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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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June 8, 2022 | Volume 13 | Issue 23 |
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Prevalence of adolescent hand gun carriage:
2002-2019
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“In 2020, 45,222 persons in the USA died from firearms (13.7 per 100,000 population), 492 unintentionally, frequently in those <25 years of age”.
Adolescents are particularly susceptible to accidental shootings due to specific behavioral characteristics of that age (impulsivity, feelings of invincibility and curiosity about firearms).
Data from repeated (annually) cross-sectional, nationally representative surveys from 2002-2019 of 297,055 adolescents (12-17 years of age) explored the changing prevalence of adolescent handgun carriage across time and socio-economic subgroups.
Between 2002-2019 handgun carriage increased 41%, particularly among rural, white and higher income adolescents (handgun carriage among Black, American Indian, Alaskan natives and lower-income adolescents decreased). Education on risk associated with handgun carriage in adolescence requires a specific socio-cultural and place-based focus.
Pediatrics
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Read the full article at JAMA Network Open
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The predictive value of the Ages and Stages Questionnaire (ASQ) in late infancy for low average cognitive ability at 5 years |
Parent questionnaires are a particularly useful tool for ongoing assessment of a young child’s milestones. The ASQ is a standardized, parent-completed questionnaire with 30 items covering 5 infant/child developmental domains (communication, growth motor, fine motor, problem solving and personal social skills) which allows parents to assess their infant/child by responding to specific questions and which potentially aids parents/pediatricians to detect intellectual dysfunction early (the American Academy of Pediatrics – AAP recommends that parent reported measures should be reviewed during routine developmental screening and the ASQ is just one example of such a screen).
A retrospective, longitudinal study of 755 infants from a birth cohort utilized the ASQ at 24 and 27 months of age to assess efficacy to identify children who progress to have low cognitive ability at 5 years of age.
The ASQ at 24-27 months DOES NOT appear to detect the majority of children who will be found at 5 years of age to have low cognitive ability (however with a specificity of 91.1% it is a useful tool to identify infants NOT at risk).
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Neutralization of the SARS CoV-2 Deltacron and BA.3 variants |
The Omicron variant (B.1.1.529) of SARS CoV-2 which has been the dominant virus throughout the USA recently has spawned subvariants (BA.1, BA.2 and BA.3) which have generated serious concerns over the durability of vaccine- and infection-induced immunity. This has been exacerbated by recombination of the Omicron variant and B.1.617.2 (Delta) variant named “Deltacron”. “The ability of Deltacron variants to evade immunity induced by either vaccination or previous infection remains unclear”.
Following SARS CoV-2 variant infection or vaccination plus a booster, neutralizing antibodies appear sufficient to neutralize BA.1, BA.2 and BA.3 variants “however the Deltacron variant retains the strong resistance of other Omicron sub-lineages…”. Strong immune escape by recombination of SARS CoV-2 variants remains a “critical concern and requires ongoing monitoring”.
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Paternal education and its impact on breastfeeding initiation and duration |
As part of a prospective cohort study, 2,839 primiparous women aged 18-35 years (and their husbands) were enrolled and interviewed during pregnancy, and at 1 and 6 months post-partum to evaluate the association between paternal education level and initiation and duration of breastfeeding (controlling for a wide variety of covariants). 92.0% of women studied initiated breastfeeding and 49.5% of those still breastfed at 6 months post-partum.
Maternally targeted breastfeeding support programs be they antenatal, intrapartum or post partum increase the rate and duration of breastfeeding. Paternal education is independently associated with breastfeeding initiation and duration – the higher the level of education the greater the impact (the role of the father is particularly important in primiparous pregnancies. First-time fathers face significant mental health and well-being challenges and stress from the restriction and demands of being a new father and breastfeeding programs need to understand this and to include fathers/partners as active participants).
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Not every white spot is vitiligo! |
A fascinating case description outlines the history etc. of an 11 years old girl who presented to a dermatology clinic for a paramedial band-like hypopigmented atrophic plaque of 15 months duration, which started as a small hypopigmented patch that over time extended from the eyebrows to the vertex of the head and which was accompanied by linear diffuse alopecia. Full examination revealed no other signs and the only positive laboratory test was for the presence of antinuclear antibodies. Skin biopsy was consistent with a diagnosis of linear scleroderma en coup de sabre (ECDS).
“ECDS is an uncommon autoimmune condition that mostly affects children and that is characterized by sclerosis and fibrosis of the skin and subcutaneous tissue”. It is often diagnosed as vitiligo. Lesions may involve the cheek, nose and/or upper lip causing deformities and facial asymmetries. Extracutaneous organ involvement (Central nervous system/eyes) may develop. “Immunosuppressive treatment is the most common treatment option”.
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Albuterol/budesonide fixed-dose combination rescue inhaler for asthma |
When asthma symptoms worsen many children rely on short-acting beta2 agonists (SABA) as rescue therapy. This treatment however does not address the underlying bronchial inflammation which increases the risk for severe asthma exacerbation.
A multinational, phase 3, double blind, randomized, event-driven trial evaluated (3,132 patients ;97% >12 years of age) the efficacy and safety of combination albuterol/budesonide treatment (as compared to albuterol alone) as a rescue therapy for asthmatic children (receiving inhaled glucocorticoid-containing maintenance) in 3 trial groups.
The risk for a severe asthma exacerbation is 26% less with a high-dose rescue combination of albuterol/budesonide inhalation therapy (compared to albuterol alone; lower dose combinations only reduce risk by 16%) with no differences noted for adverse consequences.
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Current causes of death in children and adolescents in the US |
The Center for Disease Control and Prevention (CDC) recently released updated mortality data for children and adolescents (1-19 years of age).
In summary, the 3 most common causes of death include:
- Firearms (45,222 – a new peak), primarily homicides, with a 13% increase from 2015-2019 (occurring among most demographics and types of firearms).
- Motor vehicle crashes.
- Drug overdose and poisonings (increased by 83.6% from 2019-2020).
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REGISTER - LEARN - EARN CME CREDIT |
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Pediatric Rehabilitation Medicine 101
At the completion of this activity, participants are expected to: [1] Understand general definitions, [2] Learn about the International Classification of Function Model, [3] Review the Disability Laws, [4] Understand the role of Pediatric Physical Medicine and Rehabilitation providers.
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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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