The MCG Pediatric Podcast

• Celiac Disease

  Did you know that a single crumb of bread is enough to cause an autoimmune response in children with celiac disease? Dr. Pankaj Vohra, Professor of Pediatrics and Board-Certified Pediatric Gastroenterologist, joins medical student Andrea Smith to discuss the evaluation and management of celiac disease, as well as essential guidance for following a gluten-free diet. Specifically, they will: Review the epidemiology of celiac disease and identify common symptoms and presentations of celiac disease Describe the pathophysiology of celiac disease including histopathological changes to the duodenum Identify diagnostic tests and criteria for diagnosing celiac disease in the pediatric population Identify common sources of gluten and the basics of identifying gluten on food labels Discuss typical management of celiac disease including appropriate screening tests and managing accidental gluten ingestion Special thanks to Dr. Rebecca Yang and Dr. Neeharika Bade for peer reviewing this episode. CME available free with sign up: Link coming soon! References: Bolia, R., & Thapar, N. (2023). Celiac Disease in Children: A 2023 Update. In Indian Journal of Pediatrics. Springer. https://doi.org/10.1007/s12098-023-04659-w Gidrewicz, D., Potter, K., Trevenen, C. L., Lyon, M., & Butzner, J. D. (2015). Evaluation of the ESPGHAN celiac guidelines in a North American pediatric population. American Journal of Gastroenterology, 110(5), 760–767. https://doi.org/10.1038/ajg.2015.87 Hill, I. D., Fasano, A., Guandalini, S., Hoffenberg, E., Levy, J., Reilly, N., & Verma, R. (2016). NASPGHAN clinical report on the diagnosis and treatment of gluten-related disorders. Journal of Pediatric Gastroenterology and Nutrition, 63(1), 156–165. https://doi.org/10.1097/MPG.0000000000001216 Husby, S., Koletzko, S., Korponay-Szabó, I., Kurppa, K., Mearin, M. L., Ribes-Koninckx, C., Shamir, R., Troncone, R., Auricchio, R., Castillejo, G., Christensen, R., Dolinsek, J., Gillett, P., Hróbjartsson, A., Koltai, T., Maki, M., Nielsen, S. M., Popp, A., Størdal, K., … Wessels, M. (2020). European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. In Journal of Pediatric Gastroenterology and Nutrition (Vol. 70, Issue 1, pp. 141–156). Lippincott Williams and Wilkins. https://doi.org/10.1097/MPG.0000000000002497 Nenna, R., Tiberti, C., Petrarca, L., Lucantoni, F., Mennini, M., Luparia, R. P. L., Panimolle, F., Mastrogiorgio, G., Pietropaoli, N., Magliocca, F. M., & Bonamico, M. (2013). The celiac iceberg: Characterization of the disease in primary schoolchildren. Journal of Pediatric Gastroenterology and Nutrition, 56(4), 416–421. https://doi.org/10.1097/MPG.0b013e31827b7f64 Sahin, Y. (2021). Celiac disease in children: A review of the literature. In World Journal of Clinical Pediatrics (Vol. 10, Issue 4, pp. 53–71). Baishideng Publishing Group Co. https://doi.org/10.5409/wjcp.v10.i4.53 Salden, B. N., Monserrat, V., Troost, F. J., Bruins, M. J., Edens, L., Bartholomé, R., Haenen, G. R., Winkens, B., Koning, F., & Masclee, A. A. (2015). Randomised clinical study: Aspergillus niger-derived enzyme digests gluten in the stomach of healthy volunteers. Alimentary Pharmacology and Therapeutics, 42(3), 273–285. https://doi.org/10.1111/apt.13266 Schuppan, D., Mäki, M., Lundin, K. E. A., Isola, J., Friesing-Sosnik, T., Taavela, J., Popp, A., Koskenpato, J., Langhorst, J., Hovde, Ø., Lähdeaho, M.-L., Fusco, S., Schumann, M., Török, H. P., Kupcinskas, J., Zopf, Y., Lohse, A. W., Scheinin, M., Kull, K., … Greinwald, R. (2021). A Randomized Trial of a Transglutaminase 2 Inhibitor for Celiac Disease. New England Journal of Medicine, 385(1), 35–45. https://doi.org/10.1056/nejmoa2032441 Tack, G. J., van de Water, J. M. W., Bruins, M. J., Kooy-Winkelaar, E. M. C., van Bergen, J., Bonnet, P., Vreugdenhil, A. C. E., Korponay-Szabo, I., Edens, L., von Blomberg, B. M. E., Schreurs, M. W. J., Mulder, C. J., & Koning, F. (2013). Consumption of gluten with gluten-degrading enzyme by celiac patients: A pilot-study. World Journal of Gastroenterology, 19(35), 5837–5847. https://doi.org/10.3748/wjg.v19.i35.5837 Husby S, Koletzko S, Korponay-Szabó IR, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012; 54: 136–160

