a LANGE medical book Current Diagnosis & Treatment Pediatrics TwENTy-SEcoNd EdiTioN edited by William W. Hay, Jr., MD robin r. Deterding, MD Professor, department of Pediatrics Professor, department of Pediatrics Section of Neonatology and the division of Perinatal Section of Pediatric Pulmonary Medicine Medicine University of colorado School of Medicine and University of colorado School of Medicine and children’s Hospital colorado children’s Hospital colorado Medical director, Breathing institute Myron J. Levin, MD children’s Hospital colorado 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 and Section of Pediatric infectious diseases 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 Copyright © 2014 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. 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Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. Contents Authors xix Abdominal Wall Defects 56 Preface xxvii Diaphragmatic Hernia 56 Gastrointestinal Bleeding 57 1. Advancing the Quality Gastroesophageal Reflux 57 and Safety of Care 1 Infections in the Newborn Infant 58 Bacterial Infections 58 Daniel Hyman, MD, MMM Fungal Sepsis 61 Current Context 1 Congenital Infections 62 Strategies and Models for Quality Perinatally Acquired Infections 65 Improvement (QI) 4 Hematologic Disorders in the Newborn Infant 67 Principles of Patient Safety (Incident Bleeding Disorders 67 Reporting, Just Culture, Disclosure, Anemia 68 FMEA, RCA, Reliability, Checklists) 7 Polycythemia 69 Renal Disorders in the Newborn Infant 69 2. the newborn Infant 9 Renal Failure 70 Urinary Tract Anomalies 70 Adam A. Rosenberg, MD Renal Vein Thrombosis 71 Theresa Grover, MD Neurologic Problems in the Newborn Infant 71 The Neonatal History 9 Seizures 71 Assessment of Growth & Gestational Age 9 Hypotonia 72 Examination at Birth 12 Intracranial Hemorrhage 72 Examination in the Nursery 13 Metabolic Disorders in the Newborn Infant 73 Care of the Well Neonate 15 Hyperglycemia 73 Feeding the Well Neonate 16 Hypocalcemia 73 Early Discharge of the Newborn Infant 18 Inborn Errors of Metabolism 74 Circumcision 18 Quality Assessment and Improvement Hearing Screening 19 in the Newborn Nursery and NICU 74 Common Problems in the Term Newborn 19 Neonatal Jaundice 19 3. Child Development & Behavior 75 Hypoglycemia 27 Edward Goldson, MD Respiratory Distress in the term Ann Reynolds, MD Newborn Infant 28 Heart Murmurs 30 Normal Development 75 Birth Trauma 31 The First 2 Years 75 Infants of Mothers Who Abuse Drugs 32 Ages 2–4 Years 92 Multiple Births 34 Early School Years: Ages 5–7 Years 92 Neonatal Intensive Care 35 Middle Childhood: Ages 7–11 Years 92 Perinatal Resuscitation 35 Behavioral & Developmental Variations 93 The Preterm Infant 40 Normality & Temperament 93 The Late Preterm Infant 50 Enuresis & Encopresis 94 Cardiac Problems in the Newborn Infant 52 Enuresis 94 Structural Heart Disease 52 Encopresis 95 Persistent Pulmonary Hypertension 53 Common Developmental Concerns 96 Arrhythmias 53 Colic 96 Gastrointestinal & Abdominal Surgical Feeding Disorders in Infants & Young Children 97 Conditions in the Newborn Infant 54 Sleep Disorders 99 Esophageal Atresia & Tracheoesophageal Temper Tantrums & Breath-Holding Spells 101 Fistula 54 Well-Child Surveillance & Screening 103 Intestinal Obstruction 54 Developmental Disorders 104 iii iv  ConTenTs Attention-Deficit Hyperactivity