Miami, FL
June 19, 2019
Volume X | Issue No. 25
Evaluation of a temporal association between vaccination and subdural hematoma in infants
A prospective, nested, case-controlled, population-based survey of all infants (228 - mean age 5.3 months) between 11 and 52 weeks of a age who underwent a first cerebral imaging (computerized tomography or magnetic resonance imaging) compared median time since last vaccination, frequency of at least one vaccination since birth or within 7-14 or 21 days before cerebral imaging, between those with and without a subdural hematoma.
The etiology of the 10% of infants who are diagnosed with a subdural hematoma is abusive head trauma. There is no temporal association between vaccination and subdural hematoma diagnosis.

Journal of Pediatrics 
Pneumonia and acute glomerulonephritis (AGN) 
A case report of 2 children with pneumonia who simultaneously developed AGN reminds us that though rare, there is an association between pneumonia caused (particularly) by Streptococcus pneumoniae and Mycoplasma pneumoniae/other bacteria, viruses, parasites and AGN.
Clinical Pediatrics  
See related video HERE.  
Crusts on the eyelids 
Frequent causes of crusty eyelids or eyelashes are blepharitis, a block tear duct, conjunctivitis (bacterial or viral) or eyelid cellulitis.

An interesting case presentation of a 27-month old boy referred to a pediatric dermatologist for evaluation of crusts on his eyelashes of 2 months duration, reports that dermoscopic examination revealed the crusts to be agglomerates of nits (louse eggs - Pthirus pubis) apparently transmitted from the father's chest to the child (he used to sleep on the chest of his parents). Oral and topical antibiotics with manual removal of the parasites and nits resulted in complete remission in 3 weeks.
Childhood Obesity Facts 
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Neonatal testicular torsion (NTT)
An analysis of Medline/Pubmed articles on neonatal testicular torsion reveals the following:
  • NTT is common in full-term infants delivered by vaginal delivery
  • Bilateral NTT is far less common than right/left testicular torsion
  • Extra-vaginal torsion is far more common than intravaginal torsion
  • Asynchronous NTTs occur more commonly
  • 7.6% of testicles are salvaged
  • Urgent bilateral exploration with orchiopexy of the contralateral testicle is recommended
See related video HERE & HERE
Video Feature
What are Undescended Testicles?
What are Undescended Testicles?
Magnetically controlled growth rods (MCGR) in spinal deformity; achieved to expected distraction
A prospective study of 40 children (14-57 months of age) who were treated with a MCGR implant system for a severe progressive spinal deformity and who underwent lengthening procedures every three months indicates that 94.4% achieve actual expected distraction with a low (4.6%) complication rate.
MCGR therapy for spinal deformity is extremely efficient.
Journal of Pediatric Orthopaedics 
Performance of blood biomarkers to rule out invasive bacterial infection (IBI) in febrile infants <21 days of age
"Early onset neonatal sepsis is defined as sepsis presenting within 72 hours of birth, and late-onset sepsis as sepsis occurring after 72 hours in infants in the Neonatal Intensive Care Unit (NICU) and after 7 days in full-term infants." A range of non-specific clinical presentations make diagnosis (bacterial and/or viral) difficult and while laboratory testing is undertaken (and maybe helpful) no definitive confirmatory laboratory test is available.
A study of 196 infants <21 days of age and 1,331 infants 22-90 days old which investigated the performance of procalcitonin (PCT), C-reactive protein (CRP) levels, and absolute neutrophil counts (ANC) in identifying IBI indicates that PCT, CRP and ANC are not useful for ruling out IBI in febrile infants <21 days of age. These infants "should be admitted and given empirical antibiotic therapy regardless of their general appearance or blood test results."
Montelukast and neuropsychiatric events in asthmatic children
Montelukast (a leukotriene receptor antagonist, anti-inflammatory and smooth muscle relaxant) is used to prevent bronchospasm/wheezing, tight chest, difficulty breathing and coughing in asthmatic adults and children >12 months age.  
Side effects include tiredness, runny or stuffy nose, skin rash, heartburn, nausea, vomiting and diarrhea. Neuropsychiatric complications while uncommon, include headache, dizziness, disturbed sleep/unusual dreams, mood changes and tremors.
A matched, nested, case-controlled design was used to identify asthmatic children on Montelukast and children who were hospitalized or seen in an Emergency Department for a neuropsychiatric event.
Children who present with a new-onset neuropsychiatric event (e.g. anxiety and/or sleep disturbance) are almost twice as likely to have been prescribed Montelukast than controls.

Journal of Pediatrics
Video Feature
How to Provide Infant CPR
How to Provide Infant CPR
Take the June Quiz !

What is a lingual arch?

Can you describe hemangiomas?

What variables predict future asthma in infants diagnosed with acute bronchiolitis?

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