Miami, FL
May 16, 2018
Volume IX | Issue No. 20
Tackle football, the young and cognitive function 
Football is an aggressive, rough and tough, full-contact sport that requires stamina, endurance, physical strength and conditioning.

A study which examined cognitive issues and behavioral/mood problems in athletes who began playing tackle football before or after age 12 years indicates that symptoms of chronic traumatic encephalopathy (CTE) occurs approximately 13 years earlier in those who started playing prior to 12 years of age.
An update on the management of Neonatal Brachial Plexus palsy (NBPP) 
It appears that immobilization and observation, the prevailing conservative approach to neonatal brachial plexus palsy may leave some infants at a disadvantage for persistent neurologic deficits (denervated muscle without reinnervation will undergo irreversible damage within 18-24 months).

Mounting evidence supports consideration of early referral for surgery for nerve graft repair and nerve transfer in patients unlikely to recover from conservative treatment.

Knee deformities in children with Down Syndrome
Patellofemoral instability (PFI) is the most common (5%) reported knee abnormality in Down Syndrome. Multiple variations in knee anatomy however, can be found in these children and those underlying deformities require a comprehensive anatomic approach no knee management to ensure optimal outcomes.

Childhood Obesity Facts 
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Flu vaccine - deaths/disability and the 2018 - 2019 Influenza Season 

Though the 2018 Influenza season is on the wane (3 pediatric influenza-associated deaths occurred during the week ending April 20, 2018), to date a total of 163 influenza-associated pediatric deaths have been reported for this flu season, with local influenza activity still being reported in Florida (primarily influenza A-H3N2).

Though the effectiveness of the influenza vaccine for this season for the H3N2 component has been disappointing (25% effectiveness - best protection being afforded for the other components - influenza A and B), it is estimated that a flu vaccine that is only 20% effective at a 43% vaccine coverage rate would prevent >20 million illnesses, 129,000 hospitalizations and 61,000 deaths.

Flu vaccination saves lives!

Eczema management with a natural microbiome organism

A small pilot study of 10 adults and 5 children with severe eczema who received weekly skin treatments (for 6-12 weeks) of a nebulized solution of Pseudomonas mucosa taken from the skin of people without eczema, reports significant improvement in symptoms (plus steroid reduction) without adverse effects. A larger trial appears warranted.

NIAID - National Institute of Allergy and Infectious Diseases
Video Feature
This is an overview of Obstetric Brachial Plexus Palsy (OBPP) and Erb's Palsy.
Metabolomic profile of amniotic fluid and wheezing in the first year of life

"The metabolome is defined as the complete set of small molecules, endogenous metabolites, intermediates and metabolism products found in an organism." Using mass spectrometry, it is an instant look at the biochemistry of a biological system.

A prospective study in a healthy term-born cohort analyzed and compared the metabolic profile (16 chosen variables) of 142 samples of amniotic fluid collected at birth from infants who were followed for their first year of life for recorded wheezing or not.

It appears that infants who will wheeze during their first year of life may be identified at birth by metabolic perturbations in amniotic fluid steroid hormone biosynthesis and 2-phenylalanine metabolism (both of which may play a pathogenic role in early-onset wheezing).

Auricular acupuncture for migraine 

Auricular therapy (ear acupuncture) is a form of alternative medicine (unsupported by medical or scientific evidence) based on the idea that the auricle of the ear reflects the entire body which when stimulated may improve physical, mental or the emotional health of a patient.

A prospective, interventional cohort pilot study of pain scores pre- and post- intervention in children (aged 8 to 18 years) who presented with migraine headaches to an Emergency Department, and were treated with needle contact or electrical point finder on 2 migraine lines indicates that as all patients show improvement or resolution of migraine headache without adverse events, this may be a valid management option to consider.

Pediatric Emergency Care
See related video HERE>>
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Publisher's Message
Some subscribers may have inadvertently received a draft version (still in need of corrections) of Updates in Pediatrics last week.  We regret any inconvenience. To see the accurate final version of the 5.9.18 issue click HERE.