Nov. 16, 2016
Volume VII | Issue No. 46

Gestational age and kindergarten school readiness in preterm infants
A study from 5,250 children from the Early Childhood Longitudinal Study Birth Cohort assessed reading and math readiness for kindergarten in babies born prematurely. Assessment comparisons were undertaken between paired 39-41 week infants and those born "very preterm", "moderate-late preterm" and "early term".

The highest odds of poor school readiness in reading and math are seen in "very preterm" infants, though all infants born <32 weeks gestation are at increased risk.

Postoperative amplitude-integrated electro-encephalography (aEEG) and neurodevelopmental outcomes in children with congenital heart disease (CHD)
It appears that postoperative bedside aEEG is a useful tool to predict outcomes in infants undergoing open heart surgery for CHD. An abnormal background pattern (flat trace, burst suppression and low voltage) and lack of return of sleep-wake cycles are markers for subsequent impaired cognitive function.

Pediatric neuropsychiatric disorders associated with streptococcal infection (PANDAS)
"PANDAS is hypothesized to be an autoimmune condition in which the body's antibodies to streptococci attack the basal ganglion cells of the brain, by a concept known as "molecular mimicry". Clinical presentations include the rapid onset of obsessive compulsive disorders (OCD), tic disorders and wide range of neuropsychiatric symptoms.

Treatment for PANDAS include cognitive behavioral therapy and conventional medications to treat OCD and/or tics. The use pf prophylactic antibiotics is controversial.

A study of 35 children meeting criteria for PANDAS and OCD in a double-blind, placebo-controlled, 6-week trial of intravenous immunoglobulin (IVIG) followed by an optional open-label treatment for non-responders, indicates that although IVIG treatment appears safe and well-tolerated, it does NOT achieve statistical benefit (vs. placebo).

Journal of the American Academy of Child and Adolescent Psychiatry
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Isolated femoral shaft fractures - treatment in children 1-3 years of age  
"Hip spicas are used to immobilize injured hips or fractured femurs". "The cast includes the trunk of the body and one or both legs." In the 1-3 year old age group,  abuse plus playground/furniture accidents are the most common causes of fractured femurs (<1 year; usually abuse -
adolescents; vehicle accidents).

Hip spica casting regimens for young children <4 years of age vary. A study which evaluated fractured femur outcomes using a 3-4 week single-leg hip spica vs. 6-8 weeks in a standard double-leg, non-weight bearing hip spica cast indicates that the 4 week single-leg cast has fewer skin complication and alignment abnormalities.

Operative outcomes of infantile hypertrophic pyloric stenosis (IHPS) in patients with congenital heart disease (CHD)

A retrospective, single pediatric center, case-control, matched cohort study of post-operative outcomes of 26 and 78 patients with IHPS with and without CHD respectively, indicates that though no significant differences are found in 30-day mortality and overall morbidity, CHD IHPS infants have a greater hospital length of stay (with substantial cost implications) particularly when IHPS develops incidentally during hospitalization.
Video Feature

Why aEEG Monitoring? 
The aEEG Scale Is Fixed
The aEEG Scale Is Fixed
Diluted apple juice and mild gastroenteritis dehydration  

A randomized, single-blind non-inferiority trial compared half-strength diluted apple juice to other solutions in children aged 6-60 months with mild gastroenteritis/dehydration.

It appears that in spite of both United States and European guidelines discouraging the use of fruit juices and soft drinks (due to high carbohydrate and low sodium content) in managing mild dehydration, dilute apple juice followed by preferred fluid may not only be non-inferior (offers less cost, ease of use or other non-therapeutic benefits), but superior to electrolyte maintenance solutions in children> 24 months of age with mild gastroenteritis.

Adolescent BMI >50% is associated with adult cardiovascular-death risk

A retrospective, longitudinal data set analysis of Israeli adolescents 16-19 years old compared cardiovascular risk (coronary artery disease/sudden death) in middle age of adolescents in the 50th-74th percentile to those in the 5th-24th percentile.

Adolescent BMI >50% is associated with an increased risk of cardiovascular death in middle age.

Physician Spotlight: Dr. Luis Calcedo

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