Dec. 9, 2015
Volume VI, Issue No. 49

Gluten and casein supplementation in children with autistic spectrum disorder (ASD)
A study of 74 children with ASD and severe maladaptive behavior who randomly received gluten- casein or a placebo for 7 days indicates that in the short-term administering gluten-casein does not increase maladaptive behavior or gastrointestinal symptom severity.
 
Acta Paediatrica

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Preliminary report: An updated intramedullary stabilization technique for pediatric femur fracture
Femur fractures are classified by (a) location of the fracture (b) shape of the fractured ends (c) whether angulated or displaced (d) & the number of fractured parts. Depending on the age of the infant/child, treatment may be nonsurgical or surgical with a recent trend towards surgical stabilization.
 
It appears that a single incision technique for intramedullary stabilization of shaft fractures in children is a viable alternative option (to double incision) with equivalent time to union and no increase in complication rate.
 
Early persistent blood eosinophilia and necrotizing enterocolitis (NEC) as a predictor of late complications
"Eosinophil infiltrate intestinal tissue during NEC... and adult bowel diseases".
 
It appears that early (<2 days) persistent blood eosinophilia is not a predictor of NEC complications however it may identify immature infants at greater risk for adverse outcomes (intestinal stricture or hepatic fibrosis) during convalescence.
 

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Assessing an adolescent's capacity to make autonomous decisions in clinical care

There are circumstances where a minor adolescent will be required to make personal healthcare decisions for themselves independent of a third party. Balancing rights of parents and the rights of minors continues to be debated.

Factors to be considered in deciding the decision-making capacity of an adolescent include (among others):
  1. An assessment of ability to make a decision free of coercion by a third party.
  2. The adolescent's understanding of the different facets of the medical situation.
  3. The ability/maturity to balance conflicting medical and contextual issues that may be present.
  4. An appreciation of the link between the decision(s) and outcome(s).
Video Feature 
Ooutcomes of very small preterm infants
Outcomes for very small preterm infants
Health-related quality of life (HRQoL) from adolescence to young adulthood after extremely low preterm birth (ELPB)

A number of child health/behavioral questionnaires examined information from adolescents/young adults at 17-24 years of age from a population-based cohort of 46 extremely preterm-born infants (gestational age <28 weeks or birth weight <1,000 grams) and term-born controls indicates that in general ELPB and term-born babies report similar HRQoL however, the data indicates that those ELPB infants with disabilities report poorer physical functioning, and ELPB without disabilities report lower social, mental and psychological health which remains unchanged between 17 and 24 years of age.

Bowel function and lower urinary tract (LUT) symptoms in females with anterior anus (AA) treated conservatively

Anorectal malformations are a group of conditions that form a spectrum of severity usually diagnosed at birth; a significant number of mild lesions however may not be recognized until later, frequently then because of constipation associated with the introduction of solid food.
 
AA (anterior anus, anorectal anus, or ectopic anus) is a normal appearing anus in an abnormally anterior position seen exclusively in females where the anal canal is mostly situated within the voluntary sphincter complex.
 
At age 10.2 years (median) AA children treated conservatively continue to address constipation as a primary issue, fecal continence and bowel function scores being comparable to matched peers, with no differences in LUT infections or age at toilet training.
 
Early transient newborn hypoglycemia and fourth-grade achievement proficiency
 
"Prolonged neonatal hypoglycemia is associated with poorer long-term neurocognitive function"; transient early hypoglycemia is thought however to be relatively benign.
 
It appears from a retrospective analysis of a population-based cohort of perinatal data from 1,395 normo- and early- transiently hypoglycemic (defined as occurring within the first three hours of life with a single low glucose concentration of <35mg/l / <40mg/l /<45mg/l / followed by a second normal value) infants assessed at school-age (10 years) for literacy and mathematic achievement (and controlled for a variety of potentially confounding factors) that early transient hypoglycemia in infants is associated with significantly lower achievement scores.
 
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