May 6, 2015   Vol. VI, Issue 18
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Airway compromise in children exposed to single-use laundry detergent pods (LDP's)

"Exposure" means someone who has ingested, inhaled, absorbed through the skin or eyes etc. any substance/toxin or poison. In 2014 almost 12,000 "exposures" to highly concentrated packets of laundry detergent in children <5 years of age were reported to Poison Centers in the USA.


Of 131 unintentional LDP exposures identified between 2012-2013 (median age 2 years), most cases occurred following ingestion with vomiting, ocular injuries, upper and lower airway effects and central nervous system depression.


LDP exposure can cause significant toxicity particularly in infants and toddlers; the airways being one of the most common areas of compromise.


The American Journal of Emergency Medicine

Treatment trends in adolescent clavicle fractures

Clavicle fractures are common. While multiple attempts have been made to devise a classification system, the most common one used (Allman) divides the clavicle into thirds.

When taken as a group clavicle fractures generally heal without surgery, however (particularly medial and middle clavicle fractures) some specific patterns and sites, e.g. displaced distal third fractures (plus other indications) appear to require surgery.


A study to evaluate recent trends in non-operative and operative management of adolescent clavicle fractures suggests a significant increase in operative management with open reduction and internal fixation occurring more frequently, particularly in the 15-19 year old age group.


Journal of Pediatric Orthopedics

Why is initial bacterial colonization of the intestine important to infants and children's health?

Microbial colonization of the infant occurs during a critical time for immune and gastrointestinal development. Colonization is affected by birth mode, breast feeding, by the actions of the immune system, and result in critical time education of the neonatal immune system's gut, barrier function and metabolism.  


Together with genetics and nutrition the infants' gut microbes set the stage for not only a stable lifelong adult colonization pattern, but also the development of childhood (and adult) obesity, food allergy and inflammatory bowel disease.

This is a valuable article to read in full on an increasingly important topic (Ed.).


Journal of Pediatric Gastroenterology and Nutrition 



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Predictors of disease severity in children hospitalized for pertussis    


"Pertussis may cause serious illness in infants, children and adults"; 1-2 weeks after the onset of "cold-like" symptoms, coughing may begin (lasting many weeks and/or months). In infants cough may be minimal (or absent)  & may present with recurrent apneic episodes. Almost 50% of infected infants may require hospitalization. In older children an inspiratory "whooping" sound may be heard ( though in teens this may be absent ) following the cough. Infection/coughing in teens and among those that have been vaccinated is generally less severe.  


A prospective study (during a pertussis epidemic) of 120 hospitalized children (0-17 years) evaluated a number of variables to assess the factors that may be predictive of severe illness.


Patients who present with pertussis and are <2 months old, have co-infections, fever >37.5C and a history of prematurity are more likely to present with severe disease (2/3 of affected patients have been previously immunized).


Pediatric Infectious Disease Journal 

Risk of cerebral palsy (CP) in infants with high total serum bilirubin (TSB) levels.


A study utilizing 2 cohorts from 525,409 infants (gestational age >35 weeks) compared one group of infants with at least one TSB above the AAP exchange transfusion threshold (ETT) guidelines to a randomly matched sample with TSB below the ETT. Medical records were reviewed by a pediatric neurologist for the presence of cerebral palsy.


CP (with kernicterus) is uncommon and unlikely (0.57 per 100,000 births) even in infants with elevated TSB levels. It may appear with TSB levels >5.0mg/dl above the ETT, plus at least two risk factors for neurotoxicity (e.g. prematurity, hypoxia-ischemia or G6PD deficiency etc).


JAMA Pediatrics 

Video Feature 

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Botulinum Toxin Type A for children with cerebral palsy 
Botulinum Toxin Type A for children with cerebral palsy

Nonpharmacologic treatments of Functional Abdominal Pain disorders.


A study to summarize the evidence for nonpharmacologic treatments of pediatric abdominal pain-related functional gastrointestinal disorders (AP-FGIDs) examined data on 1390 children (aged 3-18 years) which included life-style, dietary and behavioral interventions, prebiotics and probiotics and alternative medicines, indicates benefit from:

  1. Hypnotherapy.
  2. Cognitive behavioral therapy.
  3. Lactobacillus rhamnosus GG and VSL#3.
  4. (No data is available for life-style interventions, fluid intake, prebiotics or gluten-histamine or carbonic acid-free diets)

Antenatal maternal anxiety predicts variations in neural structures implicated in anxiety disorders in newborns.

"Antenatal maternal anxiety predicts offspring neurodevelopment and psychopathology"; how much of this reflects postnatal influences remains unclear.


An assessment of neuronal microstructure variation using diffusion tensor imaging (DTI) in newborns (5-17 days post natal), examined the relationship between mothers antenatally assessed as anxious (at 26 weeks gestation) and infant socio-emotional behavior at 1 year of age.


Antenatal anxiety appears to predict microscopic variations in regions important to cognitive-emotional responses to stress, sensory processing and socio-emotional functioning at 1 years of age. Mother-infant intervention programs are important.


Journal of American Academy of Child and Adolescent Psychiatry 

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