March 19,  2014   Vol. V, Issue 12
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Is "bigger" really better? Obesity among high school football players, position & team success.  

A large study of high school football players examined body mass index, player position, division and success based on win-loss percentage. Football Players


Most high school football players are "skill players" who are mostly of a healthy weight; linemen are overwhelmingly obese (21% morbidly obese). Team success correlates with "skill players" and weight only. Obesity is a significant problem in high school football.  


Clinical Pediatrics 

Childhood Functional capacity (exercise capability) of very-low-birth-weight (VLBW) premature infants.   

37 VLBW, and an equal number of infants born at full term, underwent at 6 and 9 years of age the "six minute walk test" and the "10 minutes shuttle walk test" with physiological parameters being measured before and after each test, to assess relative functional capacities.


Children born prematurely walk shorter distances than those born full term. This limited functional capacity appears to be related to height at testing and oxygen dependency at 28 days of life.


Pediatric Pulmonology

Differentiating signs & symptoms of acute sinusitis vs. viral upper respiratory tract (URI) infection.

Differentiating acute bacterial sinusitis from a viral upper respiratory tract infection (URI) is difficult. It appears that 20-40% of children diagnosed with acute sinusitis on clinical criteria alone actually suffer from an uncomplicated URI.


A study of 258 children investigated for a clinical diagnosis of sinusitis reveals that physical examination is unhelpful in separating acute bacterial sinusitis from a viral UTI. Sleep disturbances and a green nasal discharge favor a diagnosis of sinusitis.


Pediatric Infectious Disease Journal.



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-James Joyce  

Cognitive behavioral therapy (CBT) plus amitriptyline for chronic migraine headache.


"Early, safe, effective and durable evidence-based interventions for children and adolescents with chronic migraine do not exist".


A randomized trial of 135 youths aged 10-17 years with chronic migraine headaches received either 10 sessions of "CBT plus amitriptyline" or "headache education plus amitriptyline" and were followed for twelve months.


CBT plus amitriptyline results in less headaches/migraine-related disability than a treatment program which just includes headache education and the same drug.



Video Feature  
Khalili Center - The James Hardy Story
Khalili Center - The James Hardy Story
via YouTube
Neonatal jaundice/kernicterus-an unusual case of glucose-6-phosphate dehydrogenase (G6PD) deficiency masquerading as sepsis.

60% of all babies develop jaundice during their first days of life (from a variety of causes) which when severe may cause kernicterus. Kernicterus is a bilirubin-induced brain dysfunction presenting acutely with decreased feeding, lethargy, hypotonia (or hypertonia), opisthotonus, high pitched cry, fever, seizures and even death.


An interesting report of a term male infant who after phototherapy for hyperbilirubinemia was discharged from hospital at 48 hours, with a total serum bilirubin (TSB) of 10.9mg/dl, and told to return for follow-up 48 hours later. Just prior to his appointment he became listless and apneic where at the children's hospital he was thought to be septic. His TSB was 41mg/dl. He died 4 hours later. Blood drawn prior to exchange transfusion revealed low glucose-6-phosphate dehydrogenase enzymatic activity.


Acute neonatal Kernicterus can mimic septic shock.



Human breast milk-effect of fortifiers & additional protein on osmolarity.


Breast milk alone does not provide adequate calories, calcium, phosphorous, iron or vitamins for very low birth weight (VLBW) or extremely low birth weight (ELBW) infants. Breast fed infants <1500 grams birth weight should have a human milk fortifier once on >100cc/kg/day enteral feeds. ELBW infants (<1000 grams birth weight) require more protein in their feeds. At present, the American Academy of Pediatrics recommends that breast milk/infant formula not exceed 450mOsm/kg or 400mOsm/L to minimize the likelihood of necrotizing enterocolitis.


An osmolar study on 84 breast milk samples identifies the osmolar changes when adding a commercial fortifier and an addition protein supplement to human breast milk.


Breast milk has an osmolarity of 297mOsm/L; adding a commercial fortifier increases the osmolarity to 436mOsm/L; supplementing fortified human milk with additional proteins, increases breast milk osmolarity by 23.5mOsm/0.5gm protein. Multivitamins and other additives further increase the osmolarity.


Human milk plus fortifier plus protein should not be given together with multivitamins or other additives, to VLBW/ ELBW infants. 


Journal of Pediatric Gastroenterology & Nutrition 

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