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Weekly Updates in Pediatrics

June 2012 - Current Updates in Pediatrics

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June 2012
1). Adenoidectomy for recurrent Upper Respiratory Tract Infections (URI) vs. “watchful waiting”
A 24 month follow up study of 111 children with recurrent URI some of whom were treated by adenoidectomy while matched others underwent  “watchful waiting” indicates that most URIs are self-limiting, decrease with age and adenoidectomy does not improve the number of URI episodes, middle ear complaints or quality of life measurements.

The Journal of Pediatrics, March 2012


2). Zinc as an Adjuvent to therapy for severe pneumonia. (Look for reference in May 2012)
Diarrhea and pneumonia are the leading causes of illness and death in children <5 years of age. The health benefits of zinc are mediated through its role in protein synthesis and include enhancing immune system functioning, digestion, control of diabetes, etc. Deficiency results in a variety of abnormalities including diarrhea, growth retardation and weight loss.
A study of 610 children aged 2-35 months who presented with severe pneumonia, was undertaken to assess the additive effect of a 10mg-20mg daily dose (up to 14 days) of zinc on ultimate outcome.
There appears to be NO significant benefit of zinc therapy in severe pneumonia.




2). " Blue Rubber " bleb Nevus.( BRBNS)
Blue BRBNS is a fairly rare disorder of unknown origin, usually sporadic, however a dominant autosomal inheritance has been described. It is characterized by single or multiple Venus malformations in the skin, gastrointestinal system (GIT) and occasionally other organs. The blebs are deep blue, rubbery and easily compressible.
An 8 year old little girl with BRBNS, multiple Venus malformations involving skin and her entire GIT presented with massive GIT bleeding. No systemic treatment is considered “standard of care” and treatment is usually directed at the manifested complications. Low dose sirolimus treatment has been tried with good effect.

Pediatrics, April 2012




3). New treatment for Cystic Fibrosis (CF).
Approximately 70,000 people worldwide are affected by a defective/missing CFTR protein, the abnormality of which results in the clinical picture of CF. Historically gene therapy to replace the faulty gene has been and remains the primary focus of CF research.
Ivacaftor (Kalydeco-Vertex pharma) has now been approved in the USA to treat CF patients with the specific CF mutation G551D. (4% of CF patients). It appears to markedly improve patients’ lung function, decrease the sodium content of their sweat and appears to assist them in gaining weight.

Lancet, April 21, 2012





4). Neuroimaging for a "First Complex Febrile Seizure” (CFS)
268 pediatric patients with a CFS had emergent head imaging. 4 (1.5%) had clinically significant findings.
Most CFS patients requiring emergency head imaging appear to have obvious clinical findings (eg nystagmus, emesis, altered mental status and bruising suggestive of inflicted injury).

Pediatric Emergency Care, April 2012

5). Effects of Altitude on cerebral oxygen.
17 Pediatric patients had their cerebral oxygenation measured by near-infrared spectroscopy (NIRS) at different altitudes during interfacility transport.
During helicopter transport no differences in cerebral oxygenation appears to occur between baseline and altitudes below 5,000 feet.
Cerebral oxygenation significantly decreases above an altitude of 5,000 feet, particularly in patients who require mechanical ventilation.

Pediatric Emergency Care, April 2012

6). Influenza A( H1N1)associated Ischemic Stroke.
Seasonal Influenza in known to cause neurological complications in children. Stroke with Influenza is rare, however this report of a 9 month old baby presenting with H1N1 Influenza and stroke emphasizes the importance of vaccination against Influenza infection.
Pediatric Emergency Care, April 2012


7). HIV testing in sexually active High School Students.
Only 22.6% of 7,591 high school students who report having ever had sexual intercourse, have been tested for HIV infection. Testing is most likely to have been done in those who have injected an illegal drug (41.3%), were physically forced to have sexual intercourse (36.2%), had not used a condom at last contact (28.7%) or had more than 4 sexual partners in the past year (34.7%).
Few sexually active high school students, even those at high risk for HIV infection are being HIV tested.

