InterContinental Miami
Practical Updates and Cutting Edge Topics for Pediatricians 
                                        Miami, FL
Jan. 31, 2018
Volume IX | Issue No. 5
Exhibitor Opportunity 
Nicklaus Children's Hospital Annual Pediatric Postgraduate Course

Miami, FL
Feb 22-25, 2018

Antenatal magnesium for preterm delivery and cerebral palsy
The current American College of Obstetrics and Gynecology (ACOG) Committee of Opinion supports the use of magnesium sulfate for fetal neuroprotection before 32 weeks gestation.

The largest randomized control trial which examined whether maternal magnesium sulfate administration in women at high risk for preterm delivery would reduce the risk of cerebral palsy (CP) found a reduction in moderate/severe CP at 6 years of age. Further investigation is however needed as maternal magnesium sulfate administration is not without risk (50% increase in hypotension) and advances in neonatal medicine have significantly improved neonatal neurodevelopmental outcomes.

Early wheezing/
bronchiolitis and the risk of future asthma
It appears that infants and young children with early severe wheezing or bronchiolitis, have or are at high risk for developing future asthma, unexplained solely by well-known factors like current allergy or family history of asthma.

Polymorphisms in
toll-like receptor (TLR) -1, and TLR -10 genes (cell membrane pattern proteins that play an important role in regulating and activating immune responses to, for example viruses, and are primarily anti-inflammatory) are associated in infants (<6 months of age) presenting with bronchiolitis, and with the development of asthma in children 1-6 years and 5-7 years of age respectively.

Acta Paediatrica

Cardio respiratory fitness and blood pressure 
A study of 734 adolescents 12-18 of age years followed for three years examined cardio-respiratory fitness (20 meters shuttle run test), height, weight, waist circumference and resting blood pressure over three years and related them two years alter to systolic blood pressure and work load or the oxygen demand of the heart (reflecting hemodynamic stress) during exercise.

Poor cardiorespiratory fitness during adolescence is associated with a significantly higher resting systolic blood pressure and "rate pressure product" (indicating hemodynamic stress).

Childhood Obesity Facts 
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Toxicity of proton pump inhibitors (PPIs) in children 

The use of PPIs in neonates and children has become increasingly common and their short-term effectiveness for treating peptic conditions in older children is well established. Side effects (approximately 12%) for relatively short-term (<1 year of treatment) use tend to be mild (nausea, diarrhea, clostridium difficile overgrowth, constipation, headache and drug interactions (not well documented but may occur with drugs metabolized by cytochrome P450 system). With acid suppression decreased absorption of some drugs may occur. There appears to be no evidence to suggest one PPI is more effective than another. Most are approved for children and perhaps only one, for infants <1 year of age. Specific single nucleotide polymorphisms of CYP2C19 reduce PPI clearance, increase exposure and prolong proton pump inhibition.

Long-term (>1 year) use of PPI's has been associated with increased risks of gastrointestinal and respiratory infections, vitamin B12 deficiency, hypomagnesaemia, increase gastrin secretion, bone fractures and rebound hyperacidity. In general, long-term adverse effects are essentially unknown in children.

Video Feature
Toxicity of proton pump inhibitors
Toxicity of proton pump inhibitors
A study of 230 cases of testicular/paratesticular tumors or masses   
"90% of cancers of the testicles develop in germ cells (GCTs). Two main types of GCTs are Seminomas and non-Seminomas which include embryonic carcinoma, yolk sac carcinoma, choriocarcinoma and/or teratomas."

Results of a retrospective study of 230 children with testicular tumors/masses indicates:
  1. 65% are benign (mean age at operation 3.63 years)
  2. 34% are malignant (mean age at operation 2.21 years)
A pre-operative serum alpha-fetoprotein level >1000ng/ml, >100ng/ml, >20ng/ml in infants <7 months, 7-9 months and >10 months old age groups respectively all indicate testicular malignancy.

See related video HERE.
Infantile colic and lactobacillus reuteri DSM 17938 (L. Reuteri)
"Infantile colic is defined as crying of fussing for more than three hours per day, more than three days per week without obvious cause and which cannot be prevented or resolved by caregivers" in the first four months of life.

A double-blind, placebo controlled randomized trial of colicky infants treated with either daily oral L. Reuteri (one x 1 x 108 colony forming units for 30 days ) or a placebo, had crying times, retinoid-related orphan receptor-y (RORy) and forkhead box P3 (FOXP3) messenger RNA levels (transcription factors that modulate immune responses to gut microbes), gut microbiota and fecal calprotectin levels measured to assess treatment efficacy.

L. Reuteri treated colicky infants cry significantly less, have an increased FOXP3 concentration resulting in a decreased RORy-FOXP3 ratio, reduced fecal calprotectin (markers for inflammatory bowel conditions) and improved gut microbiota.
Systemic lupus erythematous (SLE) and meningococcal vaccination  

"SLE affects multiple organs and involves complex immune dysfunction". Vaccinations stimulated the immune response and it has been suggested that they might be linked to an increased risk for flare of SLE and other immune disorders.
An interesting first case report of a previously healthy young Asian female aged 17 years who presented to an Emergency Department 14 days after meningococcal vaccination with fever and fatigue (and subsequently diagnosed with SLE) reminds us of the importance of considering acute autoimmune reactions like SLE when a previously healthy child/adolescent presents with
systemic symptoms following a recent vaccination.
See related video HERE
Nicklaus Children's Pediatric Care Center Receives NCQA Patient-Centered Medical Home Recognition
The Pediatric Care Center at Nicklaus Children's Hospital has been awarded recognition by the National C ommittee for  Quality Assurance (NCQA) Patient-Centered Medical Home Program. The Pediatric Care Center provides outpatient pediatric services for more than 4,000 children annually, including many with special medical needs.
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Asthma in childhood: Can medication adherence drive better outcomes?
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