TILIR #19-20: Tenacious D

Today we had a set of parents come in to their pediatrician with their newborn. We talked about vitamin D supplementation while breastfeeding, among many other things. They remember their older child taking the older version of this medication that came as a liquid with a small dropper to dispense the not-insignificant volume of medicine into the baby's mouth. It wasn't much fun because it tasted bad and babies tend to spit it out. But thankfully the newer preparations of this supplement are concentrated enough that you only need one drop.

So, we turn to mom and explain that the easiest way to give the medication is just put a drop on the breast before a feed. Simple!

Dad chimes in: "So you just spread it across the baby's chest like a VapoRub?"

Mom shoots him a looks that plainly says, "Are you an idiot?" But the other doctor and I laugh and explain that, no, the drop is placed on mom's breast so that the baby swallows it when breastfeeding.

ThursdayIL: There is a charter school near the airport in Grand Rapids called the Aviation Academy, where kids who want to be pilots (or just get a really STEM education) can go to high school instead of a normal public high school. Weird niche schools like this are touted as examples of how charter schools (the pet project of our Grand Rapids native Secretary of Education Betsy DeVos) can expand the model of public education.

However, I'm less impressed with the system when I see kids from other charter schools that are falling behind without repercussions thanks to loose regulations. And when resources that should be helping all public schools provide a great education are diverted to niche elite schools like the Aviation Academy, it makes me sad. Strangely enough you don't see many of the inner-city population that I tend to see in my clinic attending the Aviation Academy.

TodayIL: If you are testing an eye for HSV or chlamydia (as are concerns in a newborn with a red, swollen eye) you need to culture the eyelid not just some eye discharge, because both of these organisms are intracellular. There aren't any skin cells in tears or eye discharge, so you need to scrape some off the interior of the eyelid.

If a neonate does develop a suspected chlamydial infection of the eye, you should always treat it with systemic antibiotics, rather than with just eye drops. This is because the other major area where neonates can get chlamydia is in the lungs as pneumonia. If they were exposed in the eye, they were likely exposed in the lungs, so treat now regardless of respiratory symptoms and avoid the dangerous sequelae of a newborn with pneumonia.