MCH Updates in Pediatrics Masthead  

                 Volume IV
                  Issue 42
                                                           South Florida's  only licensed  free-standing
                                                             specialty hospital  exclusively for children ...                                                      October 16,  2013 
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Dollars & Sense


by Jason Biro 


Today's tip:

Purchase office space without draining your bank account.


Have you found the perfect space for your growing practice-but are worried the down payment will wipe out your cash reserves? Look for a healthcare lender that offers 100% financing-covering the purchase and the down payment-which will allow you to keep your liquidity, and your bank accounts, healthy and intact.

Bank of America Practice Solutions  

Ketorolac (Toradol) vs. Tramadol for traumatic bone pain in children

Ketorolac is a non-steroidal anti-inflammatory analgesic frequently used (orally and by intramuscular injection) for the short-term (<5 days) reduction of moderately severe pain and balder spasm, following surgical ureteral re-implantation for vesicoureteral reflux, dental procedures, and trauma etc. Side effects increase with dose and length of treatment.


Tramadol, a weak opiate agonist with a low affinity for opioid receptors and direct modulating effect on central monoaminergic pathways, is an effective analgesic in children over 1 years of age. Its side-effects are similar to those of other opioids.


A double-blind, randomized, control trial of 131 children (aged 4-17 years) with suspected bone fracture or dislocation were treated utilizing a placebo, ketorolac or tramadol by sublingual administration. Pain was assessed every 20 minutes for 2 hours.


Both ketorolac and tramadol are equally effective to treat moderate to severe post traumatic bone pain.


Archives of Disease in Childhood 

Breastfeeding and intergenerational social mobility

A longitudinal study of 34,190 children (10-11 years) and adults (33-34 years) from 2 different cohorts of mothers examined the relationship between breastfeeding and intergenerational social mobility.


It appears that breast-fed individuals are more likely to be upwardly mobile (independent of a large number of variables), apparently due partly to improved cognitive and emotional stress management abilities.


Archives of Disease in Childhood 

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Genetics and Primary vesicoureteric reflux (VUR)


Normally the ureters enter the bladder obliquely and run for a distance submucosally which secures them posteriorly and acts as a valve to prevent urinary reflux when the bladder is full or with voiding. Approximately 18% of children without urinary tract infection (UTI) have VUR while 30-40% post febrile UTI patients are similarly affected.


In primary VUR the valvular mechanism is normal but with raised bladder pressure (due to anatomic or functional obstruction) reflux occurs. VUR is classified into five Grades, with the younger low grade patient having a higher chance of spontaneous resolution. Urinary tract infections (and not VUR) give rise to scarring.


A review of 200 children with VUR from 189 families indicates that VUR is a highly heritable condition (15% of families report multiple affected members) with a wide range of phenotypic heterogeneity. Though many different methods are available to detect VUR, a relatively new non-invasive method (ureteric jet Doppler wave form-UJDW) appears valuable as a screening tool.


Journal of Pediatric Nephrology 


Journal of Pediatric Nephrology
Video Feature  
Nasal CPAP - Infant Flow 
Nasal CPAP - Infant Flow
via YouTube

Swallowing and nasal continuous positive airway pressure (nCPAP)   


Oral feeding of premature infants should be started as soon as possible. Controversy exists as to the desirability of orally feeding premature infants while being treated with significant levels of nCPAP, which treatment may be required for fairly prolonged periods of time.


It appears form previous and present laboratory experimental data that the application of nCPAP up to 10cms water pressure has no deleterious effect on cardio respiratory function, feeding efficiency, nutritive swallowing-breathing coordination or (with 6cms water pressure nCPAP) esophageal phase of nutritive swallowing. Infant clinical studies are needed to confirm these findings.


Journal of Pediatric Gastroenterology and Nutrition

Poor postnatal head growth in premature babies and impaired neurologic development


A study of all infants <32 weeks gestation born in Tyrol, Austria examined the association between head circumference (HC) and neurodevelopmental outcome (Bayley scales of Infant Development II) from data obtained at birth, discharge, 3, 12 and 24 months of age.

Suboptimal head size (>1S.D. below mean) and microcephaly (>2S.D. below mean), particularly at 3 months of age is associated with impaired neurodevelopmental outcomes.


Acta Paediatrica
Balloon dilation in older children with upper airway stenosis


There are number of congenital and acquired causes of upper airway stenosis in children, and management remains a challenge. Balloon dilatation is often utilized for the early treatment of the young patient with less severe airway stenosis.


A small case series of 8 children and adolescents with acquired subglottic and tracheal stenosis treated with balloon dilatation indicates that even older children with airway stenosis may be successfully managed.


Journal of Pediatric Surgery 

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