Volume IV
Issue 2 

              Weekly Updates in Pediatrics         January 9, 2013

EDITOR:  Jack Wolfsdorf, MD, FAAP                   


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Autism spectrum disorder (ASD) & Attention deficit/Hyperactivity disorder (ADHD): One entity?

ASD and ADHD frequently co-occur.  


It seems that ASD and ADHD in children share some etiological underpinnings with some children presenting primarily without behavioral problems, some with only ADHD behavior and some with clinical symptoms of both - frequently one domain being more prominent than the other. Different clinical approaches appear required, depending on domains of symptomatology.



Extra-thickened formulae, gastroesophageal reflux (GER) & preterm apnea  

Apnea of prematurity (AOP) occurs frequently in preterm infants and may be induced by GER. Conservative dietary considerations appear to be the first-line approach to management.


A study of 24 preterm infants with AOP who were given 2 different commercially available starch thickened preterm formulae (one thickened additionally with amylopectin) and the number of apnea and GER episodes recorded, indicates that extra thickening with a amlylopectin of an already thickened preterm formula neither changes the frequency or apnea or GER episodes compared to a standard thickened formulation.


Source:  Neonatology 

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Late diagnosis Hirschsprung's disease (HD) and surgical outcomes


HD was diagnosed in 11 children late, at ages 3.0-9.6 years. 10 children had rectosigmoid disease, while 1 had total colonic aganglionosis. Early post-operative complications were seen in 45% of patients (mostly anastomotic leakage). At final follow-up 3 years later, 63% had normal bowel function.


Long-term post-operative treatment of children diagnosed late with HD had functional results comparable to those seen in children operated on as neonates.

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Gastrointestinal manifestation of cow's milk protein allergy (CMPA)


It may be difficult to distinguish between the gastro-intestinal manifestation of CMPA and gastro-esophageal reflux (GER). A decrease in symptomatology with an extensive hydrolysate and relapse with challenge isn't proof of allergy, as hydrolysates enhance gastric emptying time. Failure to reduce symptoms with a thickened formula suggests CMPA, but is not pathognomonic.


There are no objective diagnostic tools to separate CMPA from GER. Treatment options include treating the most likely diagnosis first, or treating both conditions with one intervention.


Source:  Acta Paediatrica

Superior mesenteric artery syndrome after Nuss procedure for pectus excavatum (PE)


PE is a congenital chest wall deformity, more frequently seen in boys, that is caused by an overgrowth of the cartilage that connects the ribs to the sternum. This causes a depression of the sternum and chest which results in a "sunken" or "funnel chest" appearance. It may be present at birth. The minimally invasive Nuss procedure (using a metal plate stabilizer) appears to be the commonest surgical treatment.


Complications following the surgical correction of PE are not uncommon (12%-15%). Superior mesenteric artery syndrome (SMA) however is a very rare life-threatening, gastro-vascular disorder characterized by compression of the duodenum by the abdominal aorta and the overlying superior mesenteric artery. This is the first reported case associated with the Nuss procedure.


Source:  Journal of Pediatric Surgery 

Pertussis & acellular vaccines   


Pertussis remains a highly contagious, vaccine preventable disease. With the wide spread use of vaccines, reported cases have diminished significantly over the past years.


DTaP (which replaced the whole-cell pertussis component with acellular purified pertussis antigens) has been in use since the 1990's and has reduced the local and systemic adverse events associated with the older vaccines (DTwP). DTaP is currently recommended for both primary (3 doses given at 2, 4, 6 months of age) and booster (2 doses administered at 15-18 months, and 4-6 years of age) immunization. An adult formulation (Tdap) is now available for an additional single boost dose.


Source:  JAMA 

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