MCH Updates in Pediatrics Masthead  

                 Volume IV
                  Issue 45
                                                           South Florida's  only licensed  free-standing
                                                             specialty hospital  exclusively for children ...                                                      November 6,  2013 
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Dollars & Sense


by Jason Biro 


Today's tip Use what you have now to save for retirement. 


Dr. Charles spent years building his practice, but one expense after another kept him from saving enough for retirement. To make up for this gap, he pre-loaded his retirement and investment accounts using a program that pulls your business real estate equity. He's now contributes to his retirement plans yearly, without sacrificing the growth of his practice.

Bank of America Practice Solutions  

Sleep & infection: no snooze, you lose?

There a large body of evidence that links sleep and the immune system through extensive and complex pathways. Studies indicate, in both animals and humans, that a variety of viral and bacterial infections lead to increased sleep.


Over the past few decades, the average number of hours that individuals sleep has decreased, and there is some evidence linking sleep deprivation and increased infection susceptibility ( mediated via effects on immune cells and cytokines). "Shift workers" who have less than 7 hours sleep (on average) are 3 times more likely to develop a "cold";" partial sleep deprivation " may negatively affect inflammatory bowel disease and cancer.


Sleep deprivation does not appear to be a benign phenomenon as it diminishes immunocompetence thereby altering the body's responses to a variety of inflammatory challenges.


Pediatric Infectious Disease Journal 

Redo Nissan fundoplications.

A large (823 patients) retrospective study reviewed the incidence and factors associated with redo Nissan fundoplications. 12.2% of patients require 1 or more redos over a median 2.9 years. Incriminating factors include: male gender, young age, hiatal dissection and retching.


Journal of Pediatric Surgery 

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Functional impairment & Attention-deficit/hyperactivity disorder (ADHD): Effects of exercise.


The functional impairment and adverse developmental outcomes from ADHD are most likely a result of the interaction between genes and environment.


A comprehensive electronic database search for animal and human studies evaluating the effect of exercise on animal behavior, symptoms of ADHD and developmental outcomes in humans, reveals that exercise, particularly early on in life (perhaps mediated by brain-derived neurotropic factor and catecholamines) appears to provide a beneficial effect against ADHD symptom outcomes.


Journal of American Academy of Child and Adolescent Psychiatry
Video Feature  
ADHD and the Brain 
ADHD and the Brain via YouTube

Use of "Conventional" & "Novel" smokeless tobacco products. 


Smokeless tobacco is a blanket term that refers to a variety of products used: ( a) "Conventional "uses - including sniffing, chewing, placing tobacco between lip and gum and application to the skin, and ( b) "Novel" usage - "snus" (a moist tobacco product placed under the upper lip for an extended period of time) and "dissolvable tobacco" (a smokeless tobacco that dissolves in the mouth).


Data from the 2011 National Youth Tobacco Survey indicates:

  1. Prevalence of smokeless tobacco usage is 5.6% (3% of middle school boys and 1.4% of middle school girls).
  2. 64% use only "conventional products."
  3. 26.8% use both "conventional" and "novel products."
  4. 9.2% only use "novel products."
  5. 72.1% use both combustible and smokeless tobacco.
  6. 40.1% desire to stop all tobacco usage.

 Youth who use smokeless tobacco believe that these products are less harmful to health. As all forms of tobacco use are potentially harmful, pediatricians need to focus on prevention and cessation interventions.



Inhaled nitric oxide (iNO) for respiratory failure in premature infants-neurodevelopmental outcomes.


While it appears that there is a place for iNO therapy for the premature infant with pulmonary hypertension, its use to manage a variety of pulmonary diseases and/or to treat/prevent bronchopulmonary dysplasia remains controversial.


A multicenter, randomized, double-blind study of preterm infants born at < 29 weeks gestation with moderate respiratory failure and given iNO 5 ppm started early (<24 hours after birth) or placebo for 7-21 days and assessed (Bayley Scales) at 1 and 2 years (corrected for prematurity) indicates that the treatment appears to have no deleterious effect on neurodevelopmental or other health outcomes.


RGS5 gene & therapeutic response to bronchodilators in asthmatic children.    


A large number of genes have been implicated in the genetics of asthma and patient's responses to bronchodilator therapy. The regulator protein G signaling 5 (RGS5 ) pathway appears to mediate the contractile effects of β2 agonists on smooth muscle cells. Variances of the RGS5 gene on chromosome 1 exist.


A study of 137 asthmatic children's responses to short acting β2 agonists examined the effects of a newly discovered variant of RGS5 on bronchodilator responses in childhood asthmatic patients. ( It appears to have an enhancing bronchodilator effect with a PDE4D gene variance -a phosphodiesterase modulator).


Pediatric Pulmonology 

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