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Feb. 6, 2019
Volume X | Issue No. 6
Children's abilities to communicate with both parents in infancy and social competence at 15 years of age 
A prospective pilot study of 19 families monitored child-mother-father communication (initially for 3 months to 48 months of age, and again at 4 years of age and at age 15 years) using the standardized Lausanne Trilogue Play method in a video studio (and subsequent teacher questionnaires) to assess the early and late long-term effects of infant triadic interaction on social competence at 15 years of age.

A child's ability to initiate turn-taking sequences and their parents' responses to those correlate with the child's social competence at both ages 4 and 15 years. Stimulating infants' capacity to initiate activities between " both parents" enhances their social competence throughout childhood/adolescence.
Treatment of acute Seymour fractures 
A Seymour fracture is one that occurs in the distal phalanx of a finger through the growth plate (20-30% of phalangeal fractures in children), often involving the middle finger, usually the result of direct trauma or a crush injury, with an associated nail bed deformity (this fracture requires antibiotics as is technically an "open" wound). It presents with a "mallet finger" because if an imbalance between the flexor and extensor tendons at the fracture site.
A retrospective study of 65 children (mean age 10 years) with an acute Seymour fracture investigated treatments, outcomes, operative indications and antibiotic choices.
Most Seymour fractures (89%) can be successfully managed in the Emergency Department with closed reduction. A few children will require operative intervention, open reduction and k-wire fixation. Complications are rare.
Intrapleural streptokinase for childhood multi-loculated empyema
A study of 195 children <12 years of age compared the efficacy of administering intrapleural streptokinase (with antibiotics and plural drainage) within 14 days after disease onset to those children who either received it later or not at all.
It appears that intrapleural streptokinase administration is effective for a multi-loculated empyema even when administered past 14 days and that utilizing 4-6 doses is superior to 3 doses.
Childhood Obesity Facts 
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The burden of surgery and postoperative complications in children with inflammatory bowel disease (IBD)
A retrospective 20-year review of 784 children with inflammatory bowel disease; celiac disease (CD - 20.8%) and ulcerative colitis (US - 10.7%) who underwent surgery indicates:
  1. Median time from diagnosis to intervention for CD decreased from 34 months to 3 months, with 13% developing complications (bowel obstruction, anastomotic stricture/leak, stomal issues).
  2. For UC, median time to surgery decreased from 62 months to 2 months with 41% developing post-operative complications (similar to above).
Time to surgical intervention in children with IBD has decreased over a 20 year period with post-operative complications occurring commonly for both CD and UC children.  
See related video HERE & HERE
High arachis hypogea (Ara h) allergen 2 immunoglobulin E (IgE) level and exposure to small amount of peanut protein
The prevalence of peanut allergy among children in the USA is at least 1.4% (2008) and apparently increasing yearly. "Usually, food allergens are proteins or glycoproteins with a molecular mass ranging from 10-70 kDa". Allergy to peanuts (taxonomically classified as Arachis hypogea) accounts >50% of food allergy fatalities. Allergens from peanuts are predominantly seed storage proteins, there are a number of them (approximately 16) able to induce the production of specific IgE antibodies with Ara h 1-3 in the USA being most commonly associated with severe symptoms. While the presence of food-specific immunoglobulin E is useful to predict clinical allergy the prediction of severity remains more difficult.
36 children with a high suspicion of peanut allergy underwent peanut protein challenges (according to the recommendations by the American Academy of Allergy Asthma and Immunology) with increasing doses (to a accumulative dose of 1,280mg), assessing dose-adjusted severity and serum Ara h 2 IgE levels.
The serum Ara h 2 IgE level appears to predict the peanut exposure threshold dose - the lower the threshold the greater the risk of a severe allergic reaction.
Video Feature
Fracture Base of The Distal Phalanx In Children (Seymour fracture)
Fracture Base of The Distal Phalanx In Children (Seymour fracture)
School connectedness, substance abuse and physical activity
"School connectedness is the belief held by students that adults and peers in the school care about their learning as well as about them as individuals."
A study of 4 years of previously collected data for 33,133 students who provided information on socio-demographics, school connectedness and 4 health-related behaviors, investigated whether a change in school connectedness predicted changes in behavior across 9th, 10th, 11th and 12th grades.
As school connectedness decreases, frequent smoking, marijuana use and binge drinking increase and physical activity declines. School connectedness appears extremely important to support healthy adolescent development.
See related video HERE.
Probiotics, enteral feeding tolerance and growth rates in extremely low birth weight (ELBW) infants 
It appears from a randomized, double-blind, placebo-controlled, comparative trial of 134 ELBW (<1,000g) infants born before gestational age 28+0 weeks, given oral supplementation with probiotic Lactobacillus reuteri DSM 17938 ( or a placebo) that probiotic administration does not enhance enteral feeding tolerance, however treated infants do have a better head growth rate during the first month of life. This may have a long term benefit.
Children's Health Chats
Dr. Otto M. Ramos Discusses the Flu
Dr. Otto M. Ramos Discusses the Flu.
Take the February Quiz !

How important is the human diaphragm?

How much do you know about juvenile idiopathic arthritis?

Is point-of-care ultrasound valuable for diagnosing pneumonia?

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