Volume IV
Issue 5

              Weekly Updates in Pediatrics         January 30, 2013

EDITOR:  Jack Wolfsdorf, MD, FAAP                   

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The effects of massage therapy on preterm infants


A randomized placebo-controlled study of stable preterm infants who received (or not!) massage therapy five days/week until hospital discharge (or a maximum of 4 weeks) and whose immune system, weight, number of infections and length of hospital stay were evaluated, indicates:


Benefits of massage therapy for preterm infants include higher NK cytotoxicity (improved killing of infective agents), and an improved daily weight gain.


Source:  Pediatrics

Long term effects of recurrent neonatal hypoglycemia  


A follow up of 47 index children previously reported to have significant motor and cognitive development abnormalities at 18 months of age associated with recurrent asymptomatic hypoglycemia (blood sugar < 20 mg/dl on > three days) indicates that by 3 years of age, no differences in physical or developmental progress (compared to a matched non-hypoglycemic group) can be detected.


A 15-year follow up indicates that recurrent asymptomatic low blood glucose levels found during the first 10 days of preterm infants' life usually does not pose a long-term hazard to later physical and cognitive development.


Source:  Pediatrics 

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Zinc deficiency-a hazard for premature babies   

An interesting case report of a normal 16 week old breast-fed premature infant who presented with erythema and crusting over the lips, nose and small joints of the hands and feet (negative for viruses/bacteria), reminds us that zinc plays an important role as a essential element; the lack of which affects many systems. Oral zinc supplementation (1mg/kg/day) results in significant improvement in 48 hours.


Zinc deficiency in infants presents with distinctive clinical manifestations which include irritability and a rash over the face, perineum and extremities. Adequate consumption of maternal zinc during pregnancy enhances breast milk zinc levels.

Source:  BMJ 2013; 346:e8642  

Video Feature
First Days - Parenting in the NICU.
First Days - Parenting in the NICU. "Coping with Uncertainty"
March of Dimes via YouTube

"Booster seats" for 6-7 year old children


"Car crashes are the number 1 killer of children 1-12 years of age in the USA". In Florida, child restraints are mandatory for children < 3 years of age. Adult seat belts are permissible for 4-5 year old children. States vary in their requirements. Booster seats which position the lap and shoulder belt correctly are frequently used for children > 4 years of age and > 40 lbs weight. Many booster laws however, exclude children 6-7 years of age. booster seat


A National retrospective study of 4-7 year old children involved in motor vehicle accidents indicates a significant decrease in childhood motor vehicle fatalities for 4-7 years of children in booster seats - particularly for those aged 6-7 years.  Booster seats should be mandatory in all states for children 6-7 years of age.


Source:  Pediatrics

Labial fusion: Etiology


Labial adhesions, usually asymptomatic, are common (approximately 2% of females up to the age 6 years) in pre-pubertal girls and are thought possibly to be related to diminishing maternal estrogen levels, local irritation, and the use of laundry products, soaps and detergents in the diaper area. Treatment is usually conservative utilizing an estrogen cream.


A study of 29 patients who had previously been treated for labial adhesion and had a recurrence was utilized to investigate the etiology of recurrent labial fusion. A wide variety of possible etiological factors were retrospectively analyzed.


Labial fusion appears unrelated to product of hygiene, frequency of diaper dermatitis, duration of breast milk feeding, presence of infection or prenatal factors.


Source:  Journal of Pediatric Surgery 

Serum Hepcidin & C- reactive protein to diagnose late-onset neonatal sepsis  


Hepcidin is a peptide hormone produced by the liver which appears to regulate (inhibits) iron transport across the gut mucosa. In inflammatory state Hepcidin levels increase.


A small study of 17 very low birth weight infants with sepsis which examined CRP and Hepcidin levels (comparing them to a matched group of non-septic infants) found that Hepcidin levels increase four fold (and to a much grater extent than the CRP) with infection and return to a non-infective patient level following treatment. It appears to be a valuable adjunct test in the evaluation of late onset neonatal sepsis.


Source:  Journal of Pediatrics