Weekly Updates in Pediatrics         December 19, 2012 

EDITOR:  Jack Wolfsdorf, MD, FAAP 


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Neurologic complaints in young children in the ED. When to do a cranial CT scan?

The records of 394 children one month through 6 years of age who had received a head CT in a large ED, were analyzed for age, sex, chief complaints, history, physical examination, indication and results of head CT, "red flags" in the above and final disposition. Most common indications for emergency head CT included, trauma (65%), seizures (11%), and headaches (6%). Head CT abnormalities were found in 40% at risk ED children, with 32% of them being certified as "significant"


All children who have   "significant" head CT abnormality appear to have "red flags" in both history and physical examination. The 35% of CT scans done on children without "red flag" do not contribute to their acute management.


Source:  The American Journal of Emergency Medicine

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Enteroviral meningitis without CFS pleocytosis


A retrospective analysis of 390 children diagnosed with enteroviral meningitis by CSF reverse transcription-PCR testing, indicates that 16-18% of them have no pleocytosis. Absence of pleocystosis is particularly associated with younger age, lower peripheral white blood cell count, and shorter interval between onset and spinal tap.


Source:  Archives of Disease in Childhood 

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Cyber and traditional bullying 


15% of 14-15 year old school children engage in cyber bullying, 21% in traditional bullying and 7% in both. Previous engagement in relational aggression is a predictor for cyber bullying. For traditional bullying previous interpersonal aggression, family conflict and academic failure appear to be a risk factor. Prevention programs reduce all forms of bullying.  


Source:  Journal of Adolescent Health 

Variance of Guillain-Barr (GB) syndrome in children

GB syndrome is characterized by acute progressive weakness, areflexia, and maximal motor disability that occurs within four weeks of onset.

Variations in GB syndrome presentation include: Demyelinating polyneuropathy (67.4%) acute axonal neuropathy (7%), Miller Fisher syndrome (a descending paralysis that usually affects the eye muscle, with a triad of opthalmoplegia, ataxia, and areflexia) (7%), Bickerstaff brainstem encephalitis (similar to Fisher syndrome plus drowsiness, or hyperflexia) (7%), pharyngo-cervical-brachial variance (4.7%), and polyneuritis cranialis (4.7%).


Fetal second trimester weight gain predicts childhood obesity


A study comparing the estimated fetal weight of 438 children at 16-20 weeks of gestation, and at each quartile till birth, (using ultrasound biometry measures) to body weight at 3 years of age, indicates that rapid fetal weight gain and persistently high weight during the second half of gestation predict over-weight at age 3 years.


Source:  The Journal of Pediatrics 

RSV infection and chronic respiratory morbidity


Prematurely born infants with lung damage appear to predispose those infants following RSV tract infection, to long term respiratory morbidity. In term infants single neucleotide polymorphisms in genes coding for IL-8, IL-19, IL-20, IL-13 mannose-binding lectin, IFNG and a RANTES polymorphism, all have been associated with subsequent wheezing following RSV lower respiratory tract infection.


Source:  Acta Paediatrica