Miami, Florida
Nov. 15, 2017
Volume VIII |  Issue No. 45

Shivering in febrile children; clinical significance 
It appears from a prospective case-controlled study of 645 febrile children that while shivering occurs in approximately 28%, serious bacterial infection occurs no more frequently in those children, as compared to matched controls.

Chronic cough postacute respiratory illness (ARI) in children
Data on the etiology of persistent cough at the transitional stage from subacute to chronic (<4 weeks duration) is limited". A study examined the prevalence of cough following an acute respiratory illness in 839 children (mean age: 2.3 years) and examined outcomes.

At 1 month post ARI, 20.4% of children have a persistent cough; of these, a new chronic lung abnormality is present in 30.8%. An underlying lung abnormality is frequently present when cough persists following an acute respiratory illness.

A long term follow-up following bariatric procedures in adolescents
Bariatric procedures to prevent the secondary deleterious effects of obesity essentially fall into three categories; "restrictive", "malabsorptive" or a "combination" of both. A retrospective study examined the medium/long term outcomes from data from 173 consecutive adolescents (13 to 18 years of age) who underwent bariatric procedures for weight reduction - (49% treated with an adjustable gastric band (AGB); 27%with intragastric balloon (IB); 15% with sleeve gastrectomy (SG) and 6% with malabsorptive techniques (MT; gastric bypass).

A 5 year follow up review after bariatric surgery for obesity indicates that the sleeve gastrectomy appears to achieve the greatest weight loss (compared to other non malabsorption techniques), safely.

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Unintentional cannabis ingestion in children 
An analysis of published reports from a number of sites identified 3,582 children (<12 years of age) with unintentional cannabis ingestion in States which have decriminalized medical and recreational cannabis use.

The most common forms of cannabis ingestion in children (mean age 25 months - range 6 weeks to 12 years) appear to be cannabis resin, followed by cookies and joints. Passive smoke, medical cannabis, candies, beverages and hemp oil may all result in clinical symptomatology.

Unintentional cannabis ingestion in children most commonly presents with sudden lethargy and ataxia (18% require Pediatric Intensive Care Admission; 16% require intubation).

Video Feature
Risk factors for serious adverse events (SAEs) in Emergency Department (ED) procedural sedation for children
"Procedural sedation for children undergoing painful procedures is standard practice in EDs".

A prospective, multicenter, observational cohort study of 6,295 children (mean age: 8.0 years) examined SAE's, significant interventions performed, oxygen desaturation and vomiting associated with procedural sedation.

Adverse incidences associated with procedural sedation occurs in 11.7% of children; desaturations 5.6% and vomiting 5.2%. 1.1% are SAEs and 1.4% require significant intervention.

Ketamine alone results in the least number of adverse incidences while propofol, and combinations of ketamine/fentanyl, ketamine/propofol have the highest incidence of significant/serious adverse events.

Cognitive and psychosocial function of preschool-age children with cancer
From a study of 98 preschool-age children (mean age: 5.17 years) diagnosed with cancer (brain tumor, solid tumor and leukemia), studied 2.56 years from diagnosis where indicators of cognitive adaptive, pre-academic and emotional behavioral functioning was analyzed, it appears that mean IQ scores are significantly below expectations as are adaptive functioning (how one handles common demands in life) and pre-academic skills (emotional/behavioral outcomes appear unaffected).

Hospital-based preschool programs are urgently needed for this academically at risk group of children.

See related video HERE.
How to predict oral rehydration failure in children with acute gastroenteritis (AGE)
A prospective observational study of an Emergency Department (ED) on 812 previously health children 1 month - 5 years of age with AGE managed with oral rehydration examined the prognostic factors associated with failure to rehydrate within 72 hours.
21% of children presenting to an ED with AGE fail to orally rehydrate. Predictors of oral failure include significant abnormality in vital signs, level of consciousness, an abnormal capillary refill time and moderate/severe clinical dehydration.
New treatment labeled "a game changer" for patients with diabetes

Nicklaus Children's Palm Beach Gardens Outpatient Center kicked off National Diabetes Month by introducing a new treatment option for children with Type 1 diabetes. Colton Smith, age 16, is one of the first patients in the nation to use a new hybrid closed loop system to monitor his glucose levels. Smith and his mother, Jean Smith, were joined on Wednesday, November 1 by LPGA golfer Michelle McGann, also a user of the new insulin pump, along with Barbara and Jack Nicklaus of the Nicklaus Children's Health Care Foundation. The Smith family explained the freedom the Jupiter teen has experienced since receiving the new insulin pump six weeks ago...
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