March 11, 2015   Vol. VI, Issue 10
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2-day-old newborns recognize their mothers by her axially odor.

Immediate post-natal skin-to-skin contact between mother and baby appears to have multiple benefits to both: Relaxing the mother, improving birth experience, enhancing bonding and breast feeding. Babies have less cold stress, longer periods of sleep, improved weight gain, better brain development, and decreased crying with longer periods of alertness and earlier hospital discharge.


A study of 19 vaginally delivered 2-day old breast feeding infants following maternal-infant skin-to-skin contact, on exposure to their own mother's axillary odor on a pad and the odor of another unfamiliar new mother indicates that babies are able to recognize their mother's axillary odor (measured by time to and the length of head orientation towards their mother's pad.)


Acta Paediatrica 

Fluticasone and Montelukast in preschool wheeze 

30% of preschool children younger than 3 years of age experience at least 1 episode of wheezing. While antihistaminics are frequently prescribed, their efficacy remains questionable.

A prospective study of children 3-36 months of age with a first to third preschool wheezing episode randomly assigned to receive Montelukast (an anti-inflammatory leukotriene inhibitor produced by mast cells and basophils) fluticasone (a corticosteroid) or no treatment for 12 weeks, assessed benefits. Neither Montelukast nor fluticasone appears effective in preventing wheezing in young preschool children.


Clinical Pediatrics 



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Prepare for the ICD 10 Deadline Without Blowing Your Budget: Free Resources  

By Kathy McCoy

Are you getting started with preparation for the transition to ICD-10 coding, and worried about how to make the transition in time for the ICD 10 deadline? Concerned that just the cost of training will blow your budget?


If so, good news: There are a lot of free resources available to help you plan and make sure your practice is ICD-10 ready.

Here are a few we recommend...



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Less invasive surfactant administration (LISA) in spontaneously breathing preterm infants.


"Bronchopulmonary dysplasia (BPD) is one of the most prevalent chronic morbidities associated with preterm birth". While the pathogenesis remains largely unknown many factors (including genetic), their timing, extent and duration play a role in the different patterns of BPD seen. Since mechanical ventilation is a major factor in producing lung injury, many advocate the use of non-invasive ventilation techniques in combination with surfactant to reduce the incidence of BPD.


A study of 1,103 infants born <32 weeks gestation treated with LISA and compared to a matched control group, indicates that LISA treated infants have lower rates of mechanical ventilation, post-natal dexamethasone treatment, BPD and death.


Acta Paediatrica 

Video Feature 

(via YouTube)
Pediatric Orthopedics: Osteomyelitis in Children
Pediatric Orthopedics: Osteomyelitis 

Comparative effectiveness of intravenous (IV) vs. oral antibiotics for post discharge treatment of acute osteomyelitis in children


Post discharge treatment of acute osteomyelitis treatment requires multiple weeks of antibiotic treatment. A peripherally inserted central catheter (PICC) is required for prolonged IV therapy. These carry significant risks.


A study examined the benefits and risks associated with oral vs. IV post discharge antibiotics in 2,060 children/adolescents with osteomyelitis. It appears that patients treated with oral antibiotics do not appear to experience more treatment failure, nor suffer more adverse drug reactions. Clinicians should consider oral post discharge antibiotic treatment for childhood osteomyelitis treatment.


JAMA Pediatrics

A review of pre-hospital use of activated charcoal (PAC).


Activated charcoal binds ingested poisonous substance through he entire length of the gastrointestinal tract. Activated charcoal should not be used in the situation of poisoning with lithium, strong acids or alkalis, metals and inorganic minerals, alcohols or hydrocarbon ingestion or when a patient cannot adequately protect his/her airway.


A study of 281 adult patients given PAC indicates that few have significant complications  and its administration does not appear to delay transport or the arrival of the overdosed patient to the emergency department.


American Journal of Emergency Medicine 

Validity and reliability of measurement of capillary refill time (CRT) in children


A retrospective systematic review of a number of databases utilized to define the normal range of CRT in healthy children (over 7 days of age) indicates that the upper limit of normal CRT for the finger is 2 seconds and 4 seconds, when measured on the chest or foot (with moderate pressure for 5 seconds at an ambient temperature of 20C-25C). 


Archives of Disease in Childhood 

Schooling duration rather than chronological age predicts working memory between 6 and 7 years


"Low working memory (WM) is strongly linked with poor academic

Dr Susan Gathercole explains Working Memory
Dr Susan Gathercole explains Working Memory



A study of 1,727 children in their second year of formal schooling had their WM assessed throughout their school year.


WM increases steadily with time spent in the classroom, above and beyond chronological age.


Journal of Developmental and Behavioral Pediatrics 

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