Nov. 20, 2019 
     
Volume X | Issue No. 47
Adoption of recommendations for Serogroup B meningococcal vaccine
"Meningococcal disease has an overall case fatality rate of approximately 10-15% and permanent severe sequelae are common among survivors." In 2015 the American Academy of Pediatrics Advisory Committee on Immunization Practices recommended that 16-23 year olds be vaccinated with Serogroup B meningococcal (MenB) vaccine as many outbreaks have occurred in college campuses since 2009.

From an extensive internet and mail survey of pediatricians and primary care physicians questioned on whether they initiated discussions concerning MenB vaccination it appears that only 50% routinely do this, many lack awareness, knowledge and familiarity of MenB disease and the MenB vaccine.

Pediatrics

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In-flight injuries (IFIs) involving children on commercial airline flights
Among 114,222 in-flight medical events (IFME's) 10.7% involve children. These include gastrointestinal (35.4%), infectious (20.3%), neurological (12.2%), allergic (8.6%) and respiratory (6.3%) conditions. 3.3% of IFME's involve IFI's.

In-flight childhood injuries occur frequently among unrestrained "lap infants" and include burns, contusions, lacerations from falls, trauma from objects falling from overhead bins, and extremity trauma from service carts or isle traffic.

Unrestrained lap children are prone to IFI's particularly during meal time or turbulence; the aisle seat makes children more vulnerable to falling objects, burns from mishandled hot items and trauma from isle traffic. To improve the safety of children while flying, infants/small children should be restrained, if appropriate in their own seat during flight, and be placed away from the aisle.

Parotitis - an unusual cause
An interesting rare report of a 10-month old boy admitted to a hospital with an 1-day history of fever, left facial swelling subsequently diagnosed and treated as an infective parotitis who 5 days later presented with bilateral conjunctival hyperemia and rashes reminds us that Kawasaki Disease may involve the parotic gland (intrasalivary gland arteritis) and should be entertained as a diagnosis in any patient with acute parotitis unresponsive to systemic antibiotics

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Cow's milk formula (CMF) supplementation of breast feedings and risks of sensitization
 
CMF supplementation of breast feeding (BF) occurs not infrequently at birth (or soon after) without clear evidence of benefit. Risk of cow's milk protein sensitization (including clinical cow's milk allergy and anaphylaxis) is significant.
 
A randomized, non-blinded clinical trial enrolled 330 newborns immediately after birth to BF with or without amino acid-based elemental formula for at least the first 3 days of life, or BF supplemented with CMF from the first day of life to 5 months of age, and measured cow's milk sensitization at the infant's second birthday.
 
Infants fed a cow's milk formula early are at significantly increased risk of sensitization to cow's milk at 2 years of age. Avoiding supplementation with cow's milk formula for at least the first 3 days of life decreases this risk. 
 
JAMA Pediatrics  
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Video Feature
Failing at Normal: An ADHD Success Story | Jessica McCabe | TEDxBratislava
Failing at Normal: An ADHD Success Story Jessica McCabe | TEDxBratislava
Attention Deficit/Hyperactivity Disorder (ADHD) children and concussion assessment
 
The Child Sport Concussion Assessment Tool Fifth Edition (Child SCAT5) is a standardized tool for evaluating concussion symptoms in children 5-12 years of age (a SCAT5 test is also available for athletes 13 years and older).
 
Pre-Season Child SCAT5 baseline testing is useful in interpreting post-injury test scores. A nested cohort case-controlled study of 54 middle school athletes (aged 11-12 years) who completed preseason testing compared Child SCAT5 performance between uninjured children with ADHD against matched normal controls.
 
Preseason testing of children with ADHD indicates more concussion-like symptoms without injury (worse on balance testing, single leg stands, etc.) in spite of similar cognitive tests compared to unaffected matched controls. This highlights the importance of preseason testing in all children playing contact sports.
 
Journal of Pediatrics 
Association between screen-based media use and brain white matter integrity in preschool-aged children
 
The American Academy of Pediatrics (AAP) recommends limiting the use of screen-based media because of an associated measured risk of cognitive-behavioral abnormalities.
 
A cross-sectional study of 47 healthy children aged 3-5 years examined a composite screen-based use score against an array of cognitive skills and neuro-imaged brain microstructural organization/myelination of white matter/tracts (measured by diffusion tensor imaging).
 
It appears from this relatively small study of young children exposed to screen times greater than those recommended by the AAP that there is a negative effect on brain microstructure and myelination of brain white matter tracts that support language, literary skills and cognition.
 
JAMA Pediatrics 
Vitamin K deficiency bleeding (VKDB) in infancy
 
Charles W Townsend first described, predominantly gastrointestinal bleeding in newborn infants soon after birth 125 years ago (mortality 62%). In the 1930's Dan et al. discovered that lack of vitamin K in chicks resulted in similar large hemorrhages and Warner et al. subsequently demonstrated that this could be reversed by feeding material which contained vitamin K.

Since its introduction in the 1960's, intramuscular vitamin K has been the gold standard prophylactic treatment for infantile VKDB (oral vitamin K regimens exist). Maternal vitamin K
The Newborn Vitamin K Injection
The Newborn Vitamin K Injection
supplementation does not prevent VKDB. Increasingly parents are refusing vitamin K prophylactic for their newborns. Not infrequently (25%) breast feeding mothers complain that they have not received enough information about its importance.
 
Despite differing ethical approaches to ensuring vitamin K prophylactic treatment for the newborn infant, it appears that while "nudging" parents is acceptable, a better way may be for neonatal vitamin K prophylaxis to be a "default option" from which parents can opt-out.
 
Acta Paediatrica
Did You Know?  
The Colorectal Center- Conditions we see
The Colorectal Center- Conditions we see
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