Disorder 105 6. eating Disorders 172 Autism Spectrum Disorders 107 Eric J. Sigel, MD Intellectual Disability 112 Specific Forms of Intellectual Disability & Etiology 172 Associated Treatment Issues 114 Incidence 173 Predisposing Factors & Clinical Profiles 174 4. Adolescence 117 Anorexia Nervosa 174 Bulimia Nervosa 180 Amy E. Sass, MD, MPH Binge-Eating Disorder 182 David W. Kaplan, MD, MPH Eating Disorders Not Meeting Demography 117 Criteria for Categorization 183 Mortality Data 117 Avoidant/Restrictive Food Intake Disorder 183 Morbidity Data 117 Prognosis 184 Delivery of Health Services 119 Resources for Practioners and Families 184 Guidelines for Adolescent Preventive Services 119 Relating to the Adolescent Patient 119 7. Child & Adolescent Psychiatric Disorders & The Setting 119 Psychosocial Aspects of Pediatrics 185 Confidentiality 120 Adam Burstein, DO The Structure of the Visit 120 Ayelet Talmi, PhD Growth & Development 125 Brian Stafford, MD, MPH Puberty 125 Kimberly Kelsay, MD Physical Growth 126 Sexual Maturation 127 Models of Care Encompassing Mental Psychosocial Development 127 Health in the Primary Care Setting 186 Behavior & Psychological Health 129 Early Identification & Prevention of Psychophysiologic Symptoms & Conversion Developmental & Socioemotional Problems 186 Reactions 129 Identification & Assessment During Health Depression 130 Maintenance Visits 187 Adolescent Suicide 131 Consultation-Liaison Psychiatry 195 Substance Abuse 132 The Chronically Ill Child 195 Eating Disorders 132 The Terminally Ill Child 196 Overweight & Obesity 132 Psychiatric Disorders of Childhood School Avoidance 134 & Adolescence 199 School Failure 135 Pediatric Primary Care Behavioral Health Services 200 Breast Disorders 135 Anxiety Disorders 202 Breast Masses 136 Attention-Deficit Hyperactivity Disorder 210 Nipple Discharge & Galactorrhea 137 Mood Disorders 215 Gynecomastia 138 Suicide in Children & Adolescents 226 Gynecologic Disorders in Adolescence 139 Conduct Disorders 228 Physiology of Menstruation 139 High-Risk Patients and Homicide 232 Pelvic Examination 140 Somatoform Disorders 233 Menstrual Disorders 141 Adjustment Disorders 234 Contraception 149 Psychotic Disorders 235 Pregnancy 155 Other Psychiatric Conditions 238 5. Adolescent Substance Abuse 158 8. Child Abuse & neglect 239 Paritosh Kaul, MD Antonia Chiesa, MD Andrew P. Sirotnak, MD Scope of the Problem 158 Morbidity Data 163 Prevention 240 Predicting the Progression From Use to Abuse 164 Clinical Findings 240 Evaluation of Substance Abuse 165 Differential Diagnosis 245 Treatment & Referral 168 Treatment 246 Prevention 170 Prognosis 246 ConTenTs  v 9. Ambulatory & Office Pediatrics 248 Hepatitis A Vaccination 295 Meningococcal Vaccination 296 Meghan Treitz, MD Tetanus-Reduced Diphtheria-Acellular Maya Bunik, MD, MSPH Pertussis Vaccination David Fox, MD (Adolescents & Adults) 298 Pediatric History 248 Human Papillomavirus Vaccination 299 Pediatric Physical Examination 249 Vaccinations for Special Situations 299 Health Supervision Visits 251 Rabies Vaccination 299 Developmental & Behavioral Assessment 251 Typhoid Fever Vaccination 301 Growth Parameters 254 Japanese Encephalitis Vaccination 301 Blood Pressure 255 Tuberculosis Vaccination 302 Vision & Hearing Screening 256 Yellow Fever Vaccination 303 Screening 257 Passive Prophylaxis 303 Anticipatory Guidance 260 Nutrition