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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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October 12, 2022 | Volume 13 | Issue 41 |
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Empiric treatment of infant irritability and acid gastro-esophageal reflux (GER) |
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“The ongoing trend to promote proton pump inhibitors (PPIs) to infants presenting with irritability and/or inconsolable crying is hard to break, despite the absence of evidence of benefit”. Guidelines suggest PPI’s are to be used only for erosive esophagitis or symptoms associated with acid reflux demonstrated by pH monitoring.
Chronic PPI use has significant side-effects which include negatively impacting the microbiome of the mouth, gut and lungs, enhancing small intestine bacterial over-growth (bloating, abdominal pain and diarrhea) enhancing the risk of allergies (particularly in infants <6 months of age) and interfering with nutrient absorption (e.g., Iron, Vitamin B12, and Calcium).
From an interesting investigation it appears that only 23.8% of health infants with irritability and/or inconsolable crying may have evidence of acid GER on pH monitoring. Where reflux investigation is difficult, a short-course (2-4 weeks) of empiric treatment with a PPI may be considered.
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Read the full article at Acta Paediatrica
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An evaluation of signs of nipple trauma associated with breastfeeding |
While breastfeeding is an innate and biologically stable behavior many abandon it early, often due to nipple trauma, a very common occurrence (reported by 80-90% of breastfeeding mothers). Erythema, swelling, scabbing, blistering, fissures, purpura and peeling are the 7 signs of nipple trauma however differences in clinical judgment by observers of some indicators (e.g., erythema and swelling) have resulted in a lack of consensus about the most effective treatment/s for nipple trauma.
A longitudinal prospective survey design using a complex 3-step Delphi method (asking multiple rounds of questions from a target group of experts) was utilized (using a questionnaire about a case of nipple trauma) to reach consensus on the definitions of the 7 signs of nipple trauma.
Based on the responses of multiple experts, consensus definitions are described and are available for the 7 signs of nipple trauma. This should improve condition observation and evaluation (photos and wound condition descriptions of each sign are presented).
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Human milk antibody response after combining 2 different COVID-19 vaccines: Mix and Match |
“Lactating women who have been vaccinated against COVID-19 can generate a SARS-CoV-2 specific antibody in human milk”, which can persist for many months playing an important role in the protection of the infant.
Many mothers receive the same vaccine (homologous) during their immunization schedule, while others have received heterologous vaccines (e.g., Oxford AstraZeneca and an mRNA vaccine). While both induce significant serum antibody responses, the latter schedule induces greater serum antibody titers. Whether this increase is reflected in the mother’s milk is unknown.
From a small study of 2 lactating women who received heterologous vaccines (AstraZeneca and Pfizer BioNTech) where breastmilk samples (16 each) were used to quantify the SARS-CoV-2 specific antibody response, it appears that heterologous SARS-CoV-2 vaccine immunization enhances human milk antibody responses, similar to that seen in serum, with potentially further benefit to the breastfeeding infant.
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Glycemic control trajectories and risk of perinatal complications among individuals with gestational diabetes |
“Glycemic control is the cornerstone of gestational diabetes management”. Whether glycemic control trajectories from diagnosis to delivery is associated with different risk of perinatal complications is unknown.
From population-based cohort of 26,774 mothers diagnosed with gestational diabetes whose control trajectories during pregnancy were classified as “stably optimal”, “rapidly improving to optimal”, “slowly improving to near optimal” and “slowly improving to suboptimal” it appears that there is a gradient of increasing risk of caesarian deliveries, shoulder dystocia, large-for-gestational-age and neonatal intensive care unit admission associated with “stably optimal” to “slowly improving” to suboptimal” glycemic control trajectories. Early gestational diabetes intervention is required to reduce infant risk.
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Outcome predictions in neonatal hypoxic-ischemic encephalopathy (HIE) using neurophysiology and neuroimaging |
“HIE due to perinatal asphyxia remains one of the leading causes of mortality and morbidity among newborns and is a significant cause of life-long disability and mortality in term-born neonates”. Early prediction of outcomes remains challenging.
From a prospective cohort study of 56 infants with moderate/severe HIE (treated with hypothermia) where aEEG (amplitude-integrated electroencephalography), NIRS (near infrared spectroscopy) were continuously recorded over >4 days, and magnetic resonance imaging (MRI) performed at 8 days (median) and infant development assessed at 2 years, it appears that combining aEEG and MRI parameters gives the highest predictive value for longer-term HIE outcomes.
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Top surgery and chest dysphoria among transmasculine and nonbinary adolescents and young adults |
“Transgender and nonbinary (TGNB) adolescents and young adults (AYA) designated female at birth (DFAB) experience chest dysphoria which is associated with depression and anxiety”.
A non-randomized prospective cohort study of 70 TGNB adolescents (mean age 18.6 years), 36 surgical mastectomy patients, matched to 34 non-surgical controls, which examined patient-reported chest dysphoria outcomes at enrollment and 3 months post-operatively (or not), indicates that gender-affirming mastectomy carries minimal complications and is associated with improved chest dysphoria, gender congruence and body image satisfaction.
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What parents should know about Atopic Dermatitis (AD) |
AD is a chronic skin condition which often runs in families, appearing at any age from infancy through adulthood which results in typical areas of dry, itchy, inflamed and red skin (with periodic flare-ups), caused by dysfunction of the skin barrier and an imbalanced immune system. Some children will outgrow AD others will continue to have skin irritation thorough adulthood.
A brief JAMA Pediatrics Patient Page outlines AD Presentation and Treatment options. A valuable photo description for parent education is available (worth having, Ed.).
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REGISTER - LEARN - EARN CME CREDIT |
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Pick your poison: A review on pediatric toxicology
At the completion of this activity, participants are expected to:
[1] Understand Florida law on informed consent, [2] Be aware that consent for minors must be in writing and detailed, [3] Learn about Florida’s new regulatory provision specific to pelvic exams.
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