Miami, FL
Nov. 7, 2018
Volume IX | Issue No. 45
A simpler treatment for acute pediatric osteoarticular infections (OAI)
OAI is traditionally treated with large dose intravenous antibiotics for at least a week followed by several weeks of oral antibiotics. Serial C-reactive protein (CRP) levels appear to be a reliable yardstick in diagnosing and monitoring the course of the illness.
An interesting prospective study compared 25 outpatient treated OAI children who received only oral antibiotics with 228 matched hospitalized children who received traditional therapy.
It appears from a small study, using oral antibiotics only for the treatment of OAI that favorable outcomes can be achieved (larger randomized prospective studies are clearly needed).

Frenotomy for tongue-tie in infants
The management of tongue-tie by frenotomy in breast-feeding infants (tongue-tie does not affect bottle-fed babies to the same extent due to the different mechanics of sucking) is controversial.
An extensive review of the literature examined clinical experiences and scientific evidence in this field.
It appears that following meticulous examination, correct diagnosis and classification of tongue-tie, infant medical breast feeding-related problems should be the only relevant criterion to guide the decision for frenotomy in infancy.
See related video HERE. 
Antibiotics in the first week of life and atopic asthma at 12 years of age
From a longitudinal study of 3,637 children whose parents answered questionnaires from infants/child's age of 6 months to 12 years, it appears that antibiotics given to an infant during the first week of life is associated with a 2.2 fold increase in the likelihood of atopic asthma at 12 years of age.
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Initial management of primary spontaneous pneumothorax (PSP) in children
A pneumothorax is a collection of air (or gas) in the pleural cavity between the two pleural layers. They may be large or small and can be life-threatening. PSP is a pneumothorax that results in the sudden collapse of a lung without an apparent cause or lung disease. It is uncommon in childhood with most cases resulting from a peripheral lung bleb rupturing. Recurrences are quite common (30% ipsilateral - 10% contralateral). Clinically children may be asymptomatic or complain of a sudden onset of sharp or stabbing chest pain and dyspnea. Management is not standardized.
A retrospective study of 80 children (5-20 years of age) diagnosed with PSP assessed management and outcomes. Results indicate:
  1. PSP has an overall recurrence rate of 40%, with 86% occurring within 12 months
  2. A negative lung computed tomography (CT) study for subpleural blebs does not predict recurrence
  3. Initial thoracoscopic blebectomy and mechanical pleurodesis at initial presentation, lowers recurrence rate
Video Feature
Spontaneous Pneumothorax Emergency
Spontaneous Pneumothorax Emergency
Home oximetry to screen for obstructive sleep apnea (OSA) in Down syndrome
"Children with Down syndrome are at high risk of OSA and screening is recommended." A cross sectional prospective study of children (0.5-6 years of age) with Down syndrome examined whether home pulse oximetry (HPO) could be used to discriminate between those at highest risk of OSA who need further diagnostic multichannel sleep study, and those at low risk.
HPO screening may half the number of children with Down syndrome needing a multichannel sleep study and appears to be a practical universal screening approach to diagnosing significant OSA in Down syndrome.
Fish consumption during pregnancy  
Advise issued in 2017 from the USA Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) recommends that pregnant women should consume 8-12 ounces (224-336g) per week of most types of commercially available fish, stating that "fish and other  protein-rich food have nutrients that can help a child's growth and development."  
This differs from the advise issued by the FDA and EPA in 2004 which focused on limiting fish consumption during pregnancy to minimize possible risks to the fetus from methylmercury.
 Empirical evidence published since 2004 now indicates that adverse effects would only result from fish consumption far beyond that which most people would consume.
The risk of consuming too much mercury is low if women eat 2-3 servings per week of fish other than shark, sword fish, king mackerel, tilefish, orange roughly, marlin and bigeye tuna. Fish consumption during pregnancy has neurocognitive/IQ benefits for the infant.
See related video HERE & HERE. 
Randomized trial of Intranasal (IN) fentanyl vs. intravenous (IV) morphine for abscess incision and drainage (IND)
A randomized non inferiority trial of 20 children (median age 15.4 years years) undergoing IND in a pediatric Emergency Department compared IN analgesia using fentanyl (2 μg/kg; maximum-100 μg) or IV morphine (0.1 mg/kg; maximum-8 mg).
In this small study of children undergoing abscess IND, IN fentanyl was non-inferior and potentially superior to IV morphine for reducing procedural pain and distress.
Meet Ruben Gonzalez-Vallina, MD - The Division of Gastroenterology at Nicklaus Children's Hospital
Meet Ruben Gonzalez-Vallina, MD - The Division of Gastroenterology at Nicklaus Children's Hospital
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