Nov. 2, 2016
Volume VII | Issue No. 44

Association between increased bronchial hyper-responsiveness (BHR - asthma), age and gender
From a study of 1,725 subjects (aged 6-14 years) with demonstrated BHR it appears that for both boys and girls there is a direct relationship between BHR, young age and reduced lung function. Boys' BHR is also related to the presence of high eosinophil counts and atopy, while for girls BHR increases with sexual maturation (menarche - after 11 years of age).

Pediatric Pulmonology

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Signs of deterioration in infants discharged home following congenital heart surgery in the first year of life  
A qualitative study in the UK involving semistructured interviews in 21 parents whose infant had been readmitted as an emergency or died, shows that some parents are unable to identify any early warning signs, e.g. alterations in feeding, appearance, respiratory rate/effort or behavioral change (parental education and emphasis on availability of early and prompt consultation for parents is paramount).

Clinical findings in young adults with acute scrotal pain
It appears that idiopathic scrotal pain, varicocele, scrotal trauma and genital infections (with testicular torsion and cancer occurring rarely) are the most common causes of acute scrotal pain in young adults (18 years plus).

8 Ways to Get  MACRA-Ready  
Seth Flam, DO

MACRA begins in 2017 but the time to get ready for the new payment models is now.

The MIPS/MACRA reporting period begins on January 1, 2017. Preparing your practice for changes in reimbursement policies under MACRA is of utmost importance. You'll have to assess the ways in which you may need to change your practice's workflow in order to coincide with these transformations. Don't procrastinate; act quickly to shift focus to the new healthcare structure. Here are some starting points...
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Treatment of pediatric hyperkalemia with sodium polystyrene sulfonate (SPS)
SPS (e.g. Kayexalate) is an ion exchange resin which releases sodium or calcium ions in the gut (mainly large intestine) in exchange for potassium ions. It may be administered orally or rectally by enema.

A study of 156 patients (mean age 6.8 years) with peak potassium concentrations of 6.5mmol/l (mean) given 0.64g/kg SPS (91% given orally) indicates that at 16.7 hours post dose mean potassium levels drop to 4.7mmol/l; 43% of children however require a second dose in the following 48 hours. Gastrointestinal side-effects occur in 15% of patients.

Inhaled corticosteroids and increasing blood neutrophil count

A study to elucidate the mechanisms involved in the increase in blood white cell count seen following inhaled corticosteroid treatments, examined CD11b (adhesion neutrophil ligands - Mac-1), L-selectin (CD 62L) and granulocyte colony-stimulating factor serum levels (these facilitate leukocyte migration into the tissues, enhance lymphocyte migration into lymphoid tissue and stimulate the bone marrow to produce granulocytes and release them into the blood stream respectively).
Mac-1 and L-selectin levels decrease significantly after steroid inhalation (with no change in colony-stimulating factor levels) suggesting that they play a significant role in the increased white blood cell count seen following steroid inhalation.

Operative vs. conservative management of displaced non-open Tibial shaft fracture

It appears that closed reduction and casting of displaced Tibial shaft fractures (conservative treatment) (without fibula fracture) gives as good a functional and radiological outcome as operative fixation with elastic stable intramedullary nailing, though conservative treatment not infrequently requires subsequent surgery and intramedullary nailing requires longer immobilization/hospitalization times, and a higher incidence of knee pain.

Both conservative and surgical management are satisfactory choices for the treatment of closed Tibial shaft fractures with an intact fibula.

Video Feature
Acute Scrotal Pain
Acute Scrotal Pain
Effects of promoter polymorphisms on cytokine concentrations in preterm breast milk and infant outcomes

"Breast milk concentrations of immune components are variable between women". Interleukins (IL's) are a group of secreted proteins and signal molecules-cytokines - produced by white blood cells (macrophages) which respond to an antigenic stimulus, enhancing lymphocyte proliferation and interferon production.

A study examined the milk of 73 women, measuring maternal IL genotypes (single nucleotide polymorphisms - SNP's), average weekly milk concentrations of IL4, IL6 and IL10 over time and infant outcomes.

It appears that there is a relationship over time between maternal genotype, increasing IL concentrations in milk and negative infant outcomes (intraventricular hemorrhage, blood transfusion requirement and stool calprotectin level - indicating bowel inflammation)

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