Miami, FL
April 10, 2019
     
Volume X | Issue No. 15
Outdoor activity and myopia
Myopia is a common disorder (33% of individuals aged 12-54 years in the USA) in which the eye elongates out of proportion to its focal length creating blurry distant vision (light rays from distant objects are focused in front of, instead of on the retina). The strongest factor leading to myopia is having a refraction that does not as yet compromise distant vision (hereditary, near reading, studying, watching TV and computer use are all involved in its etiology).
 
It appears, for a variety of possible reasons, that a child with 2 parents with myopia who spends at least 14 hours per week outdoors decreases the genetic risk of myopia from 60% to 20% (the probability of developing myopia when no parent has myopia).
       
Time outdoors is an important environmental counter-effect to hereditary and other causes of myopia in children.
 
 
See related video HERE & HERE
Clinical management of pediatric achalasia 
Achalasia is a rare neurodegenerative esophageal motility disorder resulting in the slow (to absent) movement of food through the esophagus because of a failure of esophageal peristalsis and incomplete lower esophageal sphincter relaxation. In children it is usually diagnosed after the age of 7 years and presents with progressive dysphagia, regurgitation, failure to thrive and anorexia. Diagnosis is by history/examination, manometry and/or contrast swallowing. Standard treatments include pneumatic dilatation and esophagomyotomy.
 
A retrospective study of 31 children diagnosed with achalasia and treated with thoracoscopic esophagomyotomy indicates that this procedure is safe and effective with 97% having initial symptom relief (26% however require post-operative pneumatic dilatation).
 
Neurocognitive and functional outcomes at 5 years of age after early renal transplantation
Data from an ongoing, prospective, longitudinal, inception cohort study of the neurocognitive sequelae of children with a renal transplant performed prior to 5 years of age indicates that renal replacement therapy in young children is associated with "acceptable long-term developmental outcomes" (some neurocognitive delay however is frequently found and early intervention optimizes outcomes). Shorter time on dialysis predicts higher, and hemodialysis poorer developmental outcomes.  
 
Pediatric Nephrology
Childhood Obesity Facts 
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Anxiety/depression in childhood 
 
Four interesting articles explore the underlying mechanisms involved in the pathogenesis (and treatment options) of depression in adolescence (70% of people with life-time depression and anxiety first develop anxiety, which usually makes depressive symptoms worse). Early treatment of anxiety may decrease the likelihood of later onset depression.
 
It appears that the development of depression involves disturbances of reward processes ("reward" is the positive property of the stimulus that induces us to repeat an action and which involves wanting/craving for a reward, positive reinforcement, conditioning and emotions which involve pleasure, like experiencing joy). These appear to be disrupted before, during and after the onset of depression. Decreased reward responsiveness is a marker for vulnerability for depression.
 
Treatment options for adolescent depression included:
 
  1. Establishing an open and supportive team.
  2. Addressing other issues present, e.g. attention deficit/hyperactivity disorder, anxiety, substance abuse, etc.
  3. Cognitive and/or personal behavioral therapy.
  4. Medications.
  5. Addressing sleep, nutrition and exercise issues.
  6. Modifications of home environment to diminish likelihood of self-harm.
 
 
 
See related video HERE & HERE
Video Feature
Pharmacology - Antiemetics
Pharmacology - Antiemetics
Antiemetic drug use in children 
 
This extensive review of the therapeutic use, safety, main pharmacological properties and potential complications associated with the use of antiemetic drugs in children is worth both reading and keeping as a guide to the management of the vomiting child.
 
Journal of Pediatric Gastroenterology and Nutrition
Long-term outcomes of acute kidney injury (AKI) as a complication of twin-to-twin transfusion syndrome (TTTS)  
 
A post-natal study of 26 infants with TTTS acute renal injury examined the long-term renal outcomes. Results indicate:
 
  1. TTTS neonates with acute kidney injury have a survival rate of 79% and 70% at 5 and 10 years respectively (before renal replacement therapy).
  2. 31% develop chronic kidney disease (CKD).
  3. 50% of those with CKD require long-term renal replacement and all require renal transplantation.
  4. Infants developing CKD have a significant higher incidence of AKI in the neonatal period
  5. CKD is more likely to develop in the donor twin.
Adrenal insufficiency (AI) after use of low- to moderate-potency topical corticosteroids (TCS) for atopic dermatitis (AD) 
 
The risk of AI varies with the potency of TCS, length of treatment, area of application, integrity of the skin barrier and host factors. Adrenal crisis is most frequently associated with oral, intravenous or inhaled corticosteroids use of high potency TCS.
 
A systematic review and meta-analysis of 9 English language studies which were used to assess the likelihood of AI following the short-term (2-4 weeks) topical use of low-to-moderate-potency TCS for atopic dermatitis indicates that the risk of adrenal suppression is so low that testing for adrenal suppression is unwarranted.  
 
Children's Health Chats
Preventing medication injuries
Preventing medication injuries
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