May 4, 2016
Volume VII | Issue No. 18

Neurodevelopmental outcome at 2 years after dextrose gel treatment for neonatal hypoglycemia
A follow-up study of 184 children (mean birth weight: 3,093 grams - mean gestational age 37.7 weeks) with early (< 48 hours neonatal hypoglycemia (BS < 47 grams/deciliters) treated with either a dextrose or placebo gel and assessed at 2 years neurodevelopmentally indicates that 36% of both groups of children have neurosensory and processing impairments.

Oral dextrose gel appears safe for mild hypoglycemia of the newborn.
Medial Patellofemoral ligament-centered knee pain in adolescents
The medial Patellofemoral ligament (MPFL) originates on the medial side of the knee on the superomedial aspect of the patella and inserts on the medial femoral epicondyle (medial retinaculum). "Its main function is to prevent lateral displacement of the patella". Injury commonly occurs during a non-contact twisting action with knee pain occurring frequently in adolescents (the lateral retinacular tissues are those that stabilize the knee on the lateral side of the patella).

A database of all patients identified with MPFL pain refractory to conservative treatment and treated by laparoscopic lateral retinacular release indicates significant improvement in clinical outcomes at 5 year follow-up.

Predicting the need for surgery in neonates with necrotizing enterocolitis (NEC) without pneumoperitoneum
A study of 238 neonates with NEC (without pneumoperitoneum) of whom 22.69% required surgery) examined clinical, laboratory investigations and imaging findings to identify predictors associated with surgical intervention, indicated that abdominal erythema, C-reactive protein level and critical imaging report (persistent dilatation bowel loops, absent peristalsis, thickening of a bowel wall, portal venous gas and fluid in the abdomen) are all independent predictors of the need for surgical intervention.



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Pulse oximetry (PO) screening for critical congenital heart disease (CCHD) after home birth and early discharge

A study which evaluated percentage of screened infants and pre and post-ductal measurements at > 1 hour after birth and on days 2 or 3 (during midwife visits) in 3,059 and 394 infants respectively indicates that PO screening for CCHD is feasible after home delivery and while one hour PO measurements do not appear to identify critical CCHD, other important noncritical cardiac and non-cardiac pathologies are identified.

Video Feature
Can we expect a favorable outcome after surgical treatment for an anorectal malformation (ARM)?

A post-operative retrospective review of functional outcomes, assessed using the Krickenbeck classification (J. of Indiana Association Ped. Surgeons, 2015, Jan-March 20 (1), pages 10-15)) was undertaken in 311 children who underwent surgical treatment for ARM with mean follow-up assessment at age 10 years.

It appears that for a variety of different ARMs surgically treated (with differing pull-through procedures
depending on underlying diagnosis) and followed to 10 years of age; 84.8% have voluntary bowel movements, 30.7% are constipated and 6.5% have evidence of soiling. Continence is "good" for 82.2%, "fair" for 2.7% and "poor" in 15.2% of children.

Attention deficit hyperactivity disorder (ADHD)

ADHD appears to be a childhood onset psychiatric disorder of the neurodevelopmental type with a prevalence of 1.4%-3% (5%-7% of children when diagnosed using DSM-IV criteria). More common in boys, it appears heritable and multifactorial with multiple genes and non-inherited factors contributing to the disorder. It is characterized by "problems paying attention, excessive activity or difficulty controlling behavior"; usually beginning around age 6 years.
Management (depending on severity) recommendations include a stepwise combination of counseling, lifestyle changes and medications, though analyses of "blinded" non-drug treatments have not been shown to be efficacious.

Resuscitation of premature infants <25 weeks gestational age
A study which evaluated the adequacy of standard resuscitation guidelines in premature infants 22-24 weeks, 25-26 weeks and 27-28 weeks gestation requiring postnatal resuscitation indicates that current recommendations for resuscitation failed to achieve timely oxygenation/improve bradycardia in infants <25 weeks gestation. Effective alternatives are required!

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