Miami, FL
March 7, 2018
Volume IX | Issue No. 10
Outcomes associated with acute kidney injury (AKI) in critically ill children
AKI of varying severity is commonly seen in critically ill children during pediatric intensive care unit (PICU) admission (37%). A prospective cohort study of 1,367 children from 3 tertiary care PICUs indicates that (after adjusting for age, sex and underlying diagnosis), morbidity (hypertension and prolonged PICU/hospital stay) is increased with risk of in-hospital mortality being six times higher.
Growth trajectory and neurodevelopmental outcome in survivor infants with congenital diaphragmatic hernia (CDH)
A study of 84 CDH survivors which examined weight and length trajectories ("high" and "low"), head circumference (HC) and neurodevelopmental outcomes (cognitive, language and motor scores) at 12 months of age indicates that the "high" growth and HC score babies have significantly higher motor scores with approximately 50% of CDH survivors having a mild neurodevelopmental delay in at least one domain; a "low" growth and HC trajectory is associated with worse developmental outcomes.
Chikungunya virus (CHIKV) in breast milk
Chikungunya virus (a single-stranded RNA virus) is transmitted to people by mosquitoes. The most common symptoms are sudden onset of fever and severe joint pain - others include headache, muscle pain, joint swelling or rash. Symptoms (similar to Dengue and Zika disease) begin 3-7 days after being bitten by an infected mosquito and most patients feel better within 3-10 days (though joint pain may last for several months). The virus remains in the body for 5-7 days and detection of viral particles have been isolated in body fluids (saliva, urine and semen). Death from complications is uncommon. Phylogenetic analysis since first being discovered in 1952 indicates its genome has remained stable. As of November 2014 all locally transmitted cases have occurred in Florida.

An interesting case report of a CHIKV infection in a breast feeding mother where serum, urine and milk samples were collected on days 3, 23 and 27 and tested for CHIKV by reverse transcription polymerase chain reaction (RT-PCR) indicates that on day 3 of symptoms all samples were positive - on day 23 only milk was positive and on the third test (day 27) all were negative. The baby remained symptom free and all RT-PCR tests of body fluids remained negative.

CHIKV may be found in infected mothers' milk; it appears however risk of infant infection remains low.
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Salivary MicroRNA for assessing concussion 

In spite of significant and ongoing clinical and basic scientific investigation into concussive brain injury over the past few years, the diagnosis and assessment of a concussion remains largely based on the reporting of symptoms. These do not necessarily correlate with neurocognitive testing.

A small prospective cohort study 52 children/young adults (7-21 years of age) evaluated the efficacy of saliva MicroRNA (5 potential candidates) in identifying children at risk for experiencing prolonged symptoms (>4 weeks) after injury.

It appears that by using 5 candidate MicroRNAs it is possible to identify children who will experience persistent symptoms after concussion. The ease and speed of obtaining saliva for testing MicroRNA concentrations makes this potentially a new, exciting and novel approach to the diagnosing, monitoring and management of concussion.

JAMA Pediatrics 
See related video HERE and HERE
Bullying by siblings 
A study which required questionnaire completion by 3,600 children on sibling bullying at 12 years of age, and which was followed by a standardized psychological clinical assessment tool assessing psychotic symptoms at 18 years of age, indicates that being bullied by a sibling can lead (in 1.5%) to social defeat, self-blame and serious mental health problems (i.e. schizophrenia) in early adulthood.
Video Feature
Sibling Bullies
Bullying Exerts Psychiatric Effects Into Adulthood
Breast feeding and childhood maltreatment 
Childhood maltreatment generally encompasses 4 types; physical abuse, sexual abuse, emotional/psychological abuse and neglect. "In 2015, 4.4 million reports of alleged child maltreatment were made to the Child Protective Services in the USA involving 7.2 million children and 683,000 maltreated children were identified."

A study of data from the National Longitudinal Study of Adolescents to Adult Health analyzed information on 4,159 maltreated adolescents and breast feeding duration.

Adolescents who have a history of being breast fed for 9 months or longer have significantly less chance of experiencing neglect or sexual abuse.
Outcomes of acute or chronic labral tears  

The acetabular labrum is the dense layer of fibrocartilage which outlines the socket of the acetabulum; it acts as a shock absorber, joint lubricator and pressure distributor. Tearing of the labrum which may occur during sporting activities reduces stability of the femoral head and results in hip or groin pain and catching or locking of the hip. Hip arthroscopy has been shown to be effective in managing these and other hip pathologies.

A prospective study of patient-reported outcome scores for 194 adolescents <18 years undergoing arthroscopic hip surgery and retrospectively reviewed at minimum 2-year follow-up, examined whether outcomes depended on whether presentation was acute or chronic.

All treated patients with labral tears have significant improvement following arthroscopic surgery independent on whether they present with an acute or insidious symptom onset.
Caring for Rare   
Cristina Edmunds 

In honor of Rare Disease Day 2018, I'm sharing with you my experience so far in raising a child with a rare diagnosis. So rare, in fact, he shares the diagnosis with approximately 50 other people worldwide. This is partly because the kind of genetic testing that can be done today is more advanced than ever, and can find the underlying causes of multiple chronic health issues, and partly because it is, in fact, a rare disease. For us, this means many things physically, and emotionally. It requires patience, the ability to acquire and hold on to new knowledge, the openness to learn how to care for your child in a way that does not come naturally, and making peace with unknowns. Let's dive in.
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