Volume IV
Issue 3 

              Weekly Updates in Pediatrics         January 16, 2013

EDITOR:  Jack Wolfsdorf, MD, FAAP                   


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Surgical treatment of anal sepsis in children

Anal sepsis in children (usually infant boys) ranges from perianal abscess to fistula-in-ano. Many are treated conservatively. Older children with anal sepsis more frequently require surgery.


Children older than 2 years of age who present with anal abscess appear best treated with incision and drainage- with few recurrences or fistula formation. Fistulae are successfully treated with fistulotomy (complex fistulae are uncommon).



Burns from topical pain relievers  

Lotion Over-the-counter topical creams, lotions and patches to relieve muscle and joint pain may cause serious burns (frequently within 24 hours of use) warns the FDA following a review of 43 such cases. Burns included first-second-third-degree burns from the menthol, methyl salicylate, capsaicin (singly or in combination) found in these products. Some patients require hospitalization.


Source:  JAMA 

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American pediatric surgical association (APSA) management & outcome review of necrotizing enterocolitis (NEC)


While many studies exist outlining the medical treatment of necrotizing enterocolitis, the optimal surgical management remains a challenge. The APSA evaluated a variety of published (and unpublished) sources to answer a number of questions pertaining to the prevention and surgical care of NEC.


It appears that there is NEC literature to support:

  • The prophylactic use of probiotics in preterm infants <2,500gms.
  • Breast milk usage is recommended when possible.
  • There is no clear evidence to support:
    1. Delayed initiation or slow advancement of feeds.
    2. Peritoneal drainage versus laparotomy for NEC perforation.
    3. Enterostomy versus primary anastomosis after resection.
    4. Any particular link of antibiotic treatment to prevent recurrence.

Source:  Journal of Pediatric Surgery 

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Necrotizing enterocolitis
Necrotizing enterocolitis
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Long-term outcome of resective epilepsy  


A study of 545 children whose epilepsy could not be adequately controlled with medication and who underwent cerebral resective surgery, (including 10 hemispherotomies) and subsequently followed for 7 years indicates that 55.5% of children were seizure free. Best results appear to be found after functional hemispherotomy and temporal lobe resection. 71% of the children/parents reported improved cognitive and psychosocial functioning.


Resective surgery appears to be a valuable adjunct therapy for difficult to medically manage epilepsy.


Source:  Acta Paediatrica

Association between temperament at 1.5 yrs. & obesogenic diet at 3 & 7 yrs 

It appears that anxious dependent (internalizing), as well as hyperactive, aggressive (externalizing) infants are more likely to consume sweet drinks and foods, and less fruits and vegetable daily at 3 and 7 years of age. Active, sociable (surgent) infants appear more likely to consume significantly more fruits/vegetables daily at similar ages.


Early child temperament is a risk factor for obesogenic diet consumption later in childhood.


Source:  Developmental Behavioral Pediatrics 

Optimal dress-code for Pediatricians!


107 children (6-18 years of age) and 72 parents were seen by a pediatrician randomly wearing one of three different outfits (casual, semiformal, formal) and were subsequently interviewed regarding their preference. Children's' (0-6 years) behavior was observed during their examination.

Parents and children 6-18 years of age apparently prefer, and maintain their trust in pediatricians who dress casually. Pediatrician dress has no apparent effect on small children.

Source:  Acta Paediatrica