Nov. 27, 2019 
     
Volume X | Issue No. 48
Consensus statement on Sports-Related Concussion in Youth sports
A consensus panel of 11 experts representing a broad spectrum of expertise in youth sports and concussion addressed 7 specific questions by reviewing pertinent published studies issuing conclusions and multiple recommendations for each question.

A long and valuable summary outlines information regarding the health-related value of exercise, and the benefits and risks of individual and team related sport activities. While more data in the future will clarify many of the issues, this article is well-worth reading and perhaps keeping as a guide to advising and educating teens and their parents regarding sports related injuries.   
 

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Neurodevelopmental outcomes after perinatal arterial ischemic stroke (PAIS)
A study of 188 term infants who had magnetic resonance imaging (MRI) scans to delineate strike/tissue involvement following PAIS and neurodevelopmental outcomes measured at 41.7 months (mean) of age reminds us that while most (90%) involve middle cerebral artery (MCA), posterior or anterior cerebral artery stroke occurs in 9% and 1% respectively. Overall, 54% of infants have adverse outcomes (at least 1 neurological domain) after a stroke with 100% of those with main branch MCA ischemia, and 29%-57% of other subtypes having poorer outcomes particularly if corticospinal tracts and basal ganglia are involved.
 
Pediatrics
Training and standardization of general practitioners in the use of lung ultrasound (LUS) for the diagnosis of pediatric pneumonia
"Pneumonia is the leading cause of death in children of low-resource settings." Ultrasound is being increasingly and successfully used by non-radiologists following a relatively short period of training to diagnose pneumonia in children.
 
An interesting study of 25 general practitioners trained (didactic for 1 week and then for 2 weeks under supervision until >80% accuracy in image interpretation) in the use of chest LUS in diagnosing pediatric pneumonia in Bangladesh indicates that LUS use to diagnose pediatric pneumonia is a viable, safe and effective tool even following a limited training program.
 
Pediatric Pulmonology

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Childhood Obesity Facts 
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Dialectical Behavioral Treatment (DBT) vs. "Usual" for non-suicidal self-injury (NSSI)
 
Dialectical behavior therapy specifically focuses on providing therapeutic skills to manage painful emotions and to decrease conflict in relationships. Four domains are addressed; mindfulness (improving an ability to accept and be present in the current moment), distress tolerance, emotion regulation and interpersonal effectiveness (a technique to allow a person to communicate with others in a way that is assertive, strengthens relationships and maintains self-respect).
 
A retrospective chart review studied outcomes of 425 adolescents (in an inpatient psychiatric center) comparing DBT treatment vs. usual therapy, identifying NSSI and
What is Dialectical behavior therapy for adolescents (DBT)?
What is Dialectical behavior therapy for adolescents (DBT)?
incidence of suicidal attempts.
 
DBT decreases incidence of NSSI and suicidal attempts, hours in restraints, days hospitalized and at significantly lower cost compared to "usual therapy."
 
Effectiveness of Palivizumab (Synagis) immune prophylaxis against Respiratory Syncytial Virus (RSV)
 
"Palivizumab is a humanized mouse monoclonal antibody directed against a RSV protein and is approved for the prevention of RSV disease in selective children."
 
Form a cohort, self-controlled case study of 24,329 high risk infants admitted to a Neonatal Intensive Care Unit of whom 6.2% had RSV-confirmed infection before 2 years of age and who received at least 1 dose of Palivizumab, it appears that immuno-prophylaxis is associated with 74% protective effect.
 
Journal of Pediatrics
Video Feature
Signs of Stroke in Babies and Toddlers
Signs of Stroke in Babies and Toddlers
Infant formulas containing hydrolyzed protein for the prevention of allergic disease and food allergy
 
While reputable bodies (e.g. European Academy of Allergy and Clinical Immunology) recommend that young infants that need a supplement to maternal milk, and who are at risk (frequently because of family history) of developing allergies, should be fed a hypoallergenic breast milk substitute which is usually a "hydrolyzed cow's milk formula", a Cochrane review and meta-analysis study of data from 16 eligible trials which examined whether supplementation (or sole feeding) vs. standard formula affected the risk of developing allergic disease, indicates no benefit.
 
Feeding hydrolyzed cow's milk formula (containing proteins digested chemically or enzymatically to oligopeptides) as a breast milk substitute to high risk infants for allergy DOES NOT prevent infant allergic disease.
 
Cochrane 
   
Neonatology 
Effects of growth hormone (GH) therapy in non-obese, pre-pubertal children
 
Adults with untreated growth hormone deficiency (GHD) have unfavorable lipid profiles plus elevated insulin levels, insulin resistance, increased pro-inflammatory cytokines, C-reactive protein, adipokine and soluble intercellular adhesion molecule-markers (sICAM-1) which puts them at risk for developing cardiovascular disease.  
 
Children with childhood onset growth hormone deficiency are small in stature and have a higher percentage of body fat and lower amounts of lean mass. "GHD plays an important role in the expression of several cardiovascular risk factors thus highlighting the need to treat this deficiency...."
 
An observational, prospective, case-controlled study of 81 pre-pubertal (Tanner Stage I) non-obese children with GHD was undertaken to determine the changes in lipid metabolism/other parameters and to assess the possible beneficial effects of replacement therapy.
 
Pre-pubertal non-obese GH deficient children have higher than normal total cholesterol, LDL cholesterol, triglycerides, lipoprotein and sICAM-1 and lower levels of free fatty acids, insulin and insulin resistance. After 6 months of GH replacement lipid and adipokine levels all improve.
 
Acta Paediatrica 
Children's Health Chats   
The Colorectal Center- Collaboration is Key
The Colorectal Center- Collaboration is Key
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Are males more likely to suffer sternal fractures?

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