Miami, FL
July 3, 2019
Volume X | Issue No. 27
Pasteurized donor milk vs. raw maternal breast milk for preterm infants
A PubMed search examined studies comparing a number of milks available for the preterm infant (raw maternal milk vs. donor milk; human milk before and after Holder Pasteurization; milk from mothers who delivered preterm and at term; and milk collected during early and late lactation).
"Raw maternal milk contains factors involved in antioxidant and anti-inflammatory defenses, gut microbiome establishment and the maturation of immune defenses, food tolerability and metabolism." Processed donor milk has fewer and less of these components which promote growth and development of the preterm infant.  
Acta Paediatrica
Nocturnal asthma (NA) in children 
NA (any nighttime worsening of reversible airway disease associated with an increase in symptoms and airway responsiveness) appears to be increasing worldwide and in addition to being associated with increased mortality, it decreases quality of life, enhances sleep disturbances, daytime sleepiness and is associated with children having more behavioral and developmental difficulties. In children it is chronically underreported. The specific cause is undefined but has characteristics of a circadian rhythm disorder link to a circadian nadir at 4am.

A study which assessed interactions between 24 single-nucleotide polymorphisms (SNPs) of Retinoid Acid Receptor-Related Orphan Receptor Alpha (RORA) and 35 SNPs in Neuropeptides S Receptors 1 (NPSR1) (which are involved in the control of circadian rhythm) and nocturnal asthma, strongly suggests that a circadian rhythm control abnormality is a potent factor in NA development.

Pediatric Pulmonology

See related video HERE.
Upper airway cultures and lower airway infections in children with chronic cough
From a study which compared respiratory bacterial pathogens cultured from nasopharyngeal and oropharyngeal swabs collected during flexible bronchoscopy for a chronic cough, with bronchoalveolar lavage (BAL) cultures (collected concurrently in 309 consecutive children-median age 2.3 years), it appears that NEITHER nasopharyngeal nor oropharyngeal swabs, alone or in combination, reliably predict lower airway infection in children with a chronic wet cough.   
Childhood Obesity Facts 
Underwriting Opportunities
With a circulation
over 6,700,
Updates in Pediatrics
offers an excellent opportunity to promote your brand at affordable rates.


Contact AD DEPT to learn more.   
Alport Syndrome  
Alport syndrome is a genetic inherited disease of children occurring in approximately 1 in 50,000 newborns. Clinically it is characterized by hearing loss, eye abnormalities and kidney disease (often progressive in males) due to mutations in the COL4A3, COL4A4 and COL4A5 genes. These genes provide instruction for making a component of a protein called type IV collagen, abnormalities of which result in glomerular filtration issues with blood and protein in the urine, inner ear dysfunction/deafness, changes in lens shape and an abnormally colored retina.
All infants/children with suspected Alport syndrome should have all three genes (COL4-A3-A4-and A5)
Minute Lectures: Alport Syndrome
Minute Lectures: Alport Syndrome
examined for variants by simultaneous high throughput-next generation sequencing. This will identify 95% of the abnormalities. For a further 5% deletions, or insertions of DNA should be sought (when no variants are found alternative diagnoses should be entertained).  
Pediatric Nephrology 
Acute-onset facial paralysis 
"Bell's palsy is the most common type of peripheral facial palsy in children." An interesting case presentation of an 11 month old infant who initially presented with an upper respiratory tract infection and acute otitis media (AOM) 8 days prior to the onset of left-sided facial paralysis, reminds us that the pathophysiology of facial nerve palsy (which usually occurs in children >3 years of age) is not clearly understood and is probably multifactorial.
Recent studies appear to strongly support combined therapy for Bell's palsy utilizing corticosteroids and vitamins B.
Video Feature
Bell's Palsy - causes, symptoms, diagnosis, treatment, pathology
Bell's Palsy - causes, symptoms, diagnosis, treatment, pathology
Treatment of closed femoral shaft fractures in children 
"Management of pediatric femoral shaft fractures remains controversial, particularly in children between the ages of 6 and 10."
A study of The Kids Inpatient Database (TKID) for all children 6-10 years of age who sustained a femoral fracture in 2009-2012 indicates:
  1. The incidence of femoral shaft fractures has decreased
  2. More children are being managed in General vs. Children's hospitals
  3. Children with closed femoral shaft fractures treated at a General hospital are more likely to receive operative treatment with open reduction/internal fixation or extremal fixation, with decreased total inpatients costs
Pediatric haematohidrosis (hemidrosis/hematidrosis)
Haematohidrosis is a rare, predominantly pediatric dramatic spontaneous skin condition where bleeding/bloodstained oozing occurs through hair follicles (and/or other skin surfaces/mucous membranes) of intact skin, in the face of normal coagulation studies (usually!).
Though the exact etiology of pediatric hematohidrosis remains unknown, it appears to be due to rupturing capillary blood vessels under extreme physical or emotional stress. Blood loss is generally minimal, and "the skin may feel tender and fragile." Recurrences may occur. Treatment is primarily with Beta blockers (e.g. propranolol).
Acta Paediatrica 
Did You Know?
Seven Nicklaus Children's Hospital Pediatric Specialty Services Again Ranked Among the Best in the Nation

Seven Nicklaus Children's Hospital specialty programs are again identified among the best in the nation, according to  U.S.News & World Report's 2019-20 "Best Children's Hospitals" rankings. Nicklaus Children's has more ranked pediatric programs than any other hospital in Florida.
Take the July Quiz !

Are cereal milk drinks associated with obesity?

Can Montelukast trigger new-onset neuropsychiatric events?

What is JIA?

Click HERE to take Quiz.

Need to Study?

Click HERE to view past issues of Updates in Pediatrics.
Updates in Pediatrics is brought to you by:
Miami, FL
Advertising in this e journal in no way implies NCHS endorsement of product.