HealthFusion-MCH Masthead
December 11, 2013   Vol. IV, Issue 50
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MCH's 49th Annual Pediatric Postgraduate Course


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 Effectiveness of fundoplication at the time of gastrostomy in infants with neurological impairment.

Gastrostomy tube (GT) insertion is the most common gastrointestinal (GI) operation during the neonatal period. Fundoplication used to prevent GI reflux is frequently undertaken at the same time. Its effectiveness is unproven.


Data from 4,163 infants with neurological impairment who underwent GT placement with or without fundoplication was retrospectively utilized to evaluate at 1 year post-procedure, reflux-related hospitalization rates (defined as admission for asthma, mechanical ventilation, GI reflux disease and aspiration or other type of pneumonia).


It appears that neurologically impaired infants who undergo gastrostomy plus fundoplication have more reflux-related hospitalization. This may be related to lack of effectiveness of the fundoplication or perhaps other differences in the patient group studied.



 Cognitive enhancement in children & adolescents.

It appears that children and adolescents are consuming a variety of both stimulants and non-stimulants in an attempt to enhance academic performance through cognitive enhancement.  Utilizing the "best interests" standard for ethical, moral, social, legal and medical decision making for minors, this practice which is not without health and societal risks should not be encouraged.


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Soft drink consumption & behavioral problems.  


The "Fragile Families Child Wellbeing Study" was utilized to prospectively study birth cohorts of mother-child pairs from 20 large USA cities. Mothers of the sample of 2,929 5 year olds were asked to report how many servings of soda their child drinks per day and note aggressive and/or withdrawal behaviors and attention problems.


Adjusting for socio demographic factors 5 year old children who consume on average 1-4 servings of soda per day exhibit more aggressive and withdrawal behaviors and attention problems, compared with those drinking no soda.


Journal of Pediatrics

Recurrence of Autism Spectrum Disorder (ASD) in siblings.  

A population based cohort study of Danish children examined whether having an older sibling with ASD increased the risk of ASD's in subsequent children.


The overall relative recurrence risk for ASD's is increased for both full and half siblings when an older child has ASD, which does not appear to change over time. This data suggests both the role of genetics in ASD's plus factors that are associated with pregnancy and the maternal intrauterine environment.



Video Feature  
16x9 - Autism Awakening: Boy recovers after diagnosis
16x9 - Autism Awakening: Boy recovers after diagnosis
via YouTube

Aerosolized intranasal midazolam for CT scan etc. sedation.  


Midazolam (Versed in English speaking countries) is a rapid onset, short acting, benzodiazepine with a fast recovery time used for sedation, amnesia, anxiety, skeletal muscle relaxation CT Scanner and as an anticonvulsant. It is absorbed via the nasal, gum, cheek, and rectal mucosa.


Aerosolized nasal midazolam appears to produce effective, reliable, and predictable sedation with no significant adverse reactions. It is useful for radiological imaging (and in the Emergency Department).


Journal of Pediatrics 


Journal of Pediatrics

Chronic abdominal pain & the median arcuate ligament syndrome (MALS).


The median arcuate syndrome, also known as celiac artery compression syndrome, celiac axis syndrome, celiac trunk compression or Dunbar syndrome is characterized by abdominal pain, which may be related to meals and accompanied by weight loss. It is usually due to compression of the celiac artery by the median arcuate ligament (the fibrous ligament at the base of the diaphragm where both sides join near the 12th thoracic vertebrae), which instead of passing as it normally does over the aorta , lies over and compresses the celiac artery (25% of normal individuals).


A prospective study of 46 children initially diagnosed with chronic functional abdominal pain and subsequently diagnosed (duplex ultrasound and computed tomography) with MALS, indicates that most patients are girls, laparoscopic surgical release results in a substantial increase in celiac artery blood flow and in 67% of patients, symptomatic improvement.


Journal of Pediatric Surgery