June 7, 2017
Volume VIII |  Issue No. 23

The choking hazard of grapes
Aspiration of a foreign body is a major cause of childhood death (mostly <3 years of age) in the USA. Risk factors include incomplete sets of teeth, underdeveloped swallowing coordination, easy distraction while eating and small cross-sectional diameter of the upper airway. Small hard foods and objects may be coughed up or dislodged by chest or abdominal thrust or pass through the pharynx obstructing a bronchus. Larger round (particularly smooth and deformable) objects may wedge themselves in the upper airway causing complete obstruction. Grapes are a popular food and are the third most common cause of food related fatal choking episodes.

Three cases of young children (60 months, 24 months and 17 months) who choked while eating whole grapes (two of whom died) reminds us of this perhaps less well-known hazard for young children.

Feeding modes and gastroesophageal reflux in infants
The infant Feeding Practices Study II provides data on reflux at 9 points from month 1 to 12 on 2,841 infants whose feeding modes were defined as "direct breast feeding", "feeding of bottled human milk", "formula feeding", "their combinations" and the use of "solid food".

Compared to "direct breast feeding" any infant feeding formula appears to raise the risk of reflux.

Neonatal hypoglycemia (NH) and visual development
Neonatal hypoglycemia (plasma glucose levels <30mg/dl in the first 24 hours, and <45mg/dl thereafter) is the most common metabolic problem of the newborn baby. Infants may be asymptomatic or present with a multitude of clinical signs and symptoms. A major complication includes neurological damage. The occipital lobes which include the primary visual cortex and some extrastriate visual areas may be particularly susceptible as some cases of NH affecting the eye and optic nerve development have been described.
An extensive literature review reveals no clear evidence for an effect of NH on the development of the eye and optic nerve.

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Probiotics in preterm infants

A systematic literature search of multiple databases identified 44 studies which assessed the use of probiotics in very low birth weight (VLBW) preterm infants.
Probiotics in preterm infants

It appears that probiotics are beneficial in V L BW  preterm infants in the prevention of severe necrotizing enterocolitis, late-onset sepsis and all-cause mortality.
Ten things Transgender and Gender Non-conforming youths want their doctors to know

"Transgender" youths have a gender identity or gender expression that differs from the gender assigned sex given to them (based on anatomy) at birth.

"Non-conforming" youths are those who do not behave or dress according to society's social expectations of the gender given to them at birth.

Both groups (probably around 1% of the population) often face serious physical, emotional and sexual abuse, lack of respect and support, verbal harassment, threats and violence, inappropriate labeling as sexual predators, lack of privacy and safety in bathrooms, a hazardous school environment, unmet health needs and poor community support services.

A study with Yale Pediatric Gender Program identified ten top things transgender and gender non-conforming youths (aged 13-18 years) wanted their Pediatrician to know. They include:
  1. Sexuality and gender are two totally separate things.
  2. Talking about gender identity isn't easy.
  3. Resist the urge to use he/she as individual identity may be along a continuum.
  4. Ask what to call me - "do you prefer to be called "he", "she" or "they" for example".
  5. Don't ask about genitals unless medically necessary.
  6. Genital/breast exams are particularly uncomfortable.
  7. Puberty blocker and cross-sex hormones can be lifesaving.
  8. Please train your staff.
  9. Anxiety/depression are frequently due to society's responses.
  10. "Let me know that you are on my team".
Video Feature
Doctors Speak Out for Trans Youth
Doctors Speak Out for Trans Youth
Moderate and late preterm (MLPT) birth and neurodevelopment/social-emotional development at 2 years of age 

MLPT infants (32-36 weeks completed gestation) compared to healthy full-term controls at 2 years of age show delays in language, cognition and motor development, with poorer social competence and increased behavioral problems. Developmental surveillance and ongoing intervention is important.

Ictal epileptic headaches (IEH)

IEH's are rare and difficult to diagnose (epileptiform discharges have to register during the headache and the headache has to disappear with intravenous antiepileptic treatment) but are increasingly becoming the focus of research as more data demonstrates the existence of headache (without any sensory-motor manifestation) as the only presentation of an epileptic event. Ictal headaches are seen in all types of epilepsy.

The clinical, neurophysiological and therapeutic features of IEH in children are explored in this interesting case presentation.

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