April 8, 2015   Vol. VI, Issue 14
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Epidemiology, clinical cause and outcome of febrile cytopenia in children

Transient infectious neutropenia is common in children and usually resolves without treatment in weeks.


A study of 116 children (median age four years) diagnosed with febrile neutropenia following extensive investigation and follow-up for two years, indicates that cytopenia associated with bacterial infections is mostly mild and transient in 87.75% of children. Chronic patients have severe cytopenia with >2 cell lines affected.


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Acta Paediatrica 

Morphine and ibuprofen for post-tonsillectomy pain

In a prospective randomized clinical trial, 91 post-tonsillectomy children (aged 1-10 years) were randomized on their first post-operative night to receive acetaminophen with either 0.2-0.5mg/kg oral morphine or ibuprofen (10mg/kg). Assessments included pain, pulse oximetry oxygen saturation and apnea.


Acetaminophen plus ibuprofen provides safe and effective analgesia for post-tonsillectomy children. Morphine use should be limited (due to an increased number of desaturations noted).



Preeclampsia, placental insufficiency and autism spectrum disorder (ASD) or developmental delay (DD).

Children with ASD are twice as likely to have been exposed in utero to preeclampsia (vs. controls) with risk increasing with greater preeclampsia severity. Placental insufficiency appears to be responsible.


JAMA Pediatrics 

3 Provider Wins Proposed in the New Meaningful Use Stage 3 Regulation  

Seth Flam, DO HealthFusion 


This is the second in a series of blog posts examining the Meaningful Use Stage 3 Proposed Rule and its impact on medical practices. This post examines three wins for providers in the Meaningful Use Stage 3 Rule.



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Early discharge of infants and risk of readmission for jaundice


A recent study examined the association between discharge from hospital among 781,074 term infants, those discharged early (in the first two days after birth) and risk factors for readmission for jaundice.

0.8% of term infants are readmitted for jaundice following a hospital length of stay of 0-2 days.


Infants born at 38 weeks gestation are four times more likely, and those born at 37 weeks nine times more likely to be readmitted for jaundice compared to infants born at 39 weeks gestation with a length of stay of 3-4 days (risk factors include: vaginal birth, Asian mothers, first time mothers or being breast fed at discharge).



Incidence of short stature at three years of age in late preterm infants 


A longitudinal population-based study of 1,414 late preterm neonates divided into three groups according to birth weight and assessed at three years of age, indicates that late preterm infants have a twofold higher risk for being short, and a 4.5 fold increased risk if they are born "small for gestational age".


Archives of Diseases in Childhood

Video Feature 

(via YouTube)
Not Your Parents' Tonsillectomy 
Not Your Parents' Tonsillectomy

Anthracycline treated childhood malignancy and long term survivors: Biomarkers of cardiac damage


"Anthracyclines (e.g. adriamycin-daunorubicin-idarubicin) are a group of chemotherapy medications used to treat a variety of childhood cancers. Over half of survivors will have some damage to cardiac muscle which may only manifest 10-20 years later. Cell and animal studies suggest the cardio-toxicity to be multifactorial in origin.  


A study of 76 childhood cancer survivors (median age nine years) after primary diagnosis and anthracycline treatment examined the relationship between plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) high sensitivity cardiac troponins: T(cTnT) and I(cTnI), troponin-specific autoantibodies (cTnAAb's) and imaging as markers of late cardiac anthracyclines toxicity.


cTnAAb positivity, impaired cardiac function on MRI, and an abnormal NT-proBNP level are associated with abnormal cardiac function as late markers of cardio-toxicity.


Acta Paediatrica 

Energy and nutrient intake from pizza in the USA


Though overall energy intake from pizza consumption appears to have decreased among children, pizza consumption particularly from fast-food restaurants or eaten as a snack is significantly associated with a higher daily total energy intake, higher intake of saturated fat and sodium independent of socio-demographic characteristics  


Pizza consumption in children 2-11 years of age has multiple adverse effects and should be curbed until its nutrient content is improved.





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