July 19, 2017
Volume VIII |  Issue No. 29

Breast milk and infants' microbiome
A study of 107 healthy mother/baby pairs that analyzed maternal breast milk, a mothers' areola skin and infants' stool for bacteria, using RNA sequencing, suggests a close correlation between the newborns' gut microbes and their mother's milk with those infants predominantly breast fed having 27.7% (average) of their gut bacteria from breast milk and 10.3% from areola skin.
The effectiveness of prescribed rest following concussion
It is of interest that in a prospective randomized controlled study of pediatric concussed patients (11-18 years), children with symptoms (predominately) are more likely to remain symptomatic at days 1-6 and 8 post-injury if prescribed rest; whereas for those patients with signs of injury after concussion rest appears beneficial. Individualized treatment plans appears wise.

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Association between early childhood caries and colonization with Streptococcus mutans (S. mutans) genotypes (GT) from mothers
A study of 69 infants (approximately 1 year of age) at high risk for caries (bedtime infant feeding, no fluoride, frequent sipping, etc.) examined microbial samples collected from dental plaques, saliva and other oral surfaces and compared them to their mothers' dental plaque.
It appears that colonization of children with S. mutans genotypes that match their mothers' is highly associated with early childhood caries. Mothers' oral microbial status is important as a contributing factor to their child's oral health.
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Nonimmune hydrops fetalis (NIHF)
Hydrops fetalis describes a fetus or newborn with an abnormal amount of fluid in 2 or more body areas. Causes include immune and nonimmune mechanisms. While immune hydrops fetalis is most often a complication of severe Rh incompatibility, the nonimmune type is far more common (90%) and is usually due to heart or lung issues, severe anemia (e.g. thalassemia or infection) and genetic/developmental problems.
From a large database, a study of NIHF reveals that prematurity, polyhydramnios and large for gestational age increases the risk of death in this population (35% die as neonates - 43.2% by 1 year of age).
Video Feature
Pulmonary hemorrhage (PH) and respiratory syncytial virus (RSV) 

While for most patients RSV bronchiolitis is mild and self-limiting complications do occur particularly in those infants who are immunosuppressed or have preexisting heart or lung disease. Pulmonary hemorrhage however has not apparently been previously reported.
A retrospective case review of infants admitted to a Pediatric Intensive Care Unit with a diagnosis of RSV bronchiolitis identified 7 patients with PH; 6 of 7 were born preterm and all PH occurred after a period of mechanical ventilation and following extubation.
Polymorphisms of Mannose-binding Lectin (MBL) and Toll-like Receptors (TLR) 2, 3, 4, 7 and 8 and the risk of respiratory infection and acute otitis media in children
"Mannose-binding Lectin and Toll-like receptors are important components of the innate immune system". A prospective cohort study of blood samples from 381 Finnish children were analyzed for polymorphisms at a number of sites, and had polymerase chain reaction (PCR) and antigen testing studies to identify respiratory viruses from nasal swabs. Children were followed for respiratory infections until 2 years of age.

It appears that children with MBL variant genetic polymorphisms have an increase susceptibility to respiratory infections and rhinovirus-associated acute otitis media, while those with TLR polymorphisms may have an increased or decreased risk to recurrent infections depending on the particular TLR isolated.
Genetic polymorphisms in MBL and TLR promote or decrease susceptibility to respiratory infections and with environmental factors may explain why some children have more while others have less respiratory tract infections.
Applying vacuum to reduce wound infections in laparoscopic pediatric surgery
"Negative pressure wound therapy is used to treat complex wounds".
A controlled trial randomized 90 children with an umbilical port site to a "standard" or "vacuum" dressing. 48 post surgery, dressings were removed and at 7-10 days a "blinded" nurse unaware of treatment protocol evaluated the umbilical wound for signs of infection.
While this study was discontinued early due to the large number of patients required to show statistical power, there does not appear to be a difference in post-operative wound infection rates between standard and vacuum dressing management.
Did You Know?
Nicklaus Children's Hospital Named 2017 Most Wired
Nicklaus Children's Hospital  has been named a 2017 Most Wired Hospital by the American Hospital Association's (AHA) Health Forum. The 19th Annual Health Care's Most Wired® survey, released last week, reveals that technology tools are helping patients become more actively involved in their care and maintaining health.
"We are honored to once again be named a Most Wired hospital for recognizing the importance of investing in technology to support patients in our care, said Edward Martinez, Senior Vice President and Chief Information Officer for Miami Children's Health System. Technology is at the forefront of all we do, as part of our ongoing mission to inspire hope and create lifelong health for the children and families we serve."
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