Counseling 262 11. normal Childhood nutrition & Counseling About Television & Its Disorders 305 Other Media 262 Matthew A. Haemer, MD MPH Immunizations 263 Laura E. Primak, RD, CNSD, CSP Acute-Care Visits 263 Nancy F. Krebs, MD, MS Prenatal Visits 264 Sports Physicals 264 Nutritional Requirements 305 Chronic Disease Management 264 Nutrition & Growth 305 Medical Home 265 Energy 305 Mental & Behavioral Health 265 Protein 307 Consultations 266 Lipids 307 Telephone Management & Web-Based Carbohydrates 308 Information 266 Major Minerals 309 Advocacy & Community Pediatrics 267 Trace Elements 309 Common General Pediatric Issues 267 Vitamins 309 Fever 267 Infant Feeding 311 Growth Deficiency 269 Breast-Feeding 311 Special Dietary Products for Infants 320 10. Immunization 271 Nutrition for Children 2 Years & Older 321 Pediatric Undernutrition 321 Matthew F. Daley, MD Pediatric Overweight & Obesity 323 Sean T. O’Leary, MD, MPH Nutrition Support 326 Ann-Christine Nyquist, MD, MSPH 1. Enteral 326 Standards for Pediatric Immunization Practices 272 2. Parenteral Nutrition 327 Routine Childhood & Adolescent Immunization Nutrient Requirements & Delivery 329 Schedules 273 Vaccine Safety 273 12. emergencies & Injuries 334 Vaccination in Special Circumstances 277 Maria J. Mandt, MD Hepatitis B Vaccination 278 Joseph A. Grubenhoff, MD Rotavirus Vaccination 281 Diphtheria-Tetanus-Acellular Assessment & Management of the Acutely Pertussis Vaccination 282 Ill Infant or Child 334 Haemophilus Influenzae The ABCs of Resuscitation 334 Type B Vaccination 285 Management of Shock 338 Pneumococcal Vaccination 286 Summary of Resuscitating the Acutely Ill Poliomyelitis Vaccination 288 Infant or Child 339 Influenza Vaccination 289 Emergency Pediatric Drugs 340 Measles, Mumps, & Approach to the Acutely Ill Infant or Child 340 Rubella Vaccination 291 Preparation for Emergency Management 340 Varicella Vaccination 293 Reception & Assessment 340 vi  ConTenTs Approach to the Pediatric Trauma Patient 342 Disk-Shaped “Button” Batteries 373 Mechanism of Injury 342 Ethylene Glycol & Methanol 374 Initial Assessment & Management 342 γ-Hydroxybutyrate, γ-Butyrolactone, Primary Survey 343 & Butanediol 374 Secondary Survey 345 Hydrocarbons (Benzene, Charcoal Lighter Head Injury 347 Fluid, Gasoline, Kerosene, Petroleum Burns 349 Distillates, Turpentine) 374 Thermal Burns 349 Ibuprofen 375 Electrical Burns 351 Insect Stings (Bee, Wasp, & Hornet) 375 Disorders Due to Extremes of Environment 351 Insecticides 375 Heat-Related Illnesses & Heat Stroke 351 Iron 376 Hypothermia 352 Lead 377 Submersion Injuries 353 Magnets 378 Animal & Human Bites 354 Mushrooms 378 Dog Bites 354 Nitrites, Nitrates, Aniline, Pentachlorophenol, Cat Bites 355 & Dinitrophenol 378 Human Bites 355 Opioids & Opiates 379 Procedural Sedation & Analgesia 355 Oral Hypoglycemics (Sulfonylureas, Metformin) 380 Antipsychotics (Typical & Atypical) 380 13. Poisoning 357 Plants 381 Psychotropic Drugs 381 George Sam Wang, MD Salicylates 382 Barry H. Rumack, MD Scorpion Stings 383 Richard C. Dart, MD, PhD Serotonin Reuptake Inhibitors 383 Pharmacologic Principles of Toxicology 357 Snakebite 384 Preventing Childhood Poisonings 358 Soaps & Detergents 385 General Treatment of Poisoning 358 Spider Bites 385 Initial Telephone Contact 358 Thyroid Preparations (Thyroid Desiccated, Initial Emergency Department Contact 361 Sodium Levothyroxine) 