Updates in Pediatrics from Nicklaus Children's Hospital: March 17 Issue

March 17, 2021 | Volume 12 | Issue 11

Food and Drug Administration (FDA) authorizes marketing of novel device to help protect athlete’s brain’s during head impact

Following the assessment of safety and effectiveness in prospective longitudinal studies (utilizing Magnetic resonance imaging (MRI) and Diffusion Tensor Imaging (DTI)) of pre- and post-season children from a high school football team, a non-invasive device called a Q=Collar a (C-shaped collar worn around the neck that applies compression force to the internal jugular veins (maximum time 4 hours) thereby increasing brain blood volume and reducing brain movement in the cranial space) has been recommended to be utilized by athletes >13 years of age during any sport activity which may result in brain injury from head impact.

US Food & Drug Administration

Association of maternal autoimmune disease with Attention Deficit/Hyperactivity Disorder (ADHD) in children

Maternal autoimmune diseases (N>80) with maternal immune activation, has been associated with Kawasaki disease, increased asthma/allergies and a growing body of evidence that suggests immune-related autoantibodies and pro-inflammatory cytokines cross the placenta and alter brain development (increasing the risk of neurodevelopmental difficulties, e.g. autism spectrum disorder and mental disorders) in offspring.

A cohort study 63,050 children (singletons born term) whose mothers had any autoimmune disease examined whether their offspring were more likely to be diagnosed with ADHD.

Any maternal autoimmune disease appears to be associated with increased ADHD among offspring children.

JAMA Pediatrics

See related video HERE, HERE, HERE and below:

Pediatrics – Attention Deficit Hyperactivity Disorder

By Daniel Fung MD

Analysis of active and passive tobacco exposure and blood pressure in US children and adolescents

“Hypertension is a major health concern affecting 46% US adults."

From a cross-sectional study using data from the National Health and Nutrition Examination Survey, a population-based nationally representative sample, 8,520 US children and adolescents aged 8-19 years of age who undertook serum tobacco level testing and completed questionnaires related to tobacco exposure (defined as serum cotinine levels >0.05 µg/L or reported living with a smoker or smoking themselves) and had blood pressure measurements performed, it appears that tobacco exposure is associated with a 31% increased risk of youth hypertension and the relationship is dose dependent.

JAMA Network Open

What parents need to know about teen vaping and what they can do about it

“Vaping refers to using e-cigarettes that heat liquid to produce aerosols that users inhale into their lungs.” While vaping may be less dangerous than smoking cigarettes it enhances the likelihood of youth trying cigarettes plus the aerosol may contain not only nicotine but also a number of dangerous chemicals (e.g. formaldehyde). When Tetrahydrocannabinol is used, a severe lung injury (linked to the Vitamin E acetate) is not infrequent. Finally, vaping in teens also appears to be linked to infection with SARS-CoV-2/Covid-19.

Tell-tale signs of vaping include: fruity/candy smelling mouth, mouth sores, repetitive throat clearing, difficulty breathing, cough, nose bleeds, increased thirst, irritability and mood swings.

Vaping prevention management in teens is mediated via “talking to one’s child early” explaining the hazards of chemicals inhaled, sharing educational links on the subject and having open discussions. If addiction is a concern several treatment options are available.

JAMA Pediatrics

CDC

JAMA Pediatrics

See related video from St. Louis Children's Hospital below:

Teens & Vaping | What Parents Need to Know

Hidradenitis suppurativa (HS) in the pediatric population

HS is a non-contagious, long-term chronic skin condition that generally starts after puberty and results from plugged pores around skin hair follicles of specific sweat glands causing painful, swelling, pimples/bumps/lumps deep in the skin which burn or itch and which may break open to drain foul smelling pus. Scars may follow. Lesions occur in areas where skin tends to rub together (e.g. armpits, groin, under the breasts, neck and buttocks). While the specific etiology is unknown it is frequently associated with a family history, being female, overweight, smoking, inflammatory bowel disease, and/or hormonal changes. It is not caused by poor hygiene.

An international multi-center, cross-sectional study which examined the clinical features of 481 children with HS (disease duration at diagnosis 1-5 years) indicates that 80% are girls, 41% have a family history of HS, 48% already have scarring/comorbidities when first seen, and complications are found in 79%-85%.

JAMA Dermatology

The SARS-CoV-2 receptor-binding domain preferentially recognizes blood group A

A Receptor Binding Domain (RBD) is a key, short immunogenic fragment of a corona virus located on its 'spike' that allows it to dock to respiratory cell receptors to gain entry and lead to infection. Lectins are unique proteins (of varying biological importance) which bind to specific carbohydrate heads on the surface of the red blood cell and which specify and determine the different blood groups. ABO is the original blood group system; at its simplest there are 2 antigens A and B and 4 phenotypes; A, B, AB and O. Almost all adults have antibodies against the ABO antigens they lack.

It appears that the RBD of SARS-COV-2 shares sequence similarities with the lectin family of proteins known to bind blood group antigens and which are also expressed in epithelial cells (including respiratory epithelium). This ability of SARS-CoV-2 to preferentially recognize the type blood group A antigen uniquely also expressed on respiratory epithelia may explain why persons who have blood group A are more likely to be SARS-CoV-2 infected.

Blood Advances

See related video HERE, HERE and below:

Humoral Immune Response

Galit Alter, PhD, talks about her work using systems serology to explore antibody responses to SARS-CoV-2 during ASGCT's COVID-19 Symposium.

What You Need to Know About Information Blocking

Information Blocking Background:

In March 2019, the Office of the National Coordinator for Health Information Technology (ONC) issued a Proposed Rule, 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program and released a final rule in March 2020. The 21st Century Cures Act (Cures) is a landmark bipartisan health care innovation law enacted in December 2016. Cures includes provisions to promote health information interoperability and prohibit info blocking by “Actors,” which are defined as health information networks (HINs), health information exchanges (HIEs), health information technology developers of certified health IT, and health care providers. Information Blocking is one of the key principles of the 21st Century Cures Act and it applies to health care providers, like NCHS.

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