October 1, 2014 Vol. V, Issue 40

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Safety of medicines used in ADHD: a review of published prospective clinical trials.

An extensive bibliographic search using a variety of databases to evaluate prospective studies which examined the incidence of drug adverse events (AEs) in children with ADHD, indicates that treatment-related AEs range from 58%-78% with discontinuation of the drug/s occurring in 8%-25% of children. Few studies however evaluate the long-term safety of drugs for ADHD.

Archives of Disease in Childhood

Propranolol for severe infantile hemangiomas (IH).

Infantile hemangiomas are benign vascular neoplasms that increase in size early, followed frequently by spontaneous resolution. 60% of them are found on the head and neck, and are usually focal, well circumscribed and <5cm in size. A small percent of complicated infantile hemangiomas need early, safe and effective systemic treatment.

Propranolol is sympatholytic non-selective beta blocker which has been used off label since 2008 for IH patients. Recently the FDA has approved an oral formulation for those patients requiring systemic therapy.

A retrospective review of 207 pediatric patients with complicated IH treated with systemic propranolol indicates that this therapy is highly effective and "nearly always safe" (no side-effects produced requiring discontinuation of therapy).

Acta Paediatrica

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Bowel preparations for colonoscopy.

"Inadequate bowel preparation for colonoscopy can result in missed lesions, cancelled procedures, increased procedural time and a potential increase in complication rate". Finding the ideal preparation regimen for pediatric colonoscopy remains elusive.

A study of 299 children aged 2-18 years referred for elective colonoscopy were utilized to examine and randomly compare one of four regimens following which an assessment was made as to colon cleansing, tolerability, acceptability and compliance.

Low-volume polyethylene glycol (PEG) preparations appear to be as effective as alternative high-volume regimens.

Pediatrics

Video Features (via YouTube)

ADHD Drug Safety Featuring David W. Goodman, MD

Experts Reevaluate ADHD Drug Study

Initial oxygen saturation values can predict the need for hospitalization in children with mild wheezing.

It appears from a review of the records of 539 children aged 6 months - 16 years who presented to an emergency department because of wheezing during a respiratory infection, that an initial oxygen saturation value >93% separates those that can be defined as having "mild disease" (hospital stay <48 hours) from those requiring greater amounts of hospital management.

Acta Paediatrica

Is the use of heated, humidified high-flow nasal cannulas (HHHFNC) in the preterm infant, appropriate?

Humidified high-flow nasal airway respiratory support is a method of delivering a high minute volume of humidified respiratory gas heated to near body temperature via a nasal cannula. It has been used in the NICU to prevent endotracheal intubation, decrease the risks of retinopathy of prematurity and other forms of oxygen toxicity. Little data exists as to its purported mechanism of action and/or levels of safe flow; variations of HHHFNC produced are common.

A literature review of randomized trials of HHHFNC use comparing it to nasal continuous positive airway pressure delivered to premature infants following extubation, indicates that HHHFNC does not improve reintubation rates.

Acta Paediatrica

Functional hyposplenism is an important & underdiagnosed immunodeficiency condition in childhood.

Functional hyposplenism is a condition that occurs associated with many diseases. In pediatric hyposplenism/asplenism splenic phagocytic activity is reduced or absent resulting in a defective response to infectious bacteria (particularly encapsulated organisms).

A study of 34 children diagnosed with functional hyposplenism/asplenia (following persistent thrombocytosis and recurring infections) identified immunodeficiencies, autoimmune diseases, malignancies and genetic disorders as associated conditions, with no correlation between the presence of Howell-Jolly bodies in blood smear and disease severity. Spontaneous normalization occurs in 40% of patients.

Acta Paediatrica

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