Oct. 25, 2017
Volume VIII |  Issue No. 43

Increased breast feeding duration and growth, adiposity and blood pressure at 16 years of age
A secondary analysis of a randomized clinical intervention that increased breast feeding duration indicates that while longer breast feeding times enhances post infancy weight, height and BMI, it has little effect after 8.5 years of age and is NOT associated with a lower risk of obesity or increased blood pressure at age 16 years.
Plantar Fasciitis
Plantar fascia is a band of tissue that supports the arch of the foot connecting the heel to the toes. While heel pain is a common presenting clinical feature (usually under the heel) , it is not the most common cause of heel pain in children (approximately 8%), and is frequently only part of an underlying problem (e.g. Sever's Disease - inflammation of the growth plate of the calcaneus caused by repetitive stress to the heal from playing sports). One or both feet may be affected.
Treatment options include cooling with ice, reducing sport activities, shoe insert supports (or orthotic devices), physical therapy, daily stretching of calf muscles and analgesics. For severe pain foot casting with crutches may be necessary. In rare cases surgery may be considered if conservative therapy is unsuccessful.
See related video HERE and HERE
Inhaled corticosteroids in transient tachypnea of the newborn (TTN)
TTN is a common respiratory disorder that presents shortly after birth as short-lived (usually for 24-48 hours) tachypnea (>60 breaths per minute) in late preterm or full term ( usually make ) infants, infants following caesarian section, and infants of diabetic mothers. It is postulated that the cause is failure of fetal lung fluid clearance after delivery. Treatment is supportive.

A small double-blind randomized placebo controlled multicenter pilot study of infants >34 weeks gestation with TTN which examined the respiratory effects of inhaled budesonide given at 4 hours post birth, 2 doses 12 hours apart, indicates no beneficial effects on the clinical course.

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A new approach to the investigation of sudden unexpected death in pediatrics (SUDP)
"SUDP is an inclusive term for sudden death in children that remain unexplained by standard autopsy and death scene investigation, and includes sudden infant death syndrome (SIDS), sudden unexpected infant death, sudden unexplained death in childhood and undetermined deaths".
An interesting article outlines a new approach to SUDP (beyond preventive measures in the child's sleep environment and detection of child abuse) which aims at understanding apparent biological vulnerabilities in a small child (<3 years of age) which may be lethal. These include abnormalities in the hippocampus, advances in the detection of epilepsy, the diagnosis of rare presentations of known diseases, newer approaches to the understanding of unknown mechanisms and genetic variances. Well worth reading for all pediatricians (Ed).
Video Feature
Sudden Unexpected Infant Death
Sudden Unexpected Infant Death
Black Toenail sign in MELAS Syndrome (mitochondrial encephalopathy with lactic acidosis and stroke-like episodes)
MELAS is a genetic disorder (maternal inheritance - mtDNA) that results from mutation in one of several genes found in the DNA of mitochondria of the maternal ovum (sperm cells do not contribute to mitochondria in the developing embryo). Signs and symptoms (particularly involving the central nervous system and muscles) often appear in childhood after a normal period of growth and include muscle weakness and pain, recurrent headaches, loss of appetite vomiting and seizures. Many have single or multiple stroke-like episodes which damage the brain. Most have lactic acidosis.
A database study from two children's hospitals searched through brain magnetic imaging studies for likely MELAS patients. 124 studies from 14 MELAS patients (average age 16 years) were found. These revealed that gyral necrosis (the black toenail sign) is a common imaging feature which correlates with the disease duration.
Second hand smoke exposure and preclinical markers of cardiovascular risk in toddlers

A cross-sectional study of 139 children (2-5 years of age) exposed to second hand smoke (as assessed by hair nicotine levels) utilized a variety of clinical and research markers to assess cardiovascular risk status.
Controlling for a number of variables, it appears that high hair nicotine levels correlate directly and adversely with blood pressure and serum C - reactive protein and inversely with serum high-density lipoprotein cholesterol, and endothelial cell progenitor cell prevalence.
"Second hand smoke exposure in the very young has a detectable relationship with severe markers of cardiovascular risk, long before the emergence of clinical disease".
Two-thumb encircling technique over the head (OTTT) of patients for lone rescuer infant cardiopulmonary resuscitation (CPR)
A mannequin simulation of a 3-month old baby being transferred in an ambulance requiring CPR (for 2 minutes) compared the conventional two-finger technique (TFT) (plus bag-valve mask ventilation) to the OTTT technique for the lone rescuer.
The-over-the-head, two-thumb encircling lone rescuer CPR technique for a young infant results in greater depth and rate of compression and shorter hands off time than the conventional TFT. This may be a suitable technique for cardiac arrest during ambulance transport (or for any other lone infant rescuer CPR situation; Ed).
Case Report: Pediatric Drug Adverse Reaction

Multiple drug use has increased dramatically over the past few years with significant complications not infrequently occurring.
Of interest to pediatricians and families is the report of a 2 yr old child (only medication: a daily multivitamin fortified with iron) who, having presented 3 days prior to an Emergency Department for fever and given cefdinir (Omnicef) for pneumonia, subsequently (3 days later) returned having developed what appeared to be bloody stools. Physical examination, stool culture and testing for occult blood were all negative. 
Thoughtful medical students (Rebecca Hunt/Stephanie Montarroyos and Kenneth Wojnowski-personal communication) utilized the Naranja Nomagram (a questionnaire developed to determine the likelihood of a drug related adverse reaction) to identify the red stool and discovered that the cause was probably a rare and benign drug association between the use of cefdinir and an iron containing vitamin. Once the iron was discontinued, stools returned to normal.
Oral ingestion of an iron compound and cefdinir may present with what appears to be bloody stools.
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