Dec. 23, 2015
Volume VI, Issue No. 51

Craniosynostosis is the premature fusion of one or more cranial sutures". Most occur as a spontaneous isolated defect though about 8% of patient have a familial (usually autosomal dominant trait) or syndromic form. Characteristic head shapes allow for bedside diagnosis. Potential complications (depending on position and number of sutures involved) include raised intracranial pressure, seizures, developmental delay and upper airway obstruction.

Current surgical treatments (performed soon after birth) include calvarial reconstruction, minimally invasive strip craniectomy and cranial distraction.

Pediatric Neurology

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Pediatric acute osteomyelitis in the post vaccine methicillin-resistant Staphylococcus aureus (MRSA) era.
A retrospective chart review of 55 children, 12 years and younger presenting to a pediatric Emergency Department with a diagnosis of osteomyelitis indicates:
1.    Most common (47%) organism identified is methicillin-sensitive (S. aureus) followed by MRSA (38%).

2.    Most common bone involved is the femur (33%).

3.    85% of operative cultures are positive after antibiotics are given.

4.    Hematogenous complications include deep vein thrombosis.
Parents' ability to assess dental fear in their 6-10 year old children
From a study of 184 children/parent dyads who completed the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaire prior to dental treatment and an assess-ment of the child's behavior during dental treatment, it appears that parents of children with low anxiety overestimate, while parents of children with high anxiety underestimate their child's anxiety.



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Screw vs. K-wire fixation of lateral condyle fractures
K-wires (Kirschner wires or pins) are sharp, smooth, stainless steel pins widely used in orthopedics to hold bone fragments together. They have traditionally been used to fixate lateral condyle distal humeral fractures. Screw fixation allows for compression across the fracture site.

A retrospective analysis of 96 patients (aged 2-12 years) with an isolated lateral condyle elbow fracture treated with screw fixation indicates that initial satisfactory fracture union is achieved in 99% of patients with no case of growth arrest, alteration in carrying angle, and with a low rate of complications. In a synthetic bone model, screw fixation provides greater biomechanical stability as compared to comparable K-wire treatment.

Sleep disorder breathing in patients with Prader-Willi Syndrome (PWS)

"PWS is a rare genetic disorder in which seven genes (or some subset thereof) on chromosome 15 are deleted or unexpressed on the paternal chromosome. Characteristics include poor muscle tone, short stature, incomplete sexual development, cognitive disabilities, behavior problems and a chronic feeling of hunger that can lead to excessive eating and life-threatening obesity".

A retrospective analysis of 88 patients with PWS whose data was available for anthropometrics, sleep polygraphs and gas exchange indicates that PWS patients have a high prevalence of sleep breathing disorders that appear primarily to be due to hypotonia and/or facial dysmorphic features ( not obesity).

Video Feature 
Prader-Willi Syndrome
Prader-Willi Syndrome
Factors  predicting atypical development of nighttime bladder control
Data from 8,769 children (aged 4-9 years) longitudinally studied for their frequency of bed wetting and its association with sex, developmental level at 18 months of age, parental history of bed wetting, length of gestation and birth weight indicates that boys, developmental delay and maternal history of bed wetting are associated with increased odds of bed wetting to school age.

Outcome of breast cup use for short nipple breast feeders
A study of 90 singleton pregnant women (16-20 weeks gestation) with at least one short nipple (<7.0mm) randomly enrolled to wear either breast cups for at least 8 hours during daytime or not, with nipple length being measured prior to and at every ObGyn visit until 36 weeks gestation, indicates that breast cup use is safe, well tolerated, significantly increases the nipple length and enhances exclusive breast feeding.

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