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Nicklaus Children's Hospital Annual Pediatric Postgraduate Course
Miami, FL
Feb 22-25, 2018
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Unusual mucus impaction in an adolescent with severe asthma
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An interesting case presentation of a 14 year old African American male with chronic persistent asthma from 6 months of age who presented with a persistent (one year) chronic left lower lobe infiltrate outlines the differences between mucus hypersecretion and plugging (a prominent feature of asthmatics, children with Cystic Fibrosis and complex congenital heart disease) which uncommonly leads to death, and the relatively rare entity of mucoid impaction with hard mucous casts.
The article well describes the challenges associated with diagnosis and management, and while long is well worth reading as when
mucoid impaction occurs in children it poses a substantial risk to life (Ed.).
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Intestinal microbiota composition in Sudden Infant Death Syndrome (SIDS)
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A case-controlled analysis of fecal microbiology from 44 SIDS cases (and age matched controls) and intestinal carriage of Streptococcus aureus (S. aureus), toxigenic Clostridium difficile (CD) and pathogenic and nonpathogenic Escherichia coli (E. coli) could find no evidence of an association between altered intestinal microbiology and SIDS, nor any evidence to support a strategy to reduce SIDS by targeting intestinal microbiology.
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Impact of maternal gestational hypertension (GH) and the use of anti-hypertensives on neonatal myocardial performance
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A study of 15 term infants whose mother had GH and who underwent assessment to measure left and right ventricular function using echocardiography (compared to a matched control group), within 48 hours of birth indicates that the presence of maternal GH lowers ejection fracture (and other left ventricular function parameters) while right ventricular function appears unaffected.
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Human immunodeficiency virus (HIV); pre-exposure prophylaxis (Prep) for adolescent men
Prep with tenofovir (TFV), disoproxil fumarate (TDF) and emtricitabine (FTC) has been shown to reduce HIV transmission rates by 75% in serodiscordant heterosexual partnerships and up to 99% among men having sex with men (MSM) when taken daily. Approved in 2012 by the US Food and Drug Administration (FDA) for adults >18 years of age, and to obtain approval for younger adolescents, an open label study was undertaken to examine safety, tolerability and acceptability in MSM with a follow up at 4 years.
While most young adolescent men enrolled began taking TDF/FTC (which is well tolerated) with few adverse events noted adherence over 48 months declined with each follow up period.
Adolescents have a number of barriers to Prep adherence (difficulty discussing sexual orientation, sexual history, minority status, unstable housing and substance abuse etc.). A broad-based community wide program involving interdisciplinary and multi-team personnel is required to recognize and manage a Prep care program for at risk adolescent MSM.
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Sugar in infants, children and adolescents; a position paper
The consumption of sugars, (particularly with sugar sweetened beverages e.g. any drink that contains sucrose, high fructose corn syrup, fruit juice concentrates) is unnecessary as there is no nutritional requirement for free sugar. With consumption, there is an increased risk for overweight/obesity/dental caries/possibly type 2 diabetes/cardiovascular disorders and other deleterious health effects.
Intake of free sugars should be reduced to <5% of energy intake (or less) in infants children and adolescents. Sugar should only be consumed in the form of human milk, milk, unsweetened dairy products and fresh fruit, and all liquids with sugar should be replaced by unsweetened milk drinks or water.
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Capillary blood ketone levels as indicator of inadequate breast milk intake
A bed-side study of 585 full term neonates aged 48-95 hours who were breast fed exclusively had blood beta-hydroxybutyrate (βOHB) levels measured, and examined its relationship to percentage weight loss, blood sodium, glucose, pH, pCO2, and base-deficit.
High βOHB levels in breast fed neonates is associated with an inadequate intake of breast milk and may be a useful indicator of dehydration, energy depletion and acid-based imbalance.
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Outcome of renal replacement therapy (RRT) in boys with prune belly syndrome (PBS)
A study which examined outcome data from 88 children/adolescents diagnosed with PBS treated with RRT against children requiring RRT due to congenital obstructive uropathy (COU) and renal hypoplasia or dysplasia (RHT) indicates that outcomes are similar with respect to time on dialysis before transplantation, chance of receiving a first transplant within two years after starting RRT, with however a higher mortality rate.
Pediatric Nephrology
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