May 17, 2017
Volume VIII |  Issue No. 20

Impact of Erythropoiesis-stimulating agent (ESAs) on behavioral measures in children born prematurely
A randomized study evaluated childhood behavior in 35 children (3.5-4 years of age) given ESAs or a placebo in infants born preterm with birth weights 500-1250 grams (compared to a term control group) using a parents report (Behavioral Assessment System of Children-2) tool.

It appears that ESAs have a beneficial affect on behavior (action, cognition, emotion, introspection, etc.) and externalizing symptoms (antisocial, aggressive behavior etc.) particularly in those infants from lower socioeconomic backgrounds.

Pubertal development in children with chronic kidney disease (CKD)
In pre-dialysis children with CKD measures to improve pubertal growth are limited particularly for those who are short before puberty, on long-term dialysis and have delayed puberty. Reduced pubertal growth results in significantly shorter adults.

Early kidney transplantation with end-stage CKD, with steroid withdrawal within 6 months of renal transplantation, allows for normal pubertal development in the majority of children.

Night wakening in the first three years of life and child health
Frequent age-related night wakenings are associated with poorer health at 6 months and improve with improved health. The association between night awakenings and illness dissipates by 36 months.
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Outcomes of lung transplantation for infants and children with genetic disorders of surfactant metabolism

"Pulmonary surfactant is the complex mixture of lipids and protein needed to reduce alveolar surface tension at the air-liquid interface and prevent alveolar collapse at the end of expiration". A deficiency due to immaturity in preterm infants causes the Respiratory Distress Syndrome (RDS) while abnormalities secondary to cell injury and inactivation of surfactant are important in the development of acute respiratory distress syndrome (RDS) seen in older children. Several single gene disorders which encode important parts of surfactant or the proteins involved in surfactant metabolism, though rare, are important as causes of "unclear" long-term lung disability in children. Surfactant protein deficiencies account for 10% of all childhood interstitial lung diseases.

A retrospective review of lung transplantation in infants and children for differing surfactant deficiencies comparing morbidity and mortality between 1993-2003 and 2004-2015 indicates no significant improvement in spite of advances in immunosuppression, respiratory and nutritional support.
Lactobacillus casei rhamnosus (Lcr35) in the management functional constipation in children

Constipation usually describes infrequent, difficult, painful or incomplete evacuation of hard stools. The goal of management of functional constipation (Rome III diagnostic criteria - updated in 2006) in children is to produce soft, painless stools and to prevent re-accumulation of feces.

A randomized, double-blind, placebo-controlled trial in 94 children (<5 years of age) with functional constipation who either received Lcr35 or placebo, twice daily for four weeks, indicates that Lcr35 treatment alone is no more effective than a placebo, which adds to the lack of support for the use of probiotics to treat this condition.

Video Feature
Managing Constipation
Managing Constipation

The cause of late mortality in infants with congenital diaphragmatic hernia (CDH)

A retrospective review evaluated the cause of death in 251 consecutive infants treated in a single institution.

Most (86%) post-operative CDH infants who died, do so during the first year of life; most before 1 months of age. The most common cause of early death is respiratory insufficiency associated with pulmonary hypertension. Older infants frequently die from gastrointestinal complications.

Cryptorchidism and subsequent testicular malignancy
"Cryptorchidism or undescended testes is one of the most common pediatric disorders of the male endocrine glands..."  The standard treatment in the USA is orchiopexy (surgical reposition of the testes into the scrotum) after 6 months of age (corrected for gestational age) to decrease the risk of poor fertility, testicular malignancy, torsion and/or associated inguinal hernia. Successful repositioning may not prevent all potential sequelae.
What Causes Testicular Cancer?

A study of 1403 men operated pre-pubertally for non-syndromic undescended testes who had testicular biopsies performed and were followed into adulthood was undertaken to identify boys who would later develop testicular cancer.

In non-syndromic isolated undescended testes, the cancer that may develop subsequently is generally NOT based on dormant germ cells caused by fetal maldevelopment.

Veteran Healthcare Executive George R. Lesmes Joins Pediatric Specialists of America as Chief Operating Officer and Executive Director
Nicklaus Children's Hospital welcomes veteran healthcare  executive George R. Lesmes as chief operating officer and executive director of Pediatric Specialists of America (PSA), the physician-led multispecialty group practice of Miami Children's Health System.
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