Aug. 23, 2017
Volume VIII |  Issue No. 34

Risk factors for acute otitis media (AOM)
Though the frequency of AOM has decreased significantly since the introduction of pneumococcal conjugate vaccines, risk factors have remained the same. These include (from a study of 615 children 3-36 months of age):
  1. Age: 60% of infants experience one or more episodes of AOM by 3 years of age (with 24% having more than 3 episodes). Increased AOM risk is particularly increased for younger infants (6-12 months of age).
  2. Boys, non-Hispanic whites, those with a family history of recurrent AOM and day-care attendees.
Longitudinal evaluation of sleep disordered breathing (SDB) in infants with Prader-Willi Syndrome (PWS)
A polysomnographic (PSG) study of 12 (male) PWS infants (<1 year of age) who had baseline PSG central sleep apnea (CSA) and who were followed for two years, indicates that central sleep apnea is prevalent in infants, usually improves with age though some may have persistent CSA while others are at risk for developing obstructive sleep apnea.

PSW infants require on-going PSG surveillance.

Archives of Disease in Childhood
Longer and deeper cooling for hypoxic ischemic encephalopathy (HIE) in neonates
Therapeutic hypothermia (initiated within six hours of birth, and continued at 33.5 degrees centigrade for 72 hours) has become the standard of care for neonates with HIE.

A recent study that evaluated a longer duration and depth of cooling for infants with HIE appears to indicate that "more may not be better and may be worse". There appears to be no reason to pursue deeper or longer therapeutic hypothermia in this group of infants.

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Autism Spectrum Disorders (ASD) - "Putting it Together" 
It appears form an interesting interview recently published, that there are multiple factors which may increase the risk for ASD in children. These include:
  1. Genetic and epigenetic factors (increased maternal and paternal age).
  2. Maternal medications.
  3. Maternal infections (with and without fever).
  4. Maternal autoimmune disease.
  5. Maternal lifestyle (nutritional factors, alcohol and smoking).
  6. Maternal exposure to environmental factors (water and air pollutants).
  7. Gene-environment interplay (through complex biological processes).
Video Feature
Neonatal hypoglycemia and neurodevelopmental outcomes 

A prospective cohort study of 477 at-risk children (32+ weeks gestation, diabetic mothers, preterm, small or large for gestational age or acutely ill) who experienced hypoglycemia (blood sugar <47mg/dl in the first 7 days of life; sever episode <36mg/dl; or recurrent >3 episodes) assessed cognitive function, executive function and visual and motor function at 4.5 years of age.

Neonatal hypoglycemia (particularly recurrent and even if not detected clinically) is associated with an increased risk for poor executive, visual and motor function at 4.5 years of age.

Office preparedness for childhood emergencies

The percentage of pediatric patients presenting to a pediatric practice or outpatient clinic with an emergency varies between 39-82% per month. Many practices are ill-equipped to handle them.

91% of pediatricians say their offices do not stock all the Emergency equipment/medications recommended by American Academy of Pediatrics (AAP) Committee on Pediatric Emergency Medicine - C manual. These include:
  1. Practices undertake a self-assessment for office emergency readiness.
  2. Develop an organized plan for emergency response.
  3. Maintain recommended emergency equipment/medications and use a resuscitation aide/tool that provides suggested protocols with pre-calculated medication doses.
  4. Develop a plan to provide continuing education for all staff.
  5. Practice mock codes in the office on a regular basis (e.g. quarterly).
  6. Educate families about what to do in an emergency.
  7. Partner with EMS/hospital-based emergency providers to ensure optimal management of emergency situations.

See related video HERE.
Bronchiectasis in children and a biomarker for disease activity
"Bronchiectasis is a chronic airway disease characterized by neutrophilic inflammation, persistent bacterial infection and recurrent exacerbations in the presence of structurally damaged and dilated bronchi". Causes in children include severe lung infection (pneumonia, tuberculosis and pertussis), immune deficiencies, cystic fibrosis or primary ciliary dyskinesia, retention of an aspirated foreign body and gastrointestinal reflux disease. There may be a wide variation in etiology, clinical phenotype, radiological appearance and microbiological characteristics.
A prospective study which examined sputum neutrophil elastase (NE) activity (NE with other proteases released from activated neutrophils play a critical role in degrading invading pathogens) in 433, adult bronchiectasis patients demonstrates sputum "NE activity is associated with not only clinical and radiologic severity of the disease, but also activity as measured by increased risk for exacerbation and lung function decline".
See related video HERE
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