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• Acyanotic Congenital Heart Diseases

  Did you know that congenital heart defects (CHDs) affect nearly 40,000 babies born in the United States every year? On this episode, Pediatric Cardiologist Dr. Melissa Lefebvre and medical student Marina Hashim discuss the evaluation and management of common acyanotic congenital heart conditions. Specifically, they will: Review the classification of CHDs as cyanotic versus acyanotic. Discuss the pathophysiology of the three most common acyanotic CHDs – ASD, PDA, and VSD. Describe early clinical findings and use of diagnostic tools. Cover management options, ranging from spontaneous closure to surgical intervention. Explore prognosis and long-term outcomes on physical activity, neurodevelopment, and overall health. Special thanks to Dr. Rebecca Yang and Dr. Abeer Hamdy for peer reviewing this episode. CME available free with sign up:  Click Here! References: Dimopoulos, K., Constantine, A., Clift, P., & Condliffe, R. (2023). Cardiovascular complications of down syndrome: Scoping review and expert consensus. Circulation, 147(5). https://doi.org/10.1161/CIRCULATIONAHA.122.059706   Dugdale, D. C. (Ed.). (n.d.). Pediatric heart surgery - discharge. Mount Sinai. Retrieved April 26, 2024, from https://www.mountsinai.org/health-library/discharge-instructions/pediatric-heart-surgery-discharge   Eckerström, F., Nyboe, C., Maagaard, M., Redington, A., & Hjortdal, V. (2023). Survival of patients with congenital ventricular septal defect. European Heart Journal,  44 (1,1), 54-61. https://doi.org/10.1093/eurheartj/ehac618   Heart MRI. (2022, July 24). Cleveland Clinic. Retrieved April 19, 2024, from https://my.clevelandclinic.org/health/diagnostics/21961-heart-mri Leihao, S., Yajiao, L., Yunwu, Z., Yusha, T., Yucheng, C., & Lei, C. (2023). Heart-brain axis: Association of congenital heart abnormality and brain diseases. Frontiers in Cardiovascular Medicine, 10. https://doi.org/10.3389/fcvm.2023.1071820 Meyer, K. (Ed.). (2022, May 1). What is a ventricular septal defect (VSD)? Cincinnati Children's. Retrieved March 12, 2024, from https://www.cincinnatichildrens.org/health/v/vsd Minette, M. S., & Sahn, D. S. (2006). Ventricular septal defects. Circulation, 114(20). https://doi.org/10.1161/CIRCULATIONAHA.106.618124 Mussatto, K. A., Hoffmann, R. G., Hoffman, G. M., Tweddell, J. S., Bear, L., Cao, Y., & Brosig, C. (2014). Risk and prevalence of developmental delay in young children with congenital heart disease. Pediatrics, 133(3), e570–e577. https://doi.org/10.1542/peds.2013-2309 Pruthi, S. (Ed.). (2022, October 21). Ventricular septal defect (VSD). Mayo Clinic. Retrieved April 9, 2024, from https://www.mayoclinic.org/diseases-conditions/ventricular-septal-defect/symptoms-causes/syc-20353495     Right heart catheterization. (2022, July 24). Cleveland Clinic. Retrieved April 19, 2024, from https://my.clevelandclinic.org/health/diagnostics/21045-right-heart-catheterization Shah, S., Mohanty, S., Karande, T., Maheshwari, S., Kulkarni, S., & Saxena, A. (2022). Guidelines for physical activity in children with heart disease. Annals of pediatric cardiology, 15(5-6), 467–488. https://doi.org/10.4103/apc.apc_73_22 Sigmon, E., Kellman, M., Susi, A., Nylund, C., & Oster, M. (2019). Congenital heart disease and Autism: A case-control study. Pediatrics, 144(5). https://doi.org/10.1542/peds.2018-4114 Thacker, D. (Ed.). (2022, January 1). Ventricular septal defect (VSD). Nemours Kids Health. Retrieved April 10, 2024, from https://kidshealth.org/en/parents/vsd.html   Tierney, S., & Seda, E. (2020). The benefit of exercise in children with congenital heart disease. Current Opinion in Pediatrics, 32(5), 626-632. https://doi.org/10.1097/MOP.0000000000000942  Ventricular septal defects (VSD). (2021, November 9). Cleveland Clinic. Retrieved April 2, 2024,from https://my.clevelandclinic.org/health/diseases/17615-ventricular-septal-defects-vsd    Ventricular septal defect surgery for children. (n.d.). Johns Hopkins Medicine. Retrieved April 11,2024, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/ventricular-septal-defect-surgery-for-children#:~:text=During%20this%20surgery%2C%20a%20surgeon,the%20hole%20between%20the%20ventricles Wernovsky, G., & Licht, D. J. (2016). Neurodevelopmental Outcomes in children with congenital heart disease - what can we impact?. Pediatric Critical Care Medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 17(8 Suppl 1), S232–S242. https://doi.org/10.1097/PCC.0000000000000800

