defects 907
Fitness & Conditioning 850 Congenital Hemolytic Anemias:
Sports Nutrition 851 Hemoglobinopathies 909
Preparticipation Physical Evaluation 851 Congenital Hemolytic Anemias:
Rehabilitation of Sports Injuries 859 Disorders of Red Cell Metabolism 916
Common Sports Medicine Issues & Injuries 860 Acquired Hemolytic Anemia 917
Infectious Diseases 860 Polycythemia & Methemoglobinemia 919
Head & Neck Injuries 860 Methemoglobinemia 920
Spine Injuries 864 Disorders of Leukocytes 920
Shoulder Injuries 865 Neutropenia 920
Elbow Injuries 867 Neutrophilia 922
Hand & Wrist Injuries 869 Disorders of Neutrophil Function 923
Hip Injuries 871 Lymphocytosis 925
Knee Injuries 873 Eosinophilia 925
Foot & Ankle Injuries 877 Bleeding Disorders 925
Prevention 878 Abnormalities of Platelet Number
or Function 927
28. Rehabilitation Medicine 880 Inherited Bleeding Disorders 931
Von Willebrand Disease 935
Gerald H. Clayton, PhD Acquired Bleeding Disorders 936
Pamela E. Wilson, MD Vascular Abnormalities Associated
Pediatric Brain Injury 880 with Bleeding 938
Spinal Cord Injury 883 Thrombotic Disorders 939
Brachial Plexus Lesions & Splenic Abnormalities 943
Typical Features 885 Splenomegaly & Hypersplenism 943
Common Rehabilitation Problems 886 Asplenia & Splenectomy 943
Quality Assurance/Improvement Transfusion Medicine 944
Initiatives in Rehabilitation Medicine 888 Donor Screening & Blood Processing:
Risk Management 944
29. Rheumatic Diseases 889 Storage & Preservation of Blood & Blood
Components 944
Jennifer B. Soep, MD
Pretransfusion Testing 945
Juvenile Idiopathic Arthritis 889 Transfusion Practice 949
Systemic Lupus Erythematosus 892 References 952
Dermatomyositis 894
Vasculitis 895
Raynaud Phenomenon 896
Noninflammatory Pain Syndromes 896

xiv Contents
31. Neoplastic Disease 953 Children’s Concept of Death 992

Spiritual & Cultural Support 993
John A. Craddock, MD Withdrawal of Medical Life Support 994
Ralph R. Quinones, MD Advance Care Planning 994
Amy K. Keating, MD References 996
Kelly Maloney, MD
Jean M. Mulcahy Levy, MD 33. Immunodeficiency 997
Roger H. Giller, MD
Brian S. Greffe, MD Jordan K. Abbott, MD
Anna Franklin, MD Pia J. Hauk, MD
Timothy Garrington, MD Immunodeficiency Evaluation: Primary
Major Pediatric Neoplastic Diseases 953 Considerations 997
Acute Lymphoblastic Leukemia 953 Severe Combined Immunodeficiency
Acute Myeloid Leukemia 957 Diseases 1001
Myeloproliferative Diseases 959 SCID Classification 1002
Brain Tumors 961 Other Combined Immunodeficiencies 1004
Lymphomas & Lymphoproliferative Antibody Deficiency Syndromes 1006
Disorders 965 Phagocyte Disorders 1010
Neuroblastoma 970 Deficiencies of the Innate Immune System 1011
Wilms Tumor (Nephroblastoma) 972 Immunodeficiency Diseases
Bone Tumors 974 That Present with Autoimmunity 1013
Rhabdomyosarcoma 976 Immunodeficiency Diseases
Retinoblastoma 977 That Overlap with Allergy 1014
Hepatic Tumors 978
Langerhans Cell Histiocytosis 980 34. Endocrine Disorders 1016
Hematopoietic Stem Cell Transplant 981
General Considerations 981 Sarah Bartz, MD
Late Effects of Pediatric Cancer Therapy 983 Jennifer M. Barker, MD
Growth Complications 983 Michael S. Kappy, MD, PhD
Endocrine Complications 983 Megan Moriarty Kelsey, MD, MS
Cardiopulmonary Complications 984 Sharon H. Travers, MD
Renal Complications 984 Philip S. Zeitler, MD, PhD
Neuropsychological Complications 984 General Concepts 1016
Second Malignancies 985 Hormone Types 1016
Feedback Control of Hormone Secretion 1016
32. Pain Management & Pediatric Disturbances of Growth 1017
Palliative & End-of-Life Care 986 Target Height & Skeletal Maturation 1018
Short Stature 1018
Brian S. Greffe, MD Tall Stature 1024
Jeffrey L. Galinkin, MD, FAAP Disorders of the Posterior Pituitary Gland 1025
Nancy A. King, MSN, RN, CPNP Arginine Vasopressin
Introduction 986 (Antidiuretic Hormone) Physiology 1025
Pain Assessment 986 Central Diabetes Insipidus 1025
Acute Pain 986 Thyroid Gland 1026
Chronic Pain Management 989 Fetal Development of the Thyroid 1026
Pediatric Palliative & End-of-Life Care 991 Physiology 1026
Introduction 991 Hypothyroidism (Congenital & Acquired) 1027
Children Who May Benefit from Palliative Thyroiditis 1028
Care Interventions 991 Hyperthyroidism 1029
Pain Management in Pediatric Palliative Care 992 Thyroid Cancer 1031
Quality-of-Life Adjuncts & Symptom Disorders of Calcium & Phosphorus
Management in Pediatric Palliative Care 992 Metabolism 1031
Psychosocial Aspects of Pediatric Hypocalcemic Disorders 1031
Palliative Care 992

Contents xv
Pseudohypoparathyroidism 36. Inborn Errors of Metabolism 1065

(Resistance to Parathyroid
Hormone Action) 1035 Janet A. Thomas, MD
Hypercalcemic States 1035 Johan L.K. Van Hove, MD, PhD, MBA
Familial Hypocalciuric Hypercalcemia Peter R. Baker II, MD
(Familial Benign Hypercalcemia) 1037 Introduction 1065
Hypervitaminosis D 1037 Diagnosis 1065
Idiopathic Hypercalcemia of Suspecting Inborn Errors 1065
Infancy (Williams Syndrome) 1037 Laboratory Studies 1066
Immobilization Hypercalcemia 1037 Common Clinical Situations 1066
Hypophosphatasia 1037 Management of Metabolic Emergencies 1067
Gonads (Ovaries & Testes) 1037 Newborn Screening 1067
Development 1037 Disorders of Carbohydrate Metabolism 1068
Disorders of Sexual Development 1038 Glycogen Storage Diseases 1068
Abnormalities in Female Pubertal Galactosemia 1069
Development & Ovarian Function 1040 Hereditary Fructose Intolerance 1070
Abnormalities in Male Pubertal Disorders of Energy Metabolism 1071
Development & Testicular Function 1043 Disorders of Amino Acid Metabolism 1073
Adrenal Cortex 1045 Disorders of the Urea Cycle 1073
Adrenocortical Insufficiency Phenylketonuria & the
(Adrenal Crisis, Addison Disease) 1046 Hyperphenylalaninemias 1074
Congenital Adrenal Hyperplasias 1048 Hereditary Tyrosinemia 1076
Adrenocortical Hyperfunction Maple Syrup Urine Disease
(Cushing Disease, Cushing Syndrome) 1050 (Branched-Chain Ketoaciduria) 1077
Primary Hyperaldosteronism 1051 Homocystinuria 1077
Uses of Glucocorticoids & Adrenocorticotropic Nonketotic Hyperglycinemia 1078
Hormone in Treatment of Organic Acidemias 1079
Nonendocrine Diseases 1051 Propionic & Methylmalonic
Adrenal Medulla Pheochromocytoma 1053 Acidemia (Ketotic Hyperglycinemias) 1079
Carboxylase Deficiency 1081
35. Diabetes Mellitus 1054 Glutaric Acidemia Type I 1081
Disorders of Fatty Acid O xidation
Brigitte I. Frohnert, MD, PhD & Carnitine 1082
H. Peter Chase, MD Fatty Acid Oxidation Disorders 1082
Marian Rewers, MD, PhD Carnitine 1083
General Considerations 1054 Purine Metabolism Disorders 1083
Pathogenesis 1055 Lysosomal Diseases 1084
Prevention 1055 Peroxisomal Diseases 1087
Clinical Findings 1055 Congenital Disorders of Glycosylation 1088
Differential Diagnosis 1056 Smith-Lemli-Opitz Syndrome & D isorders
Complications 1056 of Cholesterol Synthesis 1089
Associated Autoimmune Diseases in Disorders of Brain Specific M etabolism:
Type 1 Diabetes 1059 Neurotransmitters, Synthesis
Associated Conditions with Type 2 of Amino Acids & Sphingolipids 1090
Diabetes 1060 Creatine Synthesis Disorders 1091
Treatment 1060 Quality Initiatives in the Field of
Quality Assessment (QA) & Outcomes Metabolic Disease 1092
Metrics 1064
Prognosis 1064
References 1064

