Weekly Updates in Pediatrics         October 31, 2012 

EDITOR:  Jack Wolfsdorf, MD, FAAP 


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A comparative study of a mixture of fibers/fructose vs polyethylene glycol 3350 for Functional constipation

100 children (mean age 6.5 years) with chronic functional constipation (Rome III) were randomly assigned to receive a daily dose of a mixture of acacia fiber, psyllium fiber and fructose (AFPFF-16.8 gms) or polyethylene glycol 3350 plus electrolytes (PEG + E-0.5gms/kg) daily for 3 weeks.


AFPFF and PEG+E appear equally safe and efficacious in treating chronic functional constipation in children; PEG+E appears better accepted.


The Journal of Pediatrics

Sclerotherapy for Thyroglossal Duct Cyst (TGDC)

TGDC is one of the most common congenital diseases of the middle of the neck, usually presenting as a painless, smooth cystic lump between the isthmus of the thyroid and hyoid bone. If large it may cause dysphagia and/or dyspepsia. Standard treatment is surgical resection often requiring removal of the midsection of the hyoid bone (Sistrunk procedure). Occasionally less invasive treatments are used.


Sclerotherapy as a treatment for TGDC is controversial though occasional patients have apparently been treated successfully.


Journal of Pediatric Surgery

 Infant CPR: "Two-Thumb" vs "Two-Finger"?

Using a neonatal manikin CPR was performed utilizing a "Two-Thumb" vs "Two-Finger" technique for 2 minutes and compared for efficacy and randomly, on the floor, table or radiant warmer.


A "Two-Thumb" technique in neonatal CPR appears to achieve greater depth, less variability and less decay over time as compared to "Two-Finger" CPR. "Two-Thumbs" should be the preferred method for infant CPR. An elevated firm surface for CPR is also preferable.


The Journal of Pediatrics

Male Circumcision


The American Academy of Pediatrics (AAP) convened a multidisciplinary work group to reevaluate the current evidence regarding the appropriateness, or not of male circumcision in the newborn, and to update its 1999 recommendations.


The AAP 2012 statement includes the following regarding male neonatal circumcision:

  1. The health benefits of newborn male circumcision outweigh the risks.
  2. Benefits include: Prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections and reduction in penile cancer incidence.
  3. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or satisfaction.
  4. Well-trained providers have a lower complication rate.

Source: Pediatrics

Video Feature

Circumcision for all newborn baby boys in America 
Circumcision for all newborn baby boys in America

Gene polymorphism in Hirschsprungs Disease (HSCR) Gene


"HSCR is a congenital disorder characterized by the absence of intramural ganglion cells along variable lengths of the gastrointestinal tract."


The ErbB family (of which epidermal growth factor receptor-EGFR is a member) of receptors appear to play a role with Neuregulins (a group of polypeptide factors that arise from alternate RNA splicing of a single gene) in neurodevelopment.  Recent studies have documented the potential role of neuregulin-1 (NRG1) in HSCR.


63 Patients with HSCR had their NRG1 messenger RNA and protein expression levels in gut tissue examined. It appears that aberrant expression of NRG1 may play an important role in the pathogenesis HSCR.


Source:  Journal of Pediatric Surgery 

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