Preventive effects of motorcycle helmets on intracranial injury
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A cross-sectional observational study of 495 patients with severe trauma seen in an Emergency Department, 21% of whom wore helmets at the time of a crash and 51.7% having intracranial injuries, indicates that while those wearing motorcycle helmets are less likely to have intracranial injury there is no difference in in-hospital mortality.
Motorcycle helmets reduce intracranial injury particularly in low-speed (<30km/hour) motorcycle crashes, however, they don't appear to affect mortality.
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Nebulized hypertonic saline (HS) for hospitalized patients with moderate to severe bronchiolitis
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An open-label multi-center randomized controlled trial comparing nebulized HS to normal saline treated infants with acute bronchiolitis due to RSV, indicates that HS does not significantly reduce length of hospital stay.
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Ghrelin and obesity in young (4-6 years old) children
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Ghrelin is one of the "hunger" hormones released in the stomach which determines appetite - blood levels normally decrease during and after a meal.
Obese young children have reduced ghrelin and increased insulin levels during fasting and after a meal ghrelin levels are suppressed (compared to controls). This indicates that obese children show changes in systems that regulate appetite and energy balance with signs of insulin resistance and dysregulation in hunger-related hormone levels at an early age.
Intervention for early childhood obesity appears essential.
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Behavior management of Avoidant/Restrictive food intake disorder (ARFID)
Avoidant restrictive food intake disorder is a new eating disorder diagnosis introduced in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in 2013. Symptoms include restriction or avoidance, loss of appetite/interest, fear or discomfort, pain, choking, vomiting or feelings/sensory discomfort with some foods. These result in inadequate food intake causing significant weight loss (or poor weight gain), malnutrition and/or interference in psychosocial functioning. Body image disturbance is NOT associated with this diagnosis ; it is perhaps the least understood of the eating disorders. Occurring typically in younger boys it is frequently associated with previous eating difficulties, co-morbid conditions like food allergies, gastrointestinal symptoms and psychological conditions (like anxiety, pervasive developmental or learning disorders and depression).
Two case reports of children with ARIFD and common presentations remind us that while presenting clinical features like malnutrition require attention the focus of management should be on underlying psychological issues which are best managed by focused behavior interventions of the eating pattern with consequences and rewards, and family therapy focused on communication.
Clinical Pediatrics
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Acute exertional compartment syndrome (AECS)
"Compartment syndrome is one of the true orthopedic emergencies." Independent of the initial insult, it results from a rapid accumulation of fluid within a closed fascial compartment, raising tissue pressure, decreasing perfusion pressure and muscle and nerve ischemia. The diagnosis is usually made clinically; frequently with an increased need for analgesics in a child following a tibial shaft, supracondylar humerus fracture or floating elbow injury.
An AECS is a rare presentation of an acute compartment syndrome occurring
without injury which can lead to a delay/missed diagnosis resulting in a lower leg compartment pressure of mean: 91mmHg (normal: 13-16mmHg) with substantial muscle necrosis and morbidity.
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Trans-nasal flexible bronchoscopy in wheezing/poorly controlled asthmatic children
An acute wheezing episode is common in the first few years of life (33% of children before 4 years of age) and while many respond to bronchodilators and are diagnosed as asthma; with recurrent wheezing, other causes should be considered.
A retrospective review of 94 children (3 months - 18 years) who underwent flexible bronchoscopy for persistent, frequently recurring, atypical or poorly controlled asthma indicates that anatomic causes for wheezing are found in 45.7% causes include laryngeal cleft (17%) and tracheobronchomalacia (33%) and result in management changes in 64% of patients.
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The effect skin-to-skin care (SSC) on cerebral oxygenation during nasogastric feeding of preterm infants
Skin-to-skin care" or "Kangaroo mother care" has been used in resource-limited countries where neonatal mortality and infection rates, etc. are high. Intermittent SSC is now being offered in resource-rich countries as it appears to have multiple maternal and infant benefits. In the neonatal intensive care setting it is prudent to ensure continuous cardiovascular monitoring, airway patency and stability of all access devices, even when there appears to be physiological stability.
An analysis from two crossover studies comparing cerebral oxygenation, heart rate and oxygen saturation during skin-to-skin or normal incubator care in infants 26-30 weeks gestation indicates that with gavage feeding in both situations, cerebral oxygenation, heart rate and oxygen saturations remain stable.
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