xvi Contents
37. Genetics & Dysmorphology 1093 Urticaria & Angioedema 1152

Anaphylaxis 1154
Naomi J.L. Meeks, MD Adverse Reactions to Drugs & Biologicals 1156
Margarita Saenz, MD Food Allergy 1159
Anne Chun-Hui Tsai, MD, MSc Insect Allergy 1161
Ellen R. Elias, MD
Foundations of Genetic Diagnosis 1093 39. Antimicrobial Therapy 1163
Cytogenetics 1093
Molecular Genetics 1098 Sarah K. Parker, MD
Principles of Inherited Human Disorders 1099 Jason Child, PharmD
Mendelian Inheritance 1099 Justin Searns, MD
Multifactorial Inheritance 1102 John W. Ogle, MD
Nonmendelian Inheritance 1103 Principles of Antimicrobial Therapy 1163
Family History & Pedigree 1104 Susceptibility Testing & Drug Dosing
Dysmorphology & Human Embryology 1105 Properties 1163
Mechanisms 1105 Pharmacodynamic Concepts 1164
Clinical Dysmorphology 1106 Use of Antimicrobial Agents to
Chromosomal Disorders: Prevent Disease 1165
Abnormal Number 1107 Concepts for Judicious Use of
Trisomies 1107 Antimicrobials 1165
Sex Chromosome Abnormalities 1108 Choice of Antimicrobial Agents 1167
Chromosomal Abnormalities: Specific Antimicrobial Agents 1167
Abnormal Structure 1109 b-Lactam Antibiotics
Chromosome Deletion Disorders 1109 (Step 1, Figure 39–2) 1167
Contiguous Gene Disorders 1109 b-Lactam: Penicillins 1175
Mendelian Disorders 1110 b-Lactam: Cephems 1181
Autosomal Dominant Disorders 1110 b-Lactam: Monobactams 1181
Autosomal Recessive Disorders 1113 b-Lactam: Carbapenems 1181
X-Linked Disorders 1114 Glycopeptide Agents (Step 2, Figure 39–2) 1182
Nonmendelian Disorders 1115 Daptomycin (Step 4, Figure 39–2) 1182
Disorders of Imprinting 1115 Trimethoprim/Sulfamethoxazole
Disorders Associated with Anticipation 1116 (Step 5, Figure 39–2) 1182
Disorders of Multifactorial Inheritance 1116 Metronidazole (Step 6, Figure 39–2) 1183
Cleft Lip & Cleft Palate 1117 Macrolides (Step 6, Figure 39–2) 1183
Neural Tube Defects 1118 Lincosamides (Step 6, Figure 39–2) 1183
Common Recognizable Disorders Oxazolidinones (Step 6, Figure 39–2) 1184
with Variable or Unknown Cause 1119 Tetracyclines (Step 6, Figure 39–2) 1184
Genetic Evaluation of the Child Aminoglycosides (Step 6, Figure 39–2) 1184
with Developmental Disabilities 1120 Rifamycins (Step 7, Figure 39–2) 1185
Perinatal Genetics 1122 Fluoroquinolones (Step 8, Figure 39–2) 1185
Teratogens 1122 References 1185
Assisted Reproduction 1122
Prenatal Diagnosis 1123 40. Infections: Viral & Rickettsial 1187
Myron J. Levin, MD
38. Allergic Disorders 1124 Daniel Olson,
Ronina A. Covar, MD Edwin J. Asturias, MD
David M. Fleischer, MD Adriana Weinberg, MD
Christine Cho, MD Viral Infections 1187
Mark Boguniewicz, MD Respiratory Infections 1187
Introduction 1124 Viruses Causing the Common Cold 1187
Asthma 1124 Infections due to Adenoviruses 1190
Allergic Rhinoconjunctivitis 1143
Atopic Dermatitis 1148

Contents xvii
Influenza 1194 42. Infections: Bacterial & Spirochetal 1246

Parainfluenza (Croup) 1195
Respiratory Syncytial Virus Disease 1196 James Gaensbauer, MD, MScPH
Human Metapneumovirus Infection 1198 Yosuke Nomura, MD
Infections due to Enteroviruses John W. Ogle, MD
& Parechoviruses 1198 Marsha S. Anderson, MD
Acute Febrile Illness 1199 Bacterial Infections 1246
Respiratory Tract Illnesses 1199 Group A Streptococcal Infections 1246
Rashes (Including Hand-Foot-&- Group B Streptococcal Infections 1250
Mouth Disease) 1200 Streptococcal Infections with Organisms
Central Nervous System Illnesses 1200 Other than Group A or B 1253
Infections due to Herpesviruses 1203 Pneumococcal Infections 1254
Herpes Simplex Infections 1203 Staphylococcal Infections 1257
Varicella & Herpes Zoster 1206 Meningococcal Infections 1261
Roseola Infantum (Exanthem Subitum) 1208 Gonococcal Infections 1264
Cytomegalovirus Infections 1209 Botulism 1267
Infectious Mononucleosis Tetanus 1269
(Epstein-Barr Virus) 1212 Gas Gangrene 1270
Viral Infections Spread by Insect Vectors 1214 Diphtheria 1271
Encephalitis 1214 Infections due to Enterobacteriaceae 1273
Dengue 1218 Pseudomonas Infections 1275
Chikungunya 1219 Salmonella Gastroenteritis 1277
Zika 1220 Typhoid Fever & Paratyphoid Fever 1279
Colorado Tick Fever 1221 Shigellosis (Bacillary Dysentery) 1280
Other Major Viral Childhood Exanthems 1222 Cholera 1281
Erythema Infectiosum 1222 Campylobacter Infection 1283
Measles (Rubeola) 1223 Tularemia 1284
Rubella 1225 Plague 1285
Infections due to Other Viruses 1226 Haemophilus Influenzae Type B Infections 1287
Hantavirus Cardiopulmonary Syndrome 1226 Pertussis (Whooping Cough) 1289
Mumps 1227 Listeriosis 1291
Rabies 1228 Tuberculosis 1293
Rickettsial Infections & Q Fever 1229 Infections with Nontuberculous
Human Ehrlichiosis & Anaplasmosis 1230 Mycobacteria 1296
Rocky Mountain Spotted Fever 1231 Legionella Infection 1298
Endemic Typhus (Murine Typhus) 1231 Chlamydophila & Chlamydia Infections
Q Fever 1232 (Psittacosis, C Pneumoniae, &
C Trachomatis) 1299
41. Human Immunodeficiency Cat-Scratch Disease 1301
Virus Infection 1233 Spirochetal Infections 1302
Syphilis 1302
Elizabeth J. McFarland, MD Relapsing Fever 1305
Perinatally HIV-Exposed Infant 1235 Leptospirosis 1306
Adolescents with HIV Exposure 1236 Lyme Disease 1308
Progressive HIV Disease 1237
Treatment 1240
Prevention 1244
Quality Assurance & Outcome Metrics 1245

