Pediatric Achalasia; incidence, clinical course and quality of life (QoL)
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Achalasia is a rare (0.11 per 100,000/year) neurodegenerative esophageal motility disorder characterized by an inability of the lower esophageal sphincter (LES) to relax. More prevalent in males, common symptoms include progressive dysphasia, vomiting and weight loss; it is frequently misdiagnosed as esophageal reflux. < 5% of patients with symptoms present under the age of 5 years. Definitive diagnosis is made by a barium swallow study and esophageal manometry.
Treatment of Achalasia varies and includes injection of botulinum toxin, oral administration of calcium channel blockers, pneumatic dilatation (PD - 79%) or esophageal myotomy (Heller - 21%), with or without an anti-reflux procedure. Retreatment is more frequently required after PD. When symptoms persist to adulthood, QoL is decreased.
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Association of house staff training with mortality in children with critical illness
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A study of 336,335 patients from 180 centers which compared Pediatric Intensive Care Unit (PICU) mortality in hospitals with a residency only or plus a fellowship program, to those with no pediatric training program indicates that PICU care provided in hospitals with training programs have improved survival rates (in spite of caring for more complex and sicker patients).
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Parvovirus B19 (PVB19) myocarditis in children
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A retrospective review of 17 children (median age 1.3 years; range 04-15.4 years) who presented in severe new onset cardiac failure from PV B19 myocarditis indicates:
1. Presentation follows a short prodromal illness (less than 48 hours).
2. All non-fulminant cases survive (patients with ST segment elevation die) with complete recovery of cardiac function in 12 months (median) in 65% of children.
3. "PVB19 can cause a devastating myocarditis in children".
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Treatment with oral immunotherapy (OIT) for children with cow's milk allergies (CMA)
An original study of 26 children with CMA who completed a six month escalation study of OIT found 89.3% using milk daily at 12
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| Treatment with oral immunotherapy |
months and 85.7% at 36 months. The present study evaluated the outcome seven years later. It appears that seven years after OIT for CMA 58.3% of children continue to use milk or milk products daily.
Oral immunotherapy for CMA allergy appears to be both safe and effective in desensitising school aged children with CME.
Acta Paeditriaca
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Predicting the presence of adjacent infections in septic arthritis in children
Osteomyelitis, subperiosteal abscesses and intramuscular abscesses are frequently associated with septic arthritis.
Variables highly predictive of adjacent infection in septic arthritis in children (for which a MRI would be helpful) include three of the following:
1. Age (above 3.6 years).
2. C-reactive protein level >13.8mg/l.
3. Duration of symptoms > three days.
4. Platelet count <314,000/micro UL.
5. An absolute neutrophil count >8,600.
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Outbreaks of invasive Kingella kingae (KK) infections in closed communities
"KK is a species of gram-negative coccobaccillus found in the throat of young children and transmitted from child to child. Clinical presentation is often subtle with a history of stomatitis or upper respiratory tract infection. It is best known as a cause of septic arthritis, osteomylitis, spondylodiscitis, bacteremia and endocarditis".
An epidemiologic study of preschool-aged children from four day-care facilities in which a cluster of Kingella cases was found, and who had oropharyngeal cultures performed on all contacts, indicates that 54.5% of asymptomatic children may carry the outbreak strain with 43.7% of younger children (<24 months of age) being more frequently colonized.
Clusters of invasive KK infected patients characterized by sudden onset, high attack rate and wide dissemination can occur in day care facilitates. A high index of suspicion particularly in younger children, is recommended.
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Early neonatal hydrocortisone and preschool neurodevelopment.
A neurodevelopmental study at 5-7 years of age of 51 infants (birth weight 501-1,205gms; gestational ages 23-30 weeks) who received mechanical ventilation during their first 24 hours and either hydrocortisone or a placebo for 10 days, indicates that mean full-scale and performance IQ's are significantly lower, with mild to severe neurological dysfunction noted in the hydrocortisone treated group. Further study is required.
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