InterContinental Miami
Practical Updates and Cutting Edge Topics for Pediatricians 
                                        Miami, FL
Jan. 24, 2018
Volume IX | Issue No. 4
Exhibitor Opportunity 
Nicklaus Children's Hospital Annual Pediatric Postgraduate Course

Miami, FL
Feb 22-25, 2018

Hyperoxia and neonatal alveolar epithelial cells
Neonates frequently require oxygen therapy which exposes the lung to significant oxidant stress which can (depending on a variety of factors) result in an acute hemorrhagic pulmonary edema, an increased susceptibility to injury and/or bronchopulmonary dysplasia (BPD). A study on neonatal rat alveolar barrier function examined the effects of 85% oxygen exposure (in vitro and in vivo).

Hyperoxia has a direct impact on alveolar tight and adherence junctions which impairs barrier function, and lung alveolarization. These effects appear to be mediated through downregulation of claudin 3 and - 18 and E- cadherin expression (calcium dependent adhesion molecules; Cam's). Strategies to antagonize these CAM's may potentially decrease the risk of lung injury from oxygen and BPD development.
Nitric oxide inhalation and bronchiolitis  
A double-blinded, randomized control study of intermittent inhalations of nitric oxide (160ppms) for 30 minutes (or control oxygen/air) five times a day, on 43 infants with bronchiolitis indicates no benefit in clinical score (with no evidence of adverse incidences and perhaps some benefit to hospital length of stay).

Pediatric Pulmonology
Urine testing in young infants
An Emergency Department compared urine specimens for infection (leucocyte esterase and/or nitrites) in 60 pairs of matched samples of infants < 90 days of age presenting with unexplained fever collected by either clean-catch standardized stimulation or bladder catheterization.

Urine dipstick testing using urine samples obtained by the clean-catch method is as good and accurate a screening test for diagnosing urinary tract infections in febrile infants <90 days of age as bladder catheterization.

Childhood Obesity Facts 
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Pediatric anxiety and exposure tasking therapy

All children have fears and worries which come and go. When these persist for most days, for weeks, interfere with sleep and cause difficulties in daily living, an anxiety state is diagnosed. There are a number of anxiety disorders which include: Generalized anxiety disorder, Panic attacks, Separation anxiety, Obsessive compulsive disorder and others.

Exposure tasks therapy (a component of cognitive-behavioral therapy; CBT) increasingly exposes anxious children/adolescents to tasks which cause them anxiety. Little research has examined specific exposure characteristics that predict outcomes.

A study of 279 children and adolescents with a principal diagnosis of anxiety treated with CBT and exposure tasks (14 sessions done with or without medication) examined a variety of components of tasking relating them to outcomes. Results indicates that anxiety improvement is directly related to quantity, difficulty, child compliance and mastery of tasking.

Video Feature
Cognitive behavioral therapy for childhood anxiety disorders
Cognitive behavioral therapy for childhood anxiety disorders
Childhood constipation and exercise  
Constipation in children is common and its pathophysiology multifactorial. Causes can be divided into functional and organic with >90 being functional.

A study which analyzed anonymously online parental responses of 190 children (1-18 years of age; 60 constipated and 130 matched normal controls) examined the relationship between constipation and exercise.

Young children (1-9 years of age) with and without constipation exercise similarly. Children 10-18 years of age with constipation are less likely to exercise (3 times per week >1 hour) with sedentary lifestyles being not significantly different.

Physical activity appears to decrease the likelihood of constipation in children 10-18 years of age.

See related video HERE.
Predicting need for additional computerized tomography (CT) with a non-diagnostic ultrasound (US) for appendicitis
A retrospective study reviewed recorded data of demographics and clinical outcome of 328 patients 0-18 years of age who presented to an Emergency Department (ED) with a complaint of abdominal pain and who received both US and abdominal CT scan. 78% had non-diagnostic US's.

After multivariate analysis it appears that abdominal CT in children suspected of having appendicitis with a non-diagnostic US should be considered only if such children present with 2 of 3 predictors (right lower quadrant tenderness, peritoneal signs and/or a white blood count >10,000 in mm3 - 94% sensitivity, negative predicted value of 96% for appendicitis).

 Population-based study of cognitive outcomes in children with congenital heart defects (CHD) 

A prospective population-based outcomes study examined at 3 years of age, demographics, and perinatal and operative variables as predictors of cognitive outcomes in 419 children with CHD, following open heart surgery and non-operated upon defects (catheter based interventions or no interventions).
While Global cognition is similar at 3 years of age in post-operative open heart and catheter treated children, post-operative children have difficulties in expressive language and logical reasoning and all the children are at early cognitive risk. Children with CHD born "small for gestational age" are at much greater risk for neurodevelopmental abnormality.
John M. Lie-Nielsen and Drew Kern Appointed to Nicklaus Children's Hospital Board
Mr. John M. Lie-Nielsen and Mr. Drew Kern have been appointed to serve on the board of directors of Nicklaus Children's Hospital, providing guidance to the 289-bed nonprofit pediatric specialty hospital and its network of outpatient centers. Both will provide leadership on the board's Marketing and Hospitality Committee, with Mr. Lie-Nielsen serving as committee chair.   
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