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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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November 2, 2022 | Volume 13 | Issue 44 |
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Hyperbaric oxygen therapy in children with post-concussion syndrome |
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As many as 2 million children in the US experience mild traumatic brain injury (MTBI – concussion) every year with <10% of them losing consciousness during the episode. MTBI can lead to a variety of physical, emotional and cognitive symptoms (headaches, nausea, dizziness, difficulty paying attention at school etc.) which normally improve within 1 to 2 weeks. “A minority of children will experience symptoms for >4 weeks; sometimes called “post-concussion syndrome”. Persistent post-concussion syndrome (PPCS) occurs in 10-30% lasting months to years.
Guidelines for early management of acute concussion recommend limited periods of rest followed by gradual return to school and other activities. “Existing evidence for effective PPCS treatment remains limited”.
In adults, hyperbaric oxygen therapy (HBOT) has been shown to be beneficial in PPCS (through tissue oxygenation, anti-inflammatory action, angiogenesis and enhanced restoration, number/function of mitochondria). This therapy has not been evaluated in children with PPCS.
From a randomized, sham-controlled, double-blind prospective trial of HBOT in PPCS children with ongoing symptoms for 6 months following TBI, it appears that HBOT significantly improves cognitive function, behavioral symptoms (and executive function and attention difficulties) and quality of life with improved brain microstructure on brain imaging.
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Read the full article at Scientific Reports
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Comparative safety of BNT162b2 mRNA COVID-19 vaccine vs. other approved vaccines in children <5 years |
“BNT162b2 (Pfizer-BioNTech) is a lipid nanoparticle-formulated nucleoside-modified RNA vaccine that encodes a prefusion stabilized, membrane-anchored SARS-CoV-2 full-length spike protein”, which in the US has been given emergency approval by the US Food and Drug Administration (FDA) for children <5 years of age. Its safety in this age group is not well documented.
A retrospective, online follow-up (mean 91.4 days) cohort study of 7806 children (median age: 3 years) who received an off-label outpatient BNT162b2 vaccination, evaluated and compared the safety and side-effects of the vaccine to approved non-SARS-VoV-2 vaccines in the same patients.
Following BNT162b2 vaccination to prevent COVID-19 in children <5 years of age, local injection site symptoms occur more often in those >20 months but <60 months of age; most systemic symptoms are judged to be “no” or “minimal” in severity with no childcare/school days lost, and overall adverse events after vaccination comparable to those associated with approved non-SARS-CoV-2 vaccine for children. (In adults it appears that systemic symptoms after SARS-CoV-2 mRNA vaccination is associated with a greater serum antibody response vs.” local only” or “no symptoms”).
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Reversible peripheral airway obstruction and lung hyperinflation in children presenting with dyspnea and exercise intolerance after COVID-19 infection |
Most children with SARS-CoV-2 infection report no, or mild symptoms; a few however will experience the presence of 1 or more symptoms for weeks to months (cause unknown). This has been called “long-COVID” and “post-acute sequelae of SARS-CoV-2 infection” (PASC)”. The most prominent symptoms of Long-COVID vary but include fatigue, psychological symptoms and dyspnea.
An interesting presentation of a healthy, normal 17-year-old Hispanic boy who presented to a Pediatric Pulmonary Unit for evaluation of dyspnea and exercise intolerance associated with Long-COVID (following normal spirometric lung function testing/laryngoscopy and psychological behavioral assessment) who was then further investigated utilizing lung function plethysmography/impulse oscillometry reminds us that damage to the small airways (with resultant bronchoconstriction and hyperinflation) may be the underlying cause which appears to be reversible with bronchodilator therapy (Albuterol) and inhaled corticosteroids.
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Clinician diagnostic certainty and the role of the Autism Diagnostic Observation Schedule (ADOS) in Autism |
Autism Spectrum Disorder (ASD) diagnosis affects 1 in 44 young children, and the ADOS, a semi-structured observation tool, is considered to be an important component for clinical diagnosis. Utilizing ADOS as a routine test for ASD however, adds time and cost to the diagnosis.
From a prospective semi-structured observational study of 349 children which compared the consistency of ASD diagnosis between clinical assessment undertaken by a Developmental-Behavioral pediatrician and one based on the ADOS, it appears that there is a 90% concordance between clinician clinical diagnosis and formal testing, and that for an ASD diagnosis to be made, ADOS is not generally required unless a Developmental-Behavioral pediatrician is uncertain of the diagnosis.
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Association of video gaming with cognitive performance among children |
Excessive time spent playing video games can lead to less reading, less exercise, becoming overweight, lower grades, decreased sleep, poorer social skills and aggressive thoughts and behaviors. Opinions regarding an association between video gaming and cognitive skills are divided.
From a complex, case-controlled study of 2,217 children (mean age 9.91 years) which compared self-reported screen time, video gaming time, cognitive performance and brain functional magnetic resonance imaging (fMRI) to non video gaming, it appears that increased video gaming time in children is associated with better cognitive performance (involving response inhibition and working memory) as well as improved brain oxygenation/functioning of areas associated with visual, attention, and memory processing on fMRI.
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Childhood acid suppressants and allergy risk |
A timely article reminds us again that not only does maternal use of acid-suppressants during pregnancy increase the risk of childhood asthma, but that childhood use is also associated with a 44%, 12% and 40% increased risk of asthma, atopic dermatitis and allergic rhinitis, respectively. Judicious use of acid suppressants in children is warranted.
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From the last CDC bulleting which published the latest US information on the COVID-19 outbreak, the following appears of interest:
- Total cases: 97,036,357
- Current hospitalizations: 11,771
- Deaths: 1,065,152
- People 5+ years of age with first booster vaccine: 35.6%
Omicron genomic variants:
BA.5 62.2%
BA.4.6 11.3%
BQ.1 9.4%
BQ1.1 7.2%
BF.7 6.7%
(7 other variants combined 3.2%)
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