Archives of Pediatrics & Adolescent Medicine


8). Yoga instead of Physical Education (PE).!
Psychosocial well-being was assessed by utilizing questions administered to grade 11 or 12 students enrolled either in a 10-week (2-3 times per week) standard PE class or assigned to a similar timed Kripula-based yoga program (physical postures, breathing exercises, relaxation and meditation).
Though this is only a small study, preliminary data suggests preventive benefits in mood and psychosocial well-being (decreased stress and psychosocial attitude) from Kripula yoga.

Journal of Developmental and Behavioral Pediatrics, April 2012

9). N-acetylcysteine ( NAC ) in the prevention of Necrotising enterocolitis ( NEC).
An experimental rat model was utilized to evaluate by a variety of studies the preventive ability of NAC on the development of post ischemic NEC.
NAC given at the onset of the risk situation designed to produce NEC, significantly reduces in rat pups, the severity of the intestinal damage.
Journal of Pediatric Surgery, March 2012


10). Risk factors in Perinatal Stroke.
Risk factors of 60 mother-child pairs whose infants had had a perinatal stroke were evaluated.
Perinatal arterial stroke is a result of multifactorial mother and baby factors of which a prothrombotic state in mother and/or baby appears significant.

Pediatric Neurology, August 2007


11). Beyond age of first sex.
Approximately 50% of 12,194 adolescents/early adulthood respondents to a Longitudinal Survey of Adolescent Health, reported initiating vaginal sex at average age 16 years and spent more than 1 year before having sex again. One third reported an oral-genital experience first, prior to vaginal sex. Initiation of anal sex was less common.
While a small number of typical and atypical adolescent sexual patterns of behavior occur, a variety of complex associations appear to play a role.

Journal of Adolescent Health, May 2012





12). Overeating, Binge eating & Depressive symptoms.
A group of 4,798 female adolescents were prospectively studied over 1 year and followed for 4 years. Females with a history of episodic eating of a large amount of food over a short period of time were labeled “overeaters” (no loss of control) or “binge” eaters (those with loss of control over eating), and depressive symptoms assessed. Adolescent girls with depressive symptoms at baseline are twice as likely to start “over/binge” eating. Similarly those who episodically “over-eat/ binge” are twice as likely to develop depressive symptoms over time.

Journal of Adolescent Health, May 2012

13). Neuroimaging & Prognosis in “Shaken Baby” traumatic brain injury (ITBI).
28 babies with ITBI had radiological studies performed during the acute phase (0-3 days) of injury and 4 days – 1 month later, and the clinical outcome of survivors compared to their radiological studies.
Both early and late radiological signs of significant brain abnormality (basal ganglia/brain stem) are associated poor long-term neurological outcome.

Acta Paediatrica, June 2012


14). Child behavior & 47XYY  or 47XXY karyotypes.
One in 1,000 male births appears to carry the 47XYY karyotype and most remain unaware of their abnormality. The 47XXY (klinefelters syndrome – KS) karyotype occurs in 1:500- 1:1,000 live male births which usually presents (with variations) clinically following the onset of puberty.
In a group of 47XYY and 47XXY boys studied for behavioral difficulties most were found to be within normal limits while a subset (more so in the 47XYY group) were found to have significant impairment in a variety of domains.
Boys diagnosed with 47XYY or 47XXY karyotypes should receive extensive psychoeducation and be screened for learning disabilities and ADHD/Autism spectrum disorders.

Pediatrics, April 2012



16).  Aspiration in Neurodisabled children (ND).
ND children aspirate “from above” (direct aspiration) and “from below” (reflux aspiration)
Reflux pulmonary aspiration is common but difficult to diagnose, particularly in children with ND. Results of present treatment protocols reveal inconsistent outcomes. A pulmonary biomarker of aspiration would be helpful but is presently unavailable.

