July 15, 2015
Volume VI, Issue No. 28

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Outcomes of infants with "indeterminate diagnosis" detected by Cystic Fibrosis (CF) new born screening.

All babies in the USA are screened for CF using the Guthrie test which measures immunoreactive trypsinogen. Many who are positive do not have CF. "Cystic fibrosis transmembrane conductance regulated-related metabolic syndrome (CRMS) describes asymptomatic infants with a positive CF newborn screen, but inconclusive diagnostic testing for CF".


CRMS is a common outcome of CF newborn screening; many are diagnosed as CF. (CF:CRMS ratio = 5.0:1.0). CRMS infants tend to have normal nutritional indices however 11% have respiratory pseudomonas aeruginosa during the first year of life.



Rationale for early treatment of polycystic kidney disease (PKD)

"In hereditary cystic disorders, renal injury begins with the formation of the first cyst". Autosomal dominant polycystic kidney disease (ADPKD) presents in children and adults and ADPKD and autosomal recessive PKD (ARPKD) cysts form primarily in collecting ducts and progressively expand.

While many drugs are being developed to manage renal cystic disease, at present counseling, exercise, limitation of calories, salt protein and fat, increased fluid intake and treatment of hypertension are the main stays of management and should be offered at an early stage.


Pediatric Nephrology  


See related video on PKD HERE>> 

 Long-term outcomes of parapneumonic effusions (PPE) in children

Plural effusions in children are frequently of infectious origin; usually associated with bacterial pneumonia lung abscess or bronchiectasis.


A study of 51 children with PPE (with and without previous asthma) who were compared to matched healthy controls 2 years after initial infection, indicates that PPE has minimal clinical effects on lung function and exercise capacity in the long term (preexisting asthma does not appear to affect outcomes significantly).


Pediatric Pulmonology 



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A balanced protocol for return to school for children/youth following concussive injury.


"The main occupation of childhood is participation at school, vital to social development, academic learning and preparation for future roles". While prescribed rest from physical and cognitive activity has become the "cornerstone" of recovery, little guidance exists as to "how much rest is needed", "how much time off from school is recommended" and "what to do when children have difficulty with school routines" etc. Balancing brain healing and the importance of not losing excessive time off from school is not easy. In general pediatric concussion management should be conservative and individualized.


A protocol following NICE (National Institute for Health and Care Excellence-UK) guidelines outlines five stages:

  1. Stage 1: Brain rest - no school (1-2 weeks).
  2. Stage 2: Getting ready to go back - graduated cognitive and physical activity.
  3. Stage 3: Back to school - modified academics.
  4. Stage 4: Nearly normal routines.
  5. Stage 5: Fully back to school - normal school routine and extracurricular activities.

Clinical Pediatrics 

Video Feature

via YouTube  

Post-Concussion Protocol
Post-Concussion Protocol

Assertive communication in condom negotiation in adolescent couples.


From a study of 32 young couples, individual partner's assertiveness regarding condom use negotiation was examined.


It appears that very high and very low assertiveness is associated with lower condom use compared to moderate levels, which appear to enhance condom use in young couples.


Journal of Adolescent Health 

Eating disorders and coeliac disease.


Eating disorders and coeliac disease may interact and it has been thought that "coeliac disease may exacerbate precipitate or otherwise complicate eating disorders".


A prospective study evaluated 154 children with eating disorders prior to and after nutritional interventions where all patients ingested gluten, strongly suggests that there is no coexistence between eating disorders and coeliac disease.


Acta Paediatrica 

Breast feeding and maternal sensitivity predict early infant temperament


A study which assessed 170 breast feeding mothers' sensitivity and anxiety post-partum and their effects on infants' temperaments at 18 months of age, indicates that breast feeding enhances mothers' sensitivity, their interactions with their infants and that this has a positive effect on infant temperament at 18 months of age.

Acta Paediatrica 

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