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Volume IV
Issue 13

              Weekly Updates in Pediatrics         March 27, 2013

EDITOR:  Jack Wolfsdorf, MD, FAAP                   

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Polyvalent pneumococcal conjugate vaccines 

2 interesting articles discuss the value of implementing a polyvalent pneumococcal conjugate vaccine (PCV7, PCV10, PCV13) program to decrease the incidence of pediatric pneumonia and meningitis. The prevention of pneumococcal disease is more complex because of the many disease causing pneumococcal serotypes, the ability of the organism to modify its capsule and the difficulty of making a polyvalent vaccine.

 

While the 13-Valent pneumococcal vaccine certainly appears to reduce invasive pneumococcal disease, the assessment of its effectiveness has to be examined in the light of natural variation in pneumococcal serotype, the level of immunity in the population studies, viral co-infection patterns, temperature variations, pneumococcal clonal circulation and changes in surveillance methodology, laboratory methods or clinical diagnostics.

 

Supplemental iron to improve hemoglobin status/decrease transfusions in low birth weight (LBW) infants

In infants <1,500 grams birth weight supplemental iron (2mg/kg/day) in addition to iron-fortified formula or mothers milk appears neither to increase the hematocrit or decrease the need for red blood cell transfusion at 36 weeks post menstrual age.

  

Source: Pediatrics 

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Gastroesophogeal reflux (GER) & childhood cough

 

A study of 106 children with unexplained cough, who did not receive acid suppressives was utilized to investigate the relationship between GER, weakly acid reflux and cough.

 

Weakly acid (pH: 4-7) reflux, in addition to acid reflux (pH: <4) may precede cough episodes, particularly in the <2 year old infant. This may explain this group's inconstant response to anti-acid treatment.

 

Source:  Pediatric Pulmonology 

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Acid Reflux Medication and Asthma  

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Abnormal intestinal microbiota as a cause of "colic" in infants   

 

A comprehensive DNA analysis of fecal microbiota in infants with and without colic during the first weeks of life indicates significant differences in fecal organisms.

 

At 1-2 weeks of life, diversity and stability of organisms in colicky babies is significantly lower than that of a matched group. Bifidobacteria and lactobacilli are significantly reduced in the colicky babies. This microbial signature may be helpful in the early diagnosis of the potentially colicky infant as well as provide guidance for treatment options.

 

Source:  Pediatrics 

Lung ultrasound (US) to diagnose pneumonia in children

 

A diagnosis of pneumonia is usually based on medical history, physical examination and frequently an x-ray chest (CXR). Ultrasound examination has been utilized extensively in horse veterinary practices and more frequently recently in pediatrics.

 

A study of 89 children with a confirmed diagnosis of pneumonia evaluated by both CXR and lung US on the same day indicates that lung US is a simple, radiation free and reliable imaging technique to diagnose pluro-pulmonary disease in children.

 

Source:  Pediatric Pulmonology 

Tracheostomy for infants with bronchopulmonary dysplasia (BPD)

 

The optimal time and safety for the placement of a tracheotomy in infants with BPD, has not been determined. A study was undertaken of 22 patients (median weight 750 gms; gestational age 25.4 weeks) who had a tracheostomy placed on approximately day 177 of life and were on high ventilator and inspired oxygen settings.

 

1 month post-tracheostomy of premature babies with BPD who underwent tracheostomy while on high ventilating settings, indicates that both morbidity and mortality are significantly improved. High ventilator pressures do not appear to be a contraindication for a tracheostomy. Optimal timing of tracheostomy placement requires further research.
 

Source: Pediatric Pulmonology 

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