Journal of Pediatric Surgery, February 2012


17). Acute appendicitis & intra-abdominal abscess formation.
A large retrospective study of patients undergoing appendectomy for acute appendicitis indicates that the surgical technique utilized (laparoscopic or open surgery) does not appear to affect the incidence of intra-abdominal abscess formation.

Journal of Pediatric Surgery, February 2012


18). Prognosis of Liver disease associated with prolonged Parenteral nutrition (PN).
Intestinal associated liver disease (ILD) has been reported in 40% to 60% of children receiving PN. 87 infants receiving long term PN for at least 28 days were assessed and 33% of them diagnosed with ILD.
24-month follow up of patients receiving PN with associated ILD indicates that most can be managed medically and that the majority of them reverse their liver disease. Most subsequently can be fed enterally.

Journal of Pediatric Surgery, February 2012

19). Flumazenil induced seizures.
Flumazenil is a benzodiazepine (BZ) antagonist frequently used as an antidote in the treatment of BZ overdose (it may also be effective in non-BZ sleep enhancing drug overdose). The most serious side effect of its usage is seizures.
A retrospective study of 83 children (3 mths – 12 years) given Flumazenil primarily for BZ poisoning found NO occurrence of Flumazenil associated seizures.

Pediatric Emergency Care, May 2012


20). Dangers of All Terrain Vehicles ( ATV's).
ATV usage in children continues to increase in a relatively unregulated environment. A study over a 5 year period of children <16 years of age seen at a Level 1 Trauma unit identified and compared the number of ATV injuries to those associated with motorcycle (MCC) and motor vehicle crashes (MVC).
Results indicate an almost doubling of ATV related injuries over the 5 year period examined.
ATV related injuries are >30 fold and 20 times respectively more likely to occur than those associated with motorcycle or motor vehicle accidents.

Pediatric Emergency Care, May 2012



21). "Distraction" as a technique to diminish pain.
A study of a “distraction” technique (compared to a control group) using audiovisual (A/V) glasses, on pain perception was undertaken during administration of local anesthesia in 45 healthy, cooperative 5-7 year old children undergoing nerve block anesthesia.
Pain perception using A/V glasses is significantly reduced in children undergoing injection of local anesthesia.
Pediatric Dentistry, March/April, 2012

22). Breast feeding protects against Asthma.
A prospective study of 1,105 infants followed regularly over a 6 year period and adjusted for confounding influences indicates that for each month of exclusive breast feeding, a significant reduction in asthma occurs, a greater effect being seen in atopic infants exclusively breast fed for > 3mths.

Journal of Pediatrics, June 2012


23). ECMO for Acute Respiratory Failure in a patient with Chronic Granulomatous Disease. (CGD).
CGD is a diverse group of hereditary diseases in which some of the cells of the immune system cannot generate, mostly, the superoxide radical required to kill ingested pathogens. Granulomata form as a result, in many organs.
This case report of a 9 year old CGD boy who presented with fulminant respiratory failure and who was treated with ECMO, and survived, indicates that a diagnosis of CGD should not be considered a contraindication to ECMO therapy.

Journal of Pediatric Surgery, May 2012



24). Disability following Congenital Diaphragmatic Hernia (CDH ) repair.
24-36mth follow up of 44 CDH survivors indicates that 27% have neurodevelopmental, 20.5% gastrointestinal, 11.4% pulmonary and musculoskeletal and hearing difficulties and 45% a cardiac disability, respectively.

Journal of Pediatric Surgery, May 2012



25). Genetic polymorphisms in Idiopathic Nephrotic Syndrome.(INS).
INS is the most frequent type of nephrotic syndrome in children. 74 children with INS categorized either as steroid-sensitive (SS) or steroid-resistant (SR) had genetic polymorphisms of the CYP3A5 and ABCB1 genes examined and comparisons made between those children who were SS or SR.
The C1236T polymorphism in the ABCB1 gene appears to be associated with INS steroid resistance in children.

Pediatric Nephrology, June 2012