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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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December 1, 2021 | Volume 12 | Issue 48 |
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Surgical outcomes in obese patients with Adolescent Idiopathic Scoliosis (AIS) |
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Increases in childhood obesity continue as a world-wide epidemic with substantial deleterious effects on children’s short- and long-term health. Complications include hypertension, hypercholesterolemia, glucose intolerance with Type 2 diabetes, breathing problems like asthma and sleep apnea, joint and muscle abnormalities, fatty liver, gallstones, gastrointestinal reflux, psychological problems, low self-esteem, bullying and stigma to name just a few.
A multicenter research consortium (11 Centers in the Southern US) reviewed perioperative complications in overweight/obese (85-<95th percentile) adolescents (751 patients) with AIS after treatment with posterior spinal fusion.
Obese/overweight adolescents with AIS undergoing posterior spinal fusion treatment are more frequently from lower socioeconomic groups, have increased superficial surgical site infections, wound dehiscence, readmission rates and estimated blood loses, increasing sequentially between children who are normal in weight, overweight or obese.
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Read the full article at Journal of Pediatric Orthopaedics
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Safety of Lubiprostone in pediatric patients with Functional Constipation |
Functional Constipation in children is the most common cause of constipation in children affecting up to 29.6% world-wide. Its management continues to challenge physicians, parents and families with prolongation of symptoms frequently occurring in 40% of constipated children after 6-months of treatment.
“Lubiprostone selectively stimulates type 2 chloride channels in epithelial cells causing influx into the intestinal lumen” which locally increases the amount of fluid movement into the gut lumen softening stools, enhancing intestinal transit times/improving symptoms. Lubiprostone is approved for idiopathic chronic constipation in adults but not in children.
A phase 3, multicenter, open-label trial which examined the safety and tolerability of oral Lubiprostone (give twice daily for 24 weeks) in 87 children (6-17 years of age) diagnosed with Pediatric Functional Constipation (Rome III criteria) indicates that Lubiprostone is well-tolerated (most side-effects are mild and self-resolving) and supports the positive efficacy data from a previous pediatric trial.
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Treatment of typically developing toddlers with hair pulling behavior and concurrent poor sleep hygiene |
Hair pulling is quite common in all ages and the term Trichotillomania is used for hair loss due to a child’s twisting, pulling or plucking hair from any part of the body (frequently head, eyebrows or eye lashes). In adolescence it may be associated with co-morbid psychological or psychiatric disorders. Treatment will depend on age and underlying associated issues.
An interesting case report describes 2 infants (<24 months old) with hair pulling disorders and concurrent highly disruptive sleep. Sleep hygiene intervention improved both sleep and hair behavior. For treatment of hair pulling to be successful identification of underlying factors require elucidation.
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Utilizing recorded music to reduce stress and enhance infant neurodevelopment in neonatal intensive care units (NICU) |
The application of music therapy to enhance preterm infant physiology and neurodevelopment has attracted much attention over the past years. It appears that music therapy effectively improves the preterm infant’s heart rate, stabilizes respiratory rate while attenuating pain/stress levels and improves oral feedings, parental well-being/attachment, bonding and decreases anxiety. Music therapists require specific training in music, psychology, biological and social sciences etc. to achieve therapeutic results.
A comprehensive review of 2 databases which examined the impact of recorded music interventions on hospitalized preterm infants indicates that most studies report a short-term beneficial effect in reducing stress and improving infant neurodevelopment without negative effects (however small sample size and variability in study design requires larger more rigorous trials to identify the specific elements of music therapy benefit and to document longer-term neurodevelopmental outcomes. Ed).
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Identification and characterization of oral injury in Suspected Child Abuse Cases |
From a retrospective review of billing codes and an internal clinical database that identified children younger than 24 months of age with oral injuries it appears that infants with suspected abuse (vs. accidental injury) are more likely to be identified by rarely having a history of trauma or an oral laceration and are more likely to be younger, less mobile and have a togue injury or oropharyngeal bruising.
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Safety and tolerance of a novel anti-regurgitation (AR) formula |
“Expert reviews suggest that the management of infant regurgitation should build on parental reassurance and nutritional advice”. Regurgitation however is often associated with other gastrointestinal (GI) symptoms such as infant colic, gassiness and constipation. Fermented infant formula (which creates post-biotics) has been reported as beneficial for GI symptoms. A combination of a specific prebiotic mixture of short-chain galacto-oligosaccharides (scGOS) and long-chain fructo-oligosaccharides (IcFOS) has been demonstrated to be safe, well-tolerated and to improve gut health; in combination with post-biotics these offer a wider range of potential GI symptom improvement.
A multicenter, control, double-blind, two parallel-group study of 182 singleton term-born infants (ages 21-91 days) formula fed diagnosed with uncomplicated regurgitation (Rome IV criteria) randomly assigned to receive a novel feed (Locust Gum – LBG – as a thickener, partly fermented formula with post-biotics plus scGOS and IcFOS) vs. an anti-regurgitation formula with a history of safe use, compared gut health and GI symptoms beyond regurgitation.
“A novel anti-regurgitation formula combining LBG, scGOS/IcFOS and post-biotics is well tolerated, safe and supports adequate growth with greater improvement in GI symptoms”.
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Pneumonia, sinusitis, influenza and other respiratory illnesses in acute otitis media-prone (OP) children |
“Recurrent acute otitis media in the first year of life can be explained by immune dysfunction”. Otitis media prone (OP) children should consequently be more susceptible to other infectious diseases (especially respiratory infections).
A cohort study of 285 children (6 months-5years of age; 39 OP and 346 non-otitis-prone – NOP) were utilized to determine and compare the incidence of pneumonia, acute sinusitis, influenza and other bacterial and viral infections. Stringently defined OP children (by tympanocentesis with microbiology) have a 6-fold increased frequency of pneumonia, 2.1 fold higher rate of sinusitis and 2.9 fold higher presentation of influenza compared to non-otitis media prone children (adjusted for covariates risk factors).
“Clinicians should be aware of the significant increased likelihood of bacterial and viral respiratory infection proneness among otitis media-prone children.
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