Oct. 26, 2016
Volume VII | Issue No. 43

"In-toeing" ("pigeon toe")
In-toeing is characterized by the feet turning inward (instead of pointing straight ahead) when a child walks or runs. While it is usually seen when the infant begins to walk it may occur at various ages (majority <8 years of age).

From a prospective study of 143 fully evaluated children referred to a pediatric orthopedic clinic for "in-toeing", it appears that in most cases in-toeing is a normal variation of development that will correct itself, without casts, braces surgery or any specific treatment.

Management of Acne Vulgaris  
"About 50 million people in the USA have acne. It affects 85% of all adolescents and about 12% of adult women".

An updated version of "Guidelines of Care for the Management of Acne Vulgaris" was published this year by American Academy of Dermatology (American Academy of Dermatology 216, February 15: Zaeinglein AL et al). This and/or the attached reference is a "must read" for all pediatricians (Ed.).


Video: Acne Vulgaris
Effective treatment of Cystic Fibrosis (CF) pulmonary exacerbations 
A retrospective study of 72 CF children treated in hospital for pulmonary exacerbations indicates that post-admission 43% failed to recover their baseline BMI (particularly those with poor growth prior to admission) and have a decreased forced expiratory volume in one second (FEV1) at one year follow-up.
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Extended freezer storage of human milk 
A study which examined pH, bacterial counts, host defense factors, nutrient content and osmolality of freshly frozen (-20C) human milk at baseline and 1, 3, 6 and 9 months, and milk previously refrigerated (at +4C) for 72 hours before storage for 1 - 9 months indicates:

Freezer frozen human milk stored for 9 months is associated with a decreasing pH and bacterial count but with no change in nutrient value or immunoreactive components (with or without prior 72 hour refrigeration).

Clinical presentation of pediatric patients at risk for Sudden Cardiac Arrest

A retrospective review examined the clinical presentation of newly diagnosed pediatric patients with one of four cardiac conditions predisposing to sudden cardiac death (hypertrophic cardio-myopathy, long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT) and anomalous origin of left coronary artery from the right sinus of Valsalva (ALCA-R). 7% presented with sudden cardiac arrest, others were referred on the basis of abnormal or suspicious family history, personal symptom or physical findings.
Children with CPVT have a high incidence of syncope and are most likely to present with sudden cardiac arrest (patients with LQTS and hypertrophic cardio myopathy are frequently referred for family history; ALCA-R patients usually present with chest pain, syncope or sudden cardiac death).

Patient and family history play an important role in identifying children at risk for sudden cardiac death.
Video Feature
Sudden Cardiac Arrest
Sudden Cardiac Arrest
Eating disorders in adolescents and young adult males

Three interesting articles address eating disorders in young males (much of the literature available about eating disorders addresses the topic in females Ed).

The laboratory/clinical characteristics of 33 adolescent males with moderate eating disorders are; abnormalities of complete blood count (10% to 33%); up to 25% may present with abnormalities in blood electrolytes; 5%-10% may have abnormal thyroid function tests and many present with liver function abnormalities. Variations in vital signs (bradycardia and orthostatic blood pressure changes) are frequent and are consistent with malnutrition.

Factors predicting an escalation of restrictive eating in >200 adolescents (mean age 14.5 years) include low self-esteem and depression. Addressing body image and responses to social influences in the short-term, and intervening in family dynamics, focusing on symptoms of low-esteem and depression appears to decrease long-term risk.

Journal of Adolescent Health

Finally as most eating disorders programs are not geared to male management, an article examining "barrier to their care" is well worth reading.

Journal of Adolescent Health
Plastic bronchitis (PB) - management

Plastic bronchitis is a rare disease with a high mortality characterized by tenacious mucus plugs that obstruct small or large bronchi. It is most prevalent following surgical correction of some congenital heart diseases, viral infections, etc. It has been suggested that abnormalities in lymphatic drainage may play an etiological role.

While it may not be possible to cure PB, and multiple treatment have been suggested, inhaled/topical tissue type plasminogen activator (tPA) and/or the use of optical forceps with rigid suction may provide serial relief.

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