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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
header with photos of various children
September 14, 2022 | Volume 13 | Issue 37
Decision-making in childhood predicts prodromal eating pathology in adolescence 

“Impulsivity is central to all forms of externalizing psychopathology…”. The Cambridge Gambling Task (CGT) is a popular neurocognitive task used to assess impulsivity in both clinical and healthy populations”.

Differences in decision-making under conditions of risks/uncertainty have been observed in people with eating disorders (ED) but have never been studied longitudinally.

Eating disorders are significant psychological disorders and typically present with prodromal features (like body dissatisfaction and dietary restrictions) that are also a feature of the disorder. The way adolescents respond to risk and rewards may play a role in the development of EDs.

A longitudinal perspective general-population study of 11,303 boys and girls examined the relationships between CGT variables at 11 years and prodromal eating pathology and excessive exercise at 14 years of age.

“Disadvantageous decision making in childhood may predict prodromal eating pathology in adolescence and may represent prevention target”.
Read the full article at Journal of Developmental and Behavioral Pediatrics
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Association of preconception thyrotropin levels with fecundability and risk of spontaneous abortion
Significant maternal thyroid dysfunction (hyper or hypo) is associated with fertility and “the ability to successfully conceive”. “Infertility affects approximately 9% of couples of reproductive age worldwide with 8-30% of those who have conceived being at risk for spontaneous abortion”. Identifying the risk factors that affect reproductive health would be of significant value.

A population-based cohort study of 11,194,002 female participants (mean age: 27.56 years) evaluation the association of preconception thyroid thyrotropin levels with time to pregnancy (TTP) and risk of spontaneous abortion (SA)

Both low and high preconception thyrotropin levels appear to be associated (temporarily or causatively) with delayed TTP with high thyrotropin levels being associated with an increased risk of SA.
Preconception measurement of thyrotropin level may indicate the need for levo-thyroxine supplementation (Future studies needed: Ed.).
 
 
Pediatric penile bee sting
“Summer penile syndrome” is characterized by penile swelling, pruritus, and rarely, decreased strength of urinary stream or urinary retention. Diagnosed during warm weather months, it is a benign hypersensitivity reaction involving the skin of the penile shaft and is most commonly associated with insect bites (usually chiggers) or exposure to plants (like poison ivy). Most symptoms resolve within 4 to 5 days (though may last up to 2-3 weeks). Management includes an oral antihistaminic and cool compresses (systemic steroids should only be considered if there are urinary symptoms).

A respective study of the records of all pediatric patients who presented to an Emergency Department (ED) due to an isolated bee sting to the penis (10 children, mean age 4.2 years) indicates that all are admitted (to the Surgery Department) with the most common complaints being pain (100%), swelling (100%) and dysuria (with 30% unable to pass urine). All penile symptoms regress within 48 hours with a normal appearing penis evident at the end of 72 hours.

“Penile bee sting may be evaluated within the scope of Summer penile Syndrome because symptoms, clinical finding and treatment are almost similar”.
 
Risk factors for pediatric atherosclerosis and its treatment
It is worth remembering that children as young as 10-14 years of age may show early stages of atherosclerosis with lesions being present in 1 of 6 teenagers. These set the stage for adverse cardiovascular disease in adulthood.
 
A short clinical article reminds us that cardiovascular (CV) risk factors in children that commonly precede adult CV disease include being overweight/obese, being hypertensive, having dyslipidemia, tobacco smoking, and having a sedentary lifestyle. Almost all of these may be modified by lifestyle changes (40-50% of risk for adult CV disease however appears to be of hereditary origin).
 
 
Long-term respiratory outcomes following solid organ transplantation in children
“Solid organ transplantation (SOT) has become commonly used in children and is associated with excellent survival rates into childhood”. Long-term respiratory outcomes after pediatric transplantation are lacking.
 
A retrospective review of 118 children describes the prevalence and nature of respiratory pathology following pediatric heart, kidney and liver transplantation.
 
Respiratory morbidity is common after pediatric SOT with 8% of children being subsequently diagnosed with bronchiectasis.

A high index of suspicion for respiratory complications post childhood SOT is required particularly for those with a previous history of respiratory pathology before transplant, experiencing recurrent or severe respiratory tract infections or exposed to intensified immunosuppression.
 
Ongoing dizziness following acute COVID-19 infection
A retrospective chart review of children referred from a Pediatric COVID Recovery clinic to Pediatric Cardiology for persistent debilitating dizziness weeks to months after their acute infection, found 9 (median age: 14 years, 66% female and 8 of 9 not having received SARS-CoV-2 vaccines). 5 children met inclusion criteria for postural orthostatic tachycardia syndrome (POTS) by active standing testing which improved with combination of non-pharmacologic therapy (NPT) and medication.
 
Post-acute sequalae od SARS-CoV2 infection (Long COVID) includes a subset of patients who develop autonomic dysfunction including POTS. While the etiology and prognosis remain unclear treatment outcomes remain positive.
 
 
Oral vs. Intravenous (IV) antibiotics for pediatric osteoarticular infection (OAI)
From a comparative study which included 893 children with OAI who initially received IV antibiotics vs. 64 similarly diagnosed children who received exclusively oral therapy, it appears that children with OAI in good general condition, who are young (6months-3 years of age), tolerate oral therapy, have Kingella kingae infection, a higher erythrocyte sedimentation rate/C-reactive protein ratio (>0.67), no skin injury, no recent surgery or local complication at onset, may be safely treated with oral antibiotic therapy.
 
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