xviii Contents
43. Infections: Parasitic & Mycotic 1311 Vaginal Discharge 1364

Genital Ulcerations 1365
James Gaensbauer, MD, MScPH Genital Warts & Human Papillomavirus 1368
Kevin Messacar, MD Other Viral Infections 1370
Samuel R. Dominguez, MD, PhD Ectoparasitic Infections 1371
Myron J. Levin, MD References 1372
Parasitic Infections 1311
Protozoal Infections 1312 45. Travel Medicine 1373
Systemic Infections 1312
Gastrointestinal Infections 1319 Suchitra Rao, MBBS
Trichomoniasis 1324 Introduction 1373
Metazoal Infections 1325 Preparing Children & Infants
Nematode Infections 1325 for Travel 1373
Cestode Infections (Flukes) 1331 Vaccinations—Routine Childhood
Trematode Infections 1334 Vaccines Modified for Travel 1375
Mycotic Infections 1335 Vaccinations—Travel-Specific 1377
Pneumocystis & Other Opportunistic Traveler’s Diarrhea 1379
Fungal Infections 1346 Malaria Prophylaxis & Prevention 1380
Pneumocystis Jiroveci Infection 1348 Visits to Friends & Relatives (VFR)
in High-Risk Areas 1381
44. Sexually Transmitted Infections 1351 HIV & Sexually Transmitted Diseases 1381
Fever in the Returned Traveler 1384
Daniel H. Reirden, MD References 1388
Ann-Christine Nyquist, MD, MSPH
Adolescent Sexuality 1351 46. Chemistry & Hematology Reference
Risk Factors 1352 Intervals 1389
Prevention of Sexually
Transmitted Infections 1352 Jordana E. Hoppe, MD
Screening for Sexually Robert Snyder, MT (ASCP)
Transmitted Infections 1352 Frank J. Accurso, MD
Signs & Symptoms 1353 Georgette Siparsky, PhD
The Most Common Antibiotic- Challenges in Determining & Interpreting
Responsive Sexually Transmitted Pediatric Reference Intervals 1389
Infections 1353 Guidelines for Use of Data in a Reference
Chlamydia Trachomatis Infection 1353 Range Study 1389
Neisseria Gonorrhoeae Infection 1354 Statistical Computation of
The Spectrum of Signs & Symptoms of Reference Intervals 1390
Sexually Transmitted Infections 1360 Why Reference Intervals Vary 1391
Cervicitis 1360 Sensitivity & Specificity 1391
Pelvic Inflammatory Disease 1361 Pediatric Reference Intervals 1392
Urethritis 1362
Epididymitis 1363 Index 1405
Proctitis, Proctocolitis, & Enteritis 1363

Authors
Jordan K. Abbott, MD Sarah Bartz, MD
Assistant Professor, Department of Pediatrics, University of Assistant Professor, Department of Pediatrics, Section of
Colorado School of Medicine and Children’s Hospital Pediatric Endocrinology, University of Colorado School of
Colorado; Division of Pediatric Allergy, Asthma and Clinical Medicine and Children’s Hospital Colorado
Immunology, National Jewish Health Chapter 34: Endocrine Disorders
Chapter 33: Immunodeficiency
Margret Bock, MD, MS
Frank J. Accurso, MD Assistant Professor, Department of Pediatrics, Section of
Professor, Department of Pediatrics, Section of Pediatric Pediatric Nephrology, University of Colorado and Children’s
Pulmonary Medicine, University of Colorado School of Hospital Colorado
Medicine and Children’s Hospital Colorado Chapter 23: Fluid, Electrolyte, & Acid-Base Disorders & Therapy
Chapter 46: Chemistry & Hematology Reference Intervals
Mark Boguniewicz, MD
Daniel R. Ambruso, MD Professor, Department of Pediatrics, University of Colorado
Professor, Department of Pediatrics, Section of Pediatric School of Medicine and Children’s Hospital Colorado;
Hematology, Oncology, and Bone Marrow Transplant, Division of Pediatric Allergy, Asthma and Clinical
University of Colorado School of Medicine and Children’s Immunology, National Jewish Health
Hospital Colorado Chapter 38: Allergic Disorders
Chapter 30: Hematologic Disorders
Rebecca Sands Braverman, MD
Marsha S. Anderson, MD Associate Professor, Department of Ophthalmology,
Professor, Department of Pediatrics, Section of University of Colorado School of Medicine
Pediatric Infectious Diseases, University of Colorado School Chapter 16: Eye
of Medicine and Children’s Hospital Colorado
Chapter 42: Infections: Bacterial & Spirochetal David Brumbaugh, MD
Associate Professor, Department of Pediatrics, Section of
Edwin J. Asturias, MD Pediatric Gastroenterology Hepatology and Nutrition,
Associate Professor, Departments of Pediatrics and University of Colorado School of Medicine and Children’s
Epidemiology and Infectious Diseases, University of Hospital Colorado
Colorado School of Medicine; Associate Director, Center for Chapter 21: Gastrointestinal Tract
Global Health, Colorado School of Public Health
Chapter 40: Infections: Viral & Rickettsial
Maya Bunik, MD, MSPH
Professor, Department of Pediatrics, Section of General
Christopher D. Baker, MD Academic Pediatrics, Director of the Child Health Clinic,
Associate Professor, Department of Pediatrics, Section of University of Colorado Denver School of Medicine and
Pediatric Pulmonary Medicine, University of Colorado Children’s Hospital Colorado
School of Medicine and Children’s Hospital Colorado Chapter 9: Ambulatory & Office Pediatrics
Chapter 19: Respiratory Tract & Mediastinum
Peter R. Baker II, MD Dale Burkett, MD

Assistant Professor, Department of Pediatrics, Section of
Pediatric Cardiology, University of Colorado School of
Clinical Genetics and Metabolism, University of Colorado
Medicine and Children’s Hospital Colorado
School of Medicine and Children’s Hospital Colorado
Chapter 20: Cardiovascular Diseases
Chapter 36: Inborn Errors of Metabolism
Jennifer M. Barker, MD Adam Burstein, DO

Senior Clinical Instructor, Department of Child & Adolescent
Psychiatry, Psychiatry Resident Training Programs,
Pediatric Endocrinology, University of Colorado School of
University of Colorado School of Medicine and Children’s
Hospital Colorado
Chapter 34: Endocrine Disorders
Chapter 7: Child & Adolescent Psychiatric Disorders &
Psychosocial Aspects of Pediatrics
xix

