May 19, 2021 | Volume 12 | Issue 20
Point of care diaphragm ultrasound in acute bronchiolitis
A study of 104 infants aged 1-24 months diagnosed with acute bronchiolitis evaluated diaphragmatic parameters, clinical and sonographic scores and outcomes.

“Diaphragm ultrasound appears to be an objective and useful tool to help physicians make decisions regarding the evaluation and management of bronchiolitis.”
Utilization and safety of polyethylene glycol (PEG) 3350 with electrolytes (PEG 3350+E) for children under 2 years of age with chronic constipation
PEGs are products of condensed ethylene oxide and water; many oral products are hydrophilic, not metabolized and minimally absorbed in the gastrointestinal tract. Various formulations of PEG have been developed; PEG 3350 and PEG 4000 (molecular weight 3350 and 4000 g/mol respectively) with or without the addition of electrolytes are available and both PEGs are effective in treating childhood constipation. For chronic constipation in children 2-11 years of age and fecal impaction (FI) in >5 years olds PEG 3350 +E is recommended as a first line treatment.

A retrospective study of 13,235 children with chronic constipation and 40 with FI investigated usage and risk of PEG 3350+E use in children <2 years of age (commonest daily dose 6.9g).

PEG 3350+E for children <2 years of age with
chronic constipation/FI appears safe with few children having any adverse symptoms.
Academy of Breastfeeding Medicine (ABM) Position Statement on Ankyloglossia (tongue-tie) in breastfeeding dyads
“Classical tongue-tie is a fold of mucosa and sometimes fascia that is visible on elevation of the tongue that restricts its function.” In the face of lack of high-quality evidence-based studies on the diagnosis and treatment of tongue-tie, the Academy of Breastfeeding Medicine gathered a task force of “experts” to provide a position statement after analyzing the available data to date.

While the ABM summarizes and describes the issues (both maternal and infant) associated with a diagnosis and management of tongue-tie, data available does not permit it to give a clear directive on any aspect of diagnosis or management. (Even though no clear guidance is given, this article fully outlines the subject material and is well worth reading, Ed.)
Long-term functional outcomes and complications in operative vs. non-operative treatment for displaced midshaft clavicle fractures in adolescents
Clavicular fractures account for approximately 15% of all fractures in children with the midshaft being the most common site. Treatment is classically non-operative. Recently however, following reports of higher rates of nonunion and impaired biomechanics in adults treated conservatively, management has shifted towards operative management of midshaft clavicular fractures in both adults and adolescents.

A retrospective comparative study of 109 adolescents aged 12-18 years with a displaced midshaft clavicular fracture treated non-operatively or operatively (plate or intramedullary nail) examined long-term outcomes (pain and satisfaction rate).

Adolescents aged 12-18 years with a displaced midshaft fracture treated non-operatively have good long-term functional results with adolescents expressing greater satisfaction. “Surgery should rarely be the choice of treatment for displaced midshaft clavicular fractures in adolescents.”


See related video below:
Dr. Nabil Ebraheim
Post-chemotherapy complications and probiotic use in children with acute lymphoblastic leukemia (ALL)
Anti-neoplastic drug administration not infrequently gives rise to acute complications associated with the toxicity of medications used and this affects rates of visits to the Emergency Department (ED), hospitalization, use of antimicrobials and quality of life.

A single-blinded cohort study of 60 children with treated ALL (followed for 30 days post-hospitalization) who had received a probiotic (Lactobacillus rhamnosus GG) during treatment (vs a matched non-probiotic treatment group) evaluated gastrointestinal (GI) symptoms, development of infections, antibiotic use, number of ED visits, hospitalizations and sepsis diagnosis.

Administering a probiotic during chemotherapy (for children diagnosed with ALL) appears to be of significant benefit, reducing GI symptoms and adverse effects associated with chemotherapy.


See related video HERE.
Fecal transplantation in infants born by caesarian section (C/S) and gut microbiome
“The gut microbiota of newborn infants who are born vaginally are colonized by maternal gut bacteria” (bacterioides species) which when disturbed (as occurs following C/S birth) is associated with an increase in chronic immune system related diseases. The impact of attempts to correct the microbiome of infants delivered by C/S by oral administration of vaginal flora or probiotics has been limited.

A proof of principle and safety trial of 17 pregnant women (mean age 31-40 years) scheduled for C/S utilized 7 for infant fecal transplantation (samples collected from mothers 2 weeks prior to delivery). Each infant (birth weight : 2861-3528 gems) received 3.5-7mg of maternal fecal material mixed with their first feed of mother’s milk. Infants were followed up to 3 months with repeated fecal sampling.

In this small sample of post C/S infants who received an orally administered fecal sample from a mother, (appropriately prepared) with their first feed, results indicate that the newborns’ stool microbiome composition was normalized (and similar to fecal microbiota samples collected from vaginally delivered infants).


See related video HERE, HERE & below:
Babies born vaginally have different gut bacteria - their microbiome - than those delivered by Caesarean

University of Birmingham
Synthetic cast material vs. plaster of paris (POP) for the treatment of idiopathic clubfoot by the Ponseti protocol
Clubfoot describes a range of congenital foot abnormalities (found in 1 in a 1000 live births), where the foot is twisted inward. The Ponseti technique of manipulation and plaster cast application for the treatment of idiopathic clubfoot in infants (which avoids surgery in 89% of cases) results in 78% of infants achieving excellent or good functional outcomes (with a 30-year follow-up). Synthetic casting materials have been used as an alternative to POP.

A study from 2 different institutions retrospectively reviewed outcome in 136 conservatively treated clubfeet (68 with POP casting; 68 using a semi-rigid fiberglass (SRF) cast); the first cast being placed at 10 days (mean) of age, with a follow up of ~ 5 years (mean).

The use of a SRF cast in experienced hands gives comparable results to POP in idiopathic clubfeet treated by the Ponseti method, with no differences noted in relapse or complication rates.
  • What is the latest CDC guidance regarding reduction of COVID transmission?
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Featured Video
Bradley's Story

Bradley was born at 38 weeks via emergency c-section due to the loss of fetal movement. Shortly after birth, he was rushed to the NICU for oxygen support and later began to have apneic seizures.

Nicklaus Children's Hospital
via YouTube
COVID-19 - Current Situation in Florida
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Florida's COVID-19 Data and Surveillance Dashboard
Florida Department of Health, Division of Disease Control and Health Protection
Mayo Clinic's COVID-19 Vaccine Tracker - Click HERE to view.
Dear Reader:

I am sure many of you, like I, are feeling great relief at the improving outcomes following the various public health measures and SARS-CoV-2 immunization programs being undertaken in the USA to date. It seems that while there are many unanswered questions remaining, and firm answers not yet available on many interesting aspects, at present there is significant optimism that the mRNA vaccines will provide not only substantial (but not total) protection against the worst results of COVID-19 but will also minimize spread while appearing to be effective against the variants circulating.

Nevertheless I would urge all to remember that there are places and situations that place us at increased risk for infection, like hospitals, nursing homes, prisons and homeless shelters or while traveling. Some immunocompromised people will remain vulnerable to COVID-19. Continue to take care, wear a mask when appropriate, in addition wash hands or use a sanitizer when in risky situations, continue to cough or sneeze into ones elbow and be aware and cautious in balancing risks and benefits.
 
Best of luck.

Jack Wolfsdorf, MD, Editor
Staff NCH
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