Miami, FL
Nov. 29, 2017
Volume VIII |  Issue No. 48

Outcomes of bilateral congenital diaphragmatic hernia (CDH)
This, the largest cohort study of infants (80) with bilateral CDH, outlines the various factors involved in outcomes.

Bilateral CDH carries a high mortality (74%). Lower one and five minute Apgar score, non or patch repair and Extracorporeal membrane oxygenation (ECMO) are all poor prognostic signs and are associated with a diminished survival rate.

Poor linear growth to 12 years of age and decreased weight-for-height during the first year of life strongly suggests that (for CDH) early infant nutritional intake is inadequate and has long lasting growth effects.

Intranasal ketamine for pain control
A blinded study which evaluated sedation with 1mg/kg dose of intranasal ketamine (via LMA mucosal atomizer) for 20 resistant children (>4 years of age) undergoing painful procedures (venipuncture or intravenous catheter placement) in an Emergency Department after local anesthesia indicates that 1mg/kg of nasal ketamine is safe and appears to be effective in reducing pain and anxiety in children aged 1-12 years of age.

See related video HERE.
Guns and violent media; effects on children
"The US population owns more guns per capita than any other country in the world; seven children and adolescents die every day in the USA from guns". Media violence is pervasive and there is an increased exposure to violence via not only G-rated films but also reality games and social-media posts of real-world violent events.

A study of 62 boys and 42 girls (mean age 9.9 years) examined whether children who see a movie containing guns will handle a real gun longer and pull the trigger more often than children who see the same movie without the guns.

Children who see movie characters use guns play more aggressively and are more likely to use guns themselves.

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Dyslipidemia screening of 9-11 year at well-child visits  
Guidelines form American Academic of Pediatrics (AAP - 2014 Recommendations for Pediatric Health Care) recommends the universal screening of children 9-11 years of age for dyslipidemia to identify and potentially treat (e.g. statins) children at risk for severe atherosclerosis as an adult. Adherence to the recommendations is low.

An anonymous survey of members of the Utah chapter of the AAP reveals that only 15% follow the AAP recommendation. 73% indicate they test some children (obese or those with other risk factors). Universal screening at 9-11 years of age has several advantages; the predominant one being the prevention of a cardiovascular event occurring (25-50%) in a heterozygous family (1:250-500 children) member with hypercholesterolemia.

Video Feature
Screening for hypercholesterolemia
Screening for hypercholesterolemia
Recording maternal voices; effect on preterm infant pain
Painful heel-stick procedures are common in the preterm infant cared for in a Neonatal Intensive Care Unit.

A prospective controlled study of 40 preterm infants (26-34 weeks gestation) randomized to listen to (or not) a recording of their mother's voice during a painful routine heel lance for blood collection, recorded changes in Premature Infant Pain Profile (PIPP), oxygen saturation and blood pressure occurring during the procedure.

Playing a recording of a mother's voice during a painful procedure on a preterm infant markedly reduces the PIPP score and decreases the degree of oxygen desaturation.

Medication and Cognitive Behavioral Therapy (CBT) for pediatric anxiety disorders
"Anxiety disorders are among the most prevalent pediatric behavioral health conditions, affecting roughly 32% of youths prior to adulthood and associated with impaired functioning that can continue into adulthood and increase in severity".
A multi meta-analysis of studies which evaluated the comparative efficacy of CBT, pharmacotherapy (selective serotonin reuptake inhibitors - SSRIs) and their combination, indicates that though CBT and the combination of CBT and SSRIs are valuable in the treatment of acute anxiety in children, 40-50% of anxious children remain symptomatic (limitations of the study include deficiencies in the database and the inherent weaknesses of meta-analytic methods).
Alopecia Areata (AA) and inflammatory bowel disease (IBD)
An interesting report of an 11 year old girl with Crohn's disease (CD) who initially presented with recurrent fever (and no gastrointestinal symptoms) subsequently and appropriately diagnosed and treated and who 15 months after onset of therapy presented with localized areas of alopecia, reminds us that AA is an autoimmune skin condition (several genes implicated) which has an unpredictable course. Today there are no standardized or widely accepted treatment protocols for AA with multiple topical and systemic therapies suggested.

What is the importance of a Healthy Lifestyle? - Dr. Yadira Martinez-Fernandez explains
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