Fussing and crying duration, and prevalence of colic in infants
A systematic literature search of many debases measuring outcome of total fussing/crying times during 24 hours at age 1-2 weeks, 3-4 weeks, 5-6 weeks, 8-9 weeks and 10-12 weeks indicates no statistical evidence for a universal crying peak time at 6 weeks of age; rather fussing/crying time is stable (117-133 minutes per 24 hours) in the first 6 weeks of life, decreasing to 68 minutes (mean) by 10-12 weeks of age. Colic is more frequent during the first weeks of life and rare after 9 weeks of age.
Is there a deficit after non-operative vs. operative treatment of a shortened midshaft clavicular fracture in adolescents?
A retrospective comparative study of adolescents (average age 14 years) with displaced midshaft clavicular fractures and >15mm of shortening treated operatively (plate fixation) or non-operatively indicates that both treatments have excellent outcomes with no subjective or objective differences noted between treatment groups.
Positive expiratory pressure (PEP) for the treatment of acute asthma exacerbations
A prospective control trial of 52 children with a moderate to severe asthma exacerbation randomized after completion of initial albuterol/ipratropium/ corticosteroids to receive either a brief single administration of PEP or not, indicates that this procedure does not appear to improve clinical severity, Emergency Department length of stay or disposition.
Statin-associated myopathy in a pediatric preventive cardiology practice
A study of 1,501 patients seen over 3.5 years where statins were or were not administered, where pre and post-statin levels and serum creatine kinase (CK) were measured, indicates that children on statins do not appear (in this study) to have increased mean CK levels compared to those not on statins, with mean pre and post-statin levels not differing (in those children with high CK levels no muscle symptoms or rhabdomyolysis was noted).
Pediatric patients using statins do not appear to have increased CK levels nor is there a significant increase in CK levels during treatment. Measuring CK levels without symptoms appears to be of very limited value.
Predicting time to full enteral nutrition after significant bowel resection
Normal bowel lengths in babies is dependent on gestational age (small bowel length almost doubles in the last trimester), weight, and the baby's length at time of surgery.
Parental nutrition (PN) while lifesaving in many instances contributes to significant morbidity after bowel resection.
A retrospective study evaluated 71 children who were on PN for >6 weeks after intestinal resection (for necrotizing enterocolitis, intestinal atresia or gastroschisis) and successfully weaned, to determine factors contributing to full enteral feeding.
PN time appears independent of the etiology of intestinal loss or location of anastomosis; but is strongly associated with small bowel length/percent of expected length based on gestational age. In general, children with 51-75% of their small bowel are dependent on PN for approximately one year while those with 25-50% require PN for at least two years.
Pleurectomy vs. pleural abrasion for primary spontaneous pneumothorax (PSP) in children
A pneumothorax is defined as a collection of air found in the pleural cavity between the visceral and parietal pleura. It is characterized as either spontaneous (primary-idiopathic or secondary to lung disease) or due to trauma. While uncommon in children it can be life-threatening requiring urgent surgical intervention. An initial episode is frequently managed with a chest tube; recurrent episodes usually require bleb resection and either pleurectomy or pleural abrasion.
A study of 64 operations on 52 children (mean age 15.7 years; mostly males) for PSP who underwent lung resection with either no pleural treatment, pleurectomy or pleural abrasion indicates that recurrence is significantly lower in those children who have pleurectomies.
Cord blood biomarkers of placental maternal vascular underperfusion (MVU) and the development of bronchopulmonary dysplasia - associated pulmonary hypertension (BPD-PH)
191 premature infants enrolled in a longitudinal cohort study from 4 gestational age strata had 15 cord blood factors measured from a human angiogenesis panel and compared them to placental histological MVU. Further evaluation examined association with BPD and PH.
Cord blood placental growth factor (PLGF), granulocyte-colony stimulating factor (G-CSF) and vascular endothelial growth factor-(A) are decreased with MVU and BPD-PH.
It appears that measuring cord blood angiogenic factors may serve as predictors of BPD-PH.
