Miami, FL
July 11, 2018
Volume IX | Issue No. 28
Radiation-induced cataracts in children with brain tumors receiving craniospinal irradiation (CSI)
Of 45 children who received CSI, 29% developed cataracts (median time to develop: 27.6 months). All children receiving CSI should have routine eye examinations.
Prediction of neonatal hyperthyroidism 
All newborns with TSH level of less than 0.90mlU/L should be seen by a pediatrician. This TSH level is a useful screen for neonatal hyper- and hypo-thyroidism.
See related video HERE
Intra-individual biological variation in sweat chloride concentrations in Cystic Fibrosis (CF) and CFTR dysfunction 
"The sweat test is one of the main diagnostic tools used in newborn screening programs and as a confirmatory test in the case of suspected CF."

The Cystic Fibrosis transmembrane conductance regulator (CFTR) is a membrane protein and chloride channel in humans and is encoded by the CFTR gene. Mutations lead to chloride ion channel/fluid transport dysfunction resulting in thickened mucus in the lungs (and frequent respiratory tract infections) and pancreatic insufficiency.

A study of 35 children with CF (ages 6-18 years) assigned to 3 cohorts; CF, CFTR-related disorder (CFTR-RD) and healthy volunteers underwent 8 sweat tests in different conditions and times of the year.

Intra-individual sweat chloride levels vary significantly in CF patients, more so in non-CF individuals particularly during changes in hydration (seasonal).

Childhood Obesity Facts 
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Treatment of pediatric Black Widow spider bites
Most spider bites are harmless; the two most common poisonous spiders found in the USA are the Black Widow and the Brown Recluse. When biting, Black Widow spiders, who have fangs, leave two small puncture holes in the skin. As the venomous cocktail of neurotoxins, amines and enzymes spread, there develops a target-like appearance with the bite marks in the center. Local pain, redness and swelling occurs rapidly (within one hour). Generalized severe muscle cramps, abdominal pain, weakness and tremors may follow,  leading (in severe cases) to nausea, vomiting, dizziness, chest pain and respiratory difficulties.

While most children bitten by a Black Widow spider have only minor symptoms, anti-venom for severe reactions results in shorter symptom duration.

Video Feature
Black Widow Spider Bite
Black Widow Spider Bite
Accuracy of pulse oximetry screening for critical congenital heart defects (CCDH) after Home Birth/Early postnatal discharge 

Reviewing pre and post ductal oxygen saturations (SpO2) screening data >1 hour after birth and on days 2 and 3 of  23,959 asymptomatic newborns, it appears that pulse oximetry screening for CCDH has a sensitivity of 50% and specificity is 99.1% . (pulse oximetry screening DOES NOT detect left-heart obstructive CCHD's).

Pre and post ductal SpO2 measurements following home delivery/early postnatal discharge are of value in detecting CCHDs before signs of cardiovascular collapse appear (non-cardiac illnesses detected in 0.6%  leads to early recognition and treatment).

Reference values of reticulocyte hemoglobin content (CHr) in healthy adolescents 

"Assessing iron states in a pediatric population is not easy, as it is based on parameters that undergo physiological variations in childhood and adolescence". "In adolescents, iron requirements are increased by accelerated growth, increased blood volume, greater muscle mass and menstrual loss in girls with a diet low in iron."

CHr as a screen may enhance diagnostic accuracy but no reference values for healthy adolescents have been determined. A cross-sectional study of 253 healthy non-iron deficient (ID) children aged 12-16 years examined CHr values.

Since the discovery of CHr many studies have shown its usefulness in the early detection of iron deficiency in children and adults." Mean CHr value in normal adolescents (and independent of sex/age) is 31.6 +- 1.3pg (2.5 percentile; 28pg). A CHr value above the 2.5 percentile rules out iron deficiency.  

Corticosteroids for preventing caustic esophageal strictures 

"A substance is caustic if it is capable of burning or corroding organic tissue by chemical action, typically due to strong acid or alkaline properties."
"Caustic ingestions are seen most frequently in young children between 1-3 years of age." In 2015 the American Association of Poison Control Centers (AAPC) reported 2.2 million toxic exposures in the USA with about half occurring accidentally in children <5 years of age (usually household cleaning products-bleach). Severe injury can occur rapidly resulting (usually) in damage/edema to the oral pharynx, hypopharynx and esophagus (most commonly) persisting for 48 hours. If severe this can progress to necrosis of tissue with subsequent scarring (stricture formation). While corticosteroids are widely used to prevent esophageal stricture formation, uncertainty continues as to its effectiveness.
A search of a number of databases for randomized controlled studies of steroid use to prevent esophageal stricture following caustic ingestion indicates NO benefit.
Journal of Pediatric Gastroenterology and Nutrition 
See related video HERE.  
Meet Lourdes Prieto, MD - The Heart Program at Nicklaus Children's Hospital
Meet Lourdes Prieto, MD - The Heart Program at Nicklaus Children's Hospital
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