Sept. 21, 2016
Volume VII | Issue No. 38

Breath-holding spell (PHS) and transient erythroblastopenia of childhood (TEC)
Breath-holding spells occur in approximately 5% of the population, frequently with a positive family history and most commonly between the ages of 6-18 months (unusual before 6 months and after 5 years of age). There is no definitive treatment though trials have demonstrated the efficacy of iron therapy.

A large population-based study of 443,470 children found 321 patients with PHS, 366 patients with anemia, including 41 with TEC. Correcting the anemia in those PHS patients who had TEC resolved the PHS in a number of patients.

Acta Paediatrica

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Effect of intra- and extra- uterine growth on long term neurologic outcomes of very premature infants
Small for gestational age (SGA) preterm babies have subsequent behavioral and cognitive deficiencies.

Poorer postnatal growth is associated with poorer neurologic outcomes in both SGA and AGA (appropriate for gestational age) preterm infants, independent of catch-up postnatal catch-up growth.
Nebulized hypertonic saline (HS) for acute bronchiolitis - the conundrum explained!
While standard inpatient management of bronchiolitis includes giving supplemental oxygen, gentle nasal decongestion, fluid administration to maintain hydration and clinical monitoring and oximetry, "none of these treatment modalities are, or ever will be, supported by high-quality evidence".

Though the use of nebulized hypertonic saline for acute bronchiolitis has been studied for over a decade, conflicting study findings with a wide variety of study heterogeneity and design short comings makes recommending its use problematic.
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Non-steroidal anti-inflammatory drug (NSAID) use without antibiotics for acute viral infections in children

Fever with viral infections in children is common for which acetaminophen or NSAID's (ibuprofen etc.) are frequently administered. NSAID's interfere with the inflammatory response to infection mediated by the prostaglandin and leukotriene pathways, and reduce neutrophil migration and recruitment to the lung with reduced bacterial clearance, potentially worsening the course of an infection.
A multicenter case control study investigated in children 3-15 years of age with acute viral infections any drug use 72 hours following the onset and the risk of subsequent empyema.
Children with viral infections given NSAID's without antibiotics have an increased risk of empyema.

NSAID's may not be first drug of choice for pyretic children with a viral infection.

Accuracy of prenatal detection of tracheoesophageal fistula and esophageal atresia (TOS/OA)

A retrospective study of 53 babies with TOS/OA who had prenatal ultrasound scans (USS) indicates that USS has a 35% positive predictive value (polyhydramnios occurs in 67% of mothers of infants with TOS/OA) with no significant difference in postnatal outcomes in those prenatally or postnatally diagnosed.

Video Feature  
Esophageal atresia
Esophageal atresia
Amyand's hernia: 11 years of experience 
"Amyand's hernia is a rare form of an inguinal hernia which occurs when the appendix is included in the hernial sac and becomes incarcerated. Symptoms mimicking appendicitis may occur".

Experience of Amyand's hernia over an 11 year period indicates:

1% of children with inguinal hernia have Amyand's hernia as an incidental finding.

All (in this report) are boys.

Mean age: 16.7 months (15 days - 8 years).

80.4% are found on the right side.

19.5% undergo emergency surgery for incarceration.

40% have an appendectomy during hernia repair.

Necrotizing enterocolitis (NEC)
From 2 recent studies on neonatal NEC:

1.   As "the role of ischemia in the pathogenesis of NEC remains unclear", an immunohistochemical study of markers of hypoxia was undertaken on intestinal resection specimens from NEC infants and those with spontaneous intestinal perforation (SIP).

Ischemic-positive specimens of NEC are associated with multiple areas of bowel necrosis, later onset, enteral feeding and pneumatosis (ischemia-negative specimens are from short-segment NEC with perforation. This group of patients have a clinical profile similar to SIP infants).
Better categorization of different types of NEC may enhance preventive and treatment strategies.
2.    It appears that feeding extremely low birth weight infants (ELBW) human milk is associated with a lower risk of NEC.
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