Volume IV
Issue 9

              Weekly Updates in Pediatrics         February 27, 2013

EDITOR:  Jack Wolfsdorf, MD, FAAP                   

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Biomarkers of renal involvement in children with juvenile-onset SLE

Over 80% of patients with juvenile- onset SLE will have renal involvement; the " gold standard " of documentation being histological. While this involves an invasive procedure, proteinuria, complement level, anti- double- stranded DNA antibodies & serum creatinine concentrations do not adequately predict renal flare-ups.


Promising novel biomarkers for juvenile lupus nephritis include urinary neutrophil galatinase, associated lipocalin, monocyte chemoattractant protein -1 & transforming growth factor- beta. It appears likely that a combination of biomarkers are required to detect lupus nephritis.


 Methylene blue for the treatment of refractory anaphylaxis without hypotension

Anaphylaxis is primarily treated with epinephrine. In refractory normotensive anaphylactic patients the Joint Taskforce on Practice Parameters has proposed the use of methylene blue, a competitive inhibitor of guanylate cyclase (& an inhibitor of vasodilatation) for such patients.


A case report of an adult women who developed anaphylaxis unresponsive to multiple doses of epinephrine/steroids/diphenhydramine & who responded dramatically with improvement after 6 mins treatment with an IV infusion of 1% methylene blue (1.5mg/kg) demonstrates its value in such a difficult situation.


(Ed. Note: methylene blue has also recently been recommended for refractory hypotension.)


Source:  The American Journal of Emergency Medicine 

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Infant massage therapy (iMT) & non-nutritional motor therapy (NNOMT) to enhance oral feedings in very low birth weight (VLBW) infants


A scale that takes into account nutritive sucking skills & sucking endurance (feed volume measured at 5mins after onset of feeding) demonstrates that VLBW babies exposed to these therapies (& compared to a non- intervention matched group) have enhanced maturation of oral feeding capability.


Source:  Journal of Neonatal-Perinatal Medicine 

Video Feature
Infant massage--part 1
Infant massage--part 1
Luther Hospital via YouTube

Sleep time trends in children


Sleep time steadily decreases with age, varies significantly from child to child & is differently distributed over the 24 hr period between weekdays & weekends. Most studies simply report parental observations as the yardstick of time, though perhaps more importantly, the tools to measure "optimal" sleep time should take into account other variables (vigilance, sleepiness, cognitive & emotional functioning).


A study reporting percentile distribution of children's sleep indicates, on average,

  • infants (from 3 months of age) sleep 13 hrs/day
  • 1-3 yr olds sleep  10-13 hrs/day
  • preschool/school age sleep ~ 10hrs/day.
  • teens sleep  9 hrs/day (though parents may think otherwise!)

Source:  JAMA Pediatrics 

Treatment of pediatric pulmonary arterial hypertension (PAH)


Ambrisentan (Letairis) is a selective type A endothethelin receptor antagonist (causing vasodilatation) was approved in 2007, for the treatment of adult PAH, to improve exercise capacity & to delay clinical worsening in such patients. The efficacy, pharmacokinetics & safety in children has not been extensively studied. 38 children with PAH were treated primarily or secondarily (following a different endothelin antagonist ) with ambrisentan & pulmonary artery pressure, pharmacokinetics & adverse events assessed.


Ambrisentan appears to be safe (though 39% of children had some relatively minor side effects), & efficacious for pediatric PAH , with similar pharmacokinectics to those found in adults.


Source:  Pediatric Pulmonology 

Long term cardiac effects of prematurity


Cardiovascular magnetic imaging undertaken on adults born preterm ( prior to full left ventricular development ) indicates a prolonged deleterious effect on the left ventricle.


Adults born preterm demonstrate increased left ventricular mass, a unique left ventricular 3 dimensional configuration & loss of both systolic & diastolic function.


Source: Circulation



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