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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
header with photos of various children
October 19, 2022 | Volume 13 | Issue 42
Association of Attending a High-Performing High School, with Substance Use Disorder rate and Health Outcomes in young adults
“Numerous observational studies have shown an association between early childhood education and an improved range of health outcomes”.

Younger children moved into a more affluent neighborhood have not only better education but also improved income and behavioral outcomes. Few studies have examined the association between improved Secondary education and health.

A “natural” experiment evaluated health outcomes in 2 comparable groups of 1,270 children in low income neighborhoods in which students were randomly assigned (through a lottery system) to either a “high-performing” High school vs. attending a neighborhood High school (“control group”), with self-reported outcomes of alcohol use disorder, cannabis misuse, delinquent behaviors, physical and mental health and body mass index through age 21 years, documented.

It appears that attending a high-performing public High school is associated with low rates of alcohol abuse (independent of academic achievement), improved physical health and less obesity in males 21 years of age (females however report worse physical health and obesity outcomes with no benefit to mental health outcomes for either group noted).

“Schools are a potent social determinant of health and an important target for future health interventions”.
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Effect of topical antibiotics on duration of acute infective conjunctivitis in children
Conjunctivitis is an inflammation of the eye (also known as “pink eye”) which is often classified as either “Newborn” or “Childhood” conjunctivitis.

Childhood conjunctivitis is often caused by bacteria (Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumonia or Chlamydia trachomatis) though it also may result from a viral infection (e.g. adeno and herpes viruses), chemical exposure or allergies.

Pediatricians frequently prescribe topical antibiotics for childhood conjunctivitis though the evidence for their effectiveness is limited and conflicting.

A clinical trial of 88 children (aged 6 months – 7 years) with acute infective bacterial conjunctivitis, randomized to receive either moxifloxacin eye drops (a Quinolone), a placebo or no intervention, and followed for 14 days evaluated clinical outcomes (measured as the proportion of children with conjunctival symptoms on days 3-6).

Topical antibiotic therapy for acute infective conjunctivitis shortens time to clinical cure from 5.7 days (vs. no intervention) to 3.8 days (placebo eye drops and antibiotics having similar effects).

(A meta-analysis of 584 children with acute infective conjunctivitis treated with antibiotics or placebo indicates superiority of antibiotic eye drops over placebo).
 
Cognitive Behavioral intervention for anxiety associated with food allergy
Food allergies are extremely common in children (approximately 1 in 13 US children), many finding dealing with this challenging and which not infrequently affects their quality of life (QoL).

“Food anxiety occurs when strong nervousness or scared feelings are triggered by the presence of any food, certain foods or in specific situations”. Regardless of cause, food anxiety may result in difficulty concentrating, fatigue, irritability, etc. “Multiple reviews have identified a lack of evidence-based treatments for excessive anxiety in the context of food allergy (FAA) as an unmet need”.

A group adaptation of the cognitive behavioral therapy (CBT) Food Allergy Bravery Program a brief novel manualized cognitive- behavioral based intervention (6 weekly; 90 minute child/parent active treatment sessions in person and/or by video with increasing allergen exposure) was utilized to treat children with excessive food allergy anxiety and outcomes assessed.

It appears that of 10 children with FAA treated by a group adaptation of the CBT-based Food Allergy Bravery Program all improved significantly with beneficial effects lasting at least 2-4 months post treatment.
 
 
 
 
 
Pulmonary hypertension in preterm infants treated with laser vs. anti-vascular Endothelial Growth Factor (VEGF) therapy for Retinopathy of Prematurity (ROP)
Recently intra-vitrial VEGF therapy for retinopathy of prematurity has received considerable attention as a potential alternative to traditional laser therapy for a variety of reasons (e.g. shorter treatment time, less neonatal stress, improved outcomes for aggressive posterior disease etc.).

“Widespread adoption of anti-VEGF therapy for ROP has been limited partly because of concerns of potential systemic adverse effects”.

From a multicenter retrospective cohort study of 1,577 infants with ROP who received either laser photo-coagulation or intra-ocular anti-VEGF treatment, and which assessed whether or not there is an increased risk of complicating pulmonary hypertension it appears that as greater use of pulmonary vasodilators is reported with anti-VEGF treatment (though not statistically significant) it cannot be clinically recommended until further studies are undertaken.


 
Association of apnea vs. hypopnea predominance with pediatric sleep outcomes: A secondary analysis of the childhood adenotonsillectomy trial
It is hypothesized that children with apnea predominance obstructive sleep apnea (OSA) are more likely to have a more severe OSA on polysomnography with poorer quality of life (QoL) than those with hypopnea predominant OSA. Whether this affects treatment outcomes is unknown.
 
From a case-controlled study of a secondary analysis of a randomized clinical trial (The Childhood Adenotonsillectomy Trial) which evaluated treatment outcomes in children with OSA it appears that baseline apnea predominance is not associated with better polysomnogram outcomes following treatment. 
 
 
Effect of screen time on recovery from concussion
“There are limited data to guide screen time recommendations after concussion”.

A single-center, parallel-design study randomized (within 24 hour of sustaining concussion) 125 adolescents/adults (mean age: 17 years) to either engage in screen time during the first 48 hours of recovery or not (control group) and evaluated whether early screen time during recovery after concussion affects duration of concussion symptoms.
 
It appears engaging in screen time post-concussion increases recovery time from 3.5 days (median) to 8.0 days.
 
 
Nationwide commercial laboratory pediatric antibody seroprevalence
The latest CDC/COVID Data Tracker (updated 9/30/2022) indicates that the prevalence of children (ages 6 months – 17 years) with antibodies against SARS-CoV-2 virus (evidence of at least one resolving or past infection) is 86.3% with an estimated 61,696,000 children having had 1 or more SARS-CoV-2 infection.



 
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