Miami, FL
Dec. 26, 2018
     
Volume IX | Issue No. 52
Hernia recurrence following inguinal hernia repair in children 
"TRICARE" health plans provide care to military personnel and their families around the world. A study utilized its database to describe the incidence, timing and predictors of inguinal hernia repair (IHR) recurrences of the >3 million child dependents of members of the US Armed Forces. 9,993 children met inclusion criteria of whom 137 (1.4%) had a recurrence.

Most IHRs (60%) occurred in children aged 0-1 year and the majority within a year following repair. Children with multiple co-morbidities have a 5.45 times greater odds of having a recurrence.

 
See related video HERE & HERE
Long-term neurodevelopment of low-birth weight preterm infants with patent ductus arteriosus (PDA) 
From a study of 1,090 preterm infants (mean birth weight 1,322 grams; gestational age 30.2 weeks), it appears that the presence of PDA (and in spite of multiple comorbidities, e.g. ventilators, vasopressor use and congestive heart failure) long-term neurodevelopmental outcomes (cognitive and behavioral competence) at ages 3, 8 and 18 years are unaffected.
 
Journal of Pediatrics 
Infant colic - gut inflammation and dysbiosis (microbial imbalance) 
A nested case-controlled design study compared babies with colic to normal controls examining the effects of breast milk and formula feeding on crying plus fussing, fecal calprotectin and gut microbiota.
 
Fecal calprotectin is elevated and dysbiosis increased in babies with colic independent of method of feeding, indicating that colic appears to be linked to gut inflammation.
 
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Topical steroids for lichen sclerosis (LS) and circumcision 
 
LS is an uncommon chronic skin condition that can affect any part of the body but usually affects the genital skin and anus. It most frequently occurs in girls but can also affect boys (called balanitis xerotica obliterans). Of unknown cause (though it tends to occurs in family members and in conjunction with other types of autoimmune disease) it begins as a red inflamed itchy/painful skin patch/plaque causing pain on urination which later appears white, shiny, wrinkled and atrophic. Plaques involve the glands penis and these may extend onto the shaft. Phimosis is common (40% of boys with acquired phimosis have LS).
 
A literature search of a number of databases to identify whether treatment of LS in boys with topical steroids affects circumcision rates, indicates that this treatment avoids circumcision in 35% of children (median age 6.5 years; median duration of treatment 2 months; follow up 6 weeks-5 years).
 
Familial risk of appendicitis 
 
From a nationwide, cross-sectional study of 24,394,599 Taiwanese among whom 788,042 individuals had at least one first-degree relative with appendicitis, it appears that having any affected first-degree relative increases the relative risk (RR) of appendicitis occurring by 1.67 fold, while an affected twin, sibling, offspring and parent increases the RR to 3.40, 1.98, 1.55 and 1.54 respectively.
 
Individuals with a family history of appendicitis have an increased appendicitis risk which is age-dependent, related to genetic distance and the number of affected relatives.
 
Video Feature
Appendicitis - causes, symptoms, diagnosis, treatment & pathology
Appendicitis - causes, symptoms, diagnosis, treatment & pathology
Video Feature
Appendicitis 2- RIsk factors, Diagnosis, CT scan, teenagers
Appendicitis 2- Risk factors, Diagnosis, CT scan, teenagers
Neonatal hypoglycaemia and functional outcomes 
 
While neonatal hypoglycaemia is very common in newborn infants, clinical thresholds for diagnosis and treatment are widely debated. This uncertainty is largely due to lack of evidence regarding the effect of low blood glucose levels on neurodevelopmental outcomes.
 
A systematic search and review of a number of databases aimed to assess the association between neonatal hypoglycaemia (infants >32 weeks gestation, without congenital malformations, inherited metabolic disorders and congenital hyperinsulinism) and neurodevelopmental outcomes.
 
It appears that in early childhood, exposure to neonatal hypoglycaemia is not associated with neurodevelopmental impairment, but is associated with poorer visual-motor and executive function. In mid childhood, neonatal hypoglycaemia is associated with neurodevelopmental impairment, low literacy and numeracy. (No data is available for adolescents). Though this is a long article, it is an important one and well-worth reading (Ed).
 
  Neonatology 
Probiotics for acute gastroenteritis in children 
 
Acute gastroenteritis occurs in millions of children world-wide every year and treatment with probiotics is common. Two studies examined gastroenteritis outcomes utilizing (a) Lactobacillus rhamnosus GG vs. a placebo and (b) a combination probiotic product containing lactobacillus rhamnosus R0011 and L. helveticus R0052.
 
It appears that a 5 days course of L. Rhamnosus GG for acute gastroenteritis is no better than a placebo, and for children presenting to an Emergency Department with gastroenteritis twice daily administration of a combination of probiotics does not improve 14 day outcomes.
 
 
See related video HERE & HERE
What is the Personalized Medicine Initiative (PMI)?
What is the Personalized Medicine Initiative (PMI)?
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Abdominal pain, increased pancreatic size (mass or diffuse) and obstructive jaundice are associated with which childhood condition?

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