Non-depressed linear skull fractures in children < 2 years of age
Most young children with a skull fracture following a head injury undergo brain computed tomography (CT) scanning, to exclude significant brain injury.
A retrospective review of 92 patients aged < 2 years of age diagnosed with a non-depressed linear skull fracture on plain head x-ray, indicates that none had any significant intracranial pathology.
Observation may be all that is required in < 2 year old head-injured patients diagnosed with a linear non-depressed skull fracture.
Magnetic Resonance Imaging (MRI) in Hypoxic-Ischemic Encephalopathy (HIE)
HIE accounts for 20% of neonatal deaths and 15-20% of surviving children will have permanent neurodevelopmental disabilities. Early clinical indicators of HIE, e.g. umbilical cord pH, and Apgar score, are unreliable as long-term outcome predictors. HIE may evolve during the first few days following the insult with lesions worsening over a two week period involving new brain areas.
Early MRI is now possible and safe for sick newborns and can document (at 6 days) both the benefits of neonatal hypothermic treatment and predict death or major disability at 2 years of age. MR spectroscopy and diffusion tensor imaging may be of even greater value in delineating early brain injury following HIE.
While there appears to be a growing body of literature suggesting that bilateral cochlear implants in appropriately selected children result in superior outcomes (sound localization and language development), compared to a similar group of children with a unilateral implant, a cost:benefit ratio assessment of the second high cost procedure has not to date been performed.
As healthcare budgets worldwide are being closely scrutinized, the cost utility study requires urgent undertaking.
Diagnostic Approach and Management of Cow's-milk Protein Allergy (CMPA)
A. Diagnosis (If CMPA is suspected by history and examination):
Strict allergen avoidance is initiated.
If a clear history or a life threatening reaction occurs, with a positive CMP-specific Ig test, no milk challenge may be necessary for diagnosis.
In all other circumstances a controlled oral food challenge under medical supervision is required for a firm CMPA diagnosis to be made.
B. Treatment:
For breast-fed infants, a strict CMP-free diet should be instituted.
Non-breast-fed infants with a confirmed diagnosis, should have an "extensively hydrolyzed protein-based formula". (Amino-acid based formulae are usually used for special situations)
Soy protein formulae may be an option for infants older than 6 months of age.
Nutritional counseling and regular monitoring are mandatory. Re-evaluation to assess tolerance to CMP should be undertaken every 6-12 months.
Maternal dietary fat intake during lactation and the risk of childhood asthma
A study of 1,798 mother-child pairs which evaluated the relationship between the development of child-hood asthma at 5 years of age and maternal margarine intake during the third month of breast feeding, found no association between the two.
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