Aug. 2, 2017
Volume VIII |  Issue No. 31

Risk factors in children >5 years of age with pneumococcal meningitis (PM)
Pneumococcal meningitis is the second most common cause of meningitis in children >2 years of age. A study of 316 children (5-15 years of age) diagnosed with PM assessed specific predisposing factors.

It appears that 34% of children diagnosed with PM have specific associated risk factors. 22.8% are anatomic (cerebrospinal fluid breach or fistula) and 17.9% primary or secondary immunodeficiencies. For children >5 years of age with PM it appears prudent to conduct an immunologic and radiologic work-up.

Intranasal (IN) fentanyl and inhaled nitrous oxide (N2O) for fracture reduction
A bicentric, prospective, observational cohort study of 90 children 4-18 years of age with a dislocation or mild/moderate displaced fracture evaluated pain and anxiety prior to, during and after the procedure with sedation/analgesia (PSA) utilizing IN fentanyl and inhalation of N2O.

"PSA with IN fentanyl and inhaled N2O is effective and safe for the reduction of mildly/moderately displaced fracture or dislocation and has a high satisfaction rate".

Cryptorchidism and pesticides: Is there a connection?
"Approximately 3% of full-term and 30% of premature infant boys are born with at least one undescended testes". Most descent within 3 months to 1 year of life. It appears that a combination of genetic, maternal health, anatomic, hormonal and other environmental factors may play a role in its causation.

A study compared the level of most common organophosphate metabolites in the urine of 30 women giving birth to boys with and without an undescended testis.

While pregnant women in the USA are frequently exposed to organophosphate pesticides it appears that there is no correlation between the exposure and cryptorchidism.

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Determinants of outcomes in patients with simple gastroschisis (GS)
Gastroschisis, one of a group of relatively rare congenital abdominal wall defects, presents with an opening, usually on the right side of the umbilicus, through which the intestine (and other abdominal organs) protrude.

Data from 700 infants with simple GS (no intestinal atresia, perforation or necrosis) treated with total parenteral nutrition (TPN) for 26 days (median) was analyzed to assess maternal, patient, postnatal and treatment variables on outcome.

Prenatal sonographic bowel dilatation, older age at closure, necrotizing enterocolitis, longer mechanical ventilation and central-line associated blood stream infection (CLABSI) are associated with longer TPN in duration and hospital stay.

Video Feature
2-year follow-up of Phase I trial of mesenchymal stem cell (MSC) transplantation for bronchopulmonary dysplasia (BPD)
Previous newborn animal studies demonstrated the value of MSCs in attenuating lung injury following a hyperoxic insult. Subsequent to this a Phase I clinical trial evaluated a single intratracheal transplantation of allogenic MSC on very preterm infants at high risk for developing BPD and showed its
short-term benefits in attenuating BPD, while being both feasible and safe.
A study which investigated the longer-term safety, growth respiratory and developmental outcomes of the very preterm infants enrolled in the Phase I study followed at 24 months (corrected gestational age) indicates that MSC in preterm infants appears to be safe with no adverse respiratory, growth or neurodevelopmental deleterious effects.

Serial casting for infantile idiopathic Scoliosis (IIS)

"Serial casting for early onset Scoliosis has been shown to improve curve deformity". A retrospective study of 21 children with progressive IIS, with initial casting done before 6 years of age (mean 2.1 years) divided into group I (>10-degre improvement in Cobb angle from baseline) and group II (with no improvement) and no differences at initial casting for age, sex, magnitude of spinal deformity and curve flexibility indicates that group I have a significantly higher BMI at onset of treatment than group II.

In treatment of idiopathic non-syndromic infantile scoliosis treated with serial casting, an initial higher BMI (with lower age at initial casting and de-rotation of the spine) is significantly associated with the chance of improvement. It appears that amount of correction at initial casting does not predict treatment success.

Adolescents with celiac disease (CD): Co-morbidities
A large cross-sectional, population-based study of 2,001,353 Jewish Israeli adolescents (median age 17.1 years) of whom 7,145 were diagnosed with CD examined associated morbidities between CD and various medical conditions.
High Incidence of Celiac Disease in a Long-term Study of Adolescents
High Incidence of Celiac Disease in a Long-term Study of Adolescents | Dr. Edwin Liu

CD adolescents have a significantly increased risk for autoimmune disease (insulin dependent diabetes, inflammatory bowel diseases, arthritis, thyroid disease and psoriatic skin disorders) and more frequently suffer from associated asthma, bile stones, migraine headaches, anemia and menstrual abnormalities.

Meet Shifra Koyfman, MD - The Division of Gastroenterology at Nicklaus Children's Hospital
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