MCH Updates in Pediatrics Masthead  

                       Volume IV
                        Issue 32
                                                           South Florida's  only licensed  free-standing
                                                             specialty hospital  exclusively for children ...                                                      August 7,  2013 
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Post-mortem blood/MRI studies & cause of death in infancy  

The rate of conventional autopsies to diagnose cause of death in the infant has been steadily falling over many years (now 21% for neonates in the UK).

 

A study of the results of 400 fetuses, babies and children who were undergoing conventional whole-body postmortem examinations compared the cause of death to that obtained by postmortem visual examination of the body, magnetic resonance imaging (MRI), blood samples taken by needle and genetic and metabolic study.

 

Comparing conventional whole-body postmortem results to the cause of death diagnosis found following autopsy MRI combined with other tests results in 95-96% concordance for fetuses, 81% for newborn babies, and 85% for infants up to 12 months of age. (Between 12 months and 16 years concordance is 54%).

 

BMJ

Viral infections in infancy & the development of Asthma

Wheezing frequently occurs in association with viral respiratory tract infections (Respiratory syncytial virus-RSV, human rhinovirus-HRV, metapneumovirus, parainfluenza, coronavirus and other viruses). Usually these wheezing episodes diminish with time, however in some children early-life, severe wheezing episodes mark the beginning of asthma. (A strong family history of asthma is usually present). The risk appears greatest with wheezing caused by HRV or RSV.

 

A study of 67 children (and matched controls) who had been hospitalized with bronchiolitis at < 24 months of age and who were prospectively followed-up to 16.5 years, indicates that doctor-diagnosed asthma occurs most frequently (30% vs. 5% controls) following HRV infected brochiolitic infants, higher than for RSV or other virus infected patients.

 

Pediatric Pulmonology

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Bed-sharing & risk of Sudden Infant Death (SIDS)     

 

SIDS remains a major cause of death for babies < 1 year of age. While some experts (USA) have advised mothers never to sleep in the same bed as their babies of < 3 months of age; in the UK and other countries this practice has only been advocated against for parents who smoke, drink alcohol or take drugs.

 

A recent analysis of 1,472 cot deaths and 4,679 control cases indicates that bed sharing with small babies increases the risk of SIDS up to 5 fold and is 15.6 times higher with babies who are bottle fed and parents who are smokers and/or drinkers. 81-88% of SIDS cases in breast fed babies < 3 months of age can be prevented by parents/babies sleeping in different beds during this time period.

 

BMJ 

Video Feature 
SIDS or Sudden Infant Death Syndrome 
SIDS or Sudden Infant Death Syndrome

Advocate Medical Group via YouTube

Superficial neck infections-who requires surgery?     

 

Superficial neck infections including lymphadenitis with and without abscess formation are common in children and frequently require computed tomography (CT) and/or ultrasound (US) to confirm the presence of an abscess which might necessitate surgical drainage. Criteria for determining the need for imaging are unclear.

 

A retrospective review of 768 patients with a diagnosis of cervical lymphadenitis or abscess who were fully investigated, was analyzed to determined which of a number of characteristics are more likely to be associated with an abscess that requires drainage.

 

Risk factors for surgical draining requirements of a superficial neck infection include:

 

1.    A previous Emergency Department visit.

2.    Age < 4 years.

3.    Fluctuance on physical examination.

 

Patients without the above (along with no prior antibiotic use) have < 4% chance of having an abscess that requires surgical intervention.

 

American Journal of Emergency Medicine 

Recombinant human hyaluronidase-facilitated subcutaneous (rHFSC) rehydration     

 

Mild to moderately dehydrated children frequently present to an Emergency Department. A cost-effectiveness evaluation of isotonic fluids administered via rHFSC vs. intravenous (IV) fluid administration was undertaken, with successful outcome effectiveness being measured by no requirement for subsequent hospitalization.

 

Across all pediatric age groups rHFSC rehydration appears more effective and cheaper that administering IV fluids, particularly in young patients where IV access may be difficult.

 

American Journal of Emergency Medicine

 Childhood neuromotor development of very low birth weight (VLBW) infants  

 

A prospective longitudinal study of 65 VLBW children examined at 6 and 10 years of age (without cerebral palsy), demonstrated that adaptive fine motor tasks, gross motor tasks, and static balance improve over time, though children with mild neurologic abnormalities at 6 years improve less. The majority of neuromotor functions however remain abnormal in many children.

 

Acta Paediatrica 

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