Oct. 16, 2019 
Volume X | Issue No. 42
Rotavirus vaccine and the risk of intussusception in infants and children 
Most infants who receive rotavirus vaccine have none, or insignificant side-effects (irritability mild/temporary diarrhea or vomiting). It has, however been an accepted notion (though somewhat controversial) that the vaccination carries with it a small risk of intussusception (usually within a week after the first or second dose).

A systematic study of multiple databases of 25 randomized clinical trials indicates that neonatal rotavirus vaccination IS NOT associated with an elevated risk of intussusception among neonatal infants.

JAMA Network Open
Risk of neurodevelopmental and psychiatric disorders in the offspring following cesarean delivery 
From a systematic study of 67 articles reporting on >20,000,000 deliveries (from multiple databases) which evaluated the association between cesarean delivery and risk of neurodevelopmental and/or psychiatric disorders in the offspring, it appears that cesarean section delivery significantly increases the odds of autism spectrum disorder and Attention-Deficit/Hyperactivity disorder, but not for intellectual disability, obsessive-compulsive disorder, tic disorders, eating disorders, depression/affective psychoses and non-affective psychoses.

JAMA Network Open
Incidence, risk factors and mortality associated with second malignant neoplasm (SMN) among survivors of adolescent and young adult cancer 
From a retrospective matched cohort study of 10,574 2-year survivors of adolescent and young adult cancer, it appears that there is a 2.6-fold increased risk of developing a SMN. Risk factors include demographics, stage at diagnosis, radiation therapy, and varies by first cancer type (survivors of breast cancer, melanoma and testicular cancer having substantially increased risk of developing a SMN of the same type).

JAMA Network Open
Childhood Obesity Facts 
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Maternal thyroid hormone replacement therapy (THRT) exposure and language and communication skills in offspring at 8 years of age
"Hypothyroidism symptoms in pregnancy can be similar to pregnancy symptoms" and if missed can result in neurodevelopmental delays in the offspring. Whether prenatal THRT decreases the risk of neurodevelopmental delay (particularly children's language and communications skills) is unknown.
A study of pregnant women (from a National cohort) who delivered a live-born singleton infant (53,842) examined the language and communication skills at 8 years of age of 3 groups of mother-baby dyads; (1) THRT exposed during pregnancy, (2) unexposed to THRT during pregnancy, (3) mothers given THRT after delivery.
Child language/communication outcomes at 8 years of age between mothers treated with THRT for hypothyroidism during the prenatal period are similar to those of a normal population group.  
JAMA Network Open 
Video Feature
Pregnancy Infections May Trigger Autism and Depression
Pregnancy Infections May Trigger Autism and Depression
Long-term risk of neuropsychiatric disease after exposure to infection in utero
"The developmental origins of mental illness are incompletely understood." While it appears that autism and schizophrenia are linked to infection during fetal life it is unknown whether other common psychiatric conditions might originate from fetal exposure to maternal infection while in utero.
A Swedish population-based cohort of 1,791,520 children observed for 41 years of mothers hospitalized during pregnancy with any maternal infection indicates that fetal exposure to severe maternal infection increases the risk of inpatient diagnosis of autism or depression (but not bipolar or psychosis) during the child's life.
JAMA Psychiatry
Management of a mandible fracture
A single institution cohort study of 150 children (mean age: 12.8 years - 72% male - 71.3% white and 72.7% with 2 or more mandibular fractures) from 2 pediatric trauma centers, indicates that the most common mechanisms of injury are assault and battery, motor vehicle collisions, falls or play and sports related.
Treatments of mandibular fractures in children include:
  • Conservative (25%): managed with observation and a soft diet
  • Surgery:
    1. 56.2% treated with
      maxillomandibular fixation (MMF)
    2. 21.4% receive open reduction internal fixation (ORIF)
    3. 17.9% are managed with both MMF and ORIF
Total complication rate is 8.7%. Follow up is inconsistent!

JAMA Facial Plastic Surgery 
Comparison of ibuprofen vs acetaminophen and severe bleeding risk after pediatric tonsillectomy
Ibuprofen may increase the risk of severe bleeding post-tonsillectomy (with or without adenoidectomy) by slowing down clotting time.
A randomized, multicenter, double-blind, non-inferiority clinical trial of 741 children examined the rate of bleeding post-tonsillectomy when ibuprofen vs. acetaminophen is used for 9 days of post-operative analgesia.
In this study the likelihood of increased post-tonsillectomy bleeding in children who received ibuprofen could not be excluded. Acetaminophen appears to be the safer analgesic for post-tonsillectomy pain.
JAMA Otolaryngology Head and Neck Surgery  
See related video HERE & HERE
Did You Know?
A Pediatrician's Guide to Thyroid Function Tests featuring Dr. Alejandro Diaz
A Pediatrician's Guide to Thyroid Function Tests featuring Dr. Alejandro Diaz
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