Sept. 23, 2015
Volume VI, Issue No. 38

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Does maternal perinatal probiotic supplementation alter the intestinal microbiota of mother and child?
Allergic dermatitis in infancy appears to be ameliorated by perinatal maternal probiotic supplementation.
A randomized, double-blind trial of women receiving probiotics (or placebo) from 36 weeks of gestation to 3 months postnatally while breast feeding indicates that though at three months after birth stool samples from mothers receiving probiotics have increased probiotic bacteria, only L. rhamnosus colonized the children's bowel. At 1 and 2 years no differences from the placebo group are found.
LASER-Doppler treatment (LDT) of port wine stains (PWS) in infants
PWS are capillary malformations found in approximately 0.3% of newborn infants; LDT is the treatment of choice and requires several sessions; LASER-Doppler imaging (LDI) is a non-invasive methodology to document capillary perfusion.

A study of 20 children with PWS treated with pulsed dye Laser, and studied by LDI after three treatments, indicates that capillary vascularization decreases by 56% and that LDI can measure the efficacy of LDT allowing for "as needed" modifications and/ or improvements in treatment.
Use of Computed Tomography (CT), Magnetic Imaging (MRI) and Ultrasound (US) in the diagnosis of acute appendicitis in children (APC)
The use of CT of the abdomen in children with suspected appendicitis remains the most common imaging modality. Anxiety over ionized radiation exposure in children however has led to the search for alternative diagnostic tools.
A review of a 30 month institutional experience with the use of MRI (without contrast or sedation) in diagnosing APC indicates positive diagnostic accuracy and good outcomes.
A second study evaluating US to diagnose suspected APC presenting in the ED indicates that US is increasingly being used without detrimental clinical effects.

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Infantile colic and subsequent motor development
Colic is a common, self-limiting disorder of well-fed, healthy babies occurring equally among male and female infants and generally presenting during the first three months of life (babies cry for >3hours/day; 3days/week for 3 weeks or longer). In spite of many theories of causation, no specific etiology has been identified (infants of mothers who smoke during and after pregnancy appear to be at greater risk).
A large (1,879) Danish birth cohort of 7 year old children with a history of colic examined for developmental coordination disorder (and compared with unaffected peers) found no evidence of a strong association between a history of colic and impaired motor function.

Long-term follow-up of placental transfusion (delayed cord clamping - CC) in full-term infants
In the past fears of maternal hemorrhage, symptomatic polycythemia and hyperbilirubinemia have delayed the implementation of late (30 seconds to 2 minutes) CC, in spite of the fact that since 2000 no randomized clinical trial has indicated any such occurrences. Delayed CC in both preterm and full-term infants is associated with significant short-term benefits which include higher hemoglobin levels after birth and increased iron stores to 6 months of age. Iron deficiency during this critical period of brain growth may well affect normal oligodendrogenesis and myelination. As concern exists as to the long-term outcomes of CC, resistance to its implementation has persisted.

A study of 400 healthy full-term newborns with late CC, neurodevelopmentally assessed at four years of age indicates no detrimental effects (with potential beneficial effects on brain development). It appears that late CC should be incorporated as "part of the delivery and resuscitation pathway".

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Early Onset IBD
Early Onset IBD
Very early-onset (VEO) inflammatory bowel disease (IBD)
It appears that in children with VEO-Crohn's disease (CD) and VEO-Ulcerative colitis (UC), those with VEO-CD usually present with a mild colonic phenotype which changes to an ileocolonic clinical presentation at 6-10 years of age. Five years after diagnosis both groups of VEO-IBD will have received corticosteroids and immunomodulators indicating a more severe disease process compared to that seen in all age groups.
Bilateral retinal hemorrhages (RH) in an infant following a fall
"Retinal hemorrhage may be seen in many disorders, in particular abusive head trauma" (approximately 85% of cases) and are usually numerous covering many layers of the retina and frequently involving the entire retinal surface.
Even in severe accidental head trauma (car accidents or falls from a second story level) retinal hemorrhages are uncommon and when present are usually confined to the posterior pole.
An interesting case report of an ex-premature infant aged 4 months who fell from his father's arms on to a carpeted floor, landing head first and subsequently found to have a skull fracture, thin subdural hematoma and small subarachnoid hemorrhage with multiple intra retinal hemorrhages (and normal clotting studies) indicates that though rare short falls may result in bilateral retinal hemorrhages of moderate severity in infants.
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