Miami, FL
June 13, 2018
Volume IX | Issue No. 24
Dog bites in children
A review of 14,956 dog bites in children indicates that infants 0-3 years have a higher likelihood of being bitten on the face, head and neck by Shih-tzu's while Pitbull bites account for 27.2% of dog bites in children 3-18 years.
Acta Paediatrica  
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Prenatal ultrasonography and the incidence of Autism Spectrum Disorder (ASD) 
"ASD is heterogenous disorder characterized by clinically significant and persistent impairments in social communication, and restrictive and repetitive behaviors, interests and activities." Variability in severity of impairment, intellect, language ability and co-morbid behavioral and medical issues are frequent. The etiology is complex but probably reflects a combination of genetic and environmental factors. One of the modifiable external environmental factors is prenatal ultrasound (animal studies indicate changes in behavior and neuronal migration).

While in large studies ultra-sonography has not been shown to be a "single hit" cause of ASD, there are many  technical variables associated with fetal ultrasound and most have been poorly studied. 
The potential for ultra-sonography to act as an environmental stressor in a genetically vulnerable system remains. In the prevention of ASD, exposure of doses of ultrasound to fetal tissue "As low as reasonably achievable" is important.

Biomarkers for identifying renal and overall disease activity in pediatric Lupus Erythematosus (pSLE)
"Traditional serological biomarkers often fail to assess Systemic Lupus Erythematosus disease activity and discriminate lupus nephritis (LN)."

A study of 46 pSLE children (average age: 13.3 years) and matched healthy controls measured 9 different plasma inflammatory mediators to assess their value in predicting pSLE/renal disease activity.

Only Interferon gamma inducible protein 10 kD (IP-10 - an inflammatory chemokine produced by T and other cells after stimulation by IFN-γ)  is significantly sensitive and specific (compared to conventional laboratory parameters) to distinguish active from quiescent pSLE and renal disease.

Childhood Obesity Facts 
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Cardiac remodeling in preterm-born adults and long-term effects of human milk consumption 
Data from several animal models suggest that cardiac development may be particularly affected by premature birth resulting in associated structural changes occurring early in life (e.g. hypertrophic cardiomyopathy and increases in interstitial myocardial fibrosis). As these are associated with heart failure, preterm birth may increase the risk for cardiac disease in adulthood. (Infants born <28 weeks gestation are approximately 17 times more likely to develop heart failure in childhood/young adulthood).

A study of formula vs. exclusive human milk (which preferentially enhances immunity, brain development, vascular development and blood pressure) feedings given to preterm infants
AAP: Long-term Health and Inheritance Effects of Feeding Human Milk 
AAP: Long-term Health and Inheritance Effects of Feeding Human Milk 
demonstrates beneficial effects on heart and lung structure/
function at 23-28 years of age.

Cardio-pulmonary benefits to heart and lung function are another reason to encourage the exclusive use of breast milk feedings in preterm infants.

Residual Equinus after the Ponseti method treatment for clubfoot 

Equinus is a condition caused typically by a tight Achilles tendon from a number of conditions that gives rise to limited upward bending (dorsiflexion) of the ankle joint. Residual Equinus deformity is present in up to 20% of clubfeet treated by the Ponseti method and while surgical release may restore most dorsiflexion, some Equinus may persist.

The body of the talar bone of the ankle is located under the tibia; the head further down the foot with the neck in- between. In clubfoot residual Equinus following Ponseti treatment and posterior release may be due to a decreased neck depth and/or a neck angle that is more obtuse. Magnetic resonance imaging (MRI) measurements are helpful.

Video Feature
Multifaceted behavior of Meckel's Diverticulum (MD) in children 

"MD is one of the most common congenital malformations of the gastrointestinal tract in children." Non-specific clinical manifestations make diagnosis (and treatment) difficult.

A retrospective study analyzed data on 286 children (age 1 day - 15 years) diagnosed with MD. Results indicate:
  1. 18.5% of MDs are diagnosed incidentally at laparotomy/laparoscopy.
  2. 81.4% are symptomatic: 
    • 42% present with episodes of rectal bleeding
    • 21% present with symptoms of diverticulitis/perforation
    • 19.7% have intestinal obstruction 
    • 15% present with intussusception requiring surgical reduction
MD is difficult to diagnose because of variable clinical presentations. The diagnosis should be entertained in any child who presents with abdominal pain, gastrointestinal bleeding or obstruction. Laparoscopy is the first choice for diagnosis and treatment.

Journal of Pediatric Surgery
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Clear liquid vs. low-fiber diet in bowel cleansing for colonoscopy in children 

As measured by the Boston Bowel Preparation Scale (BBPS) clear liquid and low-fiber diets administered to children the day before colonoscopy are equally effective in bowel cleansing.
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