Weekly Updates in Pediatrics         December 5, 2012 

EDITOR:  Jack Wolfsdorf, MD, FAAP 


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Efficacy of immediate and delayed cognitive and physical rest for the treatment of sports related concussions  


The American Academy of Pediatrics recommends that post-concussion children prior to returning to sports activities, should undergo a progressive exercise program, have a complete absence of symptoms, successfully complete a standardized neuropsychological test and continue to be observed for recurring signs or symptoms.


A study of 49 concussed collegiate athletes who were prescribed at least one week of cognitive and physical rest anytime between 1-31 plus days post concussion, indicates that significant performance improvement and decreased symptomatology occur associated with this rest period.


Source:  The Journal of Pediatrics

 Duration of Cardiopulmonary resuscitation (CPR) after cardiac arrest

An interesting study of 64,359 at risk adult patients in 435 US hospitals who suffered an in-hospital cardiac arrest and who underwent CPR for CPR variable times, indicates that 48.5% achieved return of spontaneous circulation and 15. 4% survived to discharge.


Patients who undergo CPR for 25 mins (25-28 mins) appear to have a higher likelihood of return of spontaneous circulation compared to those whose CPR time is curtailed.


Source:  The Lancet

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Reducing risks of childhood overweight

Many interventions have been utilized to try to reduce the present epidemic of childhood obesity in the Western world.


A German study of 34,240 children and adolescents age 3-18 years was undertaken to assess the impact of "familial", "social", "early life", and "lifestyle factors" on overweight.


Successful management of all determinants reduces childhood obesity/overweight by 77.7%. Partial effect occurs with managing parental overweight, improving social status and reducing media time to < 1 hour per day. Lifestyle interventions alone are of limited value in reducing the prevalence of overweight children.


Sources: Pediatrics


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Overweight/obesity (O/B) and dental sedation


A retrospective analysis of 510 O/B children who underwent dental sedation and who were compared to a comparable group of normal weight children, indicates that 86% of O/B patients experience no adverse events, while 18% have one or more of desaturations, nausea/vomiting, prolonged sedation and true apnea, respectively. 12% of normal weight children will have similar problems.


Source:   Pediatric Dentistry   

Neuropharmacology of the ketogenic diet


Although the mechanisms by which ketogenic diets protect against seizures in children is unknown, there is animal evidence that suggests that it materially alters brain energy (with ketones partially replacing glucose as the basic cell fuel).  Ketones themselves have anticonvulsant properties which apparently reduce spontaneous chronic recurrent seizures and have a protective effect on other models of neuro-degenerative disease.


Source:  Pediatric Neurology  

A new hypothesis for NEC-Paneth cell (PC) injury


Paneth cells along with goblet cells, enterocytes and enteroendocrine cells are the major cell types of the epithelium of the small intestine. PC's lie in the crypts of Lieberkuhn and function as an important component of host defense by secreting anti-microbial compounds when exposed to bacteria/bacterial antigens. They also protect intestinal stem cells from injury, stimulate their differentiation and assist in the repair of the gut.


In an animal model, selective destruction of PCs appears to release tumor necrosis factor alpha, and other inflammatory mediators resulting in an inflammatory process that induces coagulation of bowel vessels which mimics the pathoclinical presentation of NEC.


Source:  Neonatology  

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