Sept. 27, 2017
Volume VIII |  Issue No. 39

Physical activity and sedentary behavior on working memory at ages 7 and 14 years
It appears from a longitudinal prospective cohort study across four Spanish regions which examined extra-curricular physical activity and sedentary behavior at preschool and primary school age on working memory at primary school age and adolescence that low extra-curricular physical activity levels is associated with poorer working memory performance at primary school age and adolescence respectively. Lack of extra-curricular activity at primary school result in poorer working memory in adolescence.

Turning one year of age in a low socioeconomic environment
"In the USA today 16 million children grow up poor". A prospective study examined and compared the effects of low versus higher socioeconomic status (assessing Adult Intelligence Scale, Depression Perceived Stress Social Support, home environment, food security, and neighborhood disadvantage) on infant developmental outcomes at one year age.

One of only a few studies which have examined multiple environmental factors associated with poverty and its effects on infant development, underscores how infants exposed to a detrimental environment early, results in poorer developmental functioning at one year of age.

"Support for families and children from impoverished circumstances cannot begin too early".

"Loop drainage" for the treatment of subcutaneous abscesses in children  
"Loop drainage" refers to a method of managing a subcutaneous abscess where two sub-5mm incisions are made at the periphery of an abscess; the abscess cavity is probed to break down loculations and drain pus, then irrigated with normal saline, and a drain (e.g. Penrose) is then looped through one incision and brought out through the other and tied together. Finally an absorbent dressing is applied over the drain.

A retrospective study of 576 consecutive children who underwent loop drainage (cf. abscess packing) of a subcutaneous abscess indicates that micro-incisions and loop drainage is safe, effective, has shorter time to discharge, lower recurrence rates, less scarring, eliminates the need for repetitive packing and is recommended to be the standard of care for subcutaneous abscess in children.

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Primary ciliary dyskinesia (PCD)

PCD is a rare polygenic recessive disorder (30% of children present with gene variance DNAH5; c.4018C < T and c.9105 + 2T < C) that causes abnormal function of motile cilia. 50% have abnormal organ positions, and recurrent sino-pulmonary infection is the hallmark presentation. Though children with a diagnosis of PDC may present in infancy (80% have a history of respiratory distress) followed by respiratory symptoms in the first year of life it usually remains undiagnosed until 5 years of age because clinical phenotypic presentation overlaps with other common respiratory illnesses (cystic fibrosis, immune deficiency and anatomic and physiological abnormalities of the pulmonary and gastrointestinal tracts).

An interesting case presentation of a 5 year old little girl with PCD outlines a characteristic clinical course and is a useful guide to remind us to remember PCD in children with recurrent pulmonary/upper respiratory tract infections.

See related video HERE and HERE.
Vitamin D insufficiency and fracture risk in urban children

Vitamin D refers to a group of fat-soluble secosteroids. Their receptors are found in nearly every tissue and impacts multiple biological processes. In humans the most important of the group are vitamin D3 (cholecalciferol) and D2 (ergocalciferol). Few foods contain vitamin D and the major natural source is synthesis from cholesterol in skin though a chemical mechanism that requires sunlight (specifically UVB radiation). It appears that as many as 70% of American children have inadequate vitamin D levels (25-hydroxyvitamin D; 25(OH)D).

A prospective case-controlled study of 60 urban children (aged 2-14 years) with fractures requiring conscious sedation/general anesthesia compared their 25(OH)D levels to a comparable non-fractured group.

After controlling for age and daily sun exposure low 25(OH)D levels are associated with a higher incidence of bone fracture. Hypovitaminosis D should be considered in all children with fractures.

Video Feature
Vitamin D Deficiency in Children
Vitamin D Deficiency in Children
Video Feature
"D" for Deficient
Perinatal risk factors and Infantile Hypertrophic Pyloric Stenosis (IHPS)

"IHPS is the most common surgical cause of non-bilious vomiting in infancy". Its etiology is incompletely understood.

A retrospective meta-analysis of 15 studies published in English from a number of databases investigated risk for a number of perinatal factors in infants with IHPS. Data suggests IHPS is associated with:
  1. Being first-born.
  2. Delivered by caesarian section.
  3. Being preterm.
  4. Being bottle-fed (most significant factor).
Detection of late-onset sepsis (LOS) in preterm infants by fecal volatile organic compound analysis 
Diagnosis sepsis early in infants remains problematic. Several studies have indicated that gut microbiota composition is altered days before the clinical onset of sepsis. Unfortunately at present microbiota analysis as an early diagnostic biomarker is not clinically feasible due to a number of factors.  

A prospective multicenter study examined daily fecal volatile organic compounds (VOCs) (as a non-invasive biomarkers) from infant (gestational age >30 weeks) stool samples up to 5 days before diagnosis of LOS to predict LOS at a preclinical stage.
Fecal samples from 36 preterm infants with LOS assessed by electronic nose technology (volatile compounds cause the smell of sweat, blood, urine, feces, etc. and are an indicator of the composition and activity of intestinal microbial metabolism) can be differentiated from matched normal controls up to 3 days prior to the clinical onset of the disease. Stool VOC profiling is clinically feasible and is potentially an exciting area for future studies in at risk infants.
Great Place to Work and FORTUNE Name Miami Children's Health System One of the Best Workplaces for Women
It takes the hard work of each and every employee at Miami Children's Health System (MCHS) to deliver the outstanding service our patient families expect. We offer a supportive and equitable place to build a career, and we're proud to announce that Great Place to Work and FORTUNE have named MCHS one of the country's Best Workplaces for Women.

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