April 7, 2021 | Volume 12 | Issue 14
Rate of incidental findings in brain Magnetic Resonance Imaging (MRI) in children
From a cohort study of 11,679 demographically diverse US children aged 9-10 years with no evidence of sensory, intellectual, medical or neurologic disorders, who underwent brain MRI’s, it appears that 21.1% have unexpected incidental findings of which 4% require non-urgent or urgent clinical referral. 


See related video below:
Penn Center for Neuroscience & Society

John A. Detre, MD is Professor of Neurology at Penn and directs Penn's Center for Functional Neuroimaging. He was instrumental in developing ASL perfusion imaging for use with MRI and has worked on a broad array of basic and applied problems in neuroimaging.
Socio-demographic factors and age-to-specific guidelines for asymptomatic umbilical hernia repair in children
An umbilical hernia is a common condition affecting approximately 800,000 infants in the USA each year with variations around gestational age and degree of African ancestry (Black children are affected approximately 8 times more often than white children). 85% of childhood umbilical hernias will close spontaneously by 4-5 years of age (with complications such as incarceration being uncommon events) and therefore routine surgical repair of an asymptomatic umbilical hernia is not recommended until children reach that age.

A retrospective cohort study of 25,877 children evaluated sociodemographic factors associated with adherence to the age-specific guidelines for the treatment of asymptomatic umbilical hernia in children.

Female children with asymptomatic umbilical hernia from low-income families receiving public insurance are at greater risk for inappropriate early repair of umbilical hernias which may spontaneously close with further observation.


See related video HERE and below:
Umbilical hernia in children:
Causes, symptoms, treatment and surgery
Vulvar ulcers in children (dramatic but self-limiting)
“Acute genital ulceration, also known as a “Lipschutz ulcer” or ulcus vulvae acutum” is an uncommon, self-limiting, non-sexually transmitted condition characterized by the rapid onset of a painful necrotic ulceration of the vulva or lower vagina”. It typically appears in non-sexually active adolescent girls and is often preceded by, or occurs during a viral illness or bacterial infection. Frequently no causative agent is found and the condition has also been referred to as “idiopathic aphthosis."

A retrospective review describes the course of 7 non-sexually active girls (average age 12.25 years) with vulvar ulcers (within the inner surface of the labium minor) presenting within the course of an upper respiratory tract infection. It initially presents as a bullous lesion that ulcerates and is then covered by a black gangrenous scab, which on falling off, leaves a white-based ulcer. This completely heals within 10 days without treatment. Recurrences may occur.
A brief home-based parenting intervention to reduce behavior problems in young children
“Behavior problems are one of the most common mental health disorders in childhood and can undermine children’s health education and employment outcomes into adulthood.” Few effective interventions exist for infants.

A 2, parallel-group, researcher-blind, multisite, randomized clinical trial of 300 eligible families of infants (12-36 months of age) with significant behavioral problems evaluated and compared a Video-Feedback Intervention (1-2 hour sessions every 2 weeks for 12 weeks of a “Promote Positive Parenting and Sensitive/Discipline; VIPP-SD,” - a home visitor program that with videotaping of parent/child interactions emphasizes the importance of parent’s accurately perceiving and responding to a child’s signal, enhances knowledge of child development and teaches the use of appropriate discipline strategies) vs. those families receiving routine community health services.

A home-based video-focused feedback program for families with infants having significant behavioral problems significantly improves infant behavior vs. routine care (with no adverse effects noted).


See related video HERE and below:
Dana Tiller, LPC, outpatient therapist at Clarity Child Guidance Center, explains what parents can do to help their child with challenging behaviors.
Neonatal Lupus Erythematosus (L.E.)
“Neonatal Lupus Erythematosus is a rare autoimmune condition caused by the transplacental passage of maternal autoantibodies, anti-SSA/Ro, anti-SSB/La and less commonly, U1RNP."

An interesting report of an otherwise healthy 3-month-old infant presenting to a pediatric dermatology clinic for evaluation of annular erythematous plaques, present from 2 weeks of age (without any family history or symptoms of any connective tissue disease) outlines the clinical, laboratory, treatment approach and outcome of neonatal L.E.
Trajectory of children’s Executive function after traumatic brain injury (TBI)
“Executive function” is a set of self-regulative cognitive skills that are necessary for control and successfully monitoring of behavior – it includes sustaining attention, inhibitory control/assessing consequences of actions, working memory, reasoning, problem solving and planning for the future. These functions develop by using neural networks that connect the frontal lobe regions with the basal ganglia and are frequently disrupted by TBI.

A prospective, longitudinal, 3-year cohort study of executive functioning in 559 children (ages 2-15 years) with mild, moderate or severe traumatic brain or orthopedic injury (OI) examined patterns of recovery associated with age and injury severity.

Executive function recovery patterns following TBI are similar for boys and girls; recovery is slow, and children do not return to their baseline over a 36-month timeline. Children suffering from severe TBI may worsen after a recovery plateau. Longitudinal reassessment beyond 1 year post injury is required.
Assessment of post-natal corticosteroids for the prevention of Bronchopulmonary Dysplasia (BPD)
From a systematic multi-base review and network meta-analysis of 62 randomized clinical trials involving 5,559 preterm infants (mean gestational age 26 weeks) who were administered a corticosteroid initiated within 4 weeks of postnatal age it appears that while several regimens are associated with a decreased risk of BPD or mortality, a moderately-early-initiated, medium cumulative dose of systemic dexamethasone is the most appropriate corticosteroid regimen for preventing BPD or death at post-menstrual age of 36 weeks. (Quality of evidence is low.)
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COVID-19 - Current Situation in Florida
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Dear Reader:

Though there may be many among you who have undergone immunization against COVID-19, this pandemic may by no means be over. We should be cautious as new mutant strains have arisen which make certainty about the absolute protection afforded by vaccination unclear, their response to treatment uncertain and there is the possibility that the variant viruses may spread even from those who are immunized.

Please continue to take care, wear a mask whenever in public, wash hands well and often, use sanitizer if available, cough or sneeze into elbow and socially distance yourself (preferably at least 6 feet from any person), outdoors, or in a well ventilated area whenever and where ever possible.
 
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Jack Wolfsdorf, MD, Editor
Staff NCH
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