xx AUTHORS
Melissa A. Cadnapaphornchai, MD Gerald H. Clayton, PhD

Professor, Departments of Pediatrics and Medicine, Instructor, Department of Physical Medicine and
University of Colorado School of Medicine, Section of Rehabilitation, University of Colorado School of Medicine
Pediatric Nephrology, Director, Pediatric Continuous Renal and Children’s Hospital Colorado
Replacement Therapy, Hemodialysis, and Peritoneal Chapter 28: Rehabilitation Medicine
Dialysis, The Kidney Center, Children’s Hospital Colorado
Chapter 24: Kidney & Urinary Tract Amy Clevenger, MD, PhD
Michelle Caraballo, MD Pediatric Critical Care Medicine, University of Colorado
Former Fellow, Department of Pediatrics, Section of Pediatric School of Medicine and Children’s Hospital Colorado
Pulmonary Medicine, University of Colorado School of Chapter 14: Critical Care
Assistant Professor, Department of Pediatrics, Division of Kathryn K. Collins, MD
Respiratory Medicine, University of Texas Southwestern Professor, Department of Pediatrics, Section of
Medical Center Pediatric Cardiology, University of Colorado School of
Chapter 19: Respiratory Tract & Mediastinum Medicine and Children’s Hospital Colorado
Kevin P. Carney, MD
Assistant Professor, Department of Pediatrics, Section of Ronina A. Covar, MD
Emergency Medicine, University of Colorado School of Associate Professor, Department of Pediatrics, University of
Medicine, Director of Quality Improvement, Children’s Colorado School of Medicine and Children’s Hospital
Hospital Colorado Colorado; Division of Pediatric Allergy, Asthma and Clinical
Chapter 12: Emergencies & Injuries Immunology, National Jewish Health
Chapter 38: Allergic Disorders
Todd C. Carpenter, MD
Associate Professor, Department of Pediatrics, Section of John A. Craddock, MD
Pediatric Critical Care Medicine, University of Colorado Assistant Professor, Department of Pediatrics, Section of
School of Medicine and Children’s Hospital Colorado Pediatric Hematology, Oncology, and Bone Marrow
Chapter 14: Critical Care Transplant, Center for Cancer and Blood Disorders,
H. Peter Chase, MD Hospital Colorado
Professor, Department of Pediatrics, Clinical Director Emeritus, Chapter 31: Neoplastic Disease
Barbara Davis Center for Childhood Diabetes, University of
Colorado School of Medicine Angela S. Czaja, MD, MSc
Chapter 35: Diabetes Mellitus Associate Professor, Department of Pediatrics, Section of
Pediatric Critical Care Medicine, University of Colorado
Antonia Chiesa, MD School of Medicine and Children’s Hospital Colorado
Associate Professor, Department of Pediatrics, Kempe Child Chapter 14: Critical Care
Protection Team, University of Colorado School of
Medicine, Children’s Hospital Colorado and Kempe Katherine S. Dahab, MD, FAAP, CAQSM
Center for the Prevention and Treatment of Child Abuse Assistant Professor, Department of Orthopedics, Fellowship
and Neglect Director, Pediatric Primary Care Sports Medicine
Chapter 8: Child Abuse & Neglect Fellowship, University of Colorado School of Medicine and
Jason Child, PharmD Chapter 27: Sports Medicine
Co-Director of Antimicrobial Stewardship, Infectious Disease
Clinical Specialist, Department of Pharmacy, University of Matthew F. Daley, MD
Colorado Skaggs School of Pharmacy and Pharmaceutical Associate Professor, Department of Pediatrics, Section of
Sciences and Children’s Hospital Colorado General Academic Pediatrics, University of Colorado School
Chapter 39: Antimicrobial Therapy of Medicine and Children’s Hospital Colorado
Chapter 10: Immunization
Christine Cho, MD
Assistant Professor, Department of Pediatrics, University Jeffrey R. Darst, MD
Colorado School of Medicine and Children’s Hospital Associate Professor, Department of Pediatrics, Section of
Colorado; Division of Allergy, Asthma and Clinical Pediatric Cardiology, University of Colorado School of
Immunology, National Jewish Health Medicine and Children’s Hospital Colorado
Chapter 38: Allergic Disorders Chapter 20: Cardiovascular Diseases

AUTHORS xxi
Richard C. Dart, MD, PhD Anna Franklin, MD

Professor, Departments of Regulatory Compliance and Associate Professor, Department of Pediatrics,
Emergency Medicine, University of Colorado School of Section of Pediatric Hematology, Oncology, and
Medicine; Director, Rocky Mountain Poison and Drug Bone Marrow Transplant, University of Colorado
Center, Denver Health and Hospital Authority School of Medicine and Children’s Hospital Colorado
Chapter 13: Poison Chapter 31: Neoplastic Disease
Emily M. Deboer, MD Norman R. Friedman, MD

Assistant Professor, Department of Pediatrics, Section of Associate Professor, Departments of Otolaryngology &
Pediatric Pulmonary Medicine, University of Colorado Pediatrics, University of Colorado School of Medicine and
School of Medicine and Children’s Hospital Colorado Children’s Hospital Colorado
Chapter 19: Respiratory Tract & Mediastinum Chapter 18: Ear, Nose, & Throat
Scott Demarest, MD Brigitte I. Frohnert, MD, PhD

Assistant Professor, Department of Pediatrics, Neurology, Assistant Professor, Department of Pediatrics, Barbara Davis
University of Colorado School of Medicine and Children’s Center for Childhood Diabetes, University of Colorado
Hospital Colorado School of Medicine
Chapter 25: Neurologic & Muscular Disorders Chapter 35: Diabetes Mellitus
Samuel R. Dominguez, MD, PhD Glenn T. Furuta, MD

Associate Professor, Department of Pediatrics, Section of Professor, Department of Pediatrics, Section of
Pediatric Infectious Diseases, University of Colorado School Gastroenterology, Hepatology and Nutrition, Attending
of Medicine and Children’s Hospital Colorado Physician, Digestive Health Institute; Director,
Chapter 43: Infections: Parasitic & Mycotic Gastrointestinal Eosinophil Disease Program, University
of Colorado School of Medicine and Children’s Hospital
Ellen R. Elias, MD Colorado
Professor, Departments of Pediatrics and Genetics, Director, Chapter 21: Gastrointestinal Tract
Special Care Clinic, University of Colorado School of
Medicine and Children’s Hospital Colorado James Gaensbauer, MD, MScPH
Chapter 37: Genetics & Dysmorphology Assistant Professor, University of Colorado, Children’s
Hospital Colorado Center for Global Health, Colorado
Mark A. Erickson, MD, MMM School of Public Health Pavilion for Women and Children
Chairman, Department of Pediatric Orthopaedics, Professor Chapter 42: Infections: Bacterial & Spirochetal
of Orthopaedic Surgery, Orthopedic Institute, University Chapter 43: Infections: Parasitic & Mycotic
of Colorado School of Medicine and Children’s Hospital
Colorado Jeffrey L. Galinkin, MD, FAAP
Chapter 26: Orthopedics Professor, Department of Anesthesiology, University of
Colorado School of Medicine and Children’s
Monica J. Federico, MD Hospital Colorado
Associate Professor, Department of Pediatrics, Section of Chapter 32: Pain Management & Pediatric Palliative &
Pediatric Pulmonary Medicine, University of Colorado End-of-Life Care
Chapter 19: Respiratory Tract & Mediastinum Roopa Gandhi, BDS, MSD
Assistant Professor, Residency Program Director, Department
David M. Fleischer, MD of Pediatric Dentistry, University of Colorado School of
Associate Professor, Department of Pediatrics, University of Dental Medicine and Children’s Hospital Colorado
Colorado School of Medicine and Children’s Hospital Chapter 17: Oral Medicine & Dentistry
Colorado; Division of Pediatric Allergy, Asthma and Clinical
Immunology, National Jewish Health Camille Gannam, DMD, MS
Chapter 38: Allergic Disorders Assistant Professor, Department of Pediatric Dentistry,
University of Colorado School of Dental Medicine and
David Fox, MD Children’s Hospital Colorado
Associate Professor, Department of Pediatrics, Section of Chapter 17: Oral Medicine & Dentistry
General Academic Pediatrics, University of Colorado School
Chapter 9: Ambulatory & Office Pediatrics

