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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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February 16, 2022 | Volume 13 | Issue 7 |
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Gut bacteria linked with long-COVID |
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“Gut microbiota influences the health of the host”, and “particular gut microbiol profiles may indicate heightened susceptibility” to a variety of illnesses. A diverse gut microbiome provides significant benefits which manifest as positive immune system development, infection prevention, nutrient acquisition and brain function.
A study which examined stool microbiome composition in 106 patients with persistent symptoms of long-COVID-19,1-6 months after Sars-CoV-2 virus clearance, and compared it to those without COVID indicates that the abundance and diversity of “good bacteria” has an inverse relationship with post-acute COVID-19 syndrome (commonly fatigue, poor memory, hair loss, anxiety and trouble sleeping”).
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Read the full article at MD Edge
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Frequency of adverse events (AEs) in the placebo arms of COVID-19 vaccine trials |
“Adverse events after placebo treatment are common in randomized clinical drug trials”. As concern over AE’s is reported to be one of the reasons for COVID-19 vaccination hesitancy, a systematic review and metanalysis of multiple randomized clinical trials (12 articles with 45,380 participants) investigated AE’s in children/adults >16 years of age to assess the proportions of vaccine and placebo recipients reporting overall, local and systemic adverse incidents within 7 days of injection.
After a first vaccine dose, 35.2% of placebo recipients experience systemic AE’s (headache 19.3% and fatigue 16.7% being most common).
After a second vaccine dose, 31.8% of placebo recipients report systemic effects.
While significant numbers of vaccine recipients report vaccine related systemic effects a significant contribution to this group is from a nocebo (negative expectations regarding a treatment) effect.
Videos
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Incidence of new-onset type 1 diabetes (T1D) among US children during the COVID-19 global pandemic |
A cross-sectional 6-year retrospective survey review of electronic medical records evaluated whether a perceived increase in new onset T1D during COVID-19 was significant or not, and whether more children presented with diabetic ketoacidosis (DKA) and/or required pediatric intensive care admission, compared to previous years.
From information from a single tertiary care institution, it appears the new onset T1D increased by 57% during a CODIV-19 year with an increased percentage (49.7%) presenting with DKA (compared to 5 years of previous matched data, an in spite of an overall decrease of hospital admissions and no increase in the number children seen at the pediatric endocrine clinic).
Videos
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Prenatal choline supplementation and childs’ sustained attention |
Choline is an essential nutrient present in some foods and which is the source of methyl groups needed to synthesize phosphatidylcholine and sphingomyelin, two major phospholipids vital in the synthesis of cell membranes, regulating gene expression, and the production of acetylcholine (an important neurotransmitter essential for nervous system functions including memory, muscle control and mood as well as an essential element in neurodevelopment/lipid metabolism). Choline has been shown to exert neuroprotective effects taken during pregnancy with prenatal deprivation causing lasting adverse effects on offspring. Few studies have evaluated the effect of maternal choline supplementation on offspring cognition.
“Sustained attention” (1 of 3 types of attention) is the process that allows us to maintain a persistent and continuous effort over an extended period of time.
A 7-year follow-up study of children born to women who participated in a randomized, double-blind, parallel-group- controlled choline feeding study of pregnant women in their third trimester (given either 480mg – “adequate intake” or 930mg choline daily-“superior dose”) until delivery, evaluated the effect of maternal choline supplementation on offspring cognition (sustained attention) at school age.
At school age, children born to mothers who receive a superior (930mg/day) dose of choline during their third trimester have improved sustained attention capabilities (it should be noted that “choline consumption by pregnant women is approximately 70% of the adequate dose” with concomitant concern regarding infant/child neurodevelopment).
Videos
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Is early activity resumption after pediatric concussion safe and does it reduce symptom burden after 2 weeks post injury? |
From a real-life conditions, multicenter, single-blinded randomized clinical trial of 456 children (mean age 13.3 years) with acute concussion who underwent a 4 week stepwise return to physical activity (PA) starting at 72-hours post concussion (even if symptomatic) (or a return-to-PA once asymptomatic) which assessed reported symptoms at 2-weeks post-concussion, it appears that early return to physical activity starting at 72 hours reduces symptoms at 2 weeks, is safe with no adverse events noted.
Videos
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Minimum 2-year outcomes following arthroscopic hip labial reconstruction in adolescents and young adults |
The hip is ball and socket joint with the socket being formed by the acetabulum (part of the pelvic bone) and the ball being the head of the femur. The joint is ringed by a strong fibrocartilage (labrum) which forms a gasket around the socket, sealing it and providing stability to it. Femoroacetabular impingement (FAI) is condition where extra bone grows (bone spurs – 3 types: pincer, cam and combined) around the head and/or along the acetabulum which prevents smooth joint function and which over time can result in tears of the labrum and breakdown of articulate cartilage (osteoarthritis).
When the labrum tears nonsurgical treatment is preferred; however in the face of failed conservative treatment and where FAI is present, arthroscopic labial reconstruction is a valid option. Little information for this in adolescence is available.
A prospectively collected and retrospectively reviewed collection of 22 adolescents/young adults (mean age 19.3 years) examined 2-year follow-up outcomes following acetabular arthroscopic hip labial reconstruction.
Following arthroscopic reconstruction of an irreparable labial tear (primary or reconstruction) at a minimum of 2 years post-operation, all adolescents report significant improvement with high patient satisfaction.
Videos
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Longitudinal asthma and allergy studies; symptom frequency into adulthood |
“The prevalence of allergic disease is high and increasing in many countries”,
A study of 112 Icelandic infants born in 1987 and followed for 29 years (at 2, 4, 8, 15, 21 and 29 years) using standardized questionnaires, physical examination and skin prick tests identifies and describes the prevalence of allergic diseases and changes in clinical expression over 3 decades.
At 29 years of age 46% of adults have 1 or more allergic disease (usually mild) eczema occurs in 14%, highest at the age of 2 years (31%).
23% have asthma, highest at age 4 years (28%).
30% are affected with allergic rhinitis (not found before 2 years of age).
34% have a positive skin prick test.
Videos
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REGISTER - LEARN - EARN CME CREDIT |
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Into the Future: Cavity-Free Children | Nicklaus Children’s Hospital Continuing Medical Education
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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What Are Functional Gastrointestinal (GI) Disorders? - Dr. Heidi Gamboa Explains |
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Underwriting Opportunities
Advertising in this e-journal in no way implies endorsement of a product by Nicklaus Children's Hospital.
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