MCH Updates in Pediatrics Masthead  

                       Volume IV
                        Issue 21
                                                           South Florida's  only licensed  free-standing
                                                             specialty hospital  exclusively for children ...                                                      May 22, 2013 
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FIU Tile Ad April 2013  
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Childhood self-control and adult outcomes

A 30 year longitudinal study from birth relating self-control measures during ages 6-12 years of age was utilized to relate (at 30 years of age) subsequent criminal offending; substance abuse; education/employment; sexual behavior and mental health, adjusting for confounding factors like gender, socio economics, I.Q. and childhood conduct problems.

 

After adjusting for confounding factors few outcomes at 30 years of age appear to be associated with childhood self-control.

 

The Journal of the American Academy of Child and Adolescent Psychiatry

Low Back Pain in Children 

Low back pain is common in children. Undiagnosed mechanical low back pain (UMLBP) is the most common cause of back pain presenting in adolescents: spondylolysis/spondyloisthesis is the most common diagnosed pathology (stress fracture of the 5th and 4th lumbar vertebrae and inability of the vertebra to maintain its normal position respectively).

 

A retrospective review of 2,159 patients (average age 14.3 years) diagnosed with UMLBP reveals:

 

1.  Most cases of UMLBP require no imaging and < 2 office visits.

 

2.  For spondyloysis, 2-view plain films are often diagnostic.

 

3.  Advanced imaging increases diagnostic accuracy but rarely changes clinical management and increases costs and radiation exposure. They should be used sparingly.

 

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Do different respiratory viruses result in variations of risk factors for bronchiolitis severity?

 

Nasopharyngeal aspirates and clinical and demographic data on 410 children < 12 months of age admitted to a pediatric ward or pediatric ICU with a diagnosis of bronchiolitis was utilized to evaluate whether type of virus or classical risk factors (caesarian birth, prematurity, congenital heart disease and BPD, etc.) are more important in determining severity of bronchiolitis (assessed by a clinical score).

 

16 different respiratory viruses (singly or mixed, identified by PCR) may be isolated from infants with a diagnosis of bronchiolitis. On multivariate analysis, classical clinical risk factors appear to be of greater importance in predicting severity of bronchiolitis in infancy.

 

Pediatric Pulmonology
Video Feature
What's the Prognosis for a Child Diagnosed With Bipolar Disorder?
What's the Prognosis for a Child Diagnosed With Bipolar Disorder?

Child Mind Institute via YouTube

"Spontaneous breathing trial" (SBT) as a predictor for successful extubation in preterm infants

 

The ability of clinicians to successfully predict which premature, intubated and ventilated infant will undergo successful extubation remains limited. A study of 49 infants whose respiratory compliance and SBT was performed prior to elective extubation in young (<3 weeks of age), premature (<32 weeks gestation) infants indicate that 80% of infants who pass SBT remain extubated independent of their respiratory compliance.

 

A successful "spontaneous breathing trial" appears to be a valuable objective predictor of successful extubation in ventilated preterm infants.

 

Pediatric Pulmonology 

Administration of oral erythromycin and the development of hypertrophic pyloric stenosis (HPS).

 

An interesting case report of an infant who received an abbreviated 4 day course of oral erythromycin reminds us that early administration of this drug to babies may be associated with the subsequent development of HPS. A second article examining retrospectively the electrolyte imbalance that is usually described with this disease, warns us that the classic hypochloremic, hypokalemic, metabolic alkalosis is not necessarily a common finding. Normal sodium bicarbonate (62%), potassium (57%) and chloride levels (69%) are commonly found in this disease.

 

Pediatric Emergency Care: Pyloric Stenosis & Electrolyte Profile

"Secondary inflammatory ultrasound signs" as a guide to a non-visualized appendix with appendicitis

 

"Acute appendicitis is the most prevalent emergency surgical diagnosis in children." Usually a clinical diagnosis, graded compression sonography has been increasingly used to avoid misdiagnosis.

 

In approximately 37% of children with a suspected diagnosis of appendicitis the appendix is not visualized on ultrasonography. Abdominal fluid (especially with enlarged lymph nodes) phlegmon and pericecal inflammatory fat changes are important and very specific secondary signs of acute appendicitis.

 

Pediatric Emergency Care 

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