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Cyclic vomiting syndrome (CVS) in children
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Cyclic vomiting syndrome first described in children by Samuel Gee in 1882 is a chronic functional disorder of unknown etiology characterized by recurrent vomiting that is associated with increased adrenocorticotropic and antidiuretic hormone levels during attacks. Prognosis and treatment remain unclear.
A 5 year follow up study of 25 patients with CVS (mean duration of the disorder 66 months) indicates that while 44% develop migraines, most patients recover completely.
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Long-term outcomes of pulmonary hypertension (PH) in preterm infants with bronchopulmonary dysplasia (BPD)
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A retrospective medical records review of 16 preterm (<32 weeks) infants diagnosed with moderate to severe BPD and PH at 3.3 months (mean) (with PH improving after 12.3 months) was utilized to assess long-term outcomes. Children were reassessed at age 7.7 years (mean).
28.6% of children born preterm with BPD and PH subsequently have an elevated blood pressure and though conventional 2-D and Doppler echocardiography demonstrate normal ventricular function, subclinical right ventricular dysfunction remains. Long-term follow-up of cardiovascular function is required.
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Comparison of drug acceptance and anxiety between intranasal and sublingual midazolam sedation
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"Both intranasal and sublingual administrations of midazolam are equally effective in reducing the child's anxiety". Children appear to accept the sublingual route more easily.
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Inflammatory indices in meconium aspiration syndrome (MAS)
MAS is linked to inflammation. A study investigated the patterns of inflammatory indices; C-reactive protein (CRP), white blood count (WBC), absolute neutrophil count (ANC) and immature-to-total neutrophil ratio (IT-ratio) in MAS, relating them to disease severity.
Severe MAS (mechanical ventilation for <7 days ), and very severe MAS (high frequency ventilation and ECMO) have higher CRP and IT-ratios during the first 2 days of life.
Neonates with elevation of all four inflammatory mediators have a 20 fold increased risk for very severe MAS.
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Executive functioning and school performance in pediatric survivors of complex congenital heart disease (CHD)
143, 8-16 year old survivors of CHD and their parents/guardians participated in a survey of measures of executive functioning, school competency and school-related quality of life (QoL). All children underwent IQ testing.
Survivors of complex CHD experience greater difficulty with cognitive control (attentional and inhibitory control), working memory, cognitive flexibility, reasoning, problem solving and planning (i.e.
executive functions
) and metacognition (i.e. problems of organization, planning, strategies for learning, self-monitoring and problem solving) all of which impact day-to-day school performance.
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Identification of neonatal hemolysis
Heme breakdown produces equimolar amounts of carbon monoxide (CO); end-tidal ( end of exhalation-ETCO) measurements of which can serve as an indicator of the degree of hemolysis as well as bilirubin production.
Total serum bilirubin (TB) and ETCO levels were determined in 79 late preterm or term newborns between 6 hours and <6 days of life. Hyperbilirubinemia risk was stratified by plotting TB against ETCO levels.
ETCO and TB measurements at post natal age epochs (0-24, 24-48 and 48-76 hours) indicates that near-simultaneous ETCO and TB measurements >75th% accurately identifies hemolytic hyperbilirubinemia.
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Free fatty acid (FFA) suppositories vs. docusate sodium and sorbitol enemas for constipated children
Suppositories frequently use a fatty base designed to melt at body temperature or lower (FFA base). Free fatty acids are usually derived from triglycerides or phospholipids and suppositories can be manufactured from omega-3 fish or cod liver oil etc.
A controlled single-blind study on 77 constipated children aged 1 to 17 years who randomly received either FFA suppositories (low or high dose) or docusate sodium and sorbitol enemas in an Emergency Department, indicates that 81% of children successfully empty their bowel following a high dose FFA suppository (vs 88% for the enema group).
FFA suppositories are effective and less invasive than enemas for childhood constipation.
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