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MCH Updates in Pediatrics Masthead
November 20, 2013   Vol. IV, Issue 47
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Obesity and chronic kidney disease (CKD).   

Obesity is not only a comorbid factor for CKD but is possibly also a risk factor. Elevated levels of adipokines (leptin and adiponectin), hypertension, cardiovascular morbidity, insulin resistance, dyslipidemia, and lipotoxicity may all play a role in the pathogenesis of CKD in obesity. Individual and community-based obesity prevention/interventions can play an important role in reducing the burden of CKD.

 

Pediatric Nephrology 

Diabetic Ketoacidosis (DKA), cerebral hyperemia and IV fluid administration.

Cerebral edema commonly occurs in children with DKA, however while only 0.5-1% of them develop severe life-threatening cerebral injury, subtle memory loss can be found in many, even without overt symptoms.

 

Near-infrared spectroscopy (NIRS) measures regional cerebral oxygen saturation in the anterior brain, and higher levels occur in patients with cerebral hyperemia.

 

A study of cerebral oxygen saturation levels undertaken in a critical care unit of 19 DKA episodes in children 8-18 years of age with either more rapid or slower intravenous treatment indicates that all children with DKA have cerebral hyperemia (starting as early as the second hour of treatment) persisting for > 27 hours, independent of the rate of fluid administration (only 1 patient was treated for suspected cerebral edema).

 

Journal of Pediatrics 

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Alcohol use from childhood through adolescence.

 

452 children aged 8-10 years, randomly sampled, had longitudinal data collected regarding initiation of alcohol use.

 

Childhood experience with alcohol is widespread.

 

Between 8.5 and 12.5 years of age children can be divided into "abstainers" and "sippers" (67% by age 12.5 years!).

 

Between 13-18 years age children can be divided in to 3 groups: "abstainers", "sippers/light drinkers" and "drinkers with drunkenness" (by 18 years 55% of children are "sippers/light drinkers" and 58% are "drinkers with drunkenness").

 

Journal of Adolescent Health 

Video Feature  
Teens and Alcohol - Akron Children's Hospital video
Teens and Alcohol - Akron Children's Hospital video
 via YouTube

Predictor of intraventricular hemorrhage (IVH) in the preterm infant: Activin A

   

Activin A is a protein complex produced in the gonads, pituitary, placenta and other organs. It has a number of biological functions including androgen synthesis, wound healing, activation of fibroblasts, scar formation, morphogenesis (the lack of which results in neural developmental defects) and many others.

 

A case-control study of 100 preterm newborns (with and without IVH) examined urine Activin A levels at 5 predetermined time points within the first 72 hours and at 1 week after birth, respectively.

 

Urine Activin A levels in infants who develop IVH (confirmed by ultrasound) is a promising tool to identify infants at risk for IVH as it significantly increases progressively from first urine void to 24 hours.

 

Acta Paediatrica 

A Novel biomarker panel to identify appendicitis in children presenting with abdominal pain.

 

3 inflammation-related biomarkers: white blood count (WBC), C-reactive protein (CRP) and myeloid-related protein 8/14 complex (a member of calcium modulated proteins that control inflammation) together have a 96.5% sensitivity, a 43.2% specificity and a 96.9% negative predictive value for acute appendicitis. It is suggested that the use of this panel in children with abdominal pain and possible acute appendicitis, will reduce abdominal CT scans by 32%.

 

The American Journal of Emergency Medicine

Behavioral sleep intervention in the first 6 months of life - outcomes.

 

Cry-fuss, feeding and sleep problems are the result of multiple interacting factors and are generally referred to as regulatory problems.

 

A widespread search of a number of databases was performed on systematic reviews, meta- analyses, clinical trials and cohort studies of behavioral interventions for sleep when applied to infants younger than 6 months of age, to identify infant and maternal outcomes.

 

To date, information on the management of sleep problems in infants less than 6 months of age with behavioral interventions does not appear to take into account a variety of problems and biases and remains unproven in value.

 

Journal of Developmental and Behavioral Pediatrics