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• Adolescent Gynecology

  Join medical students Binal Patel and Aashka Sheth as they discuss adolescent gynecology with pediatrician Dr. Shreeti Kapoor.  Specifically, they will discuss: What exactly is adolescent gynecology. The proper approach to taking a comprehensive history for a pediatric patient with a gynecologic chief complaint. The various causes of dysmenorrhea in the early menarche period and its presentation. The diagnostic approach to dysmenorrhea in adolescents. The approach to treatment of dysmenorrhea in a pediatric population. And how to approach addressing safe sex practices and sexually transmitted infections with adolescents. References: 21 reasons to see a gynecologist before you turn 21. ACOG. (n.d.). https://www.acog.org/womens-health/infographics/21-reasons-to-see-a-gynecologist-before-you-turn-21   Adams Hillard P. J. (2008). Menstruation in adolescents: what's normal?. Medscape journal of medicine, 10(12), 295.  Breehl L, Caban O. Physiology, Puberty. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534827/  Centers for Disease Control and Prevention. (n.d.). About heavy menstrual bleeding. Centers for Disease Control and Prevention. https://www.cdc.gov/female-blood-disorders/about/heavy-menstrual-bleeding.html  Primary dysmenorrhea in adolescents. UpToDate. (n.d.). https://www.uptodate.com/contents/primary-dysmenorrhea-in-adolescents?search=Primary+Dysmenorrhea+&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2  professional, C. C. medical. (2024, September 20). Pediatric gynecology. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/24574-pediatric-gynecology  professional, C. C. medical. (2025, February 18). Puberty. Cleveland Clinic. https://my.clevelandclinic.org/health/body/puberty   Sachedin, A., & Todd, N. (2020). Dysmenorrhea, endometriosis and chronic pelvic pain in adolescents. Journal of Clinical Research in Pediatric Endocrinology, 12(1), 7–17. https://doi.org/10.4274/jcrpe.galenos.2019.2019.s0217   Sexuality, Sexual Health, and Sexually Transmitted Infections in Adolescents and Young Adults. (2020). Topics in Antiviral Medicine, 28(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC7482983/pdf/tam-28-459.pdf   UpToDate. (n.d.). Abnormal uterine bleeding in adolescents. https://www.uptodate.com/contents/abnormal-uterine-bleeding-in-adolescents-evaluation-and-approach-to-diagnosis?search=heavy%2Bbleeding&usage_type=default&source=search_result&selectedTitle=3~150&display_rank=3  

