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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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August 17, 2022 | Volume 13 | Issue 33 |
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Altered neuroflexibility in children with Attention Deficit/ Hyperactivity Disorder (ADHD) |
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“ADHD is one of the most common neurodevelopmental disorders of childhood (3-5% of children) and is often characterized by altered executive functioning” (skills to focus, plan, prioritize, work towards goals, self-regulating behaviors and emotions, adapt to new and unexpected situations and engage in abstract thinking and planning. These functions supervise and coordinate many cognitive, behavioral and emotional tasks). Executive functioning requires brain region networks to dynamically connect and integrate neurofunction (functional connectivity) in real time.
A study of 180 children with ADHD (compared to a matched normally developing control group) utilized resting state functional magnetic resonance imaging (fMRI) to identify alterations in dynamic brain reconfiguration (MR derived neural flexibility) in children with ADHD.
Children with ADHD have significantly decreased neuroflexibility which can be demonstrated to improve on medication. Neuroflexibility may be used to identify children with ADHD to monitor treatment response and disease severity.
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Read the full article at Molecular Psychiatry
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Risk of severe COVID-19 infection among adults with prior exposure to children |
“Coronaviruses (CoVs) are a large family of enveloped, single-strand, zoonotic RNA viruses” (4 common ones circulating in humans include HCoV2-229E, -HKU1, -NL63 and -0C43) which have been in continuous circulation since being first isolated and cause a large number of infections, particularly in children in winter and early spring. CoVs have mutated rapidly giving rise to novel ones that can spread from animals to humans (2002: Severe Acute Respiratory Syndrome – SARS-CoV; 2012: Middle East Respiratory Syndrome – MERS-CoV and 2019: SARS-CoV-2 giving rise to COVID-19).
Children appear to have strong protection against COVID-19 illness perhaps due to cross-immunity from prior exposure to non-SARS-COV-2 coronaviruses.
A study from a large integrated healthcare delivery system (>4.5 million members and representative of the surrounding local and statewide population by age, gender and race/ethnicity) evaluated the risk of severe COVID-19 among adults with and without exposure to young children (0-5 years, 6-11 years and 12-18 years of age).
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Adults with children 0-5 years of age have less severe COVID-19 illness.
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Adults with children >6 year of age have an increased risk (9%) of COVID-19 illness.
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Adults without exposure to children have a 15% lower risk of infection (but significantly higher rates of hospitalization (49%)/ICU admission (76%).
Small children (0-5 years of age) in a household decreases the risk of severe COVID-19 in its adult members, perhaps due to endemic coronavirus-cross-immunity.
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Long-COVID-19 risks in children |
From a recent publication from the CDC we learn that information on the risks associated with long-COVID in children (<17 years of age and defined as symptoms that last for or begin at least 4 weeks after a COVID diagnosis), is limited.
A comparative study of 781,419 children/adolescents with confirmed COVID-19 (vs 2,344,257 without COVID-19) which examined outcomes (during Delta/Omicron variant surges) indicates that (while uncommon) children/adolescents with long-COVID-19 are:
- 101% more likely to have an acute pulmonary embolus.
- 99% more likely to have myocarditis.
- 87% more likely to have a venous blood clot.
- 32% more likely to have unspecified renal failure.
- 23% more likely to develop type 1 diabetes.
Acute and long-COVID in children and adolescents carries significant risk. Prevention by immunization is paramount.
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Sublingual immunotherapy for house dust mite allergies in children atopic dermatitis |
“Indoor allergens (like mold, dust mites and pet dander) are common causes of allergy symptoms in children year-round”.
Dust mites are tiny organisms that feed on discarded skin cells, thrive in warm and humid environments, and live in house dust, pillows, mattresses, rugs and carpets. Children may become allergic to the enzymes in their feces or to their hard shells.
An open-label, controlled trial randomized 60 children (5-17 years of age) with atopic dermatitis/allergy to house dust mites to receive either sublingual immunotherapy (or not) for 12 months, evaluating outcomes using Specialist scores, specific immunoglobulin levels and skin prick tests.
At 3-month post-sublingual immunotherapy, atopy severity significantly improves in atopic children allergic to house mite dust, which persists for 12 months.
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The effect of circular and oscillating breast massage on the amount of breast milk produced. An innovative method |
Mothers separated from their preterm neonatal infants experience a variety of adverse psychological effects including despair, powerlessness, disappointment, anxiety, insecurity, stress, etc. In addition mothers whose babies are hospitalized in Neonatal Intensive Care Units (NICU’s) suffer breastfeeding problems including decreased milk production.
A randomized control experimental study of 120 mothers, half using a standard milk pump only to produce milk, compared breast milk output to those mothers who in addition utilized a circulating and oscillating breast massage device for 10-15 minutes, 3 times per day for 3 days.
Circular and oscillating breast massage significantly increases breast milk production by 22.28% over 3 days, decreasing breast pain and swelling.
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Association of receiving a fourth dose of BNT162b vaccine (Pfizer-BioNTech) with SARS CoV-2 infection among healthcare workers |
From a multicenter cohort of 29,611 healthcare workers (in Israel) who received either a third or fourth dose of BNT162b vaccine (during the Omicron variant outbreak) it appears that a fourth vaccine dose reduces breakthrough infection rates from 19.8% to 6.9%.
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What parents should know about drowning |
With a hot summer encouraging outdoor activities, particularly swimming, this timely and brief outline discusses water safety/ drowning prevention in children (particularly for those children 1-4 years of age who are at highest risk) while addressing some issues relating to drowning definitions.
A short and fast read (Ed.).
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REGISTER - LEARN - EARN CME CREDIT |
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Fetal MRI for Problem Solving: Case Examples From the Body
At the completion of this activity, participants are expected to:
[1] Understand Florida law on informed consent, [2] Be aware that consent for minors must be in writing and detailed, [3] Learn about Florida’s new regulatory provision specific to pelvic exams.
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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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