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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
header with photos of various children
August 31, 2022 | Volume 13 | Issue 35
Helmet use in preventing head injury in Bicycling, Snow sports and other Recreational activities and Sports
“Sport and recreational activity-related head injuries are a significant cause of death and disability in the pediatric population”; with emergency department (ED) visits for sports-related traumatic brain injuries (TBIs) increasing by 62% between 2001-2009.

The use of a helmet has been shown to not only be highly effective in decreasing the risk of non-fatal and fatal head injuries but to also have a protective effect against upper and mid facial injury. Despite this, cross-sectional surveys indicate that 29-31% of children never wear a helmet while riding a bicycle (children 4-8 years of age are more likely to wear a helmet), the leading cause of children’s head injuries.

A long and extensive article which examined traumatic head injuries in children associated with recreational sports and which assessed a number of methods available to enhance helmet use in a variety of recreational sports indicates that a multi-prong strategy which includes legislation, enforcement of laws, public educational campaigns with guidance by primary care medical officers and EDs plus school and community programs are all valuable in the effort to increase helmet use in recreational sports.
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Trends in active treatment of live-born neonates between 22 weeks 0 days and 25 weeks 6 days by gestational age and maternal race and ethnicity in the US, 2014-2020
While there appears to be no universal consensus, currently in the US fetal viability is thought to be at approximately 6 months of pregnancy (23-24 weeks gestation).

A serial cross sectional study of 61,908 singleton neonates (born alive between 22 weeks 0 days and 25 weeks 6 days without clinical anomalies) examined the frequency of active treatment change from 2014 to 2020 and assessed whether that change varied by maternal race and ethnicity.

“Birth during the periviable period between 22 weeks 0 days and 25 weeks 6 days gestation is a major source of neonatal morbidity and mortality (20% survival without neurodevelopmental impairment; 36% overall survival) and the decision to initiate active life saving treatment is challenging”.

Between 2014 and 2020 the frequency of active treatment among periviable neonates born alive increased significantly (3.9% per year) with Black, Hispanic and Asian/Pacific periviable neonates being significantly less likely to receive active management. 
 
 
 
Gestational age at Term and Teacher-reported Attention Deficit/Hyperactivity Disorder (ADHD) symptom patterns
A secondary analysis of approximately 1,400 children in the Fragile Families and Child Wellbeing Study examined gestational age at term against teacher evaluations of children at age 9 years assessing symptoms of hyperactivity, ADHD, oppositional behavior and cognitive problems/inattention. 
 
Early-term birth (37-38 weeks) appears to be associated with a 23% higher hyperactivity score, and 17% higher ADHD score (when compared to births at 39-41 weeks gestation, with no significant association between gestational age and oppositional behavior found).
 
Elective deliveries should be delayed to at least 39 weeks and children born earlier at 37-38 weeks gestation should have regular screenings for ADHD symptoms.
 

 
 
 
Real-world association of the US Cystic Fibrosis (CF) Newborn screening (NBS) program and Nutritional and Pulmonary outcome
From a retrospective national cohort study of 9,574 infants, part of the CF Foundation Patient Registry (from January 1, 2000 to December 31, 2008) which compared longitudinal height and weight (from birth) and lung function (between 6 and 10 years) outcomes among children in the same birth cohort born before and after the implementation of NBS for CF, it appears the NBS is associated with higher weight and height percentiles in the first year (which decrease with age) and a more rapid increase in lung function between ages 6 and 10 years. Chronic infection with P. aeruginosa occurs at an older age in CF screened infants.
 
 
Prevalence of causes of subconjunctival hemorrhage (SCH) in children
“Subconjunctival hemorrhage (SCH) is a reported sign of occult abusive injury but there are limited data about SCH during childhood”.
 
A retrospective cross-sectional study 33,990 children (age range 2 days – 18 years; 313 of whom had SCH) seen by pediatric ophthalmologists in an outpatient setting over a 4 year period, examined the prevalence and causes of SCH based on history, physical ocular and non-ocular findings, laboratory and imaging studies.
 
Subconjunctival hemorrhage is uncommon in children.
In 83% of children (non surgical) who present with SCH the etiology is traumatic in origin (Trauma and Inflammation account for 90-94% of all cases).
 
Awareness of SARS-CoV-2 Omicron variant infection among adults with recent COVID-19 seropositivity
A cohort study of 201 adult employees and patients of an academic medical center enrolled in a longitudinal COVID-19 study which measured 2 IgG-N antibodies at least one month apart, (indicating seroconversion/infection) and awareness of their infectious status indicates that 56% of SARS-CoV-2 infected persons are unaware of their recent Omicron variant infection with 10% attributing symptoms to a “common cold” or other non-SARS-CoV-2 infection.
 
Unawareness of a recent SARS-COV-2 Omicron infection may be a key contributor to the rapid transmission of the virus in the community.
 

 
Asthma and risk of SARS-CoV-2 infection among children and adolescents
A retrospective survey of 6,324 children (5-17 years of age) with asthma (matched 1 : 1 to unaffected children) which evaluated the association between asthma and SARS-CoV-2 infection risk, indicates that children with asthma have a similar SARS-CoV2 infection risk to those without asthma.
 
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