April 5, 2017
Volume VIII |  Issue No. 14


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Longitudinal effects of persistent apnea on cerebral oxygenation in infants born preterm
It appears from a study of ex-preterm infants studied with daytime polysomnography at 2-4 weeks, 2-3 months and 5-6 months prost-term corrected age, that apneas lasting >3 seconds are frequent, associated with decreases in heart rate and cerebral oxygenation and are more marked at 2-3 months and 5-6 months than at 2-4 weeks. These "may contribute to the adverse neurocognitive outcomes that are common in ex-preterm children".

Breast feeding and early childhood obesity from birth to 4 years 
A large Swedish study which utilized 30,508 infants to examine childhood obesity at 4 years and related maternal variables, indicates that breast feeding up to 9 months (or at least for 4 months) successfully decreases the likelihood of obesity at 4 years while maternal education, maternal body mass index and maternal smoking are additional influencing factors.

Cost-effectiveness of prophylactic moisturization for atopic dermatitis (AD) 
It appears that avoiding dry skin through bathing and the use of moisturizers is an important part of treating atopic dermatitis. In high-risk AD infants, emerging evidence suggests that using moisturizers on the newborn to 6 months of age infants may be useful in preventing the development of AD.

From a study of the daily use of 7 common moisturizers on high-risk AD infants from birth to 6 months of age, a cost-effective analysis which measured the $/Quality-adjusted life-years (QALYs) indicates that all moisturizers utilized were cost-effective with petrolatum being the most cost effective preventing strategy in high-risk AD infants.

JAMA Pediatrics
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Renal tumors in children younger than 12 months of age 

Approximately 6% of all cancers in children are Wilms tumor (WT) (nephroblastoma) and most occur between 1 and 5 years of age.

A study from a cancer registry identified patients <12 months of age with renal masses indicates:
  1. Commonest presenting symptoms include asymptomatic mass (73%) and hematuria (9%).
  2. 73% are Wilms tumor; 20% mesoblastic nephroma.
  3. Overall 5 year survival for WT is 88%; mesoblastic nephroma 100%.
  4. Multifactorial reasons for favorable outcomes include; favorable histology and frequent well child checks in the first year of life.
  5. Most require surgical resection alone.
Ketamine for procedural sedation (PS) in the Emergency Department (ED)

"Procedural sedation may be defined as the administration of sedatives or dissociative agents, with or without analgesics, to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function". PS should only be undertaken by persons trained in airway management, in sites where proper monitoring devices are used and where written policies and procedures are in place.

Ketamine is a dissociative agent that relaxes muscle, and has sedative, analgesic and amnestic properties. In general it preserves airway reflexes and has very little effect on respiratory drive.

Data from a prospective, observational study involving 50 children 8-18 years of age who received ketamine for procedural sedation indicates that ketamine causes a significant increase in blood pressure and heart rate.

Video Feature
How to Protect Baby from Child Obesity
How to Protect Baby from Child Obesity
Preterm heel stick pain and prenatal intrauterine music exposure

From a study of 42 preterm infants (approximately 32 weeks gestation) randomly exposed to music that their pregnant mother's listened to (or not), before, during and after a heel stick with pain, physiological and behavioral responses measured, it appears that listening to the music their mother's heard during pregnancy is beneficial, reduces pain scores and respiratory rates, while increasing the length of time infants spend in a quiet alert state.

Neutrophil gelatinase-associated lipocalin (NGAL) utility in urologic conditions 
 
Non-invasive biomarkers enhance our ability to early diagnose and treat common conditions. NGAL (also known as lipocalin-2) is a protein that limits bacterial growth by sequestering iron. In acute kidney injury (AKI) it is secreted into the blood and urine within 2 hours proportionately to the degree of injury. Plasma NGAL (pNGAL) and urine NGAL (uNGAL) appear to identify different disease processes. pNGAL is a marker of systemic inflammation while uNGAL specifically identifies insults to the renal epithelium (infection of the genitourinary tract, as well as subclinical renal damage from scarring or obstruction).

A retrospective study designed to compare the diagnostic accuracy of pNGAL with procalcitonin (PCT), C-reactive protein (CRP) and white blood cell count (WBC) to predict acute pyelonephritis in 138 children with febrile urinary tract infections, indicates that pNGAL appears more useful than the other biomarkers in identifying acute pyelonephritis.

New Therapy Spaces Offer Hope and Inspiration
Thanks to generous community philanthropists, children and teens now have beautiful pictures, furniture and toys to comfort and inspire them as they receive outpatient care from Nicklaus Children's Hospital's Division of Psychology.
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