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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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October 20, 2021 | Volume 12 | Issue 42 |
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Safety and immunogenicity of a 20-valent pneumococcal vaccine in healthy infants in the US |
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Pneumococcal disease from bacteria Streptococcus pneumoniae is acquired buy inhalation of the organism, leading to colonization of the nasopharynx (50-60% of children carry the bacteria asymptomatically); invasion of local tissues and bloodstream spread leading to ear infections, pneumonia, meningitis and potentially death. Disease prevention occurs best following vaccination.
At present there are 2 types of vaccine; Pneumococcal conjugate vaccine (PCV13 – Prevnar) which contains 13 serotypes of pneumococcal bacteria antigen and Pneumococcal Polysaccharide vaccine (PPSV23 – Pneumovax) which is primarily given to adults (there are >95 pneumococcal serotypes identified by a unique polysaccharide capsule). The CDC recommends PCV13 vaccine be given to infants at ages 2, 4, 6 and 12-15 months. Expanding the serotypes in vaccines may further reduce disease burden.
A double-blind, active control study of 460 infants randomized to receive either a 4-dose series of PCV20 or PCV13 at 2, 4, 6 and 12 months of age compared local reactions, systemic events/adverse incidents and immunogenicity.
“Administration of PCV20 to US infants is well-tolerated with a safety profile and induced serotype-specific immune response similar to PCV13”.
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Read full article at Pediatric Infectious Disease Journal
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Kawasaki Disease (KD) associated with pulmonary involvement (PI) in infants |
KD is a rare, acute, self-limited, multi-systemic vasculitis of unknown cause that occurs most often in boys <5 years of age, of any race or ethnic group (though more commonly seen in East Asian or Asian ancestry). “Pulmonary involvement has been reported in case reports and a limited number of small case series”.
From a retrospective matched cohort study of children with KD and KD-PI which evaluated clinical manifestations, laboratory parameters, radiological findings, management and prognosis, it appears that 14% of children with KD present with KD-PI (they have higher Kobayashi scores – a clinical prediction model for IVIG resistance which includes 7 variables,; age, days of illness at presentation, serum sodium, % neutrophils, C-reactive protein, AST and platelet count) and have abnormal chest radiography (peripheral consolidation – 97%; localized pleural thickening – 73%; lobular septal thickening – 70.6%; ground-glass opacity – 55.9%; linear opacity – 35% and pleural effusions – 20.6%). Children with KD-PI do not appear to have an increased incidence of coronary artery abnormalities.
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Restorations vs. stainless steel crowns in primary molars |
A retrospective split-mouth study evaluated (in 988 primary molars) treatment outcomes (over mean: 22 months) of multi-surface caries in primary molars treated either with intra-coronal restorations (within the crown portion of the tooth) or stainless steel crowns.
In children <4 years of age more aggressive treatment of multi-surface caries with stainless steel crowns enhances tooth survival (92.8% vs. 80.0%) and should be considered as conservative treatment leads to an increased need for retreatment.
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Duration of breastfeeding and intelligence of children |
A pairwise meta-analysis from 8 electronic databases which utilized 15 studies to assess the impact of breast feeding on the intelligence of 12,316 children, indicates that breastfeeding for <6 months results in an IQ 4% above average, while those breast fed for >6 months have a 6% higher IQ than those who have never been breastfed.
Breastfeeding appears to enhance the intelligence of children, more so for those breastfed for >6 months.
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Life with pediatric home ventilation: Expectations vs. experience |
A purposeful sampling of 20 families/parents who chose home ventilation for their child (within the last 5 years) which examined patterns of family expectations and outcomes, indicates that while most worry about medical management they are significantly unprepared for the extensive changes to their home life (isolation, altered relationships with family/community, effects on siblings, financial strain and the need for physical changes to their homes).
“Success of home ventilation largely rests with the families’ care”; family expectations for home life adaptations must be clearly evaluated, enunciated and post-discharge support augmented.
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Course and clinical features of COVID-19 in hospitalized febrile infants up to 60 days of age |
“Minimal data exists regarding the severity of COVID-19 in febrile infants under 60 days of age”.
From a real-time prospective surveillance network for COVID-19 that included 20 of the 26 hospitals in Israel which identified 75 febrile young infants <60 days of age of whom 60% were female (median age 28 days: range 8-56 days) and 84% had no previous medical history, 29% presented with respiratory symptoms and 96% had mild illness. Outcomes are excellent with no complications or fatalities reported.
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Acquired syphilis by non-sexual contact in childhood |
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Syphilis is a worldwide public heath concern today with syphilis cases continuing to increase recently. Syphilis is mostly a sexually transmitted disease (STD) caused by Treponema pallidum (family spirochaete), a gram negative helically shaped flat and wavy (corkscrew) bacterium (with a genome of 1.14 million base pairs -small!). Infection in children may occur vertically by transplacental spread from mother to baby during the later stages of pregnancy (Congenital syphilis), sexually Acquired (following abuse or infrequently sexual activity) or more commonly (23%), Acquired by transmission during delivery or through caregiver/family contact (via saliva during breastfeeding, fondling, kissing, mouth cleaning of feeding bottle nipples or pacifiers, bathing, utensils, etc.). Clinically infections present in 3 phases; a Primary painless sore (Chancre :10-90 days post infection) with lymphadenopathy (frequently missed) which heals after 3-6 weeks with or without treatment; a Secondary phase with a rough red/brown rash appearing over the palms/soles of feet or trunk with fever, sore throat, lymphadenopathy, joint/muscle pain and kidney and liver localization. If untreated this progresses to late stage Tertiary syphilis with damage to the brain, heart, eyes, bones and skin.
A prospective cohort study of 24 children with syphilis (mean age at diagnosis 4.2 years) examined demographics, clinical findings and laboratory data.
Most cases of syphilis in children are diagnosed with the appearance of the secondary skin rash (79.2%) and arise from overcrowded homes following contact with a family member positive for Treponema (29.5%).
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"BRUE: Current Recommendations"
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