MCH Updates in Pediatrics Masthead  

                       Volume IV
                        Issue 29
                                                           South Florida's  only licensed  free-standing
                                                             specialty hospital  exclusively for children ...                                                      July 17,  2013 
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Obstructive sleep apnea (OSA) & adenotonsillectomy (TA)

It appears that as many as 1%-4% of children between the ages of 2 and 8 years suffer from sleep apnea.

Surgical removal of the adenoids and tonsils is the most common treatment for OSA. While it has previously been suggested that TA will completely eliminate OSA in 70%-90% of the children, its usefulness in reducing symptoms, and improving cognitive behavior, quality of life and polysomnographic findings have not been vigorously evaluated.


A prospective randomized trial of 464 children 5-9 years of age with OAS which evaluated TA benefits vs. a strategy of "watchful waiting", indicates that surgical treatment of OAS in school age children does not significantly benefit attention or executive function but does improve symptoms, quality of life and polysomnographic findings.


New England Journal of Medicine 

Erythropoietin for anemia of prematurity- IV or subcutaneous?

Erythropoiesis decreases after birth as a result of decreased production associated with increased tissue oxygenation. Preterm infants are born with a somewhat lower hematocrit, the nadir of which occurs early and is more severe than the anemia associated with the term baby.


A study of 100 infants weighing <1500gms and <32 weeks gestation randomly assigned to receive (at 72 hours of life) erythropoietin either subcutaneously or added to IV fluids, indicates no differences in blood transfusion requirements, nor reticulocyte count transferrin saturation or ferritin levels. Adverse incidents are similar.


Acta Paediatrica 

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Effect of "high" vs "lower" arterial oxygen saturations (O2 sats) on death/disability in extremely preterm infants  


The clinically appropriate range of oxygen saturation for the management of the sick preterm infant remains controversial. Lower O2 sat targets for these babies results in reduced rates of retinopathy of prematurity, while some studies suggest that targeting O2 sats <90% increases the risk of death.


A double-blind trial utilizing 25 hospitals and 578 infants (gest. age: 23 weeks-27 weeks 6 days) during which time infants were assigned to either a targeted O2 sat range of 85%-89%, or 91%-95% indicates no significant effect on death or disability at corrected age of 18 months.


New England Journal of Medicine



Incidence of rash after amoxicillin treatment in children with acute infectious mononucleosis (AIM)     


"Ampicillin rash" first reported in the 1960's appears to be a unique feature associated with Epstein-Barr virus treated with ampicillin.


A retrospective study of all hospitalized children diagnosed with AIM and treated (or not!) with amoxicillin indicates that only 29.5% developed a rash as compared to the 80%-100% previously reported.



Video Feature
Mono Symptoms - What is Mononucleosis?
Mono Symptoms - What is Mononucleosis?
via YouTube

Heated, humidified, high -flow nasal cannula (HHHFNC) vs. nasal CPAP (nCPAP) for neonatal respiratory support  


A randomized, controlled, un-blinded non-crossover trial of 432 infants (28-42 weeks gest. age) investigated the use of HHHFNC vs. nCPAP for respiratory support of the premature infant in the NICU. Need for endotracheal intubation at 72 hours was the primary outcome measured.


HHHFNC and nCPAP appear to be equally efficacious and safe for the initial support of the premature infant with respiratory distress.



Genetics of pediatric unconjugated hyperbilirubinemia (UCH)   


Genotyping of infants (>5 days of age) or children (to 17 years) with a diagnosis of unconjugated hyperbilirubinemia reveals that a significant proportion will have a variant of the gene UGT1A1, which encodes for a key enzyme involved in the conjugation of bilirubin. Autosomal hereditable familial conditions involving bilirubin conjugation (Gilbert syndrome, and Crigler-Najjar types I and II) are caused by a number of UGT1A1 locus variants. Other genes may also be involved. Full gene sequencing appears to be of value in the assessment of UCH in the older neonate/child.


Journal of Pediatrics 

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