Miami, FL
Feb. 28, 2018
Volume IX | Issue No. 9
Periconception exposure to air pollution and risk of congenital malformations
If one needs an additional reason for "cleaner air", a recent study which examined the association between increased periconception exposure to fine particulate matter (PM2.5) indicates that (after adjusting for coexisting risk factors) exposure to increased levels of PM2.5 during the month prior to and after conception is modestly associated with abdominal wall defects, hypospadias and other congenital abnormalities.
Storage of unfed and left-over mother's own milk
A small study which examined bacteriological and immunological properties of freshly expressed, previously frozen, and left-over mother's own milk during storage indicates that all milks remain stable during storage at 4C for at least 6 days; when stored at 24C the quality of all milk declined when stored for >3 hours.

Epidemiology and predictors of orbital fractures in children
From a study of 326 children who underwent facial and orbital computed tomography (CT) to evaluate for orbital fractures, it appears that fewer than half (41%) undergoing CT have an orbital fracture with <7% requiring operative intervention. In the absence of orbital tenderness, swelling or ecchymosis only one of 326 children will have an orbital fracture requiring surgical repair.

CME from Nicklaus Children's Hospital's iLearn  
Diagnosis and Management of Common Pediatric Rheumatology Conditions
At the conclusion of this presentation, attendees are expected to:
  •    Appreciate the various initial presentations of Juvenile arthritis
  •    Understand the basic treatment approaches for juvenile arthritis
  •    Recognize the typical clinical presentations of SLE and dermatomyositis

Nicklaus Children's Hospital is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The hospital designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

How to access iLearn? Click HERE
Childhood Obesity Facts 
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Sleep disorders in children and melatonin  

Sleep problems are common in children with potential negative impacts on health including interpersonal relations, psychological functioning, daily activities and school performance. Chronically, sleep deprivation may lead to neuronal damage and impaired brain development with cognitive, behavioral and emotional consequences.
Melatonin (pineal hormone) appears to be the "cornerstone" in the synchronization of the sleep-wake rhythm. It is inhibited during the day and secretion increases at night.

A study of 14 children (age 4-14 years) with primary sleep disorders investigated melatonin secretion patterns and actual sleep times after one week of placebo followed by 3mgm/night melatonin for 3 months.
Melatonin in children with sleep disorders improves sleep where there is insufficient melatonin secretion, a disturbed circadian rhythm and an advanced or delayed acrophase (time between peaks of cycle ).

Pediatric Neurology

See related videos HERE and HERE
Parents who allow early adolescents to drink 
Apparently, a sizable minority of parents allow their early adolescents (14 year olds) to drink alcohol. A national longitudinal study examined the prevalence, variation by socioeconomic background and parent alcohol usage.

It appears that approximately 17% of parents allow their 14 year old children to drink. Employed, more educated and non-abstaining parents of white children are more likely to permit early adolescent drinking, which is a risk for early initiation, heavier use and other problem behaviors.

Video Feature
Under Contstruction: Alcohol and the Teenage Brain
Under Construction: Alcohol and the Teenage Brain
Peroral endoscopic myotomy (POEM) in children with Achalasia
Achalasia is a rare esophageal motility disorder in children. Its characterized by a failure of the lower esophageal sphincter (LES) to relax; it usually presents with vomiting, dysphagia, regurgitation and weight loss. Barium swallow and esophageal manometry are diagnostic. Treatments include pneumatic dilatation and myotomy (Heller procedure; laparoscopic abdominal myotomy). POEM is a relatively new procedure in adults, rarely applied in children.

A study of 21 children (11 months-18 years) diagnosed with Achalasia treated with POEM and followed for 3-24 months, indicates significant clinical improvement with studies showing opening of the LES (significantly enlarged cardiac orifice with decreased obstruction).

Journal of Pediatric Gastroenterology and Nutrition

See related video HERE.
Long-term outcomes of hyperglycemic preterm infants managed with tight glycemic control  

Hyperglycemia in preterm infants is common, particularly in very low birth weight (VLBW) ones where it is associated with increased morbidity (late-onset sepsis, necrotizing enterocolitis, intraventricular hemorrhage) and mortality. Causes are multiple and while evidence supporting management is poor, treatment with insulin is common.
A study of 88 VLBW infants randomized as hyperglycemic neonates to a trial of tight vs. standard glycemic control and neurodevelopmentally assessed at 7 years of age indicates that tight glycemic control does not change survival without neurodevelopmental impairment, but does reduce fasting sugar blood concentrations, height and lean weight at school age.
Journal of Pediatrics
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