Miami, FL
Oct. 17, 2018
Volume IX | Issue No. 42
Efficacy of propranolol between 8 and 12 months of age in high-risk Infantile Hemangioma (IH) 
"IHs are the most common tumors of childhood." While many will involute and resolve without therapy, a subset of high-risk IHs rapidly develop complications like ulceration (unresponsive to standard care), are at increased risk for significant functional impairment, disfigurement, or even become life threatening.

A multicenter, phase III, open label, single-arm study evaluated the efficacy and safety of oral propranolol solution (twice daily 3mg/kg/day) given for a minimum of 6 up to a maximum of 12 months in high-risk IH infants aged 35-150 days.

6-12 months of oral propranolol treatment significantly increases the success rate of infants with high-risk IH.

Long-term outcomes of prenatally diagnosed congenital lung malformations (CLMs) 
In general, CMLs are one of four types of congenital lung disorder which includes bronchogenic cysts, congenital cystic adenomatous malformations (CCAMs or congenital pulmonary airway malformations), lobar emphysema and pulmonary sequestrations. They may be small to large and some may require urgent fetal interventions.  
A retrospective review of 199 newborns identified with fetal lung disease (by prenatal ultrasound) was undertaken to examine their natural history.
From the study results indicate that children born with CLMs identified prenatally are mostly asymptomatic at birth and the majority will remain so during childhood.
An overlooked social determinant of health
The American Academy of Pediatrics (AAP) recommends that pediatricians support parents "to provide a rich and responsive language environment."
Remind parents to "talk, read and sing" to their infants to optimize early cognitive development.
See related video HERE & HERE
Childhood Obesity Facts 
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Utility of performing a lumbar puncture (LP) for Febrile Status Epilepticus (FSE) in children

The necessity of an LP to differentiate central nervous system (CNS) infection in children with FSE remains controversial. A retrospective cohort study of 333 children aged 6-60 months admitted for seizures with fever compared clinical characteristics between patients initially diagnosed as having FSE, and complex febrile seizures excluding FSE, and the diagnostic benefits of lumbar puncture.

From this study it appears that routine LP to rule out severe CNS infection in children with FSE should not be recommended.

Acute outcomes of isolated pneumocephali in children following minor blunt head injury 

Traumatic brain injuries (TBIs) are the most common serious injuries sustained by children. On brain computed tomography (CT) scan approximately 9.7% of children have pneumocephali (air in the cranial cavity). Little data describes the acute outcomes.
Results of data analysis from a multicenter prospective study of all children <18 years of age (14,983) following minor head trauma (Glasgow Comma Score 14 or 15) with pneumocephali (1%) indicates:
  1. 36.5% are isolated.
  2. 77.8% have an associated basilar skull fracture (BSF) with 7% also having a linear skull fracture (LSF); 8% have a LSF without BSF and 7.4% have no fracture.
  3. Pneumocephali tend to be small.
  4. In this study no child required neurosurgical intervention or intubation for >24 hours.
  5. No deaths occurred.
It appears that CT scan confirmed pneumocephali in children following minor blunt head trauma have minimal adverse effects.
Video Feature
Inspiro Medical -- Novel Dry Powder Inhaler -- High-Tech
Inspiro Medical -- Novel Dry Powder Inhaler -- High-Tech
Inspiromatic - a safety and efficacy study for a new generation dry powder inhaler (DPI) for asthmatic children 
DPIs may be effective but require actions which may be difficult in small children with airway disease.
The Inspiromatic is a breath-synchronized active device that works with low inhalation flow rates enhancing drug delivery. A phase I/II randomized, single-center, double-blind, double-dummy, placebo controlled, crossover study of 29 children (mean age 12.6 years) with Forced Expiratory Flow rate (1sec), i.e. FEV 1 of 40-80%, compared the safety and efficacy of Formoterol (a long-acting Beta 2 agonist) delivered by Inspiromatic to Aerolizer, a conventional DPI.
Formoterol inhalation with the Inspiromatic appears safe and more effective in medication delivery compared to a conventional DPI with no increase in adverse events.
Marijuana use; pregnancy and breast milk feeding
Marijuana is the most common illicit substance used by pregnant women, primarily for nausea and/or vomiting. In the USA, none of the states with legal medicinal marijuana laws list pregnancy as a contraindication for recommending or dispensing medical marijuana in spite of data indicating that it enhances placental barrier permeability (with THC the substance most responsible for its psychoactive effects readily crossing the placenta), increases uterine artery resistance, increases placenta abrupture, spontaneous abortion, preterm delivery, lower infant birth weight, lower Apgar scores and increases use of neonatal intensive care services (though other variables may also play a role) with significant and pervasive long-term infant to adulthood neurodevelopment deleterious effects (affecting global measures of cognition and behavior).
Maternal use in lactating women indicates that THC is 8 times higher in breast milk compared to their mothers' plasma levels and as a lipophilic drug it accumulates in fat-rich organs like the brain (this too can disrupt normal axonal growth and potentially inflict long-term neurodevelopmental sequelae on the actively growing infant brain).
It appears unwise for pregnant or breast feeding mothers to utilize marijuana.
See related video HERE.  
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