Miami, FL
Jan. 17, 2018
Volume IX | Issue No. 3
InterContinental Miami
Practical Updates and Cutting Edge Topics for Pediatricians 
Exhibitor Opportunity 
Nicklaus Children's Hospital Annual Pediatric Postgraduate Course

Miami, FL
Feb 22-25, 2018

Hearing after cardiac surgery
Audiological and neurodevelopmental evaluations of 340 children at 4 years of age who underwent repair of congenital heart disease indicates that hearing loss appears 20-fold higher than in the general population and is associated with worse neurodevelopmental (language, cognition and attention) outcomes.

Lyme disease is spreading! 
Lyme disease is caused by a tick bite (one of many; usually the "black-legged tick" frequently found in the Northeast, Mid-Atlantic, Northern Midwest and West Coast) injecting one of three bacteria (usually) into the skin; with Borrelia burgdorferi being the only one found in the USA. Symptoms usually start 3-30 days after being bitten (Stage 1; typically a flat, small or large rash pink in the center surrounded by a deeper red ("erythema migrans" or "bulls eye rash") with symptoms of sore throat, headache, fever, fatigue, stiff neck, joint/muscle pain and swollen glands. Stage 2; if untreated bacteremia occurs week/months later with additional signs/symptoms of facial nerve palsy, lymphocytic meningitis, carditis and multiple rashes. Stage 3; months to years later presents frequently with large joint arthritis). Treatment is with antibiotics (doxycycline, amoxicillin or cefuroxime) for 1-2 weeks (or longer) and early treatment usually results in full recovery.

A recent CDC report indicates that the incidence of Lyme disease has spread out of the usual states into 8 of 11 neighboring states (with Florida reporting cases but with a low incidence).

See related video HERE.
Reasons for energy drink usage and adverse effects in adolescents 
A study of 192 mostly Latino adolescents which examined energy drink usage indicates that 61% use it to increase energy, 32% as a study aid, 29% to improve sport performance and 9% to lose weight. 40% have adverse reactions, which include insomnia (19%), jitteriness (19%), palpitation (16%), gastrointestinal upset (11%), headache (8%), chest pain (5%), dyspnea (4%) and seizures (1%). Brand name and packaging influence choice.

Pediatric Emergency Care
Childhood Obesity Facts 
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What parents need to know about electronic cigarettes (e-cigarettes) 
Use of e-cigarettes and other electronic nicotine delivery systems (ENDS) have increased substantially over the past ten years.
  • All devices use electronics to heat liquids made of flavors and nicotine. Liquids sniffed, drunk or touched can cause poisoning in children <5 years of age.
  • The act of puffing triggers a battery-powered heater to heat the liquids to vapor which is inhaled by the user ("vape" or "vaping").
  • Many ENDS resemble traditional tobacco products like cigarettes, pipes or cigars and include vaporizers, vape pens, electronic cigars and electronic hookah.
  • Electronic delivery systems can be used to smoke nicotine and marijuana.
  • Vaping, or second hand vapor inhaling is not safe, as the inhaled material contains harmful chemicals (anti-freeze and carcinogens).
  • It is not recommended to use ENDS to try and quit smoking and youths who use ENDS are more likely to smoke traditional cigarettes in the future.
  • Long-term health effects of use/bystander inhalation are unknown.
Pediatric injuries in snow sports 
A retrospective analysis of prospectively collected pediatric trauma data from 6,299 snow sport incidents indicates:
  1. Skiers account for 60.7% of patients; snow boarders 38.5%
  2. 53.5% of injuries are related to falls (knees and wrists)
  3. Helmet use decrease with age, is positively associated with higher level of ability and the rate of helmet use is inversely related to concussion
  4. Children of all ages who undertake snow sports should wear helmets
Journal of Pediatric Surgery
Video Feature
Pediatric injuries in snow sports
Pediatric injuries in snow sports
Sextortion of minors 
Sextortion  ("the threat to expose sexual images to coerce victims to provide additional pictures, sex or other favors") appears to be an emerging threat to youth. A study of incidences from 1,385 victims examine whether incidences occurring to minors (ages 17 and younger) are more or less serious than those experience by young adults (18-25 years of age).

An on-line survey of  sextortion in minors reveals:
  1. 60% of minor responders know the perpetrator in person (often as a romantic partner)
  2. Most (75%) knowingly provide the images
  3. 67% feel pressured to provide the initial photo and are pressured to provide more
  4. 33% are threatened with physical violence and menaced >6 months when teen dating
  5. 50% do not disclose the incidence
  6. Perpetrators are more likely to urge minor victims to harm themselves
(The article provides resources for the practitioner to help victims find support, legal advice and how to remove posted images).

See related video HERE and HERE.
Recurrent Acute Chest Syndrome (ACS) in pediatrics Sickle Cell Disease 

Multiple episodes of ACS are common in sickle cell disease (20% of children with sickle cell disease have >1 episode).
A retrospective medical chart review of 386 episodes of ACS examined factors on initial hospitalization which are associated with recurrent episodes.
At initial presentation risks associated with recurrence of ACS in pediatric sickle cell disease include:
  1. Age <4 years
  2. History of asthma
  3. Shortness of breath
  4. Increased length of hospital stay
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