MCH Updates in Pediatrics Masthead  

                 Volume IV
                  Issue 37
                                                           South Florida's  only licensed  free-standing
                                                             specialty hospital  exclusively for children ...                                                      September 11,  2013 
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Maternal valproate treatment for epilepsy-association with childhood ADHD  

A study of the effects of valproate taken for epilepsy control in pregnant women indicates an almost doubling of the risk for the development of both autism spectrum disorders and ADHD.  


Maternal use of valproate during pregnancy must be balanced against the increased risks to their children associated with their use.


Journal of Pediatrics 

Management of dental caries in primary teeth  

"Caries is a bio-film (plaque)-induced acid demineralization of enamel or dentin mediated by saliva. Early childhood caries can be a particularly virulent form of caries, beginning soon after dental eruption, developing on smooth surfaces and having a lasting detrimental impact on the dentition." Etiology includes host (enamel hypoplasia), diet (high carbohydrate) factors, and bacterial infection (mutans streptococci).


While removing carious teeth (up to 60% of 5 year-olds have had a carious tooth) is perhaps an accepted "best practice," it is not particularly popular with general pediatric dentists.


Glass Ionomer cements (GIC's) are restoration alternatives utilized to treat carious teeth. A study evaluating whether these will appropriately bond to affective dentine demonstrates their positive capabilities.


Pediatric Dentistry 

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 Breastfeeding-protection from Attention-Deficit/Hyperactivity Disorder (ADHD) 


Breastfeeding has a positive effect on physical and mental development.


A retrospective matched study of 6-12 year old children diagnosed with ADHD was undertaken during which information on demographics, medical perinatal and feeding history was obtained for the first year of life and compared to 2 control groups - one utilizing normal siblings and a second consisting of normal children attending an ENT clinic.


Children diagnosed with ADHD are less likely to have been breast fed at 3 months and 6 months of age. Breastfeeding appears to have a protective effect from ADHD development later in life.


Breast Feeding Medicine 

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Physical examination of the chest & diagnosis of pneumonia


525 children aged 1-16 years, who had a chest x-ray read (by a pediatric radiologist) had their medical history and physical examination reviewed. 34% were diagnosed with pneumonia.


19% of children diagnosed with pneumonia present only with fever, with 28% having a normal chest examination. Chest radiography is a valuable ancillary test to diagnose pneumonia (particularly in the small infant. Ed).


Pediatric Emergency Care

Phototherapy in preterm infants -effects of IV intralipid infusion  


Extremely low birth weight babies (<1000 grams) are at increased risk for bilirubin neurotoxicity.


IV intralipid infusions are frequently utilized in achieving optimal caloric intake for these infants.


IV intralipiud administration uncouples bound bilirubin which results in increased levels of unbound bilirubin. This bilirubin is not significantly reduced by phototherapy and thus raises the likelihood of neurotoxicity.



Cause & long term outcomes of pediatric sinus bradycardia


As survey 432,166 elementary and high school students over a 10 year period, resulted in the identification of 104 participants being diagnosed with sinus bradycardia (mean age 15.5 years; mean heart rate 48/min). Athletes composed 37.8% of the study group. 17% had self-limiting syncopal episodes.


Full clinical assessment and mutation analysis (for the HCN4 gene) and long-term follow-up of school children identified by electrocardiography with sinus bradycardia, indicates a favorable prognosis. Para-sympathetic hyperactivity overwhelmingly appears to be the etiological factor involved.


 Journal of Pediatrics 

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