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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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March 9, 2022 | Volume 13 | Issue 10 |
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Association between screen-time exposure in children at 1 year of age and Autism Spectrum Disorder (ASD) at 3 years of age |
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Etiologies for the development of ASD include congenital factors (like genomic mutations) and prenatal, perinatal and neonatal risk factors.
“Abnormalities in brain morphology and function have been observed in children with ASD from early childhood”.
Recently reports suggest duration of screen-time, brain morphology and ASD characteristics may be related. Guidelines from the World Health Organization and the American Academy of Pediatrics recommend that children should not be exposed to screen-time until 1 year or 18 months of age (respectively) because of the potential of adverse effects.
A mother-child cohort questionnaire study of 84,030 dyads examined the association of screen-time/day duration in children 1 year of age, and the development of ASD at 3 years of age.
With “no screen-time” as the reference, screen-time in boys <1 hour/day increases ASD risk 1.38 times; 1-<2hours, 2.6 times; 2-<4 hours, 3.48 times and >4 hours, 3.02-fold. (For girls no association between infant screen-time and ASD symptomatology is found).
Longer screen-time in boys at 1 year of age is associated with significant increases in ASD prevalence at 3 years of age. Excessive screen-time should be discouraged.
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Read the full article at JAMA Pediatrics
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Vitamin K and the Newborn Infant |
In spite of the American Academy of Pediatrics (AAP) recommendation (1961) that an intra-muscular (IM) injection of Vitamin K be given to all newborn infants as prophylaxis to prevent Vitamin K deficiency bleeding (VKDB – previously referred to as Hemorrhagic disease of the newborn) and characterized by its time of presentation (“early onset”, “classic or late onset”) VKDB incidence “appear to be on the rise” (attributable to parental refusal and decreased efficacy of alternate methods of administration).
The Committee on Fetus and Newborn, Section on Breastfeeding, Committee on Nutrition of the American Academy of Pediatrics has a issued new (February 2022) policy statement on Vitamin K and the newborn infant which outlines the historical background to VKDB, discusses Vitamin K prophylaxis of the newborn infant, dosing for preterm infants, the breast fed infant, parental refusal and techniques to increase Vitamin K acceptance.
In summary the AAP recommendations include:
- Vitamin K should be given to all newborn infants weighing >1500g as a single IM dose of 1mg within 6 hours of birth.
- Preterm infants <1500g should receive a single 0.3mg/kg-.05mg/kg IM of Vitamin K (an intravenous dose is not recommended for preterm infants).
- VKDB should be considered in any infant bleeding in the first 6 months of life (especially if breast fed and even if Vitamin K given prophylactically).
- Pediatricians/others must be aware of the benefits, and risk of refusal of Vitamin K prophylaxis and convey these to the infants’ parents/caregivers.
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Acute abdomen in Multi-system Inflammatory Syndrome in children (MIS-C) |
“MIS-C, a rare severe complication of SARS-CoV-2 infection, has been recently reported to mimic an acute abdomen and lead to surgical interventions…”.
A systematic review of 385 children with MIS-C (from 38 studies) indicates that prominent gastrointestinal (GI) symptoms occur in 60.5%, and “acute abdomen” is diagnosed in 30.9% of children with GI symptoms. 76.4% of diagnoses are non-surgical (mesenteric lymphadenitis, terminal ileitis/ ileocolitis, ascites and paralytic ileus); 48.6% have a laparotomy (unnecessary in 51.4%) with true abdominal emergencies (appendicitis/ obstructive ileus) occurring in 23.6% of children.
While children with MIS-C often present with an acute abdomen, most not requiring surgery, surgical complications do occur which necessitates a high index of suspicion.
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Is age during bronchiolitis the most important prediction of post-bronchiolitis outcome? |
“The risk of asthma is increased in children who have suffered from bronchiolitis in infancy and/or from wheezing associated with a lower respiratory tract infection (LRTI) in early childhood”. A number of factors however appear to influence this risk of asthma in later childhood, e.g., asthma in the mother.
The age of the infant is associated with clinical findings of bronchiolitis – severe cases occurring in infants <3 months of age tend to have more clinical signs of a viral pneumonia rather than wheezing (and atopy is uncommonly associated with it).
Respiratory Syncytial Virus (RSV) predominates in bronchiolitis in infants <6 months of age while Rhinovirus is more frequently diagnosed in children >12 months of age, who have different outcomes.
Maternal and paternal smoking impacts differently on later asthma presentation.
From 32 original articles (299,844 infants/children) on infant bronchiolitis (<24 months of age) which investigated by age (<10 years, >10 years) outcomes, geographic region and by quality of the study, it appears the bronchiolitis increases the risk of subsequent asthma (across all subgroups) 2.46-fold (average).
Rhinovirus induced bronchiolitis more commonly results in asthma at 7.2 years (median – 70.0%) vs. RSV (10.0%) and at 18.5 years.
There are a number of risk factors which influence post-bronchiolitis/asthma outcome. Age, plus type of virus, maternal history of asthma and parental smoking are all important risk factors which require individual assessment to identify the effects of bronchiolitis on the subsequent development of asthma during childhood.
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Prevention and treatment of Lyme disease (JAMA Clinical Guidelines Synopsis) |
“The prevention and treatment of Lyme disease varies depending on the clinical presentation. Antibiotic therapy remains the cornerstone of management however robust data demonstrating the most efficacious, and cost-effective antibiotic, dose, route of administration and duration are limited”.
While differences exist between treatment recommendations by a number of organizations, a fairly recent guideline from the Infectious Disease Society of America (IDSA), the American Academy of Neurology (AAN) and the American College of Rheumatology (ACR) suggests 5 practical approaches which might assist all practitioners (particularly those in high tick areas of the country) in their approach to Lyme disease management.
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Evaluating litigation as a structural strategy for addressing bias-based bullying among youth |
Bullying continues, it is widespread, inflicts immediate and long-term adverse consequences and often disproportionality affects marginalized children, plus it disrupts education, harms mental health and may alter the life trajectory of young people.
A quasi-experimental study (including 1,448,778 students, 38.9% white, mean age 14.6 years) in 499 California High schools) investigated by outcomes of litigation, whether litigation related to sexual-orientation-based harassment and discrimination in schools reduces rates of homophobic bullying.
There is a 23% reduction in the likelihood of bullying in schools where litigation over sexual-orientation has occurred, which spills over into schools of the same district (“backlash”, however may occur where the school avoids legal consequences). (A related Editorial outlines some of the negatives associated with litigation and suggests more robust bullying prevention efforts).
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Clinical benefits of music-based interventions on preterm infants’ health |
From a systematic review from multiple databases of 39 randomized clinical trials that investigated the results of different music-based interventions on the clinical health of preterm infants, it appears that while music intervention is associated with significant improvement in pain relief, improvement in cardiac and respiratory function, weight gain, eating behavior and quiet alert and sleep states are more closely associated with music therapy in the presence of a music therapist.
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What is type 2 diabetes in children? - Dr. Carrillo explains |
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