Miami, FL
Dec. 20, 2017
Volume VIII |  Issue No. 51
Happy Holidays!
Exhibitor Opportunity 
Nicklaus Children's Hospital Annual Pediatric Postgraduate Course

Miami, FL

Feb 22-25, 2018

Shiga Toxin-producing E. coli (STEC) infections associated with flour
An investigation of an outbreak of STEC in 2016 examined exposures in affected patients vs.  matched controls (age, sex and state of residence) with non-STEC enteric illness. Using whole genome sequencing on isolates from clinical and food samples, raw flour (even though it is a low-moisture food) was implicated as the source and vehicle for the  STEC infection.

Dysfunctional breathing in children and adolescents 
In the diagnosis of respiratory symptoms/dysfunctional breathing in children and adolescents, vocal cord dysfunction, hyperventilation syndrome, habit cough and sighing dyspnea should be considered. A valuable Editorial on each of the diagnoses outlines much of what a Pediatrician should know about each condition. Well worth reading (Ed.)

 
See related video HERE.
Early behavioral risks of childhood/adolescent daytime urinary incontinence and nocturnal enuresis
Data from a longitudinal cohort study of 1,119 healthy Chilean children was used to assess behavioral symptoms at 5 and 10 years of age and their relationship to subsequent daytime urinary incontinence and nocturnal enuresis.

Inattention, temperament, internalizing/externalizing symptoms at 5 years of age appear to be associated with a higher risk for school-age and adolescent urinary incontinence.

Childhood Obesity Facts 
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Sealant in caries prevention in children and adolescents
 
A guideline panel of the American Dental Association (ADA) Council on Scientific Affairs/The America Academy of Pediatric Dentistry has examined the evidence for the use of pit and fissure sealants on the occlusive surfaces of primary and permanent molars in children and adolescents.

Available data indicates three possible conclusions on tooth sealants:
  1. Sealants are effective in preventing and arresting pit and fissure occlusal caries of primary and permanent teeth, more so than fluoride varnishes.
  2. Sealants minimize the progression of non-cavitated caries (early lesions).
  3. It appears (from limited data) that all available sealants are equally effective.
Video Feature
Pectus Excavatum/Carinatum Alternative Non Surgical Bracing
Pectus Excavatum/Carinatum Alternative Non Surgical Bracing
A less intense bracing protocol for Pectus carinatum (Pigeon chest) 
 
Pectus carinatum affects about 1:1500 children, more common in boys than girls (4:1), is frequently asymmetrical, appears to run in families (25% have a family member with it), and results from abnormal/excessive growth of the cartilage of ribs and sternum. Mild to moderate Pectus carinatum is treated with a custom fitted chest-wall brace pushing directly on the sternum which usually produces good outcomes. Despite widespread use of bracing there is no consensus in the number of hours per day brace wearing is required.

A review of outcomes of children treated in a single institution plus the results of a multi-base search for studies describing the use of braces to correct Pectus carinatum indicates that less intensive brace usage (<12 hours per day) is associated with higher patient compliance, similar times to correction and success.

Interleukin (IL)-1β polymorphism and serum level in pediatric asthma
 
"Interleukin - 1 is a pro-inflammatory cytokine found in 2 forms (α and β). The α form is mainly cell-bound, whereas IL-β is primarily secreted by macrophages in response to immune system stimulation".

A study of 310 matched normal or asthmatic children aged 6-18 years examined whether IL-1α and β polymorphisms is associated with childhood asthma and if so, whether the genotype affects its serum level.

It appears that 3, IL-1β polymorphisms (and CAC haplotype disequilibrium) are associated with a significant increase in allergic asthma risk in children, with significantly higher than normal levels of serum IL-1β.

Diagnosing the cause of fever in the young infant <90 days of age
  
It appears that every year approximately 500,000 febrile children aged 60 days present to an Emergency Department in the USA. 6-10% of these infants will have invasive bacterial infection. Physical examination and individual laboratory investigations are not reliable to differentiate benign viral infection from serious bacteria ones. While clinical prediction models combined with patient characteristics and newer laboratoy investigations (like C-reactive protein and procalcitonin) are an improvement over standard white blood cell count testing, and have a higher sensitivity for detection of serious bacterial infection, they are still sub-optimal leading to overuse of invasive procedures, antibiotics and hospitalizations. Whole genome RNA expression profiles to define RNA bio signatures (presently under investigation) may soon allow for precise diagnosis of bacterial/viral infections in the infant <90 days.
 
Patient of the Month: Frankie's Story
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Does maternal caffeine consumption during pregnancy affect behavioral outcomes in 11 year old offspring?
 
Can you describe the "ABC" of a safe environment for a young infant to sleep?
 
What are the bariatric procedures to prevent the secondary deleterious effects of obesity?
 
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