Updates in Pediatrics from Miami Children's Hospital: Dec 12 Issue

Weekly Updates in Pediatrics December 12, 2012

EDITOR: Jack Wolfsdorf, MD, FAAP

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Prevalence and predictors of anxiety and depression in Adolescents with heart disease

Adolescents (12-20 years) with congenital heart disease, the majority of whom had previously had surgery and/or catheter interventions are at substantial risk (9%) for depression and anxiety (27%). Patient optimism and good social support reduces the incidence of both.

Source: The Journal of Pediatrics

Complex regional pain syndrome (CRPS) following immunization

CRPS is a relatively new disorder (1994) characterized by pain, sensory and motor disturbances affecting one or more extremities, which cannot be explained by any known condition. While the pathophysiology is not fully understood, it appear to be a systemic disease involving the central, autonomic and peripheral nervous systems. Its onset is often precipitated by physical injury.

CRPS is precipitated by a variety of immunizations including diphtheria-tetanus-acellular pertussis, human papillomavirus, rubella and hepatitis B vaccines.

Source: Archives of Disease in Childhood

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Idiopathic Toe-walking in 5 year old children

"Children walking on their toes instead of the typical gate without evidence of underlying medical condition, are defined as idiopathic toe walkers."

It appears (from history) that approximately 3% of children less than 5 years of age toe-walked in the past (inactive toe-walkers). 2% of children still walk on their toes (active toe-walkers) at 5 years of age. Children with neuropsychiatric diagnoses or developmental delay have a higher (41.2%) prevalence of both active and inactive toe-walking.

Source: Pediatrics

Video Feature
Design: Management Of Idiopathic Toe Walking
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Long term effects of urinary tract infections (UTI) in childhood

Kidney scarring related to UTIs' in childhood have been considered to be the cause of long term sequelae. With the advent of ultrasound in the 1980's, many of the kidney changes previously thought to be associated with UTI's have turned out to be congenital malformations.

A survey of the literature between 1980 and 2011 examining the long term effects of UTI's in childhood, appears to indicate that very few (0.4%) children with initial normal renal function show subsequent deterioration on follow up, and the risk of subsequently developing hypertension is low.

Source: Acta Paediatrica

Propranolol treatment for severe infantile hemangiomas (IHs)

Under careful observation, 2mg/kg/day oral propranolol as a single-agent treatment was given to 28 children with problematic, proliferative-phase infantile hemangiomas.

After one month of daily oral propranolol treatment beneficial effects on IH are noted for both color and growth. At mean 7.56 months of completed treatment, almost all hemangiomas are successfully regressed.

Source: Acta Paediatrica

"Late" better than "Early" elective cesarean section (CS)

CS deliveries have increased primarily due to patients/obstetrician preference. While CS decreases the risk of delivery related injuries, respiratory and neurologic complications are increased.

A study of 12,276 elective, matched, CS births, of which approximately half were "early" (37-38 weeks gestation) and half "late" (39 weeks plus) indicates that more "early" CS babies are admitted to a neonatal ICU with a higher prevalence of morbidites.

"Late" (>39 weeks gestation) elective CS appears safer than "early" CS.

Source: Acta Paediatrica