March 15, 2017
Volume VIII |  Issue No. 11

Acute otitis media (AOM) during infancy: Incidence (parent reported) and modifiable risk factors
It appears that no healthcare is sought for 30-50% of AOM episodes in young children.

A parent-participating study was undertaken which involved 1,056 normal full or near full-term infants. Parents filled in a questionnaire about a variety of factors and recorded respiratory symptoms from 2 months (base-line) to 12 months of age. Results indicate:
  1. 32.8% of infants experience at least one parent-reported AOM symptom episode (mean 7.8 months).
  2. 84.7% started daycare in their first year of life.
  3. Current daycare attendance is significantly associated with AOM symptom episodes (increased risk fivefold).
  4. Infants kept at home have less AOM episodes.
  5. No association with breast feeding or pre- post-natal tobacco smoking exposure found.
Daycare attendance in the first year of life is a major risk factors for AOM symptom episodes in the community. The younger the infant the greater the number of AOM symptom episodes.
Association of Bystander Cardiopulmonary Resuscitation (B-CPR) with overall and neurological outcomes after out-of-hospital cardiac arrest (OHCA)
2% of approximately 600,000 cardiac arrests per year in the USA occur in children. Survival remains static. The "Chain of Survival" refers to the following actions; immediate recognition of cardiac arrest, early CPR, early defibrillation and early advanced cardiac life support with integrated post-cardiac arrest care designed to reduce mortality.

An analysis from the Cardiac Arrest Registry to Enhance Survival, where bystander CPR was provided in OHCA in children indicates than in children younger than 18 years of age overall survival and neurological outcomes have improved, and that conventional CPR gives improved outcomes compared to compression-only CPR.
Respiratory muscle training in children with Cystic Fibrosis (CF)
From a crossover trial of 22 children aged 9-18 years with CF who undertook 8 weeks of respiratory muscle endurance training and standard chest physiotherapy in a randomized sequence, it appears that while respiratory muscle endurance is improved, exercise endurance is unchanged with no benefit noted to lung function, quality of life or CF clinical score.

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Predictors and outcomes of childhood Primary Enuresis 

Primary enuresis is the repetitive passing of urine at night in a child who has essentially never been dry at night.

A prospective study of 559 enuretic children followed from age 3 to 9 years indicates:
  1. Primary enuresis is common (12.7% of followed
    Primary and Secondary Nocturnal Enuresis
    Primary and Secondary Nocturnal Enuresis   
  2. Male female ratio: 2:1.
  3. Predictors include: child anxiety, low positive affectivity (few  positive emotions), history of maternal anxiety and poor authoritative parenting.
  4. By age 9 years 77% of children are in remission and continent. 
Parenting style appears to play a role in the development of enuresis.
Atlantoaxial Rotatory Subluxation (AARS) in children  

Cervical injuries in children are uncommon. Atlantoaxial subluxation is an abnormality of C1-C2 which causes impairment in rotation of the neck (& frequently presents as acute torticollis); the anterior facet of C1 is fixed on the facet of C2. Etiology includes:
  • Congenital; e.g. Down syndrome, Marfan disease, neurofibromatosis type 1, etc.
  • Arthritides rheumatoid arthritis, systemic lupus erythematosus etc.
  • Acquired; trauma, surgery upper respiratory tract infections, retropharyngeal abscess, etc.
Subanalysis of a large (55) case-control study of children <16 years of age with AARS after blunt trauma (compared to controls) reveals:
  1. AARS children are younger (7.7 years) than those children with other cervical spine injuries.
  2. Falls account for 36% of injuries.
  3. Neck pain and torticollis are common.
  4. Managements include; no intervention (11%), collar (44%), traction (25%), halo (16%) and internal fixation (4%).
Video Feature
Breast feeding exposure, attitudes and intentions of African American and Caucasian College Students

It appears that overall students have a favorable attitude towards breast feeding but view formula feeding as more practical. Those who have successfully breast fed previously are more likely to breast feed again especially among Caucasian students (3 times higher than African American students). Strategies to improve breast feeding exposure and attitudes among African American students is needed.
Do growing rods for Idiopathic Early Onset Scoliosis (EOS) improve activity and participation in children?
Magnetically adjustable growing rods (MAGEC) to correct severe uncontrolled scoliosis, have been viewed as a major advance in management as this technology essentially removes the requirement of multiple back surgeries by the age of 10 years ( following the initial insertion of the rods). Lengthening is performed as an outpatient using an external remote device.

A multicenter retrospective cohort study, prospectively collected data on children with significant scoliosis (Cobb angle >40 degrees) half of whom underwent brace and the
Magnetically-Controlled Growing Rods for the Treatment of Early Onset Scoliosis
Magnetically-Controlled Growing Rods for the Treatment of Early Onset Scoliosis
other 30 growth rod surgery. A questionnaire at 1 year was utilized to compare activity and participation.

It appears that while growth rod surgery reduces the Cobb angle at 1 year post-surgery, it also reduces activity and participation.

American Association of Critical-Care Nurses Recognizes Nicklaus Children's Hospital's 3 East Unit with a Gold Beacon Award for Excellence  

Nicklaus Children's Hospital's Respiratory Unit (3 East) has achieved a gold-level Beacon Award for Excellence from the American Association of Critical-Care Nurses (AACN). 

The 30-bed unit provides care for children with respiratory conditions such as asthma, bronchiolitis, RSV, croup, pneumonia and cystic fibrosis, as well as some general medical patients.

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