August 26, 2015
Volume VI, Issue No. 34

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Methotrexate in severe atopic eczema in children
Some children with severe eczema may be refractory to standard therapy. After ensuring treatment compliance, treating secondary infection, allergic or other triggers, the National Institute for Health and Care Excellence (UK-"NICE") recommends initiation of phototherapy and/or systemic treatment.

In a Cochran review the value of methotrexate in refractory childhood atopic eczema (currently recommended for adults) was examined. It appears that despite studies being retrospective and not particularly robust, available data appears to support the effectiveness of methotrexate in the management of severe refractory eczema in children.
Safety of popular herbal supplements in lactating women
A study of a number of databases examining the effects of common herbal supplements ingested by breast feeding mothers (black cohosh, cranberry, Echinacea, evening primrose, garlic, ginseng, melatonin, milk thistle and St. John's wort) on their infants,  indicates that the potentially negative effects of dietary supplements have not been evaluated in any high-quality trials.

Exclusive breastfeeding and risk of dental malocclusion
A study 1,303 children whose breastfeeding histories were available for ages 3, 12 and 24 months, and where dental malocclusion was measured at age 5 years indicates that infants exclusively breast fed for 6 months exhibit 72% lowered prevalence of moderate-severe malocclusion compared to those never breast fed.

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Feeding outcomes after pacifier activated music player with mother's voice
Feeding difficulties are common in preterm infants as feeding skills continue to mature to the level of the term infant. Following discharge form a neonatal intensive care unit, aspiration/feeding problems are significant causes (up to 25%) of re-hospitalizations during the first year of life.
"Effective non-nutritive sucking (NNS) is the basis for more complex oral feeding skills".
A trial utilizing 94 preterm infants (34-36 weeks post menstrual age) treated with a pacifier-activated music (PAM) player with mother's voice indicates that this "conditioning" treatment positively re-enforces suck strength and shortens time to oral feeding, with no one year deleterious effects.

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Atopic eczema in children
Atopic eczema in children
Quality-adjusted life-years (QALY's) and cost analysis of daily vs. intermittent inhaled corticosteroids in mild-persistent asthma
From a simulated cohort of pediatric patients with persistent asthma treated over a 12-month period comparing daily inhaled corticosteroids (ICS) to that given intermittently or as needed, data indicates that daily ICS is more cost effective with better QALY outcomes.
(A separate study in a small group of children with low vitamin D levels and mild asthma failed to show any benefits to increasing vitamin D blood levels).
Recovery from Central Nervous System (CNS) acute demyelination syndrome (ADS) in children
Acute demyelinating diseases in children may be monophasic (e.g. acute disseminated encephalomyelitis and clinically isolated syndromes optic neuritis or transverse myelitis) or chronic (progressing to Multiple Sclerosis (MS) or neuromyelitis optica).

A study of 283 children with pediatric ADS indicates that 83% require hospitalization and >90% recover physically over a 12 month period; 21% have MS at 5 year follow up and some children with optic neuritis and transverse myelitis may have permanent deficits.
Group A Streptococcal carriage and seroepidemiology in children up to 10 years of age

"Group A streptococci (GAS) carriers do not normally justify efforts to identify them nor generally require antibiotic therapy as they are unlikely to spread GAS pharyngitis and are at little risk for developing suppurative complications or rheumatic fever" (Acute rheumatic fever is rare in <3 year olds and streptococcal pharyngitis is uncommon at this age ).
In a study, 542 healthy children ages 0-10 years had a throat swab and blood sample collected for microbiological and serological analysis (anti-streptococcal C5a peptidase-"anti-SCP" IgG levels). Sequence analysis of the SCP gene was performed.
Approximately 5% of healthy children are GAS throat swab culture positive with a highest rate in 5-9 year olds (rate increases with age). Anti SCP titers increase from 2-7 years plateauing thereafter. SCP gene analysis confirms the diagnosis.

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