Lactation and maternal hypertension
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"Hypertension is relatively common in pregnancy, and pregnancy may unmask hypertension among women who are predisposed to it". A review of a number of databases investigated from 19 studies the association between breast feeding and maternal risk of hypertension.
Brest feeding for a minimum of one month is associated with a beneficial effect on maternal cardiovascular risk and blood pressure that lasts for multiple decades. Physicians/nurses should incorporate these facts in their maternal counseling.
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Neuroimaging of early life epilepsy (ELE)
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A study assessed, in 775 children with a new diagnosis of epilepsy (<3 years of age at onset) adherence to neuroimaging guidelines and diagnostic yield. Most infants (93.5%) with ELE undergo neuroimaging with magnetic resonance imaging - MRI (87%), compute tomography (CT) or ultrasound (US). These yielded (in 40%) relevant etiological abnormalities (acquired injury - 13.4%; malformations of cortical development - 7.7%; other diffuse developmental disorders of the brain - 7.0%). Imaging abnormalities are more common in those with abnormal development at diagnosis, focal seizures, spasms or unclear signs/symptoms.
Adherence to neuroimaging guidelines in ELE provides significant etiological yield.
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Experience with Morgagni Hernia (MH) repair
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"The diaphragm is the major muscle of respiration and the second most important muscle within the body after the heart." Diaphragmatic hernias are most usually congenital (CDH) and were originally described by Reverius in 1679. Morgagni in (1761) described the classical anterior diaphragmatic hernia that bears his name and later in 1848 Bochdalek described both right and left posterolateral CDHs. In 1929 the first successful surgical repair was undertaken and in 1977 Extracorporeal membrane oxygenation (ECMO) was introduced to maintain neonates in respiratory failure secondary to CDH, refractory to conventional care.
MH hernias are rare. A retrospective review was undertaken of one institution's experience plus a MEDLINE search related to minimally invasive surgery (MIS) and patch repair of MH's in infants in children, indicates that open or minimally invasive surgery are equally successful, with the use of a patch appearing to reduce the likelihood of recurrence.
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Oral immunotherapy (AR101) for peanut allergy
Peanut allergy exposes unpredictable and occasionally life-threatening allergic reactions in those affected with no approved preventative treatment option available.
In a phase III trial of immunotherapy in children and adolescents who are highly allergic to peanuts, results of treatment with AR101 (a peanut-derived investigational biologic oral immunotherapy drug) indicate that higher doses of peanut protein are able to be ingested without dose limiting symptoms, and with lower symptom severity.
New England Journal of Medicine
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Video Feature
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Peanut Desensitization Clinic open in Florida
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Septic arthritis (SA) in children: Importance of molecular diagnosis
A study investigated the etiology of SA in 81 children <14 years of age, prior to and after the implementation of universal 16SrRNA gene polymerase chain reaction and sequencing (16SPCR) of their synovial fluid.
16SPCR testing doubles the number of bacterial positive samples in synovial fluid in children with a diagnosis of SA. Organisms diagnosed include Staphylococcus aureus (37.5%) and Kingella kingae (35%).
K. kingae SA occurs more frequently in infants <3 months of age, with less anemia, lower C-reactive protein (CRP) levels, a milder clinical syndrome; is associated with less osteomyelitis, requires shorter intravenous therapy and in general has a lower rate of sequalae.
Molecular diagnosis enhances the bacterial diagnosis of SA in children and also enables therapy to be more closely aligned with etiology.
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Maternal risk factors and perinatal characteristics of anorectal malformations (ARMs)
From a study of 1,167 infants with ARMs (and 5,835 controls) it appears that ARMs occur more often in obese mothers, those who smoke, in the premature infant (<35 weeks gestation), and in babies who are small for gestational age (SGA).
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Delayed cord clamping; 4-month ferritin levels, brain myelin content and neurodevelopment
A partly blinded, control trial of 73 healthy pregnant women and their singleton fetuses randomized them to either delayed or immediate umbilical cord clamping. Ferritin level, neurodevelopmental testing and brain myelin content (measured with magnetic resonance imaging - MRI) was undertaken and correlations made between infant groups at four months of age.
Delayed cord clamping enhances ferritin levels and increases brain myelin which may offer long-term advantage to functional development (no differences in short-term neurodevelopment outcomes noted).
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Children's Health Chats
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Dr. Joshua Tarkoff Explains Type 2 Diabetes-Brought to you by Nicklaus Children's Hospital
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Take the January Quiz
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