Background: Newborn infants with risk factors may require intravenous (IV) dextrose for asymptomatic hypoglycemia. Administration of IV dextrose and transfer to the neonatal intensive care unit (NICU) may interfere with parent-infant bonding. Objective: To study the effect of implementing dextrose gel supplement with feeds in late preterm/term infants affected by asymptomatic hypoglycemia on reducing IV dextrose therapy. Method: A retrospective study was conducted before and after dextrose gel use: 05/01/2014 to 10/31/2014 and 11/01/2014 to 04/30/2015, respectively. Asymptomatic hypoglycemic (blood glucose level <45 mg/dl) infants in the newborn nursery (NBN) were given a maximum of 3 doses of dextrose gel (200 mg/kg of 40% dextrose) along with feeds. Transfer to the NICU for IV dextrose was considered treatment failure. Results: Dextrose gel with feeds increased the blood glucose level in 184/250 (74%) of asymptomatic hypoglycemic infants compared to 144/248 (58%) with feeds only (p < 0.01). Transfer from the NBN to the NICU for IV dextrose decreased from 35/1,000 to 25/1,000 live births (p < 0.01). Exclusive breastfeeding improved from 19 to 28% (p = 0.03). Conclusions: Use of dextrose gel with feeds reduced the need for IV fluids, avoided separation from the mother and promoted breastfeeding. Neonates who failed dextrose gel therapy were more likely to be large for gestational age, delivered by cesarean section and had lower baseline blood glucose levels.

Pediatric jaw tumors are rare lesions most commonly presenting with a swelling or mass. Patients can be asymptomatic with the lesion identified on routine imaging. Certain clinical features such as age, location of tumor, and presence or absence of bone and soft tissue can narrow the differential diagnosis and identify tumors that may be malignant. Incisional biopsy is an important first step. A majority of jaw tumors are benign but require surgical intervention for eradication of disease. Multiple procedures, including reconstruction, may be required for certain lesions prior to cure.

Objectives: Review the clinical presentation, radiologic features, management, and outcomes of jaw tumors diagnosed in children treated in a tertiary care academic center. Methods: Retrospective review of children age 16 and under who presented to the University of Maryland Medical Center between 1992 and 2012 and were diagnosed with a jaw tumor. Charts were reviewed for symptoms, physical exam, radiological findings, pathology, intervention, and outcomes. Results: The charts of 76 patients evaluated for a jaw mass were reviewed, and 22 were diagnosed with a jaw tumor. The two most common pathologies were ameloblastoma (27%) and ossifying fibroma (18%). Two tumors were malignant, both rhabdomyosarcomas. One-third of patients presented asymptomatically with lesions found on surveillance panorex, while the remaining two-thirds presented with evidence of a mass or swelling. All but one infant with a suspected lymphangioma underwent biopsy and surgical excision. Twenty-seven percent of patients underwent more than one procedure, including secondary reconstruction, prior to a satisfactory outcome. Conclusions: Pediatric jaw tumors are rare lesions most commonly presenting with a swelling or mass in the location. One-third of patients are asymptomatic with a lesion identified on imaging. A majority of jaw tumors are benign but require surgical intervention for excision of disease. Multiple procedures, including reconstruction, may be required for certain lesions prior to cure.

Results: Four cases of Baha® system implantation and 2 cases of cochlear implantation in children with CS are discussed including pre-operative assessment/selection criteria, scans, and surgical planning; operative challenges; implant stability postoperatively and hearing benefit. The mean age at surgery was 9 years 11 months (4 years 9 months to 14 years 10 months), and mean follow-up was 18 months (6 months to 25 months).Conclusions: Children with CS and mixed hearing-loss are challenging when considering how best to maximize hearing potential. Some children with CS will also have external ear abnormalities, potentially limiting the use of conventional BTE HAs. Bone conduction implants and cochlear implants are an effective hearing solution for selected children with CS.Objectives: Determine the cost of medical care using the CAS-15 versus polysomnography for children with sleepdisordered breathing in terms of benefit measured by change in quality-of-life and behavior scores.

IntroductionIsolated aphonia induced by acute stroke is a rare phenomenon with only a few cases reported in the literature.Case presentationWe report an unusual case of a 44-year-old African-American man with a history of hypertension, smoking and cocaine use who developed acute aphonia secondary to simultaneous ischemic infarctions of the bilateral putamen nuclei.ConclusionWe describe the clinical presentation of acute aphonia induced by bilateral putamen nuclei ischemic infarctions, correlating clinical symptoms with injury localization. We further highlight the anatomic and functional organization of the neural pathways involved.