xxii AUTHORS
Timothy Garrington, MD Melisha G. Hanna, MD, MS

Associate Professor, Department of Pediatrics, Section of Assistant Professor, Department of Pediatrics, Section of
Pediatric Hematology, Oncology, and Bone Marrow Pediatric Nephrology, University of Colorado School of
Transplant, University of Colorado School of Medicine and Medicine and Children’s Hospital Colorado
Children’s Hospital Colorado Chapter 23: Fluid, Electrolyte, & Acid-Base Disorders & Therapy
Chapter 31: Neoplastic Disease
Pia J. Hauk, MD
Roger H. Giller, MD Associate Professor, Department of Pediatrics, University of
Professor, Department of Pediatrics, Section of Pediatric Colorado School of Medicine and National Jewish Health
Hematology, Oncology, and Bone Marrow Transplant, Chapter 33: Immunodeficiency
Director, Pediatric BMT Program, University of Colorado
School of Medicine and Children’s Hospital Colorado Stephen Hawkins, MD, DO
Chapter 31: Neoplastic Disease Assistant Professor, Department of Pediatrics, Section of
Pediatric Pulmonary Medicine, University of Colorado
Edward Goldson, MD School of Medicine and Children’s Hospital Colorado
Professor, Department of Pediatrics, Section of Developmental Chapter 19: Respiratory Tract & Mediastinum
Pediatrics, University of Colorado School of Medicine and
Children’s Hospital Colorado Edward J. Hoffenberg, MD
Chapter 3: Child Development & Behavior Professor, Department of Pediatrics, Section of
Pediatric Gastroenterology, Hepatology and Nutrition,
Eva N. Grayck, MD University of Colorado School of Medicine and Children’s
Professor, Department of Pediatrics, Section of Hospital Colorado
Pediatric Critical Care Medicine, University of Colorado Chapter 21: Gastrointestinal Tract
Chapter 14: Critical Care Daniel Hyman, MD
Associate Professor, Department of Pediatrics, University of
Brian S. Greffe, MD Colorado School of Medicine, Chief Quality Officer,
Professor, Department of Pediatrics, Section of Pediatric Children’s Hospital Colorado
Hematology, Oncology, and Bone Marrow Transplant, Chapter 1: Advancing the Quality & Safety of Care
Hospital Colorado Pei-Ni Jone, MD
Chapter 31: Neoplastic Disease Associate Professor, Department of Pediatrics, Section of
Chapter 32: Pain Management & Pediatric Palliative & Pediatric Cardiology, Children’s Hospital Colorado and
End-of-Life Care University of Colorado School of Medicine
Theresa Grover, MD
Associate Professor, Department of Pediatrics, Section of Jennifer Lee Jung, MD
Neonatology, University of Colorado School of Medicine Assistant Professor, Department of Ophthalmology, University of
and Children’s Hospital Colorado Colorado School of Medicine, Children’s Hospital Colorado
Chapter 2: The Newborn Infant Chapter 16: Eye
Cameron F. Gunville, DO Michael S. Kappy, MD, PhD

Assistant Professor, Department of Pediatrics, Section of Professor, Department of Pediatrics, Section of Pediatric
Pediatric Critical Care Medicine, University of Colorado Endocrinology, University of Colorado School of Medicine
School of Medicine and Children’s Hospital and Children’s Hospital Colorado
Chapter 14: Critical Care Chapter 34: Endocrine Disorders
Matthew A. Haemer, MD, MPH Paritosh Kaul, MD

Associate Professor, Department of Pediatrics, Section of Professor, Department of Pediatrics, Section of Adolescent
Pediatric Nutrition, University of Colorado School of Medicine, University of Colorado School of Medicine,
Medicine and Children’s Hospital Colorado Children’s Hospital Colorado, and Denver Health Medical
Chapter 11: Normal Childhood Nutrition & Its Disorders Center
Chapter 5: Adolescent Substance Abuse
Ann C. Halbower, MD
Professor, Department of Pediatrics, Section of Pediatric
Pulmonology, University of Colorado School of Medicine
and Children’s Hospital Colorado
Chapter 19: Respiratory Tract & Mediastinum

AUTHORS xxiii
Amy K. Keating, MD Oren Kupfer, MD

Associate Professor, Department of Pediatrics, Section of Assistant Professor, Department of Pediatrics, Section of
Pediatric Hematology, Oncology, and Bone Marrow Pediatric Pulmonary Medicine, University of Colorado
Transplant, Center for Cancer and Blood Disorders, School of Medicine and Children’s Hospital Colorado
University of Colorado School of Medicine and Children’s Chapter 19: Respiratory Tract & Mediastinum
Hospital Colorado
Chapter 31: Neoplastic Disease Myron J. Levin, MD
Professor, Departments of Pediatrics and Medicine,
Kimberly Kelsay, MD Section of Pediatric Infectious Diseases, University
Associate Professor, Department of Psychiatry and Behavioral of Colorado School of Medicine and Children’s Hospital
Sciences, University of Colorado School of Medicine and Colorado
Children’s Hospital Colorado Chapter 40: Infections: Viral & Rickettsial
Chapter 7: Child & Adolescent Psychiatric Disorders & Chapter 43: Infections: Parasitic & Mycotic
Psychosocial Aspects of Pediatrics
Gary M. Lum, MD
Megan Moriarty Kelsey, MD, MS Clinical Professor, Departments of Pediatrics and Medicine,
Associate Professor, Department of Pediatrics, Section of Section of Pediatric Nephrology, University of Colorado
Pediatric Endocrinology, University of Colorado School of School of Medicine and Children’s Hospital Colorado
Medicine and Children’s Hospital Colorado Chapter 24: Kidney & Urinary Tract
Chapter 34: Endocrine Disorders
Cara L. Mack, MD
Nancy A. King, MSN, RN, CPNP Associate Professor, Department of Pediatrics, Section of
Inpatient Oncology Advanced Practice Nurse, Department of Pediatric Gastroenterology, Hepatology and Nutrition,
Pediatrics, Section of Hematology, Oncology, and Bone University of Colorado School of Medicine and Children’s
Marrow Transplant, University of Colorado School of Hospital Colorado
Medicine and Children’s Hospital Colorado Chapter 22: Liver & Pancreas
Chapter 32: Pain Management & Pediatric Palliative
& End-of-Life Care Kelly Maloney, MD
Professor, Department of Pediatrics, Section of
Ulrich Klein, DMD, DDS, MS Pediatric Gastroenterology, Hepatology and Nutrition,
Associate Professor and Chair, Department of Pediatric University of Colorado School of Medicine and Children’s
Dentistry, Director of Pediatric Dentistry Residency Hospital Colorado
Program, University of Colorado School of Dental Medicine Chapter 31: Neoplastic Disease
and Children’s Hospital Colorado
Chapter 17: Oral Medicine & Dentistry Jan A. Martin, MD
Gregory Kobak, MD Neurology Genops, University of Colorado School of
Senior Instructor, Department of Pediatrics, Section of Medicine and Children’s Hospital Colorado
Pediatric Gastroenterology, Hepatology and Nutrition, Chapter 25: Neurologic & Muscular Disorders
Digestive Health Institute, University of Colorado School of
Medicine and Children’s Hospital Colorado Stacey L. Martiniano, MD
Chapter 21: Gastrointestinal Tract Assistant Professor, Department of Pediatrics, Section of
Robert E. Kramer, MD School of Medicine and Children’s Hospital Colorado
Professor, Department of Pediatrics, Section of Chapter 19: Respiratory Tract & Mediastinum
Pediatric Gastroenterology, Hepatology and Nutrition,
University of Colorado School of Medicine and Children’s Elizabeth J. McFarland, MD
Hospital Colorado Professor, Department of Pediatrics, Section of Pediatric
Chapter 21: Gastrointestinal Tract Infectious Diseases, University of Colorado School of
Nancy F. Krebs, MD, MS Chapter 41: Human Immunodeficiency Virus Infection
Professor, Department of Pediatrics, Section of Pediatric
Nutrition, University of Colorado School of Medicine and Naomi J. L. Meeks, MD
Children’s Hospital Colorado Assistant Professor, Department of Pediatrics, Section of
Chapter 11: Normal Childhood Nutrition & Its Disorders Clinical Genetics and Metabolism, University of Colorado
School of Medicine
Chapter 37: Genetics & Dysmorphology

