Jan. 6, 2021
     
Volume XII | Issue No. 1
Risk factors for re detectable positivity (RP) in recovered COVID-19 children
Children are increasingly becoming infected with the SARS-CoV-2 virus causing COVID-19. It has now become apparent that 7.5%- 36.8% who are diagnosed positive by real time reverse transcriptase polymerase chain reaction (RT-PCR) have re-detectable positivity on follow-up after hospital discharge. Little is known about the risk factors for RP.

From a retrospective study of all children diagnosed with COVID-19 by RT-PCR it appears that a substantial number may be found to be re-detectably positive. Risk factors include family cluster infection, a higher white blood cell count, longer plasma prothombin time (PT) and changes in CD4+ and CD8+ T lymphocytes. (Other studies implicate younger patients with mild to moderate disease, early RNA negative conversion, children with fewer comorbidities and more frequent upper respiratory tract symptoms. While cause remains controversial it appears that the intestine may be a reservoir of SARS-COVID-2 and one of possible causes of RP. Ed.)

Pediatric Pulmonology
Antibiotics for appendicitis
From a study 1,552 adult patients hospitalized with a diagnosis of appendicitis (of whom 27% had an appendicolith) randomized to receive a 10-day course of antibiotics or an immediate appendectomy it appears that 30 days outcomes are similar (by 90 days, 29% of the antibiotic group required appendectomy, the presence of an appendicolith substantially increasing the need for surgery). (For pediatric appendicitis outcomes appear similar. Ed.)

JAMA Network

See related video HERE, HERE & HERE.
Pediatric Emergency Provider Sexually Transmitted Infection (STI) screening practices in adolescents with Oropharyngeal or Anorectal complaints
A retrospective study of 767 adolescents 13-18 years of age who presented to an urban pediatric Emergency Department (ED) with an oropharyngeal or anorectal complaint, indicates that though 19.9% are considered to have an STI, testing is only performed in 5% of cases, often at an inappropriate anatomic site or with an incorrect test.
Interventions to increase awareness among physician staff appear necessary.

Pediatric Emergency Care
Dear Reader:
With COVID-19 among us, please take care, wear a mask whenever in public, wash hands well and often, use sanitizer if available, cough or sneeze into elbow and socially distance yourself (preferably at least 6 feet from any person), outdoors, or in a well ventilated area where possible.
 
Best of luck.  

Jack Wolfsdorf, MD, Editor
Staff NCH
COVID-19 - Current Situation in Florida
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Comparison of conventional chest physiotherapy (CCP) and oscillatory positive expiratory pressure therapy (OPEPT) in Primary ciliary dyskinesia
Mucociliary clearance (MCC) is the primary innate defense mechanism of the lung (other mechanisms include anatomical barriers, aerodynamic changes, cough and immune mechanisms), components of which include the airway surface liquid layer (which lubricates airway surfaces), a protective mucus layer (produced by goblet cells scattered among the cilia), and the cilia found on the surface of ciliated cells lining the bronchi.

Cilia are "hair-like" projections that line the primary bronchi (their tips just penetrating the underside of the mucus layer) which beat in "wave-like" patterns that propel pathogens and trapped particles towards the pharynx ("The Mucociliary escalator"). Cilia dysfunction (which may be congenital or acquired) results in chronic airway disease (e.g. Primary ciliary dyskinesia (PCD), and in Cystic fibrosis (CF) and Asthma). Chest physiotherapy is a recommended treatment modality for PCD and other large airway diseases.

A 6 month randomized, controlled, cross over trial compared the efficacy and safety of conventional chest physiotherapy to oscillatory positive expiratory pressure therapy in children > 6 years of age (with the child exhaling against a fixed resistor which both rapidly fluctuates and increases the intrapulmonary pressure) examining changes in pulmonary function tests, effectiveness and comfort.

Oscillatory positive expiratory pressure treatment better improves lung function for 3 months, is more efficient and comfortable than chest physiotherapy (with no adverse effects). OPEPT is an effective alternative method of airway clearance in PCD children.

Pediatric Pulmonology
The effect of breast feeding on febrile seizures: A case-controlled study
From a case-controlled study of 336 infants in the first 6 months of life with febrile seizures (vs. a matched age and gender febrile group) which examined feeding pattern vs seizure risk, it appears that exclusively breast fed infants have an overall lower risk of febrile seizures (compared to those formula fed) though it doesn't change the risk of type of febrile seizure (simple or complex) found.

Breastfeeding Medicine
Featured Video 
via YouTube
Simple Febrile Seizures: Clinical Criteria
Simple Febrile Seizures: Clinical Criteria
Early gluten introduction and Celiac Disease (CD) in the EAT study 
It appears that while present guidelines suggest that the age of gluten introduction does not affect the prevalence of CD, variations in dosing and/or timing of gluten introduction from previous randomized trials makes this approach suspect.

From a prespecified analysis of a randomized trial (1303 children) which examined dose and timing of gluten introduction between 4 and 6 months of life vs. > 6 months, it appears that early consumption of high dose gluten significantly decreases the prevalence of CD diagnosis at 3 years of age. This should be considered as a strategy to prevent CD in future studies.


See related video HERE & HERE.
Prevalence of exercise-induced bronchoconstriction (EIB) and laryngeal obstruction (EILO) in adolescent athletes 
In adults, exercise-induced respiratory symptoms (shortness of breath, wheezing, chest tightness or cough) occurs in 15-28% of elite athletes (compared to 13% of recreationally active adults) with 35%-39% being due to EIB (and 10%-20% of adolescents in the general population).

Exercise induced laryngeal obstruction (EILO) or supraglotic EILO appears to occur in 5.7-7.5% of adolescents in the general population. There are no cross-sectional studies investigating the prevalence of EILO in adolescent athletes.

In a Swedish study, all adolescents who attended 1st year sports in high school were invited to answer a questionnaire on respiratory symptoms. Divided into 2 groups (whether they reported exercise induced dyspnea or not) they were randomly invited to undergo 2 standardized exercise test - one for EIB and a continuous laryngoscopy test to investigate for EILO.

Exercise-induced bronchoconstriction ( EIB) is common in adolescent athletes with upper airway obstruction (EILO) being less prevalent. Self-reported exercise-induced dyspnea is a poor indicator of both EIB and EILO. Adolescent athletes should undergo standardized testing for both.

Pediatric Pulmonology
Featured Video 
Nicklaus Children's Hospital via YouTube
Meet Parul Jayakar, MD - Nicklaus Children's Hospital Clinical Genetics & Metabolism
Meet Parul Jayakar, MD - Nicklaus Children's Hospital Clinical Genetics & Metabolism
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