Miami, FL
June 20, 2018
Volume IX | Issue No. 25
Botulinum Toxin (BT) injection for childhood constipation
Childhood constipation is common. "Internal anal sphincter (IAS) dysfunction is a cause of refractory constipation in children." Previously internal anal sphincterotomy has been used for hypertensive/non-relaxing sphincters.
A retrospective study of 164 children who received BT for severe constipation unresponsive to medication management (and independent of sphincter dynamics) indicates that 70% have a positive response (57% lasting >6 months) with fecal incontinence prior to BT being the only predictor of a poor response.
Yoga and Attention, Impulsivity, Hyperactivity in preschool-aged children with Attention Deficit Hyperactivity Disorder (ADHD) symptoms 
"Behavioral therapies are first-line for preschoolers with ADHD." Previous studies support yoga for school-aged children with ADHD.

A randomized study which tested a 6 week yoga intervention in preschoolers with >4 ADHD symptoms indicates modest improvements in attention, and selective improvements in many symptoms as rated by parents.

See related video HERE & HERE.
Anemia, prematurity and retinopathy 
A study which examined the relationship between extremely preterm birth, anemia, blood transfusions and retinopathy of prematurity (ROP) indicates that the number of days of anemia during the first week of life is an independent risk factor (in addition to other ROP risk factors including; number of blood transfusions , severity of anemia, sepsis and days of ventilatory support).

See related video HERE.
Childhood Obesity Facts 
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Maternal influenza immunization and prevention of severe clinical pneumonia in young infants
Most children hospitalized or who die from complications of an influenza infection are unvaccinated, <5 years of age (60% of whom have an underlying medical condition/chronic illness or compromised immune system), or are at increased risk because they are <6 months; too young to receive influenza vaccination.

A study in Nepal/Mali and South Africa evaluated the effect of maternal antenatal influenza vaccination on all-cause severe infant pneumonia using trivalent inactivated influenza vaccine compared to placebos. Post-partum follow-up was 0-24 months.

Maternal influenza immunization appears to significantly reduce severe pneumonia episodes in infants, particularly in those younger than 6 months of age.

Arthroscopic vs. open treatment for acute septic arthritis (ASA) of the knee in children

Septic arthritis occurs in all age groups but is most common in younger children particularly in those <3 years of age. "Optimal management of ASA including duration of antibiotics and surgical approach is not evidence based." Children with septic arthritis should be hospitalized and treatments include empiric antibiotics, splinting, aspiration, arthrotomy and drainage. ASA of the knee may be treated with irrigation-arthroscopic or open. A study of 24 children with ASA compared outcomes form either method followed to 6.9 (mean) years after management.

Arthroscopic irrigation ( vs open irrigation ) of an ASA knee results in earlier improved knee motion and weight bearing, with less repeat surgical irrigations and similar knee injury and osteoarthritis outcome scores.

Video Feature
Life-threatening complications and mortality of minimally invasive repair of pectus excavatum 

Pectus excavatum is a relatively common congenital chest wall deformity in children. When severe it can cause cardiopulmonary insufficiency from compression of the right atrium and diminished vital capacity of the lungs. Since 1987, the Nuss procedure (a minimally invasive technique using a convex steel bar placed beneath the pectus deformity) has achieved excellent results. Prevalence and type of life-threatening complications of this procedure are however unknown.

Between 1998 and 2016, 27 cases of life threatening complications of the Nuss procedure were published. These included cardiac perforation, hemothorax, major vessel and/or lung/liver or diaphragm injury and gastrointestinal problems. With approximately 50,000 cases of treatment reported, the likelihood of severe complications appears rare (<0.1%).

Fecal amino acid analysis as a biomarker for pediatric inflammatory bowel disease (IBD)

Though endoscopy remains mandatory in the diagnostic work-up of IBD, it is a costly, invasive procedure. Identification of a non-invasive biomarker would be of great value.
A case-controlled study of 30 untreated pediatric patients with a confirmed diagnosis of IBD (ulcerative colitis, Crohn's disease) compared fecal amino acids in IBD children to those of healthy controls.
Fecal samples from untreated IBD children have significantly higher levels (compared to healthy controls) of 6 amino acids (histidine, tryptophan, phenylalanine, leucine, tyrosine and valine). Fecal amino acid composition may be a useful diagnostic biomarker for pediatric IBD. 
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Nicklaus Children's Hospital has received three new Beacon Awards for Excellence from the American Association of Critical-Care Nurses (AACN), bringing to nine the total number of hospital units that have garnered Beacon Award status. Nicklaus Children's is the only children's hospital in the nation to be recognized with nine Beacon Awards, demonstrating the hospital's commitment to excellence in inpatient care through use of evidence-based data to enhance outcomes and satisfaction.
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