Miami, FL
June 26, 2019
Volume X | Issue No. 26
Consuming cereal milk drinks
From a 5.09 year (mean) follow-up study of 1,870 children recruited from a longitudinal-based Holland Health and Growth Study which examined the association between daily consumption of milk cereal drinks at 12 months and BMI (body mass index) at age 5 years it appears that milk cereal drinks are consumed by approximately 85% of children at 1 and 5 years of age respectively and consumption at 12 months of age is associated with double the risk of being overweight at 5 years of age (previous data indicates consuming milk cereal drinks at 6 months of age is equally associated with a high BMI
at 12 and 60 months of age).
Cereal milk given to young infants/children increases the risk of later obesity.
Acta Paediatrica
Considerations to guide treatment decisions in infants born weighing <400gms  
A recent study indicates that 26% of infants born weighing <400gms can survive to discharge. Those born at 24 weeks (plus) have twice the survival rate of those born at 22-23 weeks gestation. Most survivors have significant neurodevelopmental impairments and chronic health problems.

A very interesting editorial associated with this publication outlines the bioethical challenges that management of these tiny and immature babies' raises. Well worth reading as the ethical concepts raised impinge on other pediatric management decisions (Ed).

Appropriate CPR (cardiopulmonary resuscitation) for carers of infants outside of hospitals 
"Sudden out-of-hospital cardiac arrest with unsuccessful CPR is the third leading cause of death in industrialized nations."
A large number of cardiac arrests in infants involve family members, friends or other close caregivers (unprepared people performing CPR) with poor outcomes.
A randomized, cross-over intervention assessed (on mannequins) 2-finger vs 2-thumb-encircled CPR for a lone responder (with ventilation) 14 years of age or older.
The 2-thumb encircling technique is preferred by caregivers and achieves deeper compressions over an 8 minute scenario (while this is counter to current guidelines it adds to existing literature on the topic).
Childhood Obesity Facts 
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Glucocorticoids and croup in children 
A 2018 update of a Cochrane systematic review of 43 randomized clinical trials in multiple countries involving children (4,565; mean ages 15-41 months) compared changes in croup score (at 2, 6, 12 and 24 hours), return visits, and/or (re) admission to hospital with (a) any glucocorticoid to placebo (or another pharmacologic agent); (b) dexamethasone (dex) vs. budesonide; (c) dex vs beclomethasone, prednisolone plus budesonide, (d) oral vs. nebulized dex (e) dex doses 0.30mg/kg vs. 0.15mg/kg; 0.60mg/kg vs. 0.30mg/kg and 0.60mg/kg vs. 0.15mg/kg.
"Glucocorticoids are indicated for croup of any severity, inpatient or outpatient setting." Glucocorticoid administration in croup (primarily dexamethasone - variable doses/mode of administration) results in improved croup score at 2 hours which lasts for at least 24 hours, reduces return visits and shortens hospital stay. Nebulized budesonide is an effective alternative.
JAMA Pediatrics  
See related video HERE.  
Serum neurofilament (Nf) light chain levels and neurodevelopmental outcomes in preterm infants 
Nf's are intermediate protein polymers (10nm in diameter and many micrometers in length) which with microtubules and micro filaments form the neuronal cytoskeleton of the axon. The Neurofilament-light chain (NfL) is a biomarker that can be measured in cerebral spinal fluid (CSF), and serum (sNfL) and reflects axonal damage.
A prospective study of 48 infants born <32 weeks gestation and diagnosed with an intraventricular hemorrhage in the first few days of life where sNfL and CSF NfL levels were measured until term equivalent age, their association with cerebral imaging markers, and clinical and functional outcomes assessed to 2 years of age indicates that s NfL level is an independent prognostic biomarker for motor function at 1 year of age (or death at age 2 years).
Archives of Disease in Childhood 
Video Feature
Born 4 Months Early, This Tiny Survivor Beats the Odds | Short Film Showcase
Born 4 Months Early, This Tiny Survivor Beats the Odds | Short Film Showcase
Sternal fractures in children
Data on sternal fractures in children (3,160) <18 years of age accessed from the National Trauma Database Research Datasets identified patient demographics, injuries, procedures and outcomes.
  1. 90% of sternal fractures occur in children 12-18 years of age
  2. Median injury severity score = 17 (ISS-a standardized score of severity of trauma based on 6 systems which utilizes severity of the 3 systems most severely affected. Total score = 75)
  3. 39% are admitted to an Intensive Care Unit. Length of stay (median: 4 days) is dependent on ISS score, lack of protective devices, decrease in Glasgow Coma Score (GCS), presence of tachycardia and pulmonary contusion
  4. In-hospital mortality: 8% "Poor outcomes are impacted by associated injuries and complications."
A sternal fracture should elicit a careful examination of multiple body systems.

See related video HERE.
Bariatric surgery for adolescent obesity
A retrospective review of 38 adolescents (mean age 16.5 years) who underwent bariatric surgery (21% had laparoscopic adjustable gastric banding (LAGB), 47% laparoscopic sleeve gastrectomy (LSG), 31% laparoscopic Roux-en-y gastric bypass (RYGB) performed in a quaternary Canadian hospital indicates that "adolescent bariatric surgery in the context of a multidisciplinary obesity management program is safe and effective." RGYB and Sleeve gastrectomy are associated with best post-operative weight loss and lower reoperation rates than gastric banding.  
See related video HERE
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 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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