Miami, FL
Oct. 10, 2018
Volume IX | Issue No. 41
Infant feeding and weight gain; separating breast milk from breast feeding and formula from food
A study of 2,553 mother-infant dyads investigated breast feeding and obesity documenting the method of breast milk feeding, type of supplementation or feeding in hospital over a 12 months period.

"Breast feeding is inversely associated with weight gain velocity and BMI." This association is dose dependent being partially diminished when breast milk is fed from a bottle and subsequently further weakened by supplemental feeds being given after the neonatal period.

Blood pressure is normal, but is the heart? 
A study (using strain analysis of cardiac function by speckle tracking echocardiography - STC, a non-invasive echocardiographic imaging technique that analyzes the motion of myocardium) used to evaluate the cardio-protective effects of different drug classes in treated pediatric hypertensive patients, indicates that all treated hypertensive children have abnormal (reduced) strain parameters (compared to untreated normotensive children) independent of type of antihypertensive agent use.
See related video HERE
Diagnostic accuracy of D-dimer in children with suspected pulmonary embolism (PE) 
It appears that in children with suspected PE who have D-dimer testing most are female (2:1 female male ratio) and over the age of 12 years. Children suspected of having PE have higher mean heart rates, higher respiratory rates, lower pulse oximetry and hemoglobin concentration. Five conditions are more frequently associated with PE positivity; surgery, central line, immobility, prior PE, deep vein thrombosis and cancer.
Children with a low-clinical probability of PE and a normal D-dimer can more than likely be excluded from having a diagnosis of pulmonary embolism.

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Chief complaints among children treated for cancer 
"Children with cancer have high Emergency Department (ED) utilization...." A retrospective chart review of ED chief complaints for children with cancer in active treatment reveals:
  1. >50% have >1 complaint.
  2. Fever (60.2%), pain (6.5%), nausea and vomiting (5.0%), bleeding (3.9%) and abnormal laboratory values (3.3%) are the five most common complaints.
  3. Each increase in number of chief complaints significantly and sequentially increases the likelihood of hospital admission.
A parental early warning tool for infants with complex congenital heart disease (CCHD)
Many infants with complex congenital heart disease require several surgical procedures over 2 or 3 stages. In spite of significant medical and surgical advances, perhaps up to 15% of infants die between the first and second stage. The Congenital Heart Assessment Tool (CHAT) is a home monitoring system which aids parents in assessing their infant's clinical condition by noting "behavior" (content/smiles), "awake/sleeping status" and "crying/consolation" responsiveness.
In a study from a tertiary children's cardiac center in the UK, 12 parents of 8 infants discharged after first stage cardiac surgery for CCHD participated in a longitudinal qualitative feasibility study of CHAT following parental preparation, with appropriate medical support.
The CHAT assessment tool enables parents to identify normal infant behavior and to detect early signs of clinical deterioration.  
Video Feature
Collagenous Gastritis
Collagenous Gastritis
Pediatric collagenous gastritis (CG) and colitis 
In children CG is a rare condition of unknown etiology that is primarily characterized by the buildup of collagen in the subepithelial layer of the stomach (the "adult phenotype" form is associated with collagenous colitis and autoimmune disorders). No effective treatment has been identified.
A retrospective review of all patients with a diagnosis of collagenous gastritis and/or colitis at the Royal Children's Hospital in Melbourne, Australia was undertaken. 12 children with collagenous gastritis were identified (25% of them having associated collagenous colitis).
Common presenting signs/symptoms of CG include iron deficiency anemia (with resolves with oral supplementation), abdominal pain, nausea and vomiting, weight loss, abdominal distention and gastrointestinal bleeding. Course and long-term outlook remain unclear.
Risk factors for early anterior cruciate ligament (ACL) reconstruction failure in pediatric patients
"ACL reconstruction failure is relatively common in young high-risk athletes." A single center retrospective study of 10 years' experience with 561 ACL reconstructions and 54 failures (9.6%) was utilized to identify short-term failure rates and risk factors for revision following ACL surgery.
Data indicates:
  1. Average time to failure is 13.6 months.
  2. Mean age 15.4 years.
  3. Soft tissue grafts are twice as likely to fail compared to patella tendon grafts.
  4. Other important factors include maturity (growth plate status) and ACL technique.
See related video HERE.  
Child Life Specialists Provide Distraction Techniques - Nicklaus Children's Hospital
Child Life Specialists Provide Distraction Techniques - Nicklaus Children's Hospital
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