The Diplomat Beach Resort | Hollywood, FL |
Feb. 20, 2019
Volume X | Issue No. 8
Physiological effects of prone position in children with severe bronchiolitis
A study of 14 infants (median age 33 days) with severe bronchiolitis randomized to receive 7 cmH2O continuous positive airway pressure (CPAP) for one hour in the prone or supine position (followed by cross-over positions) in which a variety of respiratory physiological measures were undertaken, indicates that infants with severe bronchiolitis managed with noninvasive ventilation in the prone position appear to have significantly decreased respiratory effort and metabolic cost of breathing.
Parental factors in pediatric functional abdominal pain disorders
Functional abdominal pain - not otherwise specified (FAP-NOS) and Irritable Bowel Syndrome (IBS) are commonly diagnosed (world-wide prevalence: 13.5%) pediatric disorders. A study of both parents of 91 children with either FAP-NOS or IBS examined physical health, psychological distress, personality dimensions, and parenting behavior and compared these to parents of healthy peer controls.
Mothers of children with FAP-NOS/IBS report more physical problems but are similar to peer controls in all other measured areas.
Fathers of children with FAP-NOS/IBS have poorer child rearing skills, are more depressed and less agreeable than mothers.
No differences in all assessed outcomes are found between parents of children with FAP-NOS and IBS.
Association of delay in appendectomy with perforation in children with appendicitis
From a retrospective study of 857 children (median age: 12 years) diagnosed (by computed tomography) in the Emergency Department (ED) with a non-perforated appendicitis and followed to surgical appendectomy, it appears that every hour increase in the time from ED triage to incision is independently associated with a 2% increase in the odds of perforation. There appears to be no benefit to delaying surgery in children with appendicitis.
While most patients who have significant PE are treated surgically with the minimally invasive Nuss procedure, those who have mild to moderate disease and/or who prefer a conservative non-surgical correction may have an alternative treatment. The vacuum bell is a non surgical method that uses negative pressure to draw the sternum anteriorly (a process similar to bracing).
This study describes the methodology, outcomes and complications of 31 patients with PE (median age at treatment initiation: 14 years) treated with a vacuum bell (7 days per week for approximately 2 hours/day) and followed/assessed for up to 18 months (mean).
A prospective study of mild to moderate PE non-surgically managed with a vacuum bell indicates that this treatment is a potential alternative to surgery (80% show improvement) with minimal/no serious adverse effects.
Pectus Excavatum: What It Is - and the Unique Way Doctors Treat It
Operative management for pediatric/adolescent scaphoid bone fracture nonunion
The scaphoid bone is one of the proximal row of carpal bones of the wrist lying between the hand (on the lateral/radial side) and the forearm. Scaphoid fracture in children/adolescents represent approximately 3% of all hand and carpal fractures. While cast immobilization generally gives excellent results, some patients develop nonunion. Treatment consensus for this outcome is unavailable with multiple treatment options existing.
A literature review of multiple databases to compare surgical techniques and outcomes for scaphoid nonunion indicates that non-union scaphoid fractured treated either with non-grafting or a grafting technique have a union rate of approximately 95% (with excellent functional outcomes and similar complication rates).
Plasma miR-1290 (a biomarker) to detect early necrotizing enterocolitis (NEC)
Micro RNA (miRs) are a class of small RNA molecules that have gene regulatory function and appear to play a significant role in the pathogenesis in the number of diseases. Circulating blood based miRs used as biomarkers for several common inflammatory diseases (asthma, inflammatory bowel disease, rheumatoid arthritis and others) indicates a promising future for their role in disease management.
A study of plasma miRNA expression profiles (in 3 phases) compared those seen in infants with NEC, sepsis and non-NEC/non-sepsis; identifying the diagnostic usefulness of the best/specific miRNA biomarker(s) sensitive enough to separate them.
NEC has a distinct and specific miRNA expression profile (compared to sepsis and non-NEC/non-septic infants) with miR-1290, miR-1246 and miR-375 being useful as identifying biomarkers. Plasma miR-1290 appears to be the most useful and specific biomarker to identify NEC, and to differentiate it from neonatal sepsis on day 1.