MCH Updates in Pediatrics Masthead  

                 Volume IV
                  Issue 39
                                                           South Florida's  only licensed  free-standing
                                                             specialty hospital  exclusively for children ...                                                      September 25,  2013 
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Exergaming on vascular function

Fitness games or exergaming is a term used for video games that promote exercise.


15 children undertook a graded exercise test before and after (high and low intensity) exergaming sessions during which changes in heart rate, energy expenditure and flow mediated arterial "health" were measured.


Acute high intensity exergaming induces large heart rate and energy expenditure while improving vascular function.


Journal of Pediatrics 

Outcomes of non-protractile (retracted) nipples treated with breast cups

During pregnancy breasts may become tender and swollen preparing for breast feeding, while the nipple changes in color and size protruding and becoming erect when stimulated. Approximately 10% of women may present with flat, retracting or inverted nipples which may lead to difficulties in breast feeding. Retracting nipples appear to protrude but invert when stimulated. Several strategies have been used to improve the situation with varying results.  


A study of 90 singleton pregnant women with at least one short (<7.0mm) nipple were utilized to assess the benefit of wearing a breast cup (>8 hours/day) from 16/20 weeks to 36 weeks gestation. Nipple elongation was measured by a "blinded" evaluator.


Nipple elongation with the use of a breast cup significantly improves nipple size and the ability to breast feed.


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Protective effects of hydrogen-rich saline (HRS) on necrotising enterocolitis (NEC)


While the precise etiology of NEC remains elusive, the immature gut appears, under stressed conditions, to take up macromolecules and toxic products intact from the bowl lumen which results in oxidative stress and a cascading inflammatory response leading locally to intestinal wall edema and air.


Hydrogen is a free radical scavenger and in saline appears to have an anti-inflammatory protective effect reducing both edema and lipopolysaccharide (LPS) activated macrophages.

An interesting experimental study conducted on male newborn Sprague-Dawley rats, formula fed and exposed to asphyxia and cold stress with and without intra-peritoneal injections of HRS, reveals decreased pro-inflammatory mediators, enhanced antioxidant capacity, a reduction in NEC with an improved survival rate.

Journal of Pediatric Surgery 

Video Feature  
Multipad Machine Dance Exergaming 
Multipad Machine Dance Exergaming
via YouTube

"No more diet program studies for obesity please!!"- Finally common sense based on facts!! (Ed)


Numerous randomized trials and 4 recent meta-analyses comparing macro nutrient components (e.g. low carbohydrate, low fat, Mediterranean, etc.) have demonstrated only small differences in weight loss between them. The only consistent finding among all the trials is that "adherence" to whatever program is put forward, and "physical exercise" , are most strongly related to weight loss and improvement in disease-related outcomes. Why it is so difficult to adhere to any calorie reducing diet requires greater understanding of the biological, behavioral and environmental factors involved in changing one's lifestyle.

Thyroid function in Prader-Willi syndrome (PWS) 

"PWS is a rare genetic disorder in which 7 genes on chromosome 15 are deleted or unexpressed on the paternal chromosome." Characteristic features include low muscle tone, short stature, incomplete sexual development, cognitive disabilities, behavioral problems, and chronic drive to excessive eating with obesity. Recently early diagnosis and active management have decreased the obesity rate and some of the behavioral problems. Several endocrine abnormalities have been described, including growth deficiency and hypogonadotropic hypogonadism. Thyroid studies are limited.


A study of newborn (23), childhood and adolescent (21) thyroid function in PWS patients indicates that neonatal thyroid function on screening appears normal, while only 1 of 21 older patients have hypothyroidism. Routine levothyroxine treatment in PWS appears inappropriate.


Journal of Pediatrics 

Gastric suppression & clostridium difficile infection (CDI)  


"The last 2 decades have seen an increase in the incidence of clostridium difficile disease which has become the most common cause of healthcare-associated infection."


Gastric acid suppression is commonly and increasingly used for gastrointestinal reflux disease, heartburn, ulcer prophylaxis, duodenal ulceration and H. pylori infection.


Hypochlorhydria (to a pH>4.28) has been identified as a risk factor for CDI since 1990, particularly with the use of proton pump inhibitors (PPI). In 2012 the Food and Drug Administration released a drug safety communication indicating the possible association between PPI use and CDI. Obviously patients who would not benefit from PPI therapy should not be so treated. When used, however, acid suppression should be documented, with periodic "holidays" or "dosing step-downs" to evaluate need.


Journal of Pediatrics