April 12, 2017
Volume VIII |  Issue No. 15

Exercise and the multidisciplinary holistic approach to adolescent dysautonomia
Dysautonomia is a term that encompasses a number of complex conditions that are caused by functioning abnormalities (of unknown origin) of the autonomic nervous system (ANS). A diagnostic difficulty to remain upright (orthostatic intolerance) usually starts in the early teen years, with girls being more frequently affected. Other symptoms include light-headedness, palpitations, dizziness, syncope and fatigue plus other symptoms related to the gastrointestinal tract, bladder and endocrine systems.

A study involving a group of adolescents with symptoms of dysautonomia who completed a Quality of Life (QoL) questionnaire before and after a 5/week, 8-week exercise-strength training program indicates that exercise significantly improves symptoms, with benefits to QoL, psychosocial, and physical endurance scores.

Musculoskeletal low back pain (LBP) in school-aged children
LBP is common in children particularly after 10 years of age when approximately 60% will have experienced it.  Being female, sedentary, having a recent growth spurt, a previous back injury or a history of back pain in the family (heavy backpacks do not appear to cause low back pain), all increase the risk of LBP. In 80% of cases no identifiable cause is found. Referral to a pediatric subspecialist is usually not required. Most treatments include relative rest, rehabilitation with physical therapy. Pain is usually self-limiting (<4 weeks).

Oral human immunoglobulin (OHIG) treatment and intestinal permeability in Crohn's disease (CD)
Crohn's disease (Regional enteritis) is an immune related type of chronic inflammatory bowel disease affecting the mucosal of the gastrointestinal tract from mouth to anus. No cure is presently available.

A small pilot study of three boys (aged 13, 15 and 18 years) (with three matched untreated children) with active CD examined intestinal permeability (as a marker for inflammation) before and after a six-week treatment program with OHIG.
OHIG appears to normalize the mucosal barrier with minimal risk of adverse effects and is, perhaps, another treatment option.
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Childhood blood lead levels and cognitive function/socioeconomic status at 38 years  

A prospective longitudinal cohort study of 565 children (from birth in 1972 to 38 years of age) assessed health and behavior (at ages 3 years and every 2-6 years thereafter) against blood lead levels at age 11 years measuring IQ, socioeconomic status and cognitive performance in adulthood as primary outcomes.

Higher childhood blood lead levels are associated with poorer adult cognitive performance (IQ deficiency associated with verbal comprehension, perceptual reasoning and working memory) and downward adult socioeconomic status with deficits in executive function, behaviors similar to ADHD, substance abuse and other forms of social pathology.

Monosymptomatic nocturnal enuresis (MNE) in children - effects of therapeutic intervention 

A prospective study of children, (mean age 9.5 years) with MNE (of whom 75.6% are boys) identified the following:
  1. 91.1% have a close family history of nocturnal enuresis.
  2. 81.7% have a history of constipation.
  3. 40.7% have had mild to moderate apnea.
Results of randomized therapeutic interventions for 75, NME children treated with either an alarm, desmopressin, or alarm plus desmopressin for 12 months indicates:
  1. 18.7% drop out.
  2. 56.6% achieve initial complete/partial response with the alarm; 70% with desmopressin and 64% with combined therapy.
  3. Continued success occurs in 70% of alarm, 84.2% of desmopressin and 100% of the combined group.
  4. 15% in the alarm group and 5.2% of the desmopressin group recur.
  5. Therapeutic success is associated with improvement of behavioral problems and Quality of Life scores.
Video Feature
Nocturnal Enuresis
Nocturnal Enuresis
Comparison on formula-fed infants with and without colic and gastrointestinal (GIT) microbiota

"Infant colic is defined as crying and/or fussiness >3 hours/day, for >3 days/week". Approximately 30% of infants in the first few months of life are affected.

A study of fecal samples from formula fed infants (where little data is available) <16 weeks of age (half with and half without colic) compared pH, fecal ammonia, total bacteria and bifidobacteria lactic acid bacteria and coliforms.

Fecal ammonia and coliform bacteria are higher, and total bacteria lower, in colicly infants suggesting that as GIT microbiota play an important role in human health, infant formula modification with prebiotics and probiotics may be of benefit in managing formula-fed infants with colic.
Effects of delayed umbilical cord clamping for 3 minutes (vs early clamping) on anemia in infants 8 and 12 months of age
Delayed umbilical cord clamping improves iron scores in infants up to 6 months of age, but does not appear to prevent iron deficiency anemia after that time.

A clinical trial of 540 late preterm and term newborns randomized to delayed umbilical cord clamping (>3 minutes) or early clamping (<1 minute) in Nepal examined hemoglobin and ferritin levels at 8 months and 1 year of age.

Delayed cord clamping beyond 3 minutes increases hemoglobin levels and decreases the prevalence of iron deficiency anemia at 8 and 12 months of age, in a high-risk population.

Time Inc.'s People and Great Place to Work Name Miami Children's Health System One of 2017's "50 Companies That Care" 

Miami Children's Health System recently announced its place among exceptional organizations on People's first annual "50 Companies That Care" list, jointly chosen by People and Great Place to Work. The outstanding companies were recognized for going above and beyond to create a caring environment for employees, and for supporting them throughout their professional and personal lives.

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