Miami, FL
May 30, 2018
Volume IX | Issue No. 22
Complications and risk factors in pediatric bronchoscopy 
A study of 670 elective bronchoscopies performed in children, mean age 5.58 years (outside an Intensive Care Unit and not including lung transplant patients) examined complications of bronchoscopy occurring during and post-procedure to identify potential risk factors. 
While bronchoscopy in children is relatively safe, intraprocedural complications occur in 7.2% of patients with hypoxemia being the most common. 25.8% have post-procedural adverse events of which transient fever (14.2%) and transient oxygen dependency (13.4%) are most frequent.
Risk factors include age <2 years, underlying cardiovascular disease and a diagnosis of primary ciliary dyskinesia.
Wheat oral immunotherapy (OIT) for wheat allergies
Oral immunotherapy for peanut allergy appears efficacious.

A study which examined the effects of giving increasing amounts of wheat protein as cooked wheat spaghetti to 100 children (mean age 11.6 years) with wheat allergies, (every day for 17 weeks) and continued for 3 and 9 months as maintenance phases, indicates that 16 months after initiation of treatment, 57% use wheat daily, with most children having some allergic symptoms (34% mild; 36% moderate and 24% severe). Serum specific IgE for "w" 5-gliadin is related to the intensity of the reaction to immune therapy and may be used as a biomarker for tolerance.

See related video HERE and
Effect of neonatal painful procedures on post-natal growth and neurodevelopment
It appears from a study of 83 preterm infants (gestational age 28 weeks) which examined the relationship between painful procedures during the first four weeks of life and subsequent weight gain, head circumference (HC) and neurodevelopmental outcomes, that at age at 6-12 months, early neonatal invasive painful procedures affect HC growth and short-term cognitive development.  

Childhood Obesity Facts 
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Not all genital ulcers in children are herpetic 

The most common cause of genital lesions in children is due to herpes simplex virus (HSV) usually caused by spread during sex with an infected partner (sexually transmitted disease - STD), often from abuse.

An alternative diagnosis to remember in non-sexually active children/adolescents is aphthous genital ulcers (which simultaneously occur in the mouth and are "reactive" to an upper respiratory tract infection or arise "regularly/infrequently").

See related video HERE and HERE.
Age at first concussion influences the number of subsequent concussions    

The younger the age when sustaining a first concussion the longer the window of vulnerability for another episode. A questionnaire study of 23,582 collegiate athletes who self-reported their age of first concussion (<10 years, or >10-18 years) analyzed and estimated the association between age of first concussion and the number of subsequent occurrences.

Sustaining a concussion at age <10 years increases the risk of a subsequent one by 2.91-fold compared to reporting a first concussion during adolescence. Yearly increase in age of first concussion decreases risk of each subsequent one by 16%.

Video Feature
School Problems in Children After Concussions
School Problems in Children After Concussions
Course of Disinhibited Social Engagement Disorder (DSED) from early childhood to adolescence 

DSED is one of two attachment disorders where children have difficulty forming deep meaningful connections to other children and adults. The DSM-5 defines the condition as children having at least 2 of the following:
  1.  Excitement/lack of inhibition over meeting/interacting with strangers.
  2.  Overly friendly, talkative or physically inappropriate behavior with strangers.
  3.  Willingness/desire to connect with strangers.
  4. Lack of interest/desire to check with a trusted adult prior to leaving a safe place or willfully going into a foreign/strange or threatening environment.
Causes typically include the absence of a caring long-term caregiver, childhood trauma, abuse or neglect.

A study of behavioral outcomes of 124 children previously under institutional care matched to normal community controls assessed DSED behavior outcomes from baseline (mean age 22 months), 30, 42 and 54 months to 8 and 12 years of age.

Shortening the time young children spend in deprivation, and early and sustained placement into appropriate families significantly decreases sign of DSED in early adolescence.

See related video HERE.
Home-based disinfection to reduce risk of infection in Cystic Fibrosis (CF) 

The CF Foundation recommends routine nebulizer disinfection for CF patients however compliance is challenging due to the heavy burden of home care. "SoClean®" is an automated, fast, easy to use and apparently effective way to clean  equipment.

A study investigated the efficacy of SoCLean® as a potential disinfection device to kill CF associated bacteria without altering nebulizer output.

SoClean® ozone disinfection  of nebulizers with a 5-minute infusion time and 120 dwell time effectively kills >99.99% of bacteria including Pseudomonas aeruginosa and Streptococcus aureus with no change in nebulizer function.

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