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                Weekly Updates in Pediatrics         July 11, 2012 

EDITOR:  Jack Wolfsdorf, MD, FAAP 


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Current management of Idiopathic Clubfoot (IC)

Several recent studies have advocated a change in the approach to the management of IC, moving away from surgical release and toward less invasive methods (Ponseti method utilizing gentle manipulation and casting of the feet at weekly intervals).


A survey study of 323 members of the Pediatric Orthopedic Society of North America indicates that 96.7% now utilize the Ponseti treatment method for IC, 75% of them differing from how they were trained during Fellowship.


Source: Journal of Pediatric Orthopaedics

Oral corticosteroid-sparing effect of Omalizumab (OM) in children with severe asthma

Omalizumab (Xolair, Genentech-Novartis) is an expensive DNA-derived humanized antibody that binds to free IgE and is approved for patients 12 years or older with moderate-severe allergic asthma.


34 children (median age 12 years) with severe asthma on oral prednisone were given subcutaneous injections of OM every two or four weeks for a 16 week therapeutic trial.


OM treatment of severely asthmatic children results in decreased need of daily oral prenisone, and is associated with significant improvement in asthma control and quality of life score. Statistically non-significant improvement occurs in lung function.

Source: Archives of Disease in Childhood

Tongue-tie (ankyloglossia), breast feeding and frenotomy

To evaluate the association between neonatal tongue-tie and breatfeeding difficulties, and whether frenotomy improves the situation, recent prospective cohort and randomized control studies on the topic were critically evaluated.  


Recent evidence suggests that babies with toungue-ties are at increased risk for breast feeding difficulties, and that frenotomy often results in rapid improvement.  


Source: Acta Pediatrica

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Dangers of All Terrain Vehicles ( ATV's)

ATV usage in children continues to increase in a relatively unregulated environment. A study over a 5 year period of children <16 years of age seen at a Level 1 Trauma unit identified and compared the number of ATV injuries to those associated with motorcycle (MCC) and motor vehicle crashes (MVC). Results indicate an almost doubling of ATV related injuries over the 5 year period examined.

ATV related injuries are >30 fold and 20 times respectively more likely to occur than those associated with motorcycle or motor vehicle accidents

Source:  Pediatric Emergency Care, May 2012


ATV Safety Story on Good Morning America
ATV Safety Story on Good Morning America

 Source:  ABC NEWS via YouTube

Factors associated with relapse and survival in Wilms tumor

Wilms tumor or nephroblastoma is the commonest cancer of the kidney in children, primarily affecting those between the ages of 3-4 years. Usually it is unilateral.


95 patients with Wilms tumor were followed for 3.3 years. On univariate and multivariate analysis, the presence of lymph node involvement and anaplasia correlate significantly with the probability of relapse and overall survival. Regional lymph nodes should always be sampled during tumor resection. 5 year overall survival with a new diagnosis is 89%.


Source:  Journal of Pediatric Surgery 

Topical silver sulphadiazine (SSD) vs. Collogenase ointment (CO) for partial thickness burns in children


SSD and CO are the most commonly used topical agents for the treatment of partial thickness burns. SST is antibacterial and eschar separation occurs naturally. CO is an enzyme that facilitates separation but has no antibacterial properties.


To assess the need for skin grafting (at 10 days), 100 patients were randomized (after 2 days treatment with SSD) to daily debridement with SSD or CO treatment (with a Polymyxin mix for antibacterial coverage).


No differences in skin grafting outcomes is apparent following the use of either topical SSD or CO in the management of partial thickness burns in children.


Source: Journal of Pediatric Surgery  

Home transcutaneous electrical stimulation (TES) to treat children with slow-transit constipation (STC)


Constipation has many causes which can be divided into two categories: Obstructed defecation and colonic hypomobility (slow-transit constipation). Causes of STC include diet, hormones, side-effect of medication and heavy metal toxicity. Treatments vary.

32 children (3-17 mean age 8.3 years) were trained to self-administer STC at home (1 hour/day for 3-6 mths) and bowel diaries, quality of life questionnaires completed and radio-nuclear colonic transit times measured before and after treatment.


With TES, defecation frequency increased, soiling frequency decreased, urge-initiated defecation improved, abdominal pain decreased and stool consistency improved in approximately 50% of children, who not only reported better quality of life scores but also had better measured colonic transit times, following treatments.


Source: Journal of Pediatric Surgery


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