xxiv AUTHORS
Kevin Messacar, MD Rachelle Nuss, MD

Assistant Professor, Department of Pediatrics, Section of Professor, Department of Pediatrics, Section of Pediatric
Pediatric Infectious Diseases, University of Colorado School Hematology, Oncology, and Bone Marrow Transplant;
of Medicine and Children’s Hospital Colorado Associate Director, Colorado Sickle Cell Treatment and
Chapter 43: Infections: Parasitic & Mycotic Research Center at University of Colorado School of
Medicine; Director Pediatric Sickle Cell Program, Center for
Ricka Messer, MD, PhD Cancer and Blood Disorders, Children’s Hospital Colorado
Assistant Professor, Department of Pediatrics, Neurology, Chapter 30: Hematologic Disorders
Hospital Colorado Ann-Christine Nyquist, MD, MSPH
Chapter 25: Neurologic & Muscular Disorders Professor, Department of Pediatrics, Section of Pediatric
Infectious Diseases, University of Colorado School of
Shelley D. Miyamoto, MD Medicine and Children’s Hospital Colorado
Associate Professor, Department of Pediatrics, Section of Chapter 10: Immunization
Pediatric Cardiology, University of Colorado School of Chapter 44: Sexually Transmitted Infections
Chapter 20: Cardiovascular Diseases Sean T. O’Leary, MD, MPH
Associate Professor, Department of Pediatrics, Section
Jean M. Mulcahy Levy, MD of Pediatric Infectious Diseases, University of Colorado
Assistant Professor, Department of Pediatrics, Center for School of Medicine and Children’s Hospital Colorado
Cancer and Blood Disorders, University of Colorado Chapter 10: Immunization
Chapter 31: Neoplastic Disease
John W. Ogle, MD
Kyle B. Nagle, MD, MPH, FAAP, CAQSM Professor and Vice Chairman Emeritus, Department of
Assistant Professor, Department of Orthopedics, University of Pediatrics, University of Colorado School of Medicine
Colorado School of Medicine, Sports Medicine for Young Chapter 39: Antimicrobial Therapy
Athletes, Children’s Hospital of Colorado Orthopedics Chapter 42: Infections: Bacterial & Spirochetal
Institute
Chapter 27: Sports Medicine Sarah K. Parker, MD
Michael R. Narkewicz, MD Pediatric Infectious Diseases, University of Colorado School
Professor, Department of Pediatrics, Fellowship Program of Medicine and Children’s Hospital Colorado
Director, Section of Pediatric Gastroenterology, Chapter 39: Antimicrobial Therapy
Hepatology and Nutrition, Hewitt Andrews Chair in
Pediatric Liver Diseases, Medical Director, Pediatric Liver Laura E. Primak, RD, CNSD
Center and Liver Transplant Pediatric Services Professional Research Assistant, Coordinator of Nutrition
Associate Clinical Director/Associate Dean for Pediatric Electives, Section of Pediatric Nutrition, University of
Clinical Affairs, University of Colorado School of Medicine Colorado School of Medicine and Children’s Hospital
and Children’s Hospital Colorado Colorado
Chapter 22: Liver & Pancreas Chapter 11: Normal Childhood Nutrition & Its Disorders
Daniel Nicklas, MD Lori D. Prok, MD

Assistant Professor of Pediatrics, Director of Primary Care Associate Professor, Departments of Pediatrics and
Education, Children’s Hospital Colorado Residency Dermatology, Section of Pediatric Dermatology, University
Program, University of Colorado and Children’s Hospital of Colorado School of Medicine and Children’s Hospital
Colorado Colorado
Chapter 9: Ambulatory & Office Pediatrics Chapter 15: Skin
Cameron Niswander, BA Ralph R. Quinones, MD

Third Year Medical Student Clinical Professor, Department of Pediatrics, Section of
University of Colorado School of Medicine Pediatric Hematology, Oncology, and Bone Marrow
Chapter 26: Orthopedics Transplant, Center for Cancer and Blood Disorders,
Yosuke Nomura, MD Hospital Colorado
Pediatrician and Instructor of Pediatrics, Denver Health, Chapter 31: Neoplastic Disease
University of Colorado School of Medicine
Chapter 42: Infections: Bacterial & Spirochetal

AUTHORS xxv
Suchitra Rao, MBBS Margarita Sifuentes Saenz, MD

Assistant Professor, Department of Pediatrics, Section of Assistant Professor, Department of Pediatrics, Section of
Pediatric Infectious Disease, University of Colorado School Clinical Genetics and Metabolism, University of Colorado
of Medicine and Children’s Hospital Colorado School of Medicine and Children’s Hospital Colorado
Chapter 45: Travel Medicine Chapter 37: Genetics & Dysmorphology
Daniel H. Reirden, MD Scott D. Sagel, MD

Associate Professor, Department of Pediatrics, Section of Professor, Department of Pediatrics, Section of
Adolescent Medicine and Internal Medicine, Medical Pediatric Pulmonary Medicine, University of Colorado
Director, CHIP Youth Clinic, Director of Internal School of Medicine and Children’s Hospital Colorado
Medicine—Pediatric Residency, University of Colorado Chapter 19: Respiratory Tract & Mediastinum
Chapter 44: Sexually Transmitted Infections Amy E. Sass, MD, MPH
Marian Rewers, MD, PhD Adolescent Medicine, University of Colorado School of
Professor, Department of Pediatrics, Clinical Director, Barbara Medicine and Children’s Hospital Colorado
Davis Center for Childhood Diabetes, University of Chapter 4: Adolescence
Colorado School of Medicine
Chapter 35: Diabetes Mellitus
Melissa A. Scholes, MD
Ann Reynolds, MD Assistant Professor, Department of Pediatric Otolaryngology,
Associate Professor, Department of Pediatrics, Section of University of Colorado School of Medicine and Children’s
Developmental Pediatrics, University of Colorado School of Hospital Colorado
Medicine; Director, The Child Development Unit, Children’s Chapter 18: Ear, Nose, Throat
Hospital Colorado
Chapter 3: Child Development & Behavior Teri L. Schreiner, MD, MPH
Associate Professor, Departments of Pediatrics and
Jason Rhodes, MD, MS Neurology, Section of Pediatric Neurology, University
Associate Professor, Departments of Mechanical and Materials of Colorado School of Medicine and Children’s Hospital
Engineering, Director, Cerebral Palsy Program, Orthopedics Colorado
Institute, University of Colorado School of Medicine and Chapter 25: Neurologic & Muscular Disorders
Chapter 26: Orthopedics Justin Searns, MD
Pediatric Infectious Diseases Fellow, Department of Pediatrics,
Molly J. Richards, MD Section of Pediatric Infectious Diseases, University of
Associate Professor, Department of Pediatrics, Section of Colorado School of Medicine and Children’s
Adolescent Medicine, University of Colorado School of Hospital Colorado
Medicine and Children’s Hospital Colorado Chapter 39: Antimicrobial Therapy
Chapter 4: Adolescence
Eric J. Sigel, MD
Leslie Ridall, DO Professor, Department of Pediatrics, Section of
Assistant Professor, Department of Pediatrics, Section of Adolescent Medicine, University of Colorado School of
Pediatric Critical Care Medicine, University of Colorado Medicine and Children’s Hospital Colorado
School of Medicine and Children’s Hospital Colorado Chapter 6: Eating Disorders
Chapter 14: Critical Care
Georgette Siparsky, PhD
Kelley Roswell, MD Clinical Data Analyst II, Department of Clinical Informatics,
Children’s Hospital Colorado, and University of Colorado
Emergency Medicine, Co-Director Medical Student
School of Medicine
Emergency Care Clerkship, University of Colorado School
Chapter 46: Chemistry & Hematology Reference Intervals
Chapter 12: Emergencies & Injuries
Andrew P. Sirotnak, MD
Barry H. Rumack, MD Professor and Vice Chair for Faculty Affairs, Department of
Clinical Professor, Department of Pediatrics, University of Pediatrics, Director, Child Protection Team, University of
Colorado School of Medicine; Director Emeritus, Rocky Colorado School of Medicine, Children’s Hospital Colorado
Mountain Poison and Drug Center, Denver Health Chapter 8: Child Abuse & Neglect
Authority
Chapter 13: Poison

