July 27, 2016
Volume VII | Issue No. 30

Serious complication in male circumcision
Data on significant complications following circumcision in boys under the age of 1 year was recorded in Scandinavia over a 20 year period. Over 7,000 male circumcisions are performed in Norway, Sweden and Denmark every year. Over a 20 year period 32 fatalities with 74 serious complications occurred.

While complications are relatively rare following circumcision in young boys, serious complications do occur and the authors strongly suggest that circumcisions should only be performed in hospitals with 24 hr. Emergency Departments.

See related video below>>
Tolvaptan for Inappropriate antidiuretic hormone secretion (SIADH) in infants
The syndrome of SIADH is defined by hyponatraemia and hypo-osmolality in spite of a normal (or increased) intravascular volume. The hyponatraemia is due to an excess of water and not a deficiency of sodium.

Up to 33% of very low birth weight infants are hyponatraemic in the first week of life, though true SIADH in the newborn appears rare.

Water restriction is the first line treatment of SIADH, however in small infants it's potentially hazardous as fluid and caloric intake are connected. A retrospective review of 2 neonates with persistent SIADH treated with Tolvaptan (an oral vasoreceptor antagonist) identifies its potential benefits.

Prognostic value of perihematomal edema area in intracranial hemorrhage
Non-traumatic intracerebral hemorrhage (ICH) is a life-threatening condition.
Early interventions and treatment may reduce mortality. Absolute
volume of perihematomal edema appears to be directly related to mortality in adults. The prognostic value on 30-day mortality of perihematomaledema 
absolute area (PHEAA) is unknown.

PHEAA is a simple, no extra cost value study which appears to be an independent indicator of 30-day mortality in ICH patients. (It would be of interest if a similar study in infants/children was undertaken. Ed).
Play it Safe in the Sun 
INFORMATION BONUS!  Newly Updated... 

Download, print and pin this information on your office wall.


-This is a "Must Have" (Ed.) 

Right (R-CDH) vs. Left sided (L-CDH) congenital diaphragmatic hernia; outcome analysis

Though up to 25% of diaphragmatic hernias are R-CDH, these have been less well studied. A retrospective chart review of 330 CDH patients examined outcomes (specifically pulmonary hypertension) between R-CDH and L-CDH following standard treatment.

R-CDH patients appear to have increased severity of pulmonary hypertension with longer nitric oxide therapy requirements, increased requirement for tracheostomy, supplemental oxygen at the time of discharge and chronic pulmonary hypertension requiring Sildenafil treatment.
Dental erosion (DE) in children with gastroesophageal reflux disease (GERD)

A case-control study compared DE between 43, 2-4 year olds diagnosed with GERD to a paired age-matched control group.

Apparently 25.6% of GERD children (vs.5.9% normal controls) develop DE (more so if they use adult toothpaste) unrelated to dietary consumption or socio-economic characteristics.
Video Feature 
Highly Acidic Drinks And Your Children's Dental Health
Highly Acidic Drinks And Your Children's Dental Health
Factors associated with supplemental/exclusive formula feeding of infants during hospital stay
65% of mothers questioned report supplementing breast feeding with formula. Most common reasons for this include:

1      Perception of inadequate milk supply (36.4%)
2      Desire for sleep (35.4%)
3      Plan to breast and bottle feed (35.2%)

Factors associated with exclusive formula feeding include:

1     Single mothers
2     Catholic religion
3     Multiparity
4     Cesarean delivery

Addressing factors deleterious to breast feeding can enhance breast feeding rates.
Effects of maternal antihypertensive drugs on cerebral fractional tissue oxygen extraction (CFTOE)
"Antihypertensive drugs are frequently used in obstetrics for the treatment of preeclampsia (labetalol) and tocolysis (anti-contraction medication - nifedipine) or for neuroprotection (MgSo4)". These may effect the hemodynamics of preterm born infants.

A study utilizing near-infrared spectroscopy to evaluate blood flow (cerebral, renal and splanchnic tissue oxygen extraction) in 80 preterm neonates <32 weeks gestation during the first 5 postnatal days in mothers treated with one or more drugs (and compared to non-exposed infants on similar days) indicates low cerebral tissue oxygenation with antihypertensive drug exposure (neurodevelopmental outcomes not recorded. Ed).

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Did You Know?  
Dr. Chad Perlyn, plastic surgeon at
Nicklaus Children's Hospital, talks about the surgeries performed on babies born with rare craniofacial deformities.
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