Volume IV
Issue 1  

              Weekly Updates in Pediatrics         January 2, 2013

EDITOR:  Jack Wolfsdorf, MD, FAAP                   


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Sedation for pediatric EEG

Dexmedetomidine (Dex) is a sedative frequently used by Intensivists and Anesthesiologists to sedate children. As an Alpha 2-agonist it causes sedation without respiratory depression and therefore can be utilized in non-intubated children. It causes less tachycardia, hypotension and/or delirium than midazolam.


107 consecutive children (0.2-17 years of age) received intra-muscular (IM) Dex for EEG sedation. IM Dex preserves background activity and appears safe and effective for EEG sedation.

Salbutamol with metered dose inhalers (MDI) with spacers for the ED treatment of preschool wheeze

Salbutamol (albuterol/ventolin) is a short-acting selective β2-adrenergic receptor agonist used in the acute treatment of bronchospasm. By inhalation maximal effects occur within 5-25 minutes of dosing.


Over a short period of time salbutamol given by MDI with a spacer has become the mode of choice (c/f nebulizers) for the ED treatment of preschool children with wheezing.

Behavioral problems in preschool children on inhaled steroids (ICS) for asthma

A Child Behavior Checklist (CBCL) was utilized on 81 children 2-5 years of age on ICS to assess behavioral problems and compared to a published reference group of normal children, over a 3 month period.


Maintenance ICS treatment taken daily does not appear to be associated with an increased risk of behavioral problems in preschool children.

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"Trigger Thumb" (TT)-natural history/treatment


"Trigger Thumb" refers to a thumb that sticks, catches or locks as the tip of the thumb moves from a bent to a straight position. Occasionally the thumb may become "locked" in the flexed position.


The medical records of 64 patients with TT treated with a "coil splint", "regular observation" or "late surgery" were reviewed to clarify the natural history and outcomes depending on management.


"Splinting" produced complete symptom relief of TT in 92% of patients in 22 months, compared to a 60% resolution associated with "regular observation" (over 59 months). Late surgery appears safe and effective for residual snapping.


Source:  Journal of Pediatric Orthopaedics 

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Retinal hemorrhages as a predictor of inflicted traumatic (ITBI) or accidental (ATBI) brain injury


Retinal hemorrhages occur following traumatic brain injury, and many medical conditions. They may be subdivided into:


a) "subhyaloid and pre-retinal hemorrhages"

b) relatively superficial "flame-shaped" hemorrhages (within the nerve fiber layer)

c) "sub retinal" and "sub retina" pigment hemorrhages

d) "dot-blot" hemorrhages located in the deeper inner nuclear and outer plexiform layers whose cells run vertically


A prospective study using wide-field retinal and digital color/gray scale imaging evaluated, within 24 hours of admission to a PICU, the position, depth and number of hemorrhages associated with either ATBI or ITBI.


"Dot-blot" retinal hemorrhages in young children (<3yrs of age) appear strongly predictive of intentional traumatic brain injury (ITBI).


Source:  Pediatrics  

Prophylactic probiotics to prevent preterm infant death and nosocomial infection

A study evaluating the ability of a probiotic (containing 10 colony-forming units of L reuteri DSM 17938) given enterally (5 drops/day) to 750 randomly assigned premature infants (<2000 grams) from day 2 of life, to prevent death (or to discharge ) or to decrease nosocomial infections (and compared to a comparable matched placebo given group) indicates no significant decrease in the death rate nor in the prevalence of nosocomial infections. Feeding intolerance and duration of hospitalization however appear to be decreased in a subgroup of infants <1500 grams.   

Source:  Pediatrics 

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