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Breastfeeding and postpartum glucose regulation among women with prior gestational diabetes
| "Gestational diabetes mellitus is associated with adverse maternal and fetal outcomes" and increases subsequent risks of type 2 diabetes. A literature search of multiple databases investigated whether breast feeding in gestational diabetic women improved their subsequent glucose tolerance 1 year post-partum.
A cohort study which examined the association between breast feeding, gestational diabetes and subsequent maternal diabetic risk, indicates that maternal breast feeding appears to be associated with a 60% decreased risk for the subsequent maternal Type 2 diabetes. Mothers with gestational diabetes "should be strongly encouraged and supported to breast feed."
Journal of human Lactation
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Association of epidural analgesia during labor and risk of Autism Spectrum Disorder (ASD) in offspring
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From a multi-ethnic population-based clinical cohort that included 147,895 children it appears that ASD is diagnosed at 1 year of age in 1.9% of children delivered vaginally with epidural analgesia vs. 1.3% of matched infants delivered without epidural analgesic exposure (a 37% increase in relative risk after adjusting for potential confounders).
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Effects of fecal microbiome transfer in adolescents with obesity
| Fecal microbiota transplantation (FMT) treatment improves the gut microbiome, enhances production of short chain fatty acids which help maintain epithelia integrity, reduces gut permeability, inhibits Th1 cell differentiation, activity of T cells, leukocyte adhesion, and production of inflammatory mediators.
FMT appears to be an effective treatment option for recurrent Clostridium Difficile infection and individual case reports suggest it has potential benefits in a variety of diseases including obesity. "The gut microbiome plays a role in regulation of weight and metabolism by increasing energy extraction from food, altering energy expenditure, modulating satiety, glucose homeostasis and lipid metabolism in humans." Animal studies suggest FMT could be a treatment for human obesity
A randomized, double-masked, placebo-controlled trial of 87 obese adolescents who received a single course of oral encapsulated fecal microbiota from lean donors (or a saline placebo) to assess its efficacy in obesity indicates that such treatment DOES NOT lead to weight loss at 6 weeks (but does reduce visceral adiposity and decreases pathophysiological metabolic syndrome).
JAMA Network Open
See related video HERE & HERE.
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With COVID-19 among us, please 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 where possible.
Best of luck.
Jack Wolfsdorf, MD, Editor
Staff NCH
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Heavy drinking and development of frontal brain systems in adolescents
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A case-controlled study of 451 adolescents (12-21 years of age) from the National Consortium of Alcohol and Neurodevelopment in Adolescence Cohort examined (over a 4-year period), alterations in adolescent microstructural brain development (using magnetic resonance diffusion tensor imaging ; DTI-a magnetic resonance imaging technique that measures water diffusion between cells) to identify the linkages and structures of white matter tracts in the brain between self-reporting no-to-low drinkers and heavy drinkers in age and sex matched youth.
Heavy drinking in adolescents is associated with significant deleterious white matter major tract disruption/integrity (particularly in the genu and body of the corpus callosum); greater when occurring in younger alcohol drinkers caused by "heightened brain vulnerability" during a period of ongoing brain development.
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Featured Video
via YouTube
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Brain changes during adolescence
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Evaluation of cloth masks and modified procedure masks as Personal Protection Equipment (PPE) for the public during the COVID-19 pandemic
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An interesting comparative study examined the fitted filtration efficiency (FFE) of "Consumer grade masks," i.e.: (1) a 2-layer woven nylon mask with ear loops, aluminum nose bridge and nonwoven filter in place, (2) a cotton bandana folded once "bandit" style, or (3) in a multilayer rectangle, (4) a single layer woven polyester/nylon mask with ties, (5) a nonwoven polypropylene mask with fixed ear loops and (6) a 3 layer woven cotton mask with ear loops - and "Medical procedure masks" with modifications including (1) tying ear loops and tucking in the side pleats, (2) fastening ear loops behind the head with 3-dimensional printed ear guards, (3) fastening ear loops with claw type clip, (4) enhancing the mask/face feel with rubber bands over the mask and (5) enhancing the mask/face shield with a band of nylon hosiery over the fitted masks.
While modifications to improve "Medical procedure mask" fit enhances the filtering capability and reduces inhalation of airborne particles, "Consumer-grade masks" are in many cases nearly equivalent or better than non-N95 respirator Medical mask equivalents.
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Predictors of outcomes in Hypoxic-Ischemic Encephalopathy (HIE) following hypothermia
| "HIE following perinatal asphyxia is the most common cause of acquired perinatal brain injury and may lead to death or long-term neurologic sequelae." Prediction of neurodevelopment outcomes in infants with HIE remains an important challenge as an ability to predict outcomes is essential for parental counseling and intensive care management. While normally a wide variety of neurophysiological and neuroimaging techniques are available to assess the degree of brain injury/ predict long-term outcomes, their prognostic ability may change following therapeutic hypothermia (TH).
A systematic review and meta-analysis of data from a number of sources assessed the diagnostic accuracy of the different modalities being used to predict neurodevelopmental outcomes following therapeutic hypothermia.
While in general different modalities normally used to predict neurodevelopmental outcomes remain good following hypothermia, the amplitude-integrated electroencephalogram (aEEG) performs best at 27 and 72 hours; early (<8 days) conventional magnetic resonance imaging (MRI) performs better than late, and injury to the posterior limb of the internal capsule on MRI or to the thalami on diffusion weighted imaging (DWI) are particularly strong individual predictors, as is an increased lactate/N-acetylaspartate peak on proton magnetic resonance spectroscopy (H-MRS).
Neonatology
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Frequency, timing, risk factors and outcomes of desaturations in infants with Acute Bronchiolitis with a normal initial oxygen saturation
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From a prospective study of 239 infants (<1 year of age) seen at a tertiary care pediatric Emergency Department it appears the desaturations (<90% saturation) occur frequently in most infants during the first 36 hours following bronchiolitis diagnosis whether at home or in hospital, with severity of initial degree of chest desaturations being the only independent risk factor associated with desaturation (desaturations at home do not appear to be associated with hospitalization).
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Featured Video
Nicklaus Children's Hospital via YouTube
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| | Early Intervention is Key in the Management of Infantile Hemangioma with Dr. Duarte |
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