MCH Updates in Pediatrics Masthead  

                 Volume IV
                  Issue 40
                                                           South Florida's  only licensed  free-standing
                                                             specialty hospital  exclusively for children ...                                                      October 2,  2013 
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Dollars & Sense


by Jason Biro 


Today's tip: If your cash flow is tight, analyze your debt.


If your cash flow is tight-or if you are burdened by debt-set up a debt analysis. You may be able to consolidate your practice debt and other high-payment loans into a single loan-creating ample cash reserves by year's end.

Bank of America Practice Solutions  

Selenium in sepsis 

Selenium is a trace element naturally found in foods (e.g. nuts and liver). It has been suggested to be of value in preventing cancer, degenerative conditions and as an anti-inflammatory agent, functioning as an antioxidant.


A systematic review of available (though limited number) randomized control trials evaluating the effect of selenium supplementation in septic patients, shows no benefits found. Larger studies are required. 


American Journal of Emergency Medicine

Treatment of neonatal seizures-efficacy/safety of lidocaine as a second-line drug of choice

Phenobarbital remains the primary drug utilized to treat neonatal seizures, despite an estimated efficacy of <50%, and concern over its neurodegenerative side effects (increased apoptosis, & changes in cAMP signaling pathways).


A 10 year retrospective chart review of all infants >37 weeks gestation, age <28 days (30 patients) who received benzodiazepine treatment for EEG-confirmed seizures followed by IV lidocaine indicates a possible 63% efficacy with minimal cardiovascular adverse events (transient bradycardia).


Acta Paediatrica 

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Hypercholesterolemia (HC) & statins in childhood  


"HC is associated with increased risk of premature cardiovascular disease in adults" - Fatty streaks and fibrous plaques correlate with an increased serum cholesterol level. It appears that 50% of children and 85% of adolescents have evidence of these.


Total cholesterol (TC) levels are low at birth and appear to rise rapidly during the first 2 years of life, peaking at ages 9-11 years at 171mg/dl, decreasing during puberty and increasing thereafter. Ethnic differences exist. TC >200mg/dl warrants referring to a pediatric cardiologist.


2011 AAP screening recommendations include universal screening at least once between 9-11 years and again at 17-21 years. In familial hypercholesterolemia the AAP recommends statins as a first-line drug treatment.


A short-term study utilizing a statin in HC children indicates it to be well tolerated, efficacious and safe. Long-term safety remains unknown.

Acta Paediatrica 

Video Feature  
How do you know if your child has sustained a concussion?
How do you know if your child has sustained a concussion?
via YouTube
Concussion in childhood


An excellent article on pediatric concussion outlines our knowledge (or lack thereof!) on all aspects of concussion. "Concussion is defined as a complex pathophysiological process affecting the brain induced by traumatic biomechanical forces." It includes five major features:


1.   Caused by a direct blow to the head, face or neck

(or elsewhere on the body with force being transmitted to the head).

2.   It results in the rapid onset of short-lived impaired neurologic function which usually (but not always) resolves quickly and spontaneously.

3.   Acute symptoms reflect a functional disturbance and include physical, cognitive, emotional and sleep perturbations.

4.   Loss of consciousness (LOC) may or may not be a feature of the episode. LOC, headache and amnesia may indicate a more serious injury.

5.   Neuroimaging is normal.


There is a lack of consensus, perhaps due to a lack of evidence-based data, regarding management. Avoidance of activity to allow for full recovery of physical and cognitive function remains the mainstay of treatment. There is no evidence demonstrating the value of medications in shortening the course of the process. If medication is used these should not be required prior to return to play.


A questionnaire was distributed to 1,305 appropriate section members of the AAP indicates that a majority routinely manage symptoms with medications in spite of the lack of evidence indicating benefit.




Acta Paediatrica 

Ultrasound - Valuable as a predictor of bone mineral density (BMD)? 


Ultrasound is being increasingly used as a diagnostic modality in managing sick children.


A study in children with growth problems compared lumbar-spine BMD, as determined by dual energy x-ray absorptiometry (DXA) to ultrasound examination, indicates that ultrasound is a poor predictor of radiologically assessed BMD.


Acta Paediatrica

Health-related quality of life (HRQOL) among children with Type 1 diabetes  


It appears (for Norwegian children at least) that children older than 8 years of age with type 1 diabetes, of duration >4.9 years relate their negative HRQOL primarily to being a girl, having poor metabolic control, and having experienced a prior period of ketoacidosis (independent of demographic factors, the use of an insulin pump or multiple injections). 


Acta Paediatrica