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• Obsessive Compulsive Disorder in Pediatrics

  Did you know that Obsessive-Compulsive Disorder (OCD) affects approximately 1 in 200 children, with symptoms often emerging between the ages of 7 and 12? As pediatricians, you're likely the first to encounter these patients, making early recognition and intervention critical for achieving optimal outcomes. In this episode, we’ll provide you with the knowledge and tools nee ded to accurately diagnose and effectively manage OCD, laying the foundation for better long-term care. Dr. Theresa Fiagbe, a second-year Child Psychiatry Fellow, Dr. Dale Peeples, Associate Professor of Child Psychiatry, and Alisha Patel, Medical Student at the Medical College of Georgia, join forces to unpack the complexities of OCD in children and adolescents. Tune in as we: Explore key diagnostic criteria and the most effective screening tools for identifying OCD in pediatric patients Discuss evidence-based treatments such as Cognitive Behavioral Therapy (CBT) and SSRIs, and how to incorporate them into your practice Review common comorbid conditions, like anxiety and PANDAS, that can complicate diagnosis and treatment Examine the impact of OCD on school performance, social interactions, and family life Share practical guidance on managing long-term care to prevent relapse and ensure successful outcomes Whether you're encountering OCD symptoms in a patient for the first time or seeking to enhance your expertise, this episode will equip you with the essential tools to improve diagnosis and treatment. Special thanks to Dr. Yang for editing and Dr. Sarah Straka, and Dr. Baris Olten for peer reviewing this episode. CME Credit Available:  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=25556 References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. Berman, L., & Flessner, C. A. (2014). Pediatric obsessive-compulsive disorder: Diagnostic and treatment issues. Journal of the American Academy of Child and Adolescent Psychiatry, 53(2), 123-131. https://doi.org/10.1016/j.jaac.2013.10.003 Clark, C. A., & Scharf, R. (2020). Cognitive-behavioral therapy for obsessive-compulsive disorder in children and adolescents: Current trends and future directions. Journal of the American Academy of Child and Adolescent Psychiatry, 59(9), 971-979. https://doi.org/10.1016/j.jaac.2020.05.007 Fahrion, S., & Goodwin, G. M. (2019). Pharmacological treatment of pediatric obsessive-compulsive disorder: SSRIs, clomipramine, and beyond. Current Psychiatry Reports, 21(8), 58-66. https://doi.org/10.1007/s11920-019-1040-3 Franklin, M. E., & March, J. S. (2015). Treatment of obsessive-compulsive disorder in children and adolescents. Pediatric Clinics of North America, 62(3), 529-545. https://doi.org/10.1016/j.pcl.2015.02.004 March, J. S., & Mulle, K. (2017). OCD in children and adolescents: A review of treatments and practical guidance. The Psychiatric Clinics of North America, 40(2), 199-208. https://doi.org/10.1016/j.psc.2017.01.002 Murphy, T. K., & Pincus, D. B. (2019). Pediatric obsessive-compulsive disorder: Diagnosis, treatment, and future directions. Current Opinion in Pediatrics, 31(4), 517-524. https://doi.org/10.1097/MOP.0000000000000801 PANDA Study Group. (2017). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Journal of the American Academy of Child and Adolescent Psychiatry, 56(11), 933-940. https://doi.org/10.1016/j.jaac.2017.07.866 Peris, T. S., & Piacentini, J. (2021). Pediatric obsessive-compulsive disorder: Treatment strategies and challenges. Journal of Clinical Child and Adolescent Psychology, 50(1), 32-43. https://doi.org/10.1080/15374416.2020.1831504 Reaven, J. (2018). Screening for pediatric obsessive-compulsive disorder: Tools, guidelines, and challenges. Child and Adolescent Mental Health, 23(3), 133-139. https://doi.org/10.1111/camh.12267 Thienemann, M., & McGuire, L. (2019). Treating pediatric OCD with a focus on cognitive-behavioral therapy: Evidence and efficacy. Journal of Clinical Child and Adolescent Psychology, 48(4), 530-538. https://doi.org/10.1080/15374416.2019.1612851

