June 25, 2014   Vol. V, Issue 26
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Effect of Kangaroo mother care (KMC) on growth & development of low birth weight babies.

Kangaroo care is a non-conventional, low-cost technique of newborn care usually practiced on stable preterm newborns where the infant is held skin-to-skin with an adult.


A study of 500 mother-baby pairs in groups of 5, in a parallel group-control group trial which examined the effect on growth and development to 12 months of age of lowest birth weight infants given kangaroo care vs. larger preterm infants given conventional care, indicates that KMC babies despite being smaller, rapidly achieve equal physical growth parameters by 40 weeks post-gestation, & surpass the control group for both motor and mental development parameters, subsequently.


Acta Paediatrica 

 Treatment of Bronchiolitis in Infancy-nebulized hypertonic saline &/or heated humidified high-flow nasal cannula (HHHFNC)?

Bronchiolitis continues to be one of the most common and costly respiratory diseases of infancy. Two recent articles examined the effect of nebulized 3% hypertonic saline vs. 0.9% normal saline on admission rate and hospital length of stay, and whether nebulized hypertonic saline is superior to HHHFNC.


It appears that nebulized hypertonic saline administered in the Emergency Department to bronchiolitic infants decreases hospital admission rates (whiteout affecting clinical symptomology or length of stay).


When hypertonic inhalation is compared to HHHFNC for infant Bronchiolitis, no differences are found with regards to severity outcomes, length of hospital stay or PICU admission rate.


JAMA Pediatrics 


Archives of Diseases in Childhood 



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Preschool Internalizing behavior (INT) & hereditary


"Behavior and psychological problems are often described in terms of their degrees of internalizing vs. externalizing presentation". Children's "internalizing" symptoms are those that are focused inward e.g. depression, worry, fear, self-injury and social withdrawing.  


"Preschool internalizing behaviors are highly heritable and genetically stable from childhood to adulthood". A study of 4,596 children with INT (assessed by the Child Behavior Checklist) investigating genome-wide single nucleotide polymorphisms (SNP's) indicates that INT is probably polygenic, many genes having a small effect that together present clinically early in life; many of whom also playing a role in childhood psychiatric disorders.


While chromosomal genetic testing may be valuable in diagnosing pediatric genetic disorders, such testing require "clear patient information sheets, in-depth pretest discussion for informed consent, timely feedback of results and genetic referral as appropriate".


Journal of the American Academy of Child & Adolescent Psychiatry 


Acta Paediatrica 

Video Feature  
Factors That Put Teens at Risk for Drug Use
Factors That Put Teens at Risk for Drug Use
via YouTube

Testing for drugs of Abuse in Children & Adolescents.


The American Academy of Pediatrics' Committee on Substance Abuse has recently published an extensive review on this topic which would be of value for all pediatricians to read.


The summary reads as follows:


"Drug testing is a complex procedure that, when used properly, may have a number of clinical indication. However, drug testing also has a number of drawbacks; it can be invasive, it yields only limited information, and results can easily be misinterpreted. Drug testing should never be the sole basis for making a diagnosis of a substance use disorder; rather test results should be used to supplement information obtained by history and physical examination......."



Retained fetal lung fluid: Not always bilateral.


Five major events establish the lungs as an organ of gas exchange at birth. These include:

  1. Release of surfactant into the alveolar-air interphase.
  2. Establishing spontaneous breathing.
  3. Decreasing pulmonary vascular resistance.
  4. Cessation of the right-to-left shunting of venous blood returning to the heart.
  5. The clearing of fetal lung fluid.

The clearance of lung fluid can be affected by many factors and when impaired results clinically in tachypnea-referred to as "Transient tachypnea of the newborn (TTN)". This usually clears within 24 hours in the full term infant.  


An interesting case presentation of a full term infant who presented with respiratory distress on the first day of life and was subsequently found to have congenital polyalveolar lobar emphysema of the right middle lobe and unilateral retained fetal lung fluid, reminds us that this condition and bronchial obstruction may present initially with a unilateral failure of lung fluid removal.


Journal of Pediatrics 

Cervical spondylodiscitis following button battery ingestion.


"Severe and fatal button battery ingestions are increasing" Complications include perforation of the esophagus, fistula formation, stricture, vertebral ostemyalitis and discitis (spondylodiscitis). Fatalities mostly occur in children less than 4 years of age who have ingested large (> 20 mm) button batteries.


While discitis is a fairly uncommon complication of button-battery ingestion, a case of a 14 month old boy who presented with abnormal neck posture, cough and fever is instructive.


Journal of Pediatrics 

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