April 29, 2015   Vol. VI, Issue 17
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More on Vitamin D (and acute respiratory infections - ARI).

"ARI's are among the leading causes of childhood mortality worldwide", causing (in 2013) an estimated 935,000 pediatric deaths. Vitamin D is associated with both antiviral and antibacterial immune responses. Trials of Vitamin D supplementation have yielded variable results.


An interesting double-blind, placebo controlled study of healthy pregnant women (from 27 weeks gestation to birth) and their infants (from birth - 6 months) who received either placebo or daily low or high doses of Vitamin D (followed to 18 months of age) appears to indicate that daily high doses of Vitamin D given to mother and infant reduces ARI visits during early childhood (as this is the seventh of eight trials reported, all with variable results and multiple unanswered questions, this issue has not been resolved).


Acta Paediatrica

Posterior reversible encephalopathy syndrome (PRES) associated with licorice consumption in a child

"PRES (also known as reversible posterior leukoencephalopathy syndrome and hypertensive encephalopathy) first described in 1996, is a syndrome


characterized by nausea, vomiting, headache, confusion, stupor, seizures and visual loss". Focal signs are uncommon. On magnetic imaging (MRI) of the brain symmetrical vasogenic edema involving the occipital and parietal lobes bilaterally is seen (cerebral infarction and/or hemorrhage may also be found). Causes include severe hypertension, eclampsia and some medical treatments. Treatment depends on the underlying cause and many cases resolve within 1-2 weeks.


An interesting case report of a 10 year old boy who developed generalized tonic-clonic seizures and constant hypertension following the eating of a large number of licorice toffees over a four month period, reminds us that liquorish contains a sweet tasting compound called glycyrrhizic acid, a high intake of which may result in hypermineralocorticoidism and PRES.


Pediatric Neurology 

Fetal Doppler flow abnormality and risk of sepsis and necrotizing enterocolitis (NEC) in small for gestational age (SGA) preterm infants.

A prenatal Doppler flow study of the umbilical artery, middle cerebral artery and ductus venosus examining circulatory compromise in SGA premature infants or after pre-eclampsia, indicates that fetal flow abnormalities are associated with an increased risk of neonatal sepsis and NEC.


Acta Paediatrica 

Updates in Pediatrics is brought to you by:

Assessing tongue color of the newborn as a predictor of the need for supplemental oxygen in the delivery room.   


In the delivery room preductal oxygen saturation (SpO2) measurements are used as a guide to the need for supplemental oxygen for the newborn infant. Pulse oximetry is not always available in developing communities.


A prospective observational study of 68 infants (mean: 3.2kg) evaluated the presence (or not) of a pink tongue at 1-7 and 10 minutes after birth and compared them to simultaneous SpO2 readings.


When a newborn infant's tongue is pink it appears that the SpO2 > 70% (tongue color appears to be a specific but insensitive indicator).


Acta Paediatrica 

Activity programs during the first year of life and obesity at 2.5 years.


"Obesity tracks from childhood into adulthood".


A Dutch study of 96 infants (and matched controls) which evaluated an intervention program where nurses advised parents on stimulating their infants' motor development and physical activity during regular visits at 2 weeks, and 2-4-8 and 11 months of age and reviewed outcomes at 2.5 years indicates that skinfold sickness is significantly reduced in intervention children, particularly for girls. Longer term effects require further investigation. 


Acta Paediatrica 

Video Feature 

(via YouTube)
Formula for Childhood Obesity
Formula for Childhood Obesity

Azithromycin in early infancy and infantile hypertrophic pyloric stenosis (IHPS).


"Use of oral erythromycin in infants is associated with IHPS". The risk with azithromycin remains unknown.


A retrospective cohort study of 2,466 children who had received either oral erythromycin or azithromycin in the first 14, or 15-42 days of life indicates that oral ingestion of either places infants at risk for IHPS (especially if given during the first two weeks of life - risk persists to 6 weeks of age).



Cost saving and quality of care in a Pediatric Accountable Care Organization (ACO)


ACO's are responsible for costs and quality of care for a defined population group.


A study undertaken from 2008 through 2013 examined the changes in cost and quality of care (utilizing a variety of measures) in a pediatric ACO (PFK) serving a Medicaid population, compared to a historical local Statewide Medicaid C-4-Service (FFS) and a Managed care (MC) model of healthcare delivery.  


PFK's ACO reduced per-member cost-growth through the five years substantially ($2.40/yr. vs. FFS $16.15/yr. and MC $6.47/yr.) with quality and overall outcomes measured remaining essentially unchanged.




See related video: What's in an ACO? 



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