xxvi AUTHORS
Danielle Smith, MD Ayelet Talmi, PhD

Assistant Professor, Department of Pediatrics, Section of Assistant Professor, Departments of Psychiatry and Pediatrics,
Neonatology, University of Colorado School of Medicine Associate Director, Irving Harris Program in Child
and Children’s Hospital Colorado Development and Infant Mental Health, University of
Chapter 2: The Newborn Infant Colorado School of Medicine and Children’s Hospital
Colorado
Robert Snyder, MT (ASCP) Chapter 7: Child & Adolescent Psychiatric Disorders &
Clinical Chemistry Supervisor, Department of Pathology and Psychosocial Aspects of Pediatrics
Laboratory Medicine, University of Colorado, Children’s
Hospital Colorado Janet A. Thomas, MD
Chapter 46: Chemistry & Hematology Reference Intervals Associate Professor, Department of Pediatrics, Section of
Clinical Genetics and Metabolism, Director—IMD Clinic,
Jason Soden, MD University of Colorado School of Medicine and Children’s
Associate Professor, Department of Pediatrics, Section of Hospital Colorado
Pediatric Gastroenterology, Hepatology and Nutrition, Chapter 36: Inborn Errors of Metabolism
Hospital Colorado Carla X. Torres-Zegarra, MD
Chapter 21: Gastrointestinal Tract Assistant Professor, Pediatric Dermatology Fellow, Pediatric
Dermatology, Department of Dermatology, University of
Jennifer B. Soep, MD Colorado and Children’s Hospital Colorado
Associate Professor, Department of Pediatrics, Section of Chapter 15: Skin
Pediatric Rheumatology, University of Colorado School of
Medicine and Children’s Hospital Colorado Sharon H. Travers, MD
Chapter 29: Rheumatic Diseases Associate Professor, Department of Pediatrics, Section of
Pediatric Endocrinology, University of Colorado School of
Ronald J. Sokol, MD, FAASLD Medicine and Children’s Hospital Colorado
Professor and Vice Chair, Department of Pediatrics, Arnold Chapter 34: Endocrine Disorders
Silverman MD Endowed Chair in Digestive Health; Head,
Section of Pediatric Gastroenterology, Hepatology and Meghan Treitz, MD
Nutrition and the Digestive Health Institute, University of Assistant Professor, Department of Pediatrics, Section of
Colorado School of Medicine and Children’s Hospital General Academic Pediatrics, University of Colorado
Colorado; Director, Colorado Clinical and Translational Denver School of Medicine and Children’s Hospital
Sciences Institute and Assistant Vice Chancellor for Clinical Colorado
and Translational Science, University of Colorado Denver Chapter 9: Ambulatory & Office Pediatrics
Chapter 22: Liver & Pancreas
Anne Chun-Hui Tsai, MD, MSc
Paul Stillwell, MD Professor, Department of Pediatrics, Section of
Senior Instructor, Department of Pediatrics, Section of Pediatric Clinical Genetics and Metabolism, University
Pediatric Pulmonary Medicine, University of Colorado of Colorado School of Medicine and Children’s Hospital
School of Medicine and Children’s Hospital Colorado Colorado
Chapter 19: Respiratory Tract & Mediastinum Chapter 37: Genetics & Dysmorphology
Shikha S. Sundaram, MD, MSCI Johan L. K. Van Hove, MD, PhD, MBA
Associate Professor, Department of Pediatrics, Section of Professor, Department of Pediatrics, Head, Section of Clinical
Pediatric Gastroenterology, Hepatology and Nutrition, Genetics and Metabolism, University of Colorado School of
University of Colorado School of Medicine and Children’s Medicine and Children’s Hospital Colorado
Hospital Colorado Chapter 36: Inborn Errors of Metabolism
Chapter 22: Liver & Pancreas
Armando Vidal, MD
Alex Tagawa, BS Associate Professor, Department of Orthopedics—Sports
Research Assistant, Center for Gait and Movement Analysis, Medicine Program, University of Colorado School of
Department of Pediatric Orthopedics, University Medicine and Children’s Hospital Colorado
of Colorado School of Medicine and Children’s Hospital Chapter 27: Sports Medicine
Colorado
Chapter 26: Orthopedics

Contents xxvii
Johannes Von Alvensleben, MD Pamela E. Wilson, MD

Assistant Professor, Department of Pediatrics, Section of Associate Professor, Department of Physical Medicine &
Pediatric Cardiology, University of Colorado School of Rehabilitation Medicine, University of Colorado School of
Medicine and Children’s Hospital Colorado Medicine and Children’s Hospital Colorado
Chapter 20: Cardiovascular Diseases Chapter 28: Rehabilitation Medicine
Thomas Walker Michele L. Yang, MD

Professor of Pediatrics, Section of Pediatric Gastroenterology, Assistant Professor, Departments of Pediatrics and Neurology,
Hepatology and Nutrition, Digestive Health Institute, Section of Child Neurology, University of Colorado School
University of Colorado School of Medicine and Children’s of Medicine and Children’s Hospital Colorado
Hospital Colorado Chapter 25: Neurologic & Muscular Disorders
Chapter 21: Gastrointestinal Tract
Patricia J. Yoon, MD
Diana Walleigh, MD Associate Professor, Department of Otolaryngology, Associate
Assistant Professor, Department of Pediatrics, Neurology, Director, Bill Daniels Center for Children’s Hearing,
University of Colorado School of Medicine and Children’s University of Colorado School of Medicine and Children’s
Hospital Colorado Hospital Colorado
Chapter 25: Neurologic & Muscular Disorders Chapter 18: Ear, Nose, & Throat
George Sam Wang, MD Carleen Zebuhr, MD

Assistant Professor, Department of Pediatrics, Section of Assistant Professor, Department of Pediatrics, Section of
Emergency Medicine, Medical Toxicology, University of Pediatric Critical Care Medicine, University of Colorado
Colorado School of Medicine and Children’s Hospital School of Medicine and Children’s Hospital Colorado
Colorado Chapter 14: Critical Care
Chapter 13: Poison
Philip S. Zeitler, MD, PhD
Michael Wang, MD Professor, Department of Pediatrics, Head, Section of Pediatric
Associate Professor, Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine
Pediatric Hematology, Oncology, and Bone Marrow and Children’s Hospital Colorado
Transplant, Center for Cancer and Blood Disorders, Chapter 34: Endocrine Disorders
Hospital Colorado Edith T. Zemanick, MD
Chapter 30: Hematologic Disorders Associate Professor, Department of Pediatrics Section of
Adriana Weinberg, MD School of Medicine and Children’s Hospital Colorado
Professor, Departments of Pediatrics and Medicine, Director of Chapter 19: Respiratory Tract & Mediastinum
Clinical Virology Laboratory, Section of Pediatric Infectious
Diseases, University of Colorado School of Medicine and
Chapter 40: Infections: Viral & Rickettsial

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Quand je respire, des milliers d’échos me répondent...
H. HEINE
enri Heine, j’ai fait avec vous un voyage,

C’était un soir d’automne, encor tiède, encor clair;
Heidelberg fraîchissait sous ses rouges feuillages,
Nous cherchions, dans la rue aux portails entr’ouverts,
L’humble hôtel, romantique et vieux, du Chasseur Vert.
Je reposais sur vous, compagnon invisible,

Ma tête languissante et mes cheveux défaits;
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Sur la place où le jour, lumineux et sensible,
Jetait un long appel de désir et de paix...
C’était l’heure engourdie où le soleil s’incline;

Par un mortel besoin de pleurer et de fuir,
J’ai souhaité monter sur la verte colline;
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Où flottait un parfum de soierie et de cuir,
Et nous vîmes jaillir les romanesques ruines.
Sur la terrasse, auprès de la tour en lambeaux,