386 Definitive Therapy of Poisoning 361 Vitamins 386 Management of Specific Common Poisonings 363 Warfarin (Coumadin) and Other Oral Acetaminophen (Paracetamol) 363 Anticoagulants 386 Alcohol, Ethyl (Ethanol) 363 Amphetamines & Related Drugs 14. Critical Care 387 (Methamphetamine, MDMA) 365 Todd C. Carpenter, MD, Anesthetics, Local 366 Angela S. Czaja, MD, MSc, Antihistamines & Cough & Cold Preparations 367 Jennifer Exo, DO, Eva N. Grayck, MD, Arsenic 367 Cameron F. Gunville, DO, Carleen Zebuhr, MD Barbiturates & Benzodiazepines 368 Belladonna Alkaloids (Atropine, Introduction 387 Jimsonweed, Potato Leaves, Scopolamine, Respiratory Critical Care 387 Stramonium) 368 Acute Respiratory Failure 387 b-Blockers & Calcium Channel Blockers 369 Conventional Mechanical Ventilation 391 Carbon Monoxide 369 Major Respiratory Diseases in the Pediatric ICU 395 Caustics 369 Acute Respiratory Distress Syndrome 395 Central Alpha-2 Adrenergic Agonist 370 Status Asthmaticus 399 Cocaine 371 Cardiovascular Critical Care 402 Contraceptive Pills 371 Shock 402 Cosmetics & Related Products 371 Sepsis 405 Cyclic Antidepressants 372 Neurocritical Care 409 Digitalis & Other Cardiac Glycosides 372 Traumatic Brain Injury 409 Diphenoxylate with Atropine (Lomotil) & Hypoxic-Ischemic Encephalopathy 413 Loperamide (Imodium) 373 Additional Therapeutic Considerations Disinfectants & Deodorizers 373 in the Pediatric ICU 414 ConTenTs  vii Acute Kidney Injury and Renal Replacement Ophthalmic Examination 449 Therapy 414 History 449 Fluid Management and Nutritional Support Visual Acuity 449 of the Critically Ill Child 415 External Examination 450 Sedation & Analgesia in the Pediatric ICU 418 Pupils 451 End-of-Life Care and Death in the PICU 422 Alignment & Motility Evaluation 451 Quality Improvement Initiatives in the PICU 424 Ophthalmoscopic Examination 453 Ocular Trauma 453 15. Skin 426 Ocular Foreign Bodies 453 Corneal Abrasion 454 Joseph G. Morelli, MD Intraocular Foreign Bodies & Perforating Lori D. Prok, MD Ocular Injuries 455 General Principles 426 Blunt Orbital Trauma 455 Diagnosis of Skin Disorders 426 Lacerations 456 Treatment of Skin Disorders 426 Burns 457 Disorders of the Skin in Newborns 428 Hyphema 457 Transient Diseases in Newborns 428 Abusive Head Trauma & Nonaccidental Pigment Cell Birthmarks, Nevi, & Melanoma 429 Trauma 458 Melanocytic Nevi 430 Prevention of Ocular Injuries 459 Vascular Birthmarks 430 Disorders of the Ocular Structures 459 Epidermal Birthmarks 431 Diseases of the Eyelids 459 Connective Tissue Birthmarks (Juvenile Viral Eyelid Disease 460 Elastoma, Collagenoma) 432 Miscellaneous Eyelid Infections 461 Hereditary Skin Disorders 432 Eyelid Ptosis 461 Common Skin Diseases in Infants, Children, Horner Syndrome 462 & Adolescents 432 Eyelid Tics 463 Acne 432 Disorders of the Nasolacrimal System 463 Bacterial Infections of the Skin 435 Nasolacrimal Duct Obstruction 463 Fungal Infections of the Skin 436 Congenital Dacryocystocele 463 Viral Infections of the Skin 437 Dacryocystitis 464 Virus-Induced Tumors 438 Diseases of the Conjunctiva 465 Insect Infestations 438 Ophthalmia Neonatorum 465 Dermatitis (Eczema) 439 Bacterial Conjunctivitis 466 Common Skin Tumors 442 Viral Conjunctivitis 466 Papulosquamous Eruptions 443 Allergic Conjunctivitis 467 Hair Loss (Alopecia) 444 Mucocutaneous Diseases 467 Reactive Erythemas 445 Disorders of the Iris 469 