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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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November 24, 2021 | Volume 12 | Issue 47 |
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What are the rates and risk factors for developing a complication with the Pavlik method for the treatment for Hip Dysplasia (DDH) |
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DDH is a spectrum of disorders of the hip affecting the proximal femur and acetabulum that leads to hip subluxation and dislocation.
“Ultrasonography (US) is the preferred modality for evaluating the hip in infants who are <6 months of age”, where there is clinical suspicion of DDH, following an abnormal physical exam in the neonatal period which subsequently normalizes, a family history of DDH, breach position in the third trimester, oligohydramnios/other causes of postural molding, neuromuscular conditions or a history of improper swaddling. For infants <6 months of age a soft dynamic movable brace that holds the baby’s legs in a position that allows the hip joint to be aligned (24hrs/day for 8-12 weeks; i.e.“Pavlik method”) appears to have been the most effective and reproducible treatment for >75 years.
A retrospective cohort study of 307 infants with DDH (dysplasia, instability or dislocation) treated with the Pavlik method identified risk factors and major complications (among other parameters).
7% of DDH infants treated with a Pavlik harness have a major complication (femoral growth disturbance – 5.8%, and femoral nerve palsy – 0.98%). An initial diagnosis of a dislocated hip or being over 5 months of age at diagnosis are major risk factors.
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Read full article at Journal of Pediatric Orthopaedics
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Simulation-based curricula for enhanced retention of pediatric Resuscitation skills |
“Resuscitation skills decay as early as 4 months after course acquisition”.
A partial, double-blind controlled study of First year Pediatric Residents following a Pediatric Advanced Life Support course (PALS) randomized 12 to an intervention group (a simulation-based curriculum intervention) or not, at 4 months post PALS course and assessed 8 months after the initial course, resuscitation knowledge and adjunct skills.
A simulated-based curriculum grounded in principles of deliberate practice and debriefing at 4 months post-PALS certification significantly improves scores on a simulated-based assessment and multiple-choice test at 8 months follow up (Residents performed only 61% of assessed items immediately following the PALS course!).
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Effect of amoxicillin dose and treatment, on the need for antibiotic re-treatment in children with Community Acquired Pneumonia |
From a randomized clinical trial of 814 children requiring amoxicillin for Community Acquired Pneumonia (discharged from an Emergency Department/Observational Unit or Inpatient ward within 48 hours) it appears that subsequent outpatient treatment with amoxicillin 35-50mg/kg/day for 3 days is as effective as a 7 days course of amoxicillin (70-90mg/kg/day). (Disease severity, prior antibiotics received etc. may need to be taken into consideration).
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Effectiveness of a multifaceted intervention for the prevention of obesity in Primary School children |
Obesity in children has reached epidemic proportions with 1/3 of children in the USA being overweight or obese, and that number continues to increase yearly (an increase of 8-fold over the past 40 years). Children become overweight/obese from many causes which include genetic background/family factors, unhealthy eating patterns, physical lack of activity, socioeconomic issues or a combination of these (rarely is it related to a hormone problem). Childhood obesity may be a precursor of poor self-esteem, depression, diabetes, hypertension, hypercholesterolemia, nonalcoholic fatty liver disease, joint pain and asthma/obstructive sleep apnea. As treatment is difficult, preventing childhood obesity may be a better strategy. The effectiveness of prevention strategies remains limited.
A cluster clinical trial utilizing 24 schools and 1,362 eligible children (8-10 years of age) conducted during a single year across 3 socio-economic distinct regions (in China) randomized comparable groups to receive either a “multifaceted intervention” vs. usual practice.
A multifaceted intervention to prevent obesity in children (health education, reinforcement of physical activity, BMI monitoring/feedback plus targeting a child’s environment at school and at home to support children’s/family behavioral changes) results in a 27% decrease in obesity prevalence (compared to 6% of controls).
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Noninferiority and safety of Nadolol vs. Propranolol for Infantile Hemangioma (IH) |
Nadolol (a non-selective beta-blocker, possibly 2-4 times more potent than propranolol, used once daily and which lacks a direct depressant effect on the heart) may be preferable to propranolol in babies with IH unresponsiveness or who have adverse events associated with propranolol use.
A double-blind, non-inferiority prospective study of 71 infants 1-6 months of age with problematic IH (e.g. large, on the face, etc.) compared oral Nadolol effectiveness/safety to propranolol (in escalating doses)
Nadolol is an equally effective and safe alternative to propranolol in the treatment of IH, especially when faster involution is required or there is propranolol unresponsiveness.
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Identification of LZTFL1 as a candidate effector gene as COVID-19 risk locus |
The severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) disease (COVID-19) has caused 250 million infections world-wide and 5 million deaths (to date) primarily from pneumonia/respiratory failure. Genome-wide association studies (GWAS) have identified a region on chromosome 3P21.31 as predisposing individuals to susceptibility to severe COVID-19.
A study using multiomics and machine learning has identified an allele variation of a single nucleotide polymorphism (rs17713054G>A) on chromosome 3P21.31 which increases by 2-fold the risk of COVID-19 producing respiratory failure (the mechanism appears to be by upregulating a transcription factor – LZTFL1 – involved in Epithelial-Mesenchymal transition (EMT), a process that leads epithelial cells to transform themselves into mesenchymal cells/fibrosis).
The identification of a biologic process involved in damaging the lungs during COVID-19 offers a potential for drug treatment to prevent/cure an important cause of respiratory failure.
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Accuracy of parental-reported Tetanus vaccination status for children with lacerations |
An 8-month prospective, cross sectional study of 375 children (aged 5 months – 17 years) presenting with a laceration to a pediatric Emergency Department (ED) assessed ED physician knowledge of, and accuracy of “determination of need” for Tetanus prophylaxis.
“ED providers make an inaccurate assessment of necessary Tetanus prophylaxis in 8.8% of patients”, by either inappropriately administering Tetanus prophylaxis or missing the need for prophylaxis (particularly for older children, children with a dirty wound and in children who have received fewer than 3 Tetanus-containing vaccines).
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