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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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September 21, 2022 | Volume 13 | Issue 38 |
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Blood-based brain injury biomarker concentrations with outcomes after pediatric cardiac arrest
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“Approximately 10,000 children experience in-hospital or out-of-hospital cardiac arrest annually in the US”. Of those that survive with return of spontaneous circulation, neurologic damage due to hypoxic-ischemic brain injury is common.
In small studies blood-based brain injury biomarkers (Glial fibrillary acid protein: GFAP; ubiquitin carboxyl terminal esterase L1: UCH-L1; neurofilament light: NfL) appear to be associated with neurological morbidity/mortality outcomes after pediatric cardiac arrest.
A multicenter prospective blinded cohort study (The Personalized Outcomes After Child Cardiac Arrest) which included 120 children (ages 48 hours – 17 years) who were resuscitated after cardiac arrest analyzed the association between blood-brain injury biomarkers concentrations and death/neurological outcomes at 1 year.
1 year after surviving a pediatric cardiac arrest 58.3% of children are alive with a favorable neurological outcome. Higher blood-based brain injury biomarkers, especially NfL are associated with unfavorable outcomes (primarily death).
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Read the full article at JAMA Network Open
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Development variability in Autism across 17,000 autistic individuals and 4,000 siblings without an autism diagnosis |
From retrospective 4 cohort cross-sectional study which examined parent reported data from 17,098 autistic individuals (and siblings without an autism diagnosis) which evaluated (on average) the time to acquire key developmental milestones, it appears that substantial variation exists with delays being influenced by intellectual disability, genetic abnormalities associated with neurodevelopmental disorders, and earlier autism diagnosis. Later milestones (e.g., phrase, speech, bowl control, etc.) being more largely affected.
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Association between exposure to tobacco content on social media and tobacco use |
From an extensive 3-level, random effects, meta-analysis which was utilized to assess the odds of tobacco use (following a systematic review of multiple databases and social media platforms) it appears that exposure to tobacco content on social media is significantly associated with adolescent/young adult and adults being more likely to report lifetime tobacco use, past-30 day tobacco use and susceptibility to use tobacco among “never users”.
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Intranasal fentanyl to reduce pain and improve oral intake in the management of children with painful infectious mouth lesions |
“Painful infectious mouth conditions such as herpangina (from group A coxsackie viruses), hand-foot-mouth disease (enteroviruses) and herpetic gingivostomatitis can cause pain, dehydration and hospitalization in young children”. Treatment is generally supportive and primarily directed towards pain relief to facilitate oral intake.
A prospective, non-blinded, controlled trial randomized 84 children with painful infectious mouth lesions to receive either intranasal fentanyl (1.5 microgram/kg) or oral acetaminophen/hydrocodone (0.15mg/kg: control group) and assessed volume of fluid intake 60 minutes after treatment, with secondary outcomes, including pain score, hydration score, hospital admission rate and overall satisfaction, measured.
Intranasal fentanyl for mouth ulcers in children with poor oral intake appears safe and effective in reducing pain and improving hydration, while significantly decreasing hospital admission.
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Risk factors for upper extremity refractures in children |
“Childhood forearm fractures are very common and typically occur after a fall on an outstretched hand”, with closed reduction and casting being standard therapy.
While refractures (fractures occurring at the initial fracture site) are not infrequent, there are few large cohort studies which have analyzed for odds of refracture and an assessment of predictive factors.
A retrospective review of 2,902 children, 1-18 years of age with an upper extremity fracture examined the characteristics, frequency, and timing of children with an upper extremity refracture.
Upper extremity refracture apparently occurs in 2% of children, with a median time to refracture of approximately 6 months.
Factors more strongly associated with refracture include midshaft forearm fracture (vs. clavicle or humerus), and noncompliance with treatment guidelines.
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The influence of the introduction of biologic agents on surgical intervention in Pediatric Inflammatory Bowel Disease (PIBD) |
From hospital data (1997-2015 within England, UK ) on 22,645 children, 0-18 years of age, with a diagnosis of Crohn’s Disease (CD), ulcerative colitis (UC) or inflammatory bowel disease – unclassified (IBD-U), major surgical resection and biologic therapy, it appears that since biologic therapy was introduced surgical intervention for PIBD has decreased significantly (it is unknown whether biologic therapies prevent the need for surgery or just delay it until adulthood).
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Pediatric Benign Neutropenia (PBN): Assessing practice preferences in Canada |
“The normal neutrophil count varies by age and ethnicity”. Neutropenia or a low absolute neutrophil count (ANC) is defined as less than 1,000 UL before age 1 year and 1,500 / uL after 1 year of age (after the age of 1-year mild ANC is 1,000–1,500 / uL; moderate ANC 500–1,000 / uL and severe ANC is Less than 500 /uL).
Children with neutropenia frequently have no symptoms, however a mild/moderately low ANC may result in a variety of minor bacterial infections. Severe ANC may give rise to serious-life threatening infections.
Neutropenia is frequently associated with a recent infection (or medication), is usually temporary, resolving within 3-6 weeks. Neutropenia lasting longer than 8 weeks is considered chronic and the most common cause of chronic neutropenia in children is “Chronic benign neutropenia”.
Children with Pediatric benign neutropenia usually have an adequate neutrophil response to infection or stress, and rarely (10-12%) present with life threatening infections. The management of fever in children with benign neutropenia is often similar to that following malignancy or chemotherapy as guidelines are based on retrospective data and expert opinion.
A survey among Canadian Hematology/Oncology practitioners which questioned trends in benign neutropenia diagnosis and treatment demonstrates considerable variability. Prospective studies to establish diagnostic criteria and evaluate management in this interesting condition are needed.
Journal of Pediatric Hematology/Oncology
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