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                Weekly Updates in Pediatrics         June 13, 2012 

EDITOR:  Jack Wolfsdorf, MD

 

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Neuroimaging for a "First Complex Febrile Seizure" (CFS)

268 pediatric patients with a CFS had emergent head imaging. 4 (1.5%) had clinically significant findings.

 

Most CFS patients requiring emergency head imaging appear to have obvious clinical findings (eg nystagmus, emesis, altered mental status and bruising suggestive of inflicted injury).

 

Source: Pediatric Emergency Care, April 2012  

Effects of Altitude on cerebral oxygen

17 Pediatric patients had their cerebral oxygenation measured by near-infrared spectroscopy (NIRS) at different altitudes during interfacility transport.

 

During helicopter transport no differences in cerebral oxygenation appears to occur between baseline and altitudes below 5,000 feet.

Cerebral oxygenation significantly decreases above an altitude of 5,000 feet, particularly in patients who require mechanical ventilation.   

 

Source: Pediatric Emergency Care, April 2012

Influenza A(H1N1) associated Ischemic Stroke

Seasonal Influenza in known to cause neurological complications in children. Stroke with Influenza is rare, however this report of a 9 month old baby presenting with H1N1 Influenza and stroke emphasizes the importance of vaccination against Influenza infection.

 

Source:  Pediatric Emergency Care, April 2012 

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CURRENT BEST EVIDENCEBest Evidence

Adenoidectomy for recurrent Upper Respiratory Tract Infections (URI) vs "watchful waiting"

A 24 month follow up study of 111 children with recurrent URI some of whom were treated by adenoidectomy while matched others underwent "watchful waiting" indicates that most URIs are self limiting, decrease with age and adenoidectomy does not improve the number of URI episodes, middle ear complaints or quality of life measurements.

Source:  The Journal of Pediatrics, March 2012

New treatment for Cystic Fibrosis (CF)  

 

Approximately 70,000 people worldwide are affected by a defective/missing CFTR protein, the abnormality of which results in the clinical picture of CF. Historically gene therapy to replace the faulty gene has been and remains the primary focus of CF research.

 

Ivacaftor (Kalydeco-Vertex pharma) has now been approved in the USA to treat CF patients with the specific CF mutation G551D. (4% of CF patients). It appears to markedly improve patients' lung function, decrease the sodium content of their sweat and appears to assist them in gaining weight.

 

Source: Lancet, April 21, 2012

 

VIDEO

CBS Evening News - Breakthrough in cystic fibrosis treatment 
 Breakthrough in cystic fibrosis treatment
Source:  CBS Evening News via YouTube

Zinc as an Adjuvent to therapy for severe pneumonia

 

Diarrhea and pneumonia are the leading causes of illness and death in children <5 years of age. The health benefits of zinc are mediated through its role in protein synthesis and include enhancing immune system functioning, digestion, control of diabetes, etc. Deficiency results in a variety of abnormalities including diarrhea, growth retardation and weight loss.

 

 A study of 610 children aged 2-35 months who presented with severe pneumonia, was undertaken to assess the additive effect of a 10mg-20mg daily dose (up to 14 days) of zinc on ultimate outcome.

 

There appears to be NO significant benefit of zinc therapy in severe pneumonia.

"Blue Rubber" bleb Nevus (BRBNS)

 

BRBNS is a fairly rare disorder of unknown origin, usually sporadic, however a dominant autosomal inheritance has been described. It is characterized by single or multiple venus malformations in the skin, gastrointestinal system (GIT) and occasionally other organs. The blebs are deep blue, rubbery and easily compressible.  

 

An 8 year old little girl with BRBNS, multiple venus malformations involving skin and her entire GIT presented with massive GIT bleeding. No systemic treatment is considered "standard of care" and treatment is usually directed at the manifested complications. Low dose sirolimus treatment has been tried with good effect.    

Source: Pediatrics, April 2012