Volume IV
Issue 8

              Weekly Updates in Pediatrics         February 20, 2013

EDITOR:  Jack Wolfsdorf, MD, FAAP                   

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Combined formoterol-corticosteroid therapy for asthma

Formoterol is long-acting beta 2 agonist (LABA) used in the treatment of asthma, with apparent similar bronchodilator effects delivered by metered dose inhaler or nebulizer, to high-dose salbutamol & terbutaline. As the US FDA indicated that using LABs may, in some patients, result in worsening, combination inhaler medications utilizing a LABA plus a corticosteroid are becoming more wide spread.


In an interesting first case report, a 9 year old asthmatic boy treated with formoterol and budesonide developed insomnia, pressured speech, agitation and suicidal ideation within 1 month of the onset of treatment. All symptoms resolved within 48 hours of discontinuation of the formoterol.


Source:  Pediatric Pulmonology 

Pain-a "familial" trait

The level of post operative pain children experience appears to have a "genetic" component. Children whose parents were genotyped with 6 polymorphisms of genes implicated in pain receptors, and who had 2 of the 6 genes, demonstrate considerably more pain (on The Pain Faces Scale) post abdominal/orthopedic surgery.


Source: Anesthesia and Analgesia 2013;116:170-7,


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Diagnosing urinary tract infection


Microscopic pyuria and leukocyte esterase are poor substitutes for urine culture in patients with symptoms of lower urinary tract infection. 40% of white blood cells are lost within 4 hours in spite of refrigeration and preservatives.


British Journal of Urology International 2013, doi:10.111/j1464-410x.2012.11694.x

Video Feature
Urinary Tract Infection: Pathogens, Diagnosis 
Urinary Tract Infection: Pathogens, Diagnosis

USMLEVideoLectures via YouTube

Risk factors for Retinopathy of prematurity (ROP)


Of 423 premature infants (gestational age: 26-28 weeks) (birth weight: 840-1190gms) screened for ROP in a Neonatal Intensive Care Unit, ROP developed in 40.4%, most being "severe".


Risk factors for the development of ROP include premature birth, low birth weight, mechanical ventilation and the development of necrotizing enterocolitis. Close follow-up is required to ensure best visual outcomes.


Source:  Pediatric Ophthalmology and Strabismus 

Vaginal progesterone to prevent preterm delivery


It appears from a study of approximately 300 women with twin pregnancy that using a high does (400 mg) vaginal progesterone pessary (twice daily from 20-34 weeks gestation), does not decrease preterm or very preterm births, perinatal morbidity or mortality.


Source::BJOG 2013;120:50-7, doi:10.1111/j.1471-0528.2012.03448.x)

Nasal continuous positive airway pressure (nCPAP) vs conventional oxygen therapy for viral bronchiolitis


It appears that 6 cmH2O nCPAP pressure support delivered via a jet flow generator (for infants < 6 months) in severe respiratory distress associated with RSV bronchiolitis (and compared to a comparable group treated with an air/oxygen mixture) results in significant clinical improvement, and decreased work of of breathing.


Immediate nCPAP (6 cmH2O pressure) should be considered first for young infants with severe RSV bronchitis.


Source:  Pediatric Pulmonology 

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