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• Neonatal CMV and Universal Screening

  Did you know that congenital cytomegalovirus (cCMV) is the most common congenital viral infection in newborns and a leading cause of non-genetic hearing loss? Despite its prevalence, awareness and screening for cCMV remain inconsistent across healthcare systems. In this episode, we dive into the critical importance of cCMV screening, early diagnosis, and intervention. Join our expert guests Dr. Ingrid Camelo and Dr. John Noel as they discuss: The impact of cCMV on neonatal and long-term health outcomes Best practices for screening and diagnostic methods The role of early intervention, including antiviral therapy How advocacy efforts are shaping the future of universal screening policies Tune in to stay informed on how pediatricians and healthcare providers can play a vital role in improving outcomes for infants affected by cCMV. Special thanks to Dr. James Grubbs for peer reviewing this episode. CME Credit (requires free sign up): Link Coming Soon! References:  American Academy of Pediatrics. A targeted approach for congenital cytomegalovirus. Available at: https://publications.aap.org/pediatrics/article/139/2/e20162128/60211/A-Targeted-Approach-for-Congenital-Cytomegalovirus. Accessed August 13, 2024. Chiopris G, Veronese P, Cusenza F, Procaccianti M, Perrone S, Daccò V, Colombo C, Esposito S. Congenital cytomegalovirus infection: update on diagnosis and treatment. Microorganisms. 2020 Oct 1;8(10):1516. doi: 10.3390/microorganisms8101516. PMID: 33019752; PMCID: PMC7599523. Gantt S. Newborn cytomegalovirus screening: is this the new standard? Curr Opin Otolaryngol Head Neck Surg. 2023 Dec 1;31(6):382-387. doi: 10.1097/MOO.0000000000000925. Epub 2023 Oct 11. PMID: 37820202. Minnesota Department of Health. Minnesota implements universal newborn screening for cytomegalovirus. Available at: https://www.health.state.mn.us/news/pressrel/2023/ccmv020823.html. Accessed August 13, 2024. National CMV Foundation. Advocacy: universal newborn CMV screening. Available at: https://www.nationalcmv.org/about-us/advocacy#:~:text=Minnesota%20was%20the%20first%20state%20to%20enact%20universal%20newborn%20CMV%20screening. Accessed August 13, 2024. New York State Department of Health. Newborn screening for cytomegalovirus. Available at: https://www.health.ny.gov/press/releases/2023/2023-09-29_newborn_screening.htm#:~:text=ALBANY%2C%20N.Y.,all%20babies%20for%20the%20virus. Accessed August 13, 2024. UpToDate. Congenital cytomegalovirus (CMV) infection: clinical features and diagnosis. Available at: https://www.uptodate.com/contents/congenital-cytomegalovirus-ccmv-infection-clinical-features-and-diagnosis?search=cmv%20screening&source=search_result&selectedTitle=1%7E28&usage_type=default&display_rank=1#H92269684. Accessed August 13, 2024. UpToDate. Congenital cytomegalovirus (CMV) infection: management and outcome. Available at: https://www.uptodate.com/contents/congenital-cytomegalovirus-ccmv-infection-management-and-outcome?search=congenital%20cmv&source=search_result&selectedTitle=2%7E66&usage_type=default&display_rank=2. Accessed August 13, 2024. UpToDate. Ganciclovir and valganciclovir: an overview. Available at: https://www.uptodate.com/contents/ganciclovir-and-valganciclovir-an-overview?search=ganciclovir&source=search_result&selectedTitle=2%7E80&usage_type=default&display_rank=1#H6. Accessed August 13, 2024. University of Texas Medical Branch. Neonatology manual: infectious diseases. Available at: https://www.utmb.edu/pedi_ed/NeonatologyManual/InfectiousDiseases/InfectiousDiseases3.html#:~:text=may%20be%20required.-,Cytomegalovirus,Clinical%20findings. Accessed August 13, 2024. National Center for Biotechnology Information. Cytomegalovirus (CMV) infection. Available at: https://www.ncbi.nlm.nih.gov/books/NBK541003/. Accessed August 13, 2024.                                                                                                             

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