May 13, 2015   Vol. VI, Issue 19
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Abdominal oxygen saturations for return of spontaneous circulation following out-of-hospital cardiac arrest.

Near-infrared spectrophotometry (NIRS) allows for the measurement of oxygen saturation in blood.


A study of 34 out-of-hospital cardiac arrest adult patients, brought to the Emergency Department where abdominal and cerebral oxygen saturations using NIRS from the start of cardio pulmonary resuscitation (CPR) were measured, indicates that increased saturation levels correlate well with the early return of spontaneous circulation.


American Journal of Emergency Medicine 

Chikungunya virus (CHIKU) and pediatric disease.

CHIKU is a single-stranded RNA virus that is transmitted by the bite of the Aedes spp. mosquito. Non-human and human primates are probably the main reservoir of the virus; epidemics in Africa and Asia are common, and first cases have been reported in the Americas and Caribbean islands. Adults and children can become infected and symptomatic, though up to 28% of infected people remain asymptomatic. Maternal-fetal transmission during pregnancy may occur (none found in breast milk).


The incubation period of Chigungunya disease is typically 3-7 days with sudden onset of high fever, and/or muscle pain and polyarthralgia, rash and headache. Diagnosis is typically clinical and laboratory studies may indicate thrombocytopenia, lymphopenia, elevated creatinine and liver function tests (rare but more serious complications may occur). No specific antiviral treatment exists and management is symptomatic.


New England Journal of Medicine 

Accuracy of head circumference measurement for hydrocephalus.

It appears that measuring head circumference during the first year of life to diagnose hydrocephalus has a 72.1% sensitivity and 97.1% specificity for "very large heads" (>2.5 standard deviations on the growth chart), & 74.4% and 93.0% respectively for a "large head" (>2.0 standard deviations).  


Measuring the head circumference in the first year of life may only diagnose accurately a "vary large" and/or a "progressively increasing head circumference".  (Further improvements in accuracy may need to take into account parental head circumference etc.)


Pediatric Neurology 

Changes to Meaningful Use Stage 1 & Stage 2-What Do They Mean to Your Practice?

Dr. Seth Flam, board certified in Family Practice, co-founder and CEO of HealthFusion


CMS has released a proposed rule that would dramatically change the Meaningful Use program, starting in 2015. Here are the 5 most important proposed changes to the rule and ramifications of these proposed changes...




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Anti-TNF therapy for pediatric inflammatory bowel disease (PIBD).


PIBD is a group of chronic inflammatory small and large bowel disorders (most commonly Chron's disease and ulcerative colitis) that present with slow or sudden onset of symptoms (varying from mild to severe), pain, frequent diarrhea, blood in


the stool, fever, weight loss and joint, skin or eye irritation. 30% of affected children have a family member who also has the disease.


While antinflammatory steroid sparing drugs are frequently utilized, early use of biological agents (or targeted immunotherapy) appears to significantly improve bone metabolism and reverse (partially) grow failure. Infliximab (Remicade) and adalinmumab (Humira) are two anti-TNF biological agents used in the treatment of pediatric IBD. There is however only limited evidence of efficacy and safety.


A study of 132 IBD children treated (over a 10 year period) with anti-tumor necrosis factor agents indicates moderate effectiveness, and while in this study no deaths occurred many had significant adverse reactions and 95 required hospitalization. Much still needs to be learned regarding efficacy, duration and safety.


Archives of Diseases in Childhood 

Video Feature 

(via YouTube)
Chikungunya virus
Chikungunya virus

Update in the medical management of eating disorders in adolescents


"Eating disorders are complex biopsychosocial disorders" best managed by a multidisciplinary team.


"A proposed classification for the degree of malnutrition of adolescents with eating disorders" indicates:


1.    Mild       

: % median BMI = 80% - 90%.

: weight loss >10% body weight.

: BMI z score (percentile) -1 to -1.9.


2.    Moderate   

: %median BMI = 70% to 79%.

: weight loss >15% body weight.

: BMI z score -2 to -2.9.


3.    Severe           

: % median BMI = <70%.

: weight loss >20% body weight mass loss in one year.

: BMI z score -3 or greater.


Most adolescents with eating disorders can be managed as outpatients. Family-based therapy (structured into three phases) appears to be the best methodology to ensure improvement and parents have a critical role in restoring weight loss.


(This is an excellent guide for Pediatricians on their role in the diagnosis, classification and management of adolescent eating disorders.)


Journal of Adolescent Health 

Proximal Phalanx fractures in children.


"Fractures of the proximal phalanx are potentially the most disabling fractures of the hand." Proximal fragments are usually flexed (by intrinsic muscles) while distal pieces are extended which with adhesions may lead to loss of motion. Reduction is easy but difficult to maintain.


A retrospective study of 105 children with displaced proximal phalanx fractures treated by closed reduction and percutaneous pinning (CRPP) and assessed a year later, suggests that:

  • 4.8% have initial complications.
  • 34% have initial stiffness requiring hand therapy to correct.
  • At one year follow-up all children have full hand motion, no pain and visually virtually normal finger appearance.

Journal of Pediatric Orthopedics 

Parental Child-rearing attitudes and functional constipation in children.

"There is no precise definition of constipation that fits all people" and there appears to be no "right" number of bowel movements per day. In general two or less normal bowel movements per week (depending on age, diet, activity, etc.) may be indicative of constipation. Causes vary. Functional constipation (or chronic idiopathic constipation) has no anatomic or physiological etiology, but may have a psychological or psychosomatic basis.


A study of 133 constipated children (4-18 years) examined the association between parental child-rearing attitudes and their development and maintenance of childhood constipation.


Parents who "over-control", "over-protect" and exhibit "self-pity" attitudes are more likely to have constipated children.


Archives of Diseases in Childhood

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