Miscellaneous Skin Disorders Seen in Iris Coloboma 469 Pediatric Practice 445 Aniridia 469 Albinism 470 16. eye 447 Miscellaneous Iris Conditions 470 Glaucoma 470 Rebecca Sands Braverman, MD Uveitis 471 Common Nonspecific Signs & Symptoms 447 Anterior Uveitis/Iridocyclitis/Iritis 471 Red Eye 447 Posterior Uveitis 472 Tearing 447 Intermediate Uveitis 473 Discharge 447 Ocular Manifestations of AIDS 473 Pain & Foreign Body Sensation 447 Disorders of the Cornea 474 Photophobia 447 Cloudy Cornea 474 Leukocoria 448 Viral Keratitis 474 Refractive Errors 448 Corneal Ulcers 475 Myopia (Nearsightedness) 449 Disorders of the Lens 475 Hyperopia (Farsightedness) 449 Cataracts 476 Astigmatism 449 Dislocated Lenses/Ectopia Lentis 476 viii  ConTenTs Disorders of the Retina 477 Epistaxis 521 Retinal Hemorrhages in the Newborn 477 Nasal Infection 521 Retinopathy of Prematurity 477 Nasal Trauma 521 Retinoblastoma 478 Foreign Bodies in the Nose 522 Retinal Detachment 479 The Throat & Oral Cavity 522 Diabetic Retinopathy 479 Acute Stomatitis 522 Diseases of the Optic Nerve 480 Pharyngitis 523 Optic Neuropathy 480 Peritonsillar Cellulitis or Abscess (Quinsy) 526 Optic Nerve Hypoplasia 480 Retropharyngeal Abscess 526 Papilledema 481 Ludwig Angina 527 Optic Neuritis 482 Acute Cervical Adenitis 527 Optic Atrophy 482 Snoring, Mouth Breathing, & Upper Airway Periorbital & Orbital Cellulitis 483 Obstruction 528 Craniofacial Anomalies 483 Tonsillectomy & Adenoidectomy 530 Orbital Tumors 484 Disorders of the Lips 531 Nystagmus 485 Disorders of the Tongue 531 Amblyopia 485 Halitosis 532 Strabismus 486 Salivary Gland Disorders 532 Unexplained Decreased Vision in Infants Congenital Oral Malformations 532 & Children 488 Learning Disabilities & Dyslexia 488 19. respiratory tract & Mediastinum 534 Monica J. Federico, MD, Christopher D. Baker, MD 17. Oral Medicine & Dentistry 490 Vivek Balasubramaniam, MD, Emily M. Deboer, MD Ulrich Klein, DMD, DDS, MS Robin R. Deterding, MD, Ann Halbower, MD Oren Kupfer, MD, Stacey L. Martiniano, MD Issues in Pediatric Oral Health 490 Scott D. Sagel, MD, Paul Stillwell, MD Dental Caries 492 Edith T. Zemanick, MD Oral Examination of the Newborn & Infant 495 Eruption of the Teeth 497 Respiratory Tract 534 Periodontal Disease 498 Growth & Development 534 Dental Emergencies 499 Diagnostic AIDS 535 Antibiotics in Pediatric Dentistry 500 Physical Examination of the Respiratory Tract 535 Special Patient Populations 500 Pulmonary Function Tests 536 Orthodontic Referral 501 Assessment of Oxygenation & Ventilation 537 Diagnosis of Respiratory Tract Infections 539 18. ear, nose, & throat 502 Imaging of the Respiratory Tract 540 Laryngoscopy & Bronchoscopy 540 Norman R. Friedman, MD General Therapy of Pediatric Lung Diseases 541 Melissa A. Scholes, MD Oxygen Therapy 541 Patricia J. Yoon, MD Inhalation of Medications 541 The Ear 502 Airway Clearance Therapy 542 Infections of the Ear 502 Avoidance of Environmental Hazards 542 Acute Trauma to the Middle Ear 512 Disorders of the Conducting Airways 543 Cerumen Impaction and Ear Canal Laryngomalacia & Congenital Disorders of the Foreign Body 512 Extrathoracic Airway 544 Auricular Hematoma 512 Laryngomalacia 544 Congenital Ear Malformations 513 Other Causes of Congenital Extrathoracic Identification & Management of Obstruction 544 Hearing Loss 513 Acquired Disorders of the Extrathoracic Airway 544 The Nose & Paranasal Sinuses 515 Foreign Body Aspiration in the Extrathoracic Acute Viral Rhinitis 515 Airway 545 Rhinosinusitis 518 Croup Syndromes 545 Choanal Atresia 520 Vocal Cord Paralysis 548 Recurrent Rhinitis 520 Subglottic Stenosis 548 ConTenTs  ix Congenital Causes of Intrathoracic Airway 20. Cardiovascular Diseases 588 Obstruction 548 Jeffrey R. Darst, MD Malacia of Airways 548 Kathryn K. Collins, MD Vascular Rings and Slings 549 Shelley D. Miyamoto, MD Bronchogenic Cysts 549 Acquired Causes of Intrathoracic Airway Diagnostic Evaluation 588 Obstruction 550 History 588 Foreign Body Aspiration in the Intrathoracic Physical Examination 588 Airway 550 Electrocardiography 591 Disorders of Mucociliary Clearance 551 Chest Radiograph 593 Cystic Fibrosis 551 Echocardiography 594 Primary Ciliary Dyskinesia 552 Nuclear Cardiology 595 Bronchiolitis Obliterans 553 Magnetic Resonance Imaging 595 Bronchiectasis 554 Cardiopulmonary Stress Testing 595 Congenital Malformations of the Lung Parenchyma 555 Arterial Blood Gases 595 Pulmonary Agenesis & Hypoplasia 555 Cardiac Catheterization & Angiocardiography 596 Pulmonary Sequestration 556 Perinatal & Neonatal Circulation 598 Congenital Lobar Emphysema 557 Heart Failure 598 Congenital Pulmonary Airway Malformation Genetic Basis of Congenital Heart Disease 601 (Cystic Adenomatoid Malformation) 557 Acyanotic Congenital Heart Disease 601 Acquired Abnormalities of the Lung Parenchyma 559 Defects in Septation 601 Bronchopulmonary Dysplasia 559 Patent (Persistent) Ductus Arteriosus 605 Community-Acquired Bacterial Pneumonia 561 Right-Sided Obstructive Lesions 607 Parapneumonic Effusion & Empyema 562 Left-Sided Lesions 610 Atypical Pneumonias 563 Diseases of the Aorta 614 Viral Pneumonia 563 Coronary Artery Abnormalities 615 Bronchiolitis 564 Cyanotic Congenital Heart Disease 616 Mycoplasma Pneumonia 566 Tetralogy of Fallot 616 Tuberculosis 566 Pulmonary Atresia with Ventricular Aspiration Pneumonia 568 Septal Defect 618 Pneumonia in the Immunocompromised Host 569 Pulmonary Atresia with Intact Ventricular Lung Abscess 571 Septum 618 Children’s Interstitial Lung Disease Syndrome 572 Tricuspid Atresia 619 Hypersensitivitiy Pneumonitis 573 Hypoplastic Left Heart Syndrome 620 Diseases of the Pulmonary Circulation 574 Transposition of the Great Arteries 621 Pulmonary Hemorrhage 574 Total Anomalous Pulmonary Venous Return 623 Pulmonary Embolism 576 Truncus Arteriosus 625 Pulmonary Edema 576 Quality Improvement in Congenital Congenital Pulmonary Lymphangiectasia 577 Heart Disease 626 Disorders of the Chest Wall & Diaphragm 578 Acquired Heart Disease 626 Scoliosis 578 Rheumatic Fever 626 Pectus Carinatum 578 Kawasaki Disease 628 Pectus Excavatum 578 Infective Endocarditis 629 Neuromuscular Disorders 578 Pericarditis 631 Eventration of the Diaphragm 579 Cardiomyopathy 632 Disorders of the Pleura & Pleural Cavity 579 Myocarditis 634 Hemothorax 580 Preventive Cardiology 635 Chylothorax 580 Hypertension 635 Pneumothorax & Related Air Leak Syndromes 580 Atherosclerosis & Dyslipidemias 636 Mediastinum 581 Chest Pain 636 Mediastinal Masses 581 Cardiac Transplantation 637 Sleep-Disordered Breathing 582 Quality Improvement for Pediatric Heart Obstructive & Central Sleep Apnea 582 Transplantation 639 Apparent Life-Threatening Events 583 Primary Pulmonary Hypertension 639 Sudden Infant Death Syndrome 586 Disorders of Rate & Rhythm 640