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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
header with photos of various children
January 5, 2022 | Volume 13 | Issue 1
The causal effect of being born extremely preterm/extremely low birth weight on neurodevelopmental and social-emotional development at 2 years
“Low birth weight” (LBW) or “Preterm” is often defined as a baby being <2,500 grams at birth, “Very low birth weight” (VLBW) is accepted for those being born <1,500 grams and “Extremely low birth weight “ (ELBW) is an infant with a birth weight of <1,000 grams.

A prospective geographic cohort study over 12 months, of 205 children born extremely preterm (<28 weeks) or ELBW assessed and compared (to 201 infants born at term) at 2 years of age (corrected) using a number of Developmental Scales, neurodevelopmental and social/emotional developmental outcomes.

Being born extremely preterm or ELBW increases the risk of cognitive delay/concerns by 3.7 times, the chance of language deficit by 5.3 fold, delayed motor development by 3.9 times and the likelihood of decreased social/emotional competence by 4.1 fold. “Close developmental surveillance including social/emotional development is recommended for infants born extremely preterm/extremely low birth weight”. 
Neurodevelopmental problems and quality of life in 6-year-olds with a history of developmental language disorder (DLD)
Developmental language disorder is a common condition in which a child has difficulty using and/or understanding language. It includes speech disorders like apraxia (difficulty in coordinating oral movements to create sounds), dysarthria (weak speech muscles causing slurred speech, etc.), speech sound disorders, stuttering etc. and language disorder (for example difficulty finding words, asking questions, or using short and non-grammatical sentences like “car go”; “me happy” etc.

A study of 85, 6-year olds who had screened positive for developmental language disorder at 2.5 years explored (by parental questionnaire and speech/language testing) neurodevelopmental difficulties and quality of life as school children.

Children screened at 2.5 years of age for developmental language disorder have language difficulties and other neurodevelopmental problems as 6 year olds (Some children rated their quality of life as impaired though their parents did not necessarily perceive this).

 
Asthma risk after early-childhood hospitalization for wheezing
Wheezing is common in young children with 33% of children experiencing a wheezing episode before 3 years of age. “Wheezing may be either a benign, self-limiting process or the presenting symptom of a significant respiratory disease”.

A prospective-controlled cohort follow-up study evaluated (vs. normal controls) doctor-diagnosed and self-reported asthma in 58 young adults (24-28 years of age) who had been hospitalized for a first episode of wheezing when <24 months of age.

Being hospitalized as an infant for wheezing increases the likelihood of doctor-diagnosed asthma 2.14 fold and is therefore a strong risk factor for asthma in young adulthood.

 
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Longitudinal outcomes in adolescents after referral for metabolic and bariatric surgery (MBS)
“Bariatric surgery is for all patients with a very high weight who need weight loss surgery. Metabolic surgery is used with the specific intent to address diabetes and metabolic dysfunction that have failed to respond to lifestyle and medication changes as opposed to obesity per se”.

A single-center longitudinal study of 352 adolescents (mean age 15.6 years) compared outcomes over 2 years of those who had completed laparoscopic sleeve gastrectomy (75% of stomach removed) to a matched non surgical control group.

Following sleeve gastrectomy adolescents lose 22 % of their BMI at 24 months while matched adolescents who do not undergo surgery have a 3% BMI weight gain.

A minority (22%) of adolescents referred for metabolic and bariatric surgery proceed to surgery despite obesity-associated condition improvement and safety.
Bed-sharing in the first 6 months 
A longitudinal sample of 178 infants and their caretakers assessed whether bed-sharing during the first 6 months of life is associated with infant attachment and behavioral outcomes, and mother bonding/sensitive parenting at 18 months of age.

Mother/infant bed-sharing during the first 6 months of life is not associated with positive or negative outcomes about infant/mother attachment, infant behavior, maternal bonding or sensitive parenting (The American Academy of Pediatrics (AAP) and Centers for Disease Control (CDC) both advise against sharing a bed with a child <1 year of age. Bed sharing increases the risk of suffocation, accidental strangulation and sudden infant death syndrome. Ed.).
 
Parentally reported early childhood upper gastrointestinal symptoms at school age
“Recurrent upper gastrointestinal (GI) symptoms such as abdominal pain, gastroesophageal reflux and vomiting are common in the pediatric age group…” and as adherence to published guidelines on management is patchy, many of these otherwise healthy children are exposed to unnecessary medication and invasive procedures.

A study identified 199 children (mean age 2.6 years) from a local upper endoscopy registry with undefined GI symptoms and a normal oesophagogastroduodenoscopy to assess long term outcomes.

At 7.9 years follow-up, parents report recurrent GI symptoms in 24%; 41% follow a specific diet and regular antacid use occurs in 3.5%.

While upper GI symptoms are frequent in young children most (without reflux disease) have a good quality of life without GI-related morbidity at school age.

 
Olfactory dysfunction in children and adults post-COVID-19 infection
“Common symptoms of acute COVID-19 include fever, cough, headache, shortness of breath and anosmia” (50% have sudden, partial or complete loss of smell prior to respiratory symptoms).

A retrospective analysis of olfactory testing from 53 adults and 44 children aimed to identify post-COVID-19-related olfactory dysfunction and recovery times.

Loss of smell post-COVID-19 is greatest at 4-6 months post-infection, improving subsequently.


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"Our Miami Experience With Bariatric Surgery in Adolescents"

This Virtual Grand Round was recorded LIVE and includes the post-session Q&A portion. This content is available for free - without CME credit (Fee may apply for those who wish to claim CME).
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Contact the Editor | jackwolfsdorf@gmail.com