MCH Updates in Pediatrics Masthead  

                 Volume IV
                  Issue 43
                                                           South Florida's  only licensed  free-standing
                                                             specialty hospital  exclusively for children ...                                                      October 23,  2013 
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Dollars & Sense


by Jason Biro 


Today's tip:

Calculate your true lease costs.


Have your leased equipment in the past, only to be "surprised" by hefty prepayment penalties? Consider purchasing your equipment instead. Look for a lender who offers 100% financing, a period of deferred payments, and the ability to pay down the loan with no penalty at all.

Bank of America Practice Solutions  

Living "related", "unrelated" or "deceased" donor kidney transplantation?

Survival data from matched pediatric kidney-only transplants (performed in the USA between 1987-2012) for end-stage renal disease, was utilized to compare "living related", "living unrelated" and "deceased donor" renal transplantations (adjusted for HLA mismatch).


"Living related" and "living unrelated" kidney grafts survive better than those from younger "deceased" donors.

Journal of Pediatric Surgery 

Reduced complications following bariatric surgery with an inpatient weight loss program in extremely obese adolescents

The long-term consequences of bariatric surgery for extremely obese (BMI >60kg/n2) adolescents remains a subject of debate as not all operative devices are available for this group of patients and complications rates appear higher than those that occur in adults.


A small group of extremely obese adolescents who completed an in-patient multidisciplinary run weight-loss-program prior to undergoing laparoscopic sleeve gastrectomy achieved total weight loss comparable to that of a primary surgical procedure alone, with a significantly reduced perioperative risk.


Clinical Pediatrics 

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Umbilical cord care- "antimicrobials" or "dry care"?  


In spite of a number of studies attempting to identify "best practice" for umbilical cord care, clarification of optimum practice remains elusive.


The umbilical cord stump in babies who room-in with their mothers, is rapidly colonized with nonpathogenic organisms, while infants in nurseries, have the potential of acquiring pathogenic bacteria from the hospital environment.


Using topical solutions/antimicrobials on umbilical stumps may decrease colonization and/or select for new and resistant organisms. Dry cord care is advocated by the American Academy of Pediatrics but may (rarely in the USA) give rise to a staphylococcal omphalitis.


Clinical Pediatrics 

Video Feature  
Chlorhexidine for umbilical cord care  
Chlorhexidine for umbilical cord care
PATH via YouTube

Natural history of stuttering to 4yrs of age   


Stuttering/stammering or dysfluency (pauses, repetitions, additions, or prolongation of words, sounds or phrases) is a disruption in the normal pattern of speech. It is not uncommon for young children to have dysfluencies with 5% of children stuttering at some point, usually between the ages of 18 months and 5 years. It may come and go, may last for weeks or a few years. No exact cause for stuttering is known, however evidence suggests that there appears to be at least 4 contributing factors:

  • Family history (<60% have or have had a family member stutter).
  • Developmental (children with other language or speech difficulties are more likely to stutter).
  • Neurophysiological (language may be processed differently interfering with brain/speech muscle interactions).
  • And family dynamics (parental attitudes and expectation).

Physical or emotional trauma rarely results in stuttering.


A study of 1619 infant/mother pairs, recruited at 8 months of age and followed to 4 years examining a variety of factors pertaining to stuttering, reveals:

  • By age 4 years the cumulative incidence of stuttering appears to be 11.2%.
  • Male gender and twinning predict onset.
  • Stuttering children at 4 years have stronger language and nonverbal cognition.
  • 6% recover (with treatment) within 12 months of onset.

Is facial nerve palsy (FNP) in children benign?


FNP is a common disease in children (congenital or acquired) from which most recover completely.


A study of 56 children with peripheral facial nerve palsy divided into 2 groups: normal/mild dysfunction (House-Brackmann (HB) score <2) or, with persistent mild/moderate dysfunction (HB score >2) followed for a year, indicates that while functional recovery in general is excellent, facial asymmetry may persist.


Pediatric Neurology 

Neonatal stomach volume & physiology suggest feeding at hourly intervals!  


Optimal feeding intervals for term babies remains unclear, with a wide range of feeding frequencies being practiced.


The capacity of the neonatal stomach appears (from a literature research) to be 20ml; this amount the neonatal stomach normally empties hourly. It is suggested that 20ml hourly feedings may be least stressful for the neonate and could result in less "spitting up" reflux and hypoglycemia.


Acta Paediatrica