Dec. 7, 2016
Volume VII | Issue No. 49

Respiratory health in school-aged children following preterm birth or bronchopulmonary dysplasia (BPD)
A follow-up study at 11 years of age of 88 school children born preterm (mean gestational age 28.8 weeks) which compared them to term-born babies indicates that preterm infants (at age <2 years) are more frequently hospitalized, particularly for wheezing but being preterm does not increase the development of atopy.

BPD appears to decrease subsequent atopy rates.

"School-age children enjoy good respiratory health and fewer allergies despite having lung disease after preterm birth".

Bronchodilator response (BDR) as a diagnostic tool to evaluate children who wheeze
Following an extensive database search for studies reporting on the diagnostic efficacy of BDR (vs. clinical diagnosis of asthma/recurrent wheezing) it appears that there is "little evidence to suggest that spirometry-based BDR can be used in the clinical assessment of preschool children who wheeze".

Biomarkers and physical examination to detect bacterial infection in febrile infants without source (FWS) < 3 months of age
A retrospective study of 318 infants <3 months of age who presented with FWS in whom 3.5% had bacteremia and 23.9% were diagnosed with a urinary tract infection indicates that procalcitonin is better than C-reactive protein, white blood count or absolute neutrophil count to confirm (or dismiss) a diagnosis of invasive bacterial infection.

Infants who have invasive bacterial infection may appear clinically well and it appears that additional newer biomarkers will be needed to enhance diagnostic accuracy.

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American Academy of Pediatrics - latest guidelines on Sudden Infant Death Syndrome (SIDS)
Prevention guidelines include:
  • Safe sleep environment; supine position; room sharing without bed-sharing; firm bedding until 4 months of age; no overheating.
  • Avoidance of exposure to smoke, alcohol, illicit drugs.
  • Breast feeding.
  • Routine immunizations (AAP and CDC recommendations)
  • Pacifier use at nap and bed-time.
  • Skin-to-skin care for the newborn infant.
  • Advice on use of couches/armchairs/sitting devices for sleeping.
  • Awake supervised "tummy time" daily.
  • Management in car seats, swings etc. to address gastrointestinal reflux and positional Plagiocephaly.
Video Feature
New advice to protect babies from SIDS
New advice to protect babies from SIDS
Video Feature
The lung in prolidase deficiency (PD)
Prolidase is an enzyme responsible for breaking down iminodipeptides, the defect in which causes a rare autosomal recessive disease affecting collagen metabolism and connective tissues. PD generally presents with intellectual disabilities, increased vulnerability to infection particularly in the lungs and persistent skin lesions or ulcers on legs and feet which may not heal well.

A report of 2 children presenting with severe pulmonary cystic lesions reminds us that prolidase deficiency frequently presents with a history of recurrent pulmonary infection/chronic lung disease which not infrequently goes on to respiratory failure and death.
Aggravated peer victimization (APV)/"peer abuse (rather than bullying)"

The use and definition of the term bullying, while convenient and frequently used includes repeated peer aggression that takes place in the relationship where there is an imbalance of power. In many situations of abuse, for example sexual assault by a peer, using the term bullying is inappropriate.

The APV measure which is behaviorally specific and examines episodes of injury, weapon use, bias content, sexual context, multiple perpetrators ( without necessarily an imbalance of power) identifies more youths suffering from the effects of peer victimization and appears to be a better measure than those situations covered by the term "bullied".

Peer victimization and its management should not be constrained by definitions.

Factors associated with poorer outcome in childhood swimming pool submersion

A retrospective evaluation of 211 swimming pool submersions identifies male children, median age 4 years, swimming in both single residential (48%) and multi-residential (35%) pools being at greatest risk. 75% have favorable outcomes, including 8.6% with absent pulses at poolside.

A poor prognosis is associated with submersions occurring on weekdays, during the summer, lasting > 5 minutes, on-scene apnea or cardiac arrest needing cardiopulmonary resuscitation and transfer to a tertiary care center.

Pediatric Emergency Care
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