MCH Updates in Pediatrics Masthead  

                       Volume IV
                        Issue 18
                                                           South Florida's  only licensed  free-standing
                                                             specialty hospital  exclusively for children ...                                                      May 1, 2013 
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FIU Tile Ad April 2013  
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Additive antiproteinuric effect of enalapril plus losartan in post-hemolytic uremic syndrome (HUS) children

Enalapril (vasotec) is an angiotensin converting enzyme (ACE) inhibitor that vaso dilates post- glomerular nephron blood vessels thereby decreasing glomerular vessel permeability, and losartan (Cozar) is a selective competitive angiotensin II receptor antagonist which not only decreases peripheral vascular resistance but also enhances impaired auto regulation of the renin system following kidney injury. Both individually decrease postdiarrheal HUS (D+HUS) proteinuria.

 

A post-acute study of 17 D+HUS enalapril treated proteinuric children given an additional 1.0 mg/kg/day (median dose) losartan, indicates that a further 83.8% reduction in proteinuria occurs, without significant adverse effects on serum potassium, glomerular filtration rate, and blood pressure.

 

Cardio-respiratory response to moderate chloral hydrate (CH) sedation (in lambs)

Chloral hydrate was introduced into pediatric medical use in 1894. In general it produces effective short term sedation (particularly in the less than 3 year old child) without significant adverse effects though it tends to have an unpredictable onset and long duration. It is probably superior to midazolam for procedural sedation, however it may cause mild respiratory depression, nausea and vomiting in 4-15% of children and cardiorespiratory monitoring is required.

 

A lung function study of 13 chronically instrumented 7-8 week old lambs which measured functional residual capacity (FRC), airway function, distal airway gas mixing, inspiratory drive and oxygenation indicates that moderate CH sedation does not affect airway function, FRC or inspiratory drive, though minute ventilation decreases slightly. Cardiovascular parameters are unaffected.

 

CH is a reliable sedative for lung function testing in small children.

 

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Mortality after discharge following an Apparent life-threatening episode (ALTE)   

 

A 5 year retrospective chart review of 176 infants (0-6 months of age) who met Emergency Department criteria (and were fully investigated) for a first episode ALTE was utilized to follow their subsequent clinical course.

 

At 34 months (mean) 1.1% of survivors had died, with deaths occurring within 2 weeks of discharge.

 

The American Journal of Emergency Medicine  

Video Feature
Apparent Life Threatening Event (ALTE)
Apparent Life Threatening Event (ALTE)
University of Rochester via YouTube

Post-natal steroid use in preterm infants  

 

A new study on the potential benefits of post-natal steroid use in very preterm infants to decrease ventilator dependence, BPD and/or death has been outstandingly commented on recently.

 

In summary:

  • The benefits of steroid use for the conditions above, remain unknown, as clear evidence on the subject is not available.
  • High doses of dexamethasone (>0.25mg/kg/dose or >1.0mg/kg/total) should be avoided (it reduces brain volume and increases risk of disability); low dose dexamethasone (0.15mg/kg/dose or 0.9mg total) does not improve BPD or survival.
  • Neither low nor high dose hydrocortisone after the first week of life have been proven to improve rate of survival without BPD.

More data is required.

 

Dysfunctional voiding (DV) in asthmatic children

 

The demographics and asthma related characteristics of 178 asthmatic 4-10 year old children and healthy subjects with DV (any voiding symptom and/or urinary incontinence) were compared.

 

Suspected DV appears to occur in 27.9% of mostly younger (<6 years) asthmatic children who are already toilet trained, and 6.6% of comparable healthy subjects.

 

Archives of Disease in Childhood 

Capillary refill time (CRT) in children

 

Capillary refill time is the rate in seconds at which blood refills empty capillaries under normal environmental temperatures following compression. In infants and children it is usually measured by emptying the capillary bed with pressure on a finger (nail or pad), toe or sternum. Normal CRT is less than 2 seconds for the upper limbs and 3 seconds for newborns and lower limbs.

 

A study of 92 essentially normal children (aged 0-12 years) measured the correlation between fingertip and sternal CRT.

 

CRT ranges are wide for both fingertips and sternum and the 2 poorly correlate. The value of this test is questionable.

 

Archives of Disease in Childhood 

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