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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
header with photos of various children
February 2, 2022 | Volume 13 | Issue 5
World health Organization (WHO) recommends 2 new drugs to treat COVID-19
“Severe coronavirus disease 2019 (COVID-19) is associated with dysregulated inflammation”.

Baricilinib is an oral anti-inflammatory drug previously used in rheumatoid arthritis. It is a janus kinase inhibitor (a family of intracellular, non-receptor tyrosine kinases involved in cell growth, survival, development and differentiation which are critically important in blocking immune cells from overproducing cytokines -small proteins involved in immune and inflammatory responses). The WHO recommends it be given with corticosteroids for severe or critical COVID-19.

Sotrovimab is a synthetic monoclonal antibody similar in function to one of the body’s natural antibodies and which is “designed to restore, mimic, inhibit or enhance immune system functions”. It is now conditionally recommended for treating mild/moderate COVID-19 in patients at high risk for hospitalization.

This “eighth update” of the WHO living guidelines on therapeutics and COVID-19 utilizes evidence from 7 trials involving over 4,000 patients with non-severe, severe and critical COVID-19.
Read the full article at World Health Organization
Analysis of neurodevelopmental disorders in offspring of mothers with eating disorders
“Eating disorders are complex and severe psychiatric disorders characterized by an irrational fear of obesity in combination with weight-controlling behaviors resulting in physical complications and impaired psychosocial function”. Most affected are women; frequently occurring in adolescence and early adulthood and are often chronic.

It appears that the intrauterine environment affects not only fetal growth and development (including neurodevelopment) but also influences health during childhood (and throughout life) probably through a variety of mechanisms which include genetics (mother and father), metabolic and endocrine factors (through epigenetic mediation – DNA methylation).

A complex study of a large nationwide cohort which identified a number of eating disorders in women and subsequently identified the presence (or not) of neuropsychiatric disease in their offspring (followed from 1 year for autism spectrum disorder (ASD) and from 3 years of age for attention deficit/hyperactivity disorder (ADHD) indicates that ADHD risk is increased by 42% where there is a history of anorexia nervosa, 91% for bulimia nervosa and is doubled when a history of “un-specified eating disorder” is present. For ASD the risk increases are 2.04 times, 2.07-fold (following adjustment for parental confounders – not significant) and 1.95 respectively.
 
Clinical and bacteriological characteristics of 6 cases of Bifidobacterium breve (B. breve) bacteremia due to probiotic (BBG-01) administration
“B. breve is widely used as a probiotic in preterm infants and children with congenital surgical conditions”.

A study of 298 infants (261 preterm infants without surgical conditions and 26 term infants with congenital surgical conditions) admitted to a neonatal intensive care unit (NICU) examined the clinical and bacteriological consequences following probiotic (BBG-01) administration.

2% of surgical neonates given BBG-01 develop B. breve bacteremia (mean age at onset 8 days, corrected age 35 weeks and weight 1,940 grams). Triggers for bacteremia include gastrointestinal perforation, protein-induced enterocolitis syndrome, adhesive ileus and aspiration pneumonia.

Ileus and intestinal mucosal damage may give rise to B. breve bacteremia following probiotic (BBG-01) administration. Prognosis is generally good.

 
Outcomes of operatively managed lumbar and sacral facet fractures in pediatric athletes
Spinal column injuries in children >9 years of age tend to occur in the thoracic, lumbar and sacral regions, where the anatomy and biomechanics of the pediatric spine are comparable to the adult spine (cervical spine injuries are more common in very young children).Common causes are falls, sport and road accidents. Facet fractures are rare but may be under-recognized.

A retrospective review of 10 children with symptomatic lumbar or sacral facet fractures following competitive sport (mean age 13.3 years; 70% female – primary symptom lower back pain exacerbated with lumbar spine extension) examined outcomes of operatively managed isolated lumbar or sacral facet fractures (from 3 tertiary pediatric hospitals 2014-2019) diagnosed by limited computed tomography (CT) scan.

Results of operatively managed childhood facet fractures are good (90% are pain-free at first, and 80% at final follow-up). All children (small group!) return to full sport participation.
Analysis of preconception paternal smoking and neonatal outcomes
“Maternal smoking in pregnancy is associated with placenta DNA methylation and adverse neonatal outcomes such as low birth weight and preterm birth”. Little is known about the effects of paternal factors, including paternal smoking which can modify the sperm genome/epigenome and which may be passed onto offspring affecting their gene regulation and physiology.

A prospective, preconception cohort observational study recruited 1,174 newly married couples intending to conceive within 6 months to evaluate the associations of preconception paternal smoking with neonatal outcomes.

Despite much higher prevalence, preconception paternal smoking does NOT appear to be associated with adverse neonatal outcomes, preterm birth, low birth wight, small-for-gestational age or large-for-gestational-age babies. (Later deleterious effects of paternal preconception smoking cannot be ruled out).
Association of telomere length with risk of disease and mortality
“Telomeres are DNA structures at the end of chromosomes that protect them from damage and instability”. Telomeres shorten with each cell division (when they become critically short cell-cycle ceases or undergoes apoptosis – controlled normal cell death). Leukocyte telomere length (LTL) serves as a biomarker for telomere length and is an indicator of age being associated with a broad range of multiorgan pathology.

A multicenter, community-based cohort study (with a 12-year follow-up) utilized 472,432 English participants (54% women; mean age 57 years) from the United Kingdom Biobank to analyze LTL and morbidity and mortality.

A shortened telomere length appears to be associated with an increased overall (8%), cardiovascular (9%), respiratory (40%), digestive (26%) and musculoskeletal (51%) mortality risk (no cancer-related mortality).

 
SARS-CoV-2 acute bronchiolitis in hospitalized children
Previous coronaviruses have been described as a causative pathogen in upper respiratory tract infections, asthma, bronchiolitis, pneumonia and croup. 

From a cross-sectional study of 666 infants (median age 1.9 months) infected with SARS-CoV-2 who required hospital admission, 12 of whom met the diagnostic criteria for bronchiolitis, it appears that SARS-CoV-2 infection does not appear to be a trigger for severe bronchiolitis in infants.

 
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