Dec. 4, 2019 
Volume X | Issue No. 49
Risk factors for recurrent community-associated (CA) Clostridiodes Difficile infection (CDI) in children
Risk factors for recurrent CA-CDI in children (defined strictly as children with CA disease, at least 3 episodes of diarrhea per day, a positive microbiological laboratory test for C. Difficile on liquid stool and recurrence within 8 weeks of primary CA-CDI) are scarce.

A retrospective cohort study of the electronic health records of children 1-17 years of age with primary CA-CDI and defined recurrence indicates that 11% experience a recurrence (lower than previously reported). Races other than Caucasian are at increased risk of recurrence as are those with inflammatory bowel disease and cancer. (For primary CA-CDI a short course of metronidazole remains the first-line drug for treatment.)

Pediatric Infectious Disease Journal
Pectus deformities, Marfan syndrome and cardiac anomalies
Marfan syndrome is a genetic disorder that affects connective tissue with the cardiovascular system, skeletal and eye being most often affected. It is inherited as an autosomal dominant trait with mutations of the Fibrillin-1 (FBN1) gene being linked to the disorder. 66% of patients with Marfan syndrome (0.3% of the general population) have a concurrent pectus deformity.

From a study of 241 patients diagnosed with pectus deformity (either pectus carinatum or pectus excavatum) it appears that 5.3% will have Marfan syndrome and approximately 33% will have cardiac abnormalities.

Journal of Pediatric Surgery

See related video HERE.
Clinical significance of the bronchodilator (BD) response in children with severe asthma
A study was conducted of 129 severe asthmatic children (SA) and 101 non severe asthmatics (NSA) (6-17 years of age) who underwent spirometry before and after being given 180 micrograms of albuterol to determine airway reversibility (>12% increase in  FEV1) followed by escalating doses of albuterol to 720 micrograms (to determine maximum reversibility).

" FEV1% predicted is a predictor of BD response of children with asthma." Second-hand smoke exposure, a higher fractional exhaled nitric oxide concentration or IgE level and a low blood neutrophil count are associated with increased odds of airway reversibility after maximal bronchodilation.

Pediatric Pulmonology
Childhood Obesity Facts 
Laryngeal stenosis in children
It appears from a study of 78 children (median age: 9 months) diagnosed with laryngeal stenosis that:
  1. Acquired lesions (from endotracheal intubation) account for 84.6%
  2. The subglottic region is most frequently involved (77%)
  3. 38.4% are severe
  4. 48.7% require a tracheostomy
  5. Endoscopic and surgical treatment is 91% successful with approximately 80% being decannulated
Journal of Pediatric Surgery
See related video HERE, HERE, HERE & HERE.
Vascular health of children conceived via In-Vitro Fertilization (IVF)
While some report IVF infants may be at increased risk for major cardiac and/or urogenital tract malformations, it appears that at the present time the risk is more likely to be for the presence of minor birth defects (rate 5 times higher).
Intrauterine cardiac remodeling is found in IVF fetuses which continues to age 3 years and it appears that this might be associated with premature vascular ageing and hypertension found in adolescents.
A cross-sectional pilot study of 17 children aged 10-14 years conceived via IVF evaluated arterial stiffness and endothelial function comparing IVF offspring with a matched controlled natural pregnancy conceived group.
Children conceived with IVF appear (from this small study) to have evidence of abnormal vascular health with abnormal arterial properties and endothelial function.
Journal of Pediatrics 
See related video HERE
Video Feature
Acute painless lower gastrointestinal bleed that mimics a Meckel Diverticulum

Meckel Diverticulum is a congenital outpouching in the lower part of the lower intestine and is the most common congenital defect of the gastrointestinal tract (2-3% of the general population; from the vitelline duct that connects the fetus to the yolk sac not being fully absorbed). It is usually symptomless though it may contain stomach and pancreatic cells which can cause ulcers and bleeding.
An interesting story of a 2-month old infant who presented with fresh blood in her diaper without distress or pain, was found to have a positive Meckel scan, had an exploratory laparotomy at which a jejunal duplication cyst was found, reminds us that gastrointestinal duplication (which can occur at any level of the gastrointestinal tract) while uncommon can present with gastrointestinal bleeding from heterotrophic gastric mucosae.  
Pediatric Emergency Care
Neuroimaging evidence of cortex differences in adolescents with emotional and behavioral dysregulation
From a neuroimaging study of 233 adolescents aged 14 years with increased emotional and behavioral difficulties ("dysregulated") and compared to a matched control group it appears that whole-brain grey matter differences are found in the right orbitofrontal cortex. This indicates its role in impaired emotional and behavioral control and from modeling suggests that this brain area is also involved in anxiety or conduct disorders.
Journal of the American Academy of Childhood & Adolescent Psychiatry
Children's Health Chats   
Is constipation a common condition in children?
Is constipation a common condition in children?
Take the December Quiz !

Can you describe Ankyloglossia or Tongue-tie?
Are males more likely to suffer Developmental Dysplasia of the Hip?

What is the universally accepted standard of treatment for NAS?

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