Pneumatic vs. hydrostatic reduction for pediatric intussusception
A study randomized 124 children diagnosed with intussusception into ultrasound-guided hydrostatic or x-ray guided pneumatic reduction groups to compare success rate, intestinal perforations and recurrence.
Ultrasound-guided hydrostatic reduction of pediatric intussusception appears simple, safe and effective and could be considered a first treatment option.
Complications after plate fixation of displaced pediatric midshaft clavicular fractures
While most clavicular fractures will heal without operative management, "the operative treatment of displaced midshaft fractures has become increasingly popular despite lack of evidence that surgical management leads to superior outcomes."
A retrospective study of 36 children (10-18 years of age) who underwent plate fixation of a midshaft clavicle fracture examined (mean follow-up time 1.3 years), time to return to activity and post-operative complications.
Following plate fixation of a displaced midshaft clavicular fracture the average time to activity is 58 days with an overall post-operative complication rate of 86%. Patients should be appropriately counseled before surgery!
Craniofacial, head, face and neck injuries make up more than half child abuse cases and now in a retrospective secondary analysis of a prospective study, it appears that 3.3% of child abuse consultation have oral injury (42% of 0-12 months old infants; 39% of 1-3 year olds and 18% >3 years of age).
Young children with an unexplained oral injury should be evaluated for abuse as well as for other occult abusive injuries (e.g. retinal hemorrhages and occult fractures).
Urinary problems following posterior spinal fusion (PSF) for idiopathic scoliosis in adolescents
Idiopathic scoliosis affects approximately 2-3% of children under the age of 16 years and while the curve in the back will mostly remain small and stable, some (1:1,000) over time and growth, may worsen. Spinal fusion (after other conservative measures have failed) has been shown to be effective in correcting the deformity and preventing further progression. The commonest approaches are either from the back (posterior approach) or side (anterior approach). Post-operative urinary retention/difficulty in emptying the bladder may affect up to 27% of adults but there is no data for the young patient.
A study of 117 consecutive adolescents (mean age 16 years) undergoing PSF for idiopathic scoliosis were investigated post operatively (after removal of urinary catheter) for voiding difficulties, with urinary bladder residual volume being measured.
Almost half of adolescents undergoing PSF for idiopathic scoliosis will have post-operative voiding difficulties. Risk factors include length of surgery, intra-operative blood loss and being a male.
Fecal Calprotectin (FC) in evaluating chronic gastrointestinal symptoms
Gastrointestinal (GI) complaints are among the most common conditions encountered by pediatricians and it is often difficult to differentiate between children with inflammatory bowel disease (IBD)/organic etiologies, from those with functional GI disorders.
FC is a calcium-binding protein found in the granules of neutrophils and is a well-recognized biomarker of intestinal inflammation.
A retrospective study (in a primary care setting) of all children between 0-18 years of age who had an FC test performed and were followed for >1 year (or prior to diagnosis of IBD), indicates that FC can be an excellent tool in the primary care setting to exclude IBD.
EoE is a chronic allergic immune inflammatory disease (non-IgE-mediated) of the esophagus. It is becoming increasingly recognized as distinct from reflux esophagitis with which it is often confused as symptoms are similar; young children present with vomiting, regurgitation and feeding difficulty while older children and adolescents present with dysphagia, food impaction and stricture. Currently the diagnosis requires a minimum of 2 but usually 3 endoscopies 8 weeks apart. For treatment with topical steroids, monitoring usually requires esophageal endoscopic biopsies every 6-12 months. A 6 food elimination diet may require even more endoscopies.
Two articles examined simplifying the diagnosis by a new technique called mucosal impedance (different from multichannel intraluminal impedance) and treatment with a proton-pomp inhibitor. With an editorial all 3 are very well worth reading.
Latest thinking on antidepressant use in children and young people
A meta-analysis examined the effectiveness of antidepressants (selective serotonin re-uptake inhibitors-SSRIs and serotonin norepinephrine re-uptake inhibitors-FNRI's) across a range of mental disorders (in 36 trials involving 6,678 participants).
Antidepressants appear to be more effective for anxiety and obsessive-compulsive rather than depressive disorders.