Oct. 7, 2015
Volume VI, Issue No. 40

Exposure to gastric acid suppression and clostridium difficile infection (CDI) in children
A retrospective case-control chart review of 138 children (aged 1-18 years) with hospital or community (outpatient) acquired CDI examined its association with co-morbidities, exposure to gastric acid suppression and antibiotic therapy in the previous three months.

It appears that gastric acid suppression, antibiotic use and an immunosuppressed state are all significantly associated with CDI in both hospital and community patients.

Cognitive dysfunction in adolescents with chronic fatigue
A study involving 120 adolescents with chronic fatigue (average age: 15.4 years) and matched healthy controls (HC) examined neurocognitive function (processing speed, working memory, cognitive inhibition and flexibility and verbal learning and memory) and by questionnaire, demographic data, depression symptoms, anxiety traits and fatigue and sleep problems. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) which measures executive function in children.
Adolescents with chronic fatigue have impaired cognitive functions (compared to HC) predominantly from difficulty in working memory and speed processing.
"Conditional probability" of survival of patients with biliary atresia
"Conditional probability" measures the probability of the likelihood of an event occurring after an initial action/event. For patients with biliary atresia it provides information on prognosis after survival for some time.

Overall median survival for post-Kasai portoenterostomy appears to be 41.2 months. At 5 years post operation, surviving after 1, 2, 3, or 4 years appears to be 50%, 56%, 73% and 93% respectively. Age at operation (>90 days) and post-operative cholangitis are associated with a poorer prognosis.
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Glucocorticoids and hospital length of stay (LOS) for children with anaphylaxis

A study of 5,203 hospitalized children with anaphylaxis was undertaken where patient were stratified by disposition from the Emergency Department (ED), (hospitalized or discharged) and the associations between hospital LOS, steroid administration and in those patients discharged, glucocorticoid administration and subsequent ED visits within three days.  

In hospitalized children with anaphylaxis glucocorticoid administration results in shorter hospital LOS, less epinephrine and less ED revisits within three days.

Journal of Pediatrics 
Comparative effectiveness: dexamethasone vs. prednisone in children hospitalized with asthma

It appears from a large matched cohort study of children hospitalized with a principal diagnosis of asthma, that the use of dexamethasone in treatment results in significant shorter hospital length of stay, and lower hospital and total episode costs (including readmission) compared to those asthmatic children receiving prednisone/prednisolone (with no increase in Intensive Care - ICU - admissions). Dexamethasone appears to be a reasonable alternative to prednisone/prednisolone for non-ICU hospitalized children with asthma

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Appendicitis in children
Appendicitis in children
Single-incision laparoscopic appendectomy (SILA) for simple and complex appendicitis in children

In a retrospective review of 703 patients (mean age 11.8 years) from a single institution who underwent SILA (from August 2009 - November 2013) for the treatment of appendicitis, children were grouped by "early experience", "late experience without surgical trainees" and "late experience with trainees". Further stratification into simple and complex appendicitis was also undertaken.
Operative times with SILA are significantly reduced for both simple and complex appendicitis, however SILA requires a significant learning curve even for the experienced laparoscopist. Trainees do not appear to affect quality outcomes.
Complex neurological outcomes of pediatric supracondylar fractures
Elbow fractures account for about 10-16% of all childhood fractures and structures in the elbow such as nerves, blood vessels and ligaments may also be injured. Supracondylar fractures are the most common type of elbow fracture usually occurring in younger children (<8 years of age) and not infrequently (6-8%) resulting in nerve damage. While most neurological injuries resolve within a few months, follow up of long-term functionality is lacking.
Long-term (ave: 8.6 years) follow up of upper limb functionality after supracondylar fracture with nerve damage in children, indicates that excellent functional recovery occurs in the vast majority of patients, however only 25% of patients with ulna nerve injury, recover fully. Paresthesias are common.
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