Des étudiants riaient avec vos bien-aimées.
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Qui frisent sous le poids des vignes renommées,
Et l’espace semblait à la fois vaste et clos.
Le Neckar, au courant scintillant et rapide,

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L’insidieux automne avait sur nous lâché
Ses tourbillons de songe et ses buis arrachés...
O sublime, languide, âpre mélancolie

Des beaux soirs où l’esprit, indomptable et captif,
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D’enfermer l’univers dans un amour plaintif!
Tout à coup, dans le parc public, humide et triste,

L’orchestre qui jouait sur les bords de l’étang
Près d’un groupe attentif de studieux touristes,
Lança le son du cor qui chante dans Tristan...
Henri Heine, j’ai su alors pourquoi vos livres

Regorgent de buée et de soudains sanglots,
Pourquoi, riant, pleurant, vous voulez qu’on vous livre
La coupe de Thulé qui dort au fond des flots;
L’amour de la légende et la vaine espérance

Vous hantaient d’un appel sourdement répété:
Hélas! vous aviez trop écouté, dès l’enfance,
Les sirènes du Rhin, à Cologne et Mayence,
Quand l’odeur des tilleuls grise les nuits d’été!
Voyageur égaré dans la forêt des fables,

Moqueur désespéré qu’un mirage appelait,
Ni le chant de la mer d’Amalfi sur les sables,
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Ne pouvait retenir votre vol inlassable,
Pour qui l’espace même est un trop lourd filet!
O soirs de Düsseldorf, quand les toits et leur neige

Font un scintillement de cristal et de sel,
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Et que, petit garçon qui rentrait du collège,
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L’oriental aspect de la nuit de Noël!
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L’horloge des beffrois, dont les coups accompagnent
Les rondes et les chants des filles aux bras nus;
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Qui semblent fasciner l’errante volupté,
Quand l’or des calmes soirs recouvre les demeures,
Les gais marchés, le Dôme et l’Université;
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La double solitude où sont tous les amants!
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Soupire auprès d’un jeune et dédaigneux rabbin...
Les frais torrents du Hartz et la mauresque Espagne

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Que de pleurs près des flots! de cris sur la montagne!
Que de lâches soupirs, ô Heine! que surprit
La gloire au front baissé, votre sombre compagne!
Parfois, vers votre cœur que brisaient les démons,

Et qui laissait couler sa détresse infinie,
Vous sentiez accourir, par la brèche des monts,
,p ,
Les grands vents de Bohême et de Lithuanie;
Les cloches, les chorals, les forêts, l’ouragan

Qui composent le ciel musical d’Allemagne,
Emplissaient d’un tumulte orageux, où se joignent
Les résineux parfums des arbres éloquents,
Vos Lieder, à la fois déchirés et fringants.
Mais quand le vent se tait, quand l’étendue est calme,

Vous repoussez le verre où luit le vin du Rhin;
Le Gange, les cyprès, la paresse des palmes
Vous font de longs signaux, secrets et souverains;
Et votre œil fend l’azur et les sables marins,
Immobile, extatique et vague pèlerin!
Vous riez, et tandis que tinte votre rire,

Vos poèmes en pleurs invectivent le sort;
Vous chantez, justement, de ne pas pouvoir dire
Les sources et le but d’un multiple délire,
Rossignol florentin, Grèbe des mers du Nord,
Qui mélangez au thym du verger de Tityre
Les gais myosotis des matins de Francfort.
J’ai vu, un soir d’automne, au bord d’un chaud rivage,

Un grand voilier, chargé de grappes de cassis,
Ne plus pouvoir voguer, tant le faible équipage,
Captif sous un réseau d’effluves épaissis,
Gisait, transfiguré par le philtre imprécis
D’un arome, grisant plus encor qu’un breuvage.
O Heine! ce parfum languissant et fatal,

Cette vigne éthérée et qui pourtant accable,
N’est-ce pas le lointain et pressant idéal
Qui vous persécutait, quand de son blanc fanal
La lune illuminait, dans les forêts d’érables,
Vos soupirs envolés vers sa joue de cristal!
Vous me l’avez transmis, ce désir des conquêtes,

Cet enfantin bonheur dans les matins d’été,
Ce besoin de mourir et de ressusciter
Pour le mal que nous fait l’espoir et sa tempête;
Vous me l’avez transmis, ô mon brûlant prophète,
Ce céleste appétit des nobles voluptés!
O mon cher compagnon, dès mes jeunes années

J’ai posé dans vos mains mes doigts puissants et doux;
Bien des yeux m’ont déçue et m’ont abandonnée,
Mais toujours vos regards s’enroulent à mon cou,
Sur le chemin du rêve où je marche avec vous...
Syracuse 1
Les soirs du monde 6
Le port de Palerme 13
Dans l’azur antique 15
Le désert des soirs 20
A Palerme, au jardin Tasca... 22
Agrigente 26
L’auberge d’Agrigente 29
L’enchantement de la Sicile 32
Palerme s’endormait... 36
Les soirs de Catane 39
Musique pour les jardins de Lombardie 45
L’air brûle, la chaude magie... 49
Les journées romaines 52
Un automne à Venise 61
Un soir à Vérone 57
Va prier dans Saint-Marc 63
La Messe de l’aurore à Venise 66
Sirocco à Venise 68
Cloches vénitiennes 69
L’île des folles à Venise 70
Nuit vénitienne 74
Midi sonne au clocher de la tour sarrasine 76
Je n’ai vu qu’un instant... 83
Ainsi les jours s’en vont... 85
Le retour au lac Léman 89
Octobre et son odeur... 92
Les rives romanesques 95
Au pays de Rousseau 101
Un soir en Flandre 104
Bonté de l’univers que je croyais éteinte... 109
Chaleur des nuits d’été... 110
Automne 113
Arles 114
La nuit flotte... 116
L’évasion 118
Ceux qui n’ont respiré... 121
Le ciel bleu du milieu du jour... 124
La Terre 127
Un soir à Londres 128
Rivages contemplés 133
La langueur des voyages 134
Le printemps du Rhin 137
Ce matin clair et vif... 141
Les nuits de Baden 143
Henri Heine 147
La décoration de cet ouvrage a été
conçue et gravée sur bois par
F.-L. SCHMIED
La typographie et le tirage des
planches ont été exécutés sur
ses presses à bras; pressier:
Pierre Bouchet
Achevé d’imprimer le 30 avril 1924.

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Parasomnias 81 Predicting the Progression from

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8. Child Abuse & Neglect 213 Vaccination in Special Circumstances 254

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12. Emergencies & Injuries 309 Barbiturates & Benzodiazepines 342

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20. Cardiovascular Diseases 561 Cardiac Transplantation 611

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Congenital Anorectal Anomalies 646 Pancreatic Disorders 708

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Idiopathic Nephrotic Syndrome Acute Ataxias of Childhood 794

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Fractures 840 30. Hematologic Disorders 898

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31. Neoplastic Disease 953 Children’s Concept of Death 992

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Pseudohypoparathyroidism 36. Inborn Errors of Metabolism 1065

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37. Genetics & Dysmorphology 1093 Urticaria & Angioedema 1152

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Influenza 1194 42. Infections: Bacterial & Spirochetal 1246

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43. Infections: Parasitic & Mycotic 1311 Vaginal Discharge 1364

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Peter R. Baker II, MD Dale Burkett, MD

Jennifer M. Barker, MD Adam Burstein, DO

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Melissa A. Cadnapaphornchai, MD Gerald H. Clayton, PhD

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Richard C. Dart, MD, PhD Anna Franklin, MD

Emily M. Deboer, MD Norman R. Friedman, MD

Scott Demarest, MD Brigitte I. Frohnert, MD, PhD

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Timothy Garrington, MD Melisha G. Hanna, MD, MS

Cameron F. Gunville, DO Michael S. Kappy, MD, PhD

Matthew A. Haemer, MD, MPH Paritosh Kaul, MD

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