May 14,  2014   Vol. V, Issue 20
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Cardiovascular effects of passive smoking on infants.

A study of beat-to-beat blood pressure reaction (BPR) during brief repositioning maneuvers (mild stress) of 4-6 month old infants exposed during daytime naps to passive smoke indicates that such exposure increases cardiovascular reactivity (20 fold) early and strongly. Families need to be aware that exposing infants to passive smoke has significant deleterious effects (Ed).

Effects of Secondhand Smoke
Effects of Secondhand Smoke

Acta Paediatrica 

 Relative bioequivalence of Amoxicillin dissolved in breast milk.

While oral liquid formulations of antibiotics for infants are freely available in developed countries, in developing communities the water supply may not be safe and the formulations may not be freely available.

 

A pharmacokinetic study in a randomized crossover design study, evaluated the oral administration, in 16 healthy fasting adults of amoxicillin powder dissolved in either human milk or water. Timed blood samples measured plasma amoxicillin levels.

 

Oral administration of amoxicillin dissolved in human milk results in similar plasma levels (and kinetics) to that of amoxicillin dissolved in water.

 

Archives of Disease in Childhood

Do You Know the Top 5 Ways to Improve Your Practice Workflow?

Guest Blog by Kathy McCoy 

 

Economic pressures are forcing many practices to look for efficiencies in their workflows. It's important to perform this type of assessment on a regular basis in order to keep your practice as efficient as possible.

INFORMATION BONUS!   

 

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Head Injury-hematocrit as an indicator of abusive head trauma (AHT).

 

Diagnosing AHT may be difficult and as concern exists regarding radiation exposure during head CT, a retrospective review of 1,129 traumatic head injured patients under 5 years of age (mean 1.7 years) was undertaken to assess early indicators of AHT.

 

Of 429 children identified with AHT, 48% have a hematocrit of <30% on presentation (compared to 19% of non-AHT children) which was highly predictive, as was a platelet count >400,000.

 

Journal of Pediatric Surgery

Scaphoid fracture in children.

 

The scaphoid bone is the largest of the proximal carpal bones of the wrist, situated between the hand and forearm on the lateral (radial or thumb) side. While fractures are uncommon, suspected fracture of the scaphoid is not.

 

A study of scaphoid fractures in children <13 years undertaken over a 5 years period indicates:

  • 6.7% of suspected scaphoid fractures are confirmed.
  • Most occur in boys, average age 12.2 years.
  • Scaphoid fractures under the age of 11 years (boys)/9 years (girls), are very rare.
  • Most fractures involve the distal third and carry a good prognosis with conservative management.

Journal of Pediatric Orthopedics 

Video Feature  
Scaphoid Fracture
Scaphoid Fracture
via YouTube

Effects of bedtime and sleep duration on academic and emotional outcomes of adolescents (grades 7-12).

 

Late school year bedtime is associated with shorter sleep times which may result in worse educational outcomes and emotional distress 6-8 years later. Many adolescents go to sleep at 11:15pm or later during the school year and sleep fewer than the recommended 9 hours.

 

Journal of Adolescent Health

Buccal midazolam for pediatric status epilepticus (SE).  

 

Prolonged seizures (or status epilepticus) is a common life threatening epileptic crisis which requires aggressive management. Treating physicians should not wait for blood level results of antiepileptic drugs previously administered. Usually intravenous (IV) diazepam (Valium) or lorazepam (Ativan) (after IV bolus of 50% dextrose; additionally consider IV thiamine/naloxone) are the anti-convulsants of choice, followed by phenytoin. (Monitor; airway-breathing-circulation; oxygen saturation (intubatation if necessary), IV fluids/urine output; laboratory studies including electrolytes, calcium, magnesium, CBC, liver and renal function tests and toxicology screening).  

 

Buccal midazolam (Versed) has emerged as an effective alternative for prolonged seizures. A study of 34 carers, after using buccal midazolam administration for SE, evaluated its effectiveness, convenience and adverse effects.

 

It appears that most families find using buccal midazolam effective, easy to administer, & safe with less sedative effects than rectal diazepam.

 

Acta Paediatrica 

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