March 10, 2021 | Volume 12 | Issue 10
Clinical implication of pulmonary nodules detected in children
From a study of 88 children diagnosed with a pulmonary nodule/s, 64% have a single nodule and 24% have a pre-existing non-oncologic systemic disease. In otherwise healthy children with a solitary nodule, 94% do not have a definitive diagnosis (and none go on to develop systemic disease).

"Diagnostic workup of a solitary nodule in children is often inconclusive" and it appears not to be the sole presenting sign of any systemic disease. "Observation without laboratory work-up or repeat imaging is a reasonable option" in previously healthy asymptomatic children presenting with a single pulmonary nodule.

Presence of armed school officials and fatal gunshot injuries during mass school shootings; USA 1980-2019
A cross-sectional study which examined each identified case (133) where at least 1 person was intentionally shot in a school building during a school day, and related them to offender motive, the presence of an armed guard on the scene during the shooting, the number and type of firearm used and other factors, indicates that most shooters are young (89% <22 years of age), 70% are current students (15% former students), 76% are white, 98% are male, 47.11% are targeted shootings with 8.9% involving more than 1 shooter. An armed guard was on the scene in 23.58% of shootings.

Controlling for a number of factors, it appears that the death rate at schools involved in a shooting with an armed guard present is 2.83 times greater than schools without one, and that having an armed guard does not appear to reduce the rate of injuries either.


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Does human milk fortifier affect intestinal inflammation in preterm infants?
"Fecal calprotectin, a recognized marker of intestinal inflammation is derived from neutrophil migration to a site of inflammation. Introduction of bovine-based human milk fortifier containing intact protein in preterm infants is associated with an increase in fecal calprotectin suggestive of intestinal inflammation."

A study of 401 stool samples from 24 infants (birth weight 990g; gestational age 27.5 weeks) collected during the first week to 60 days postnatal age, measured fecal calprotectin in human milk-fed preterm infants before and after the introduction of human milk fortification using a fortifier containing hydrolyzed protein.

"The feeding of protein hydrolysate-containing human milk fortifier does not appear to be associated with an increase in a marker of intestinal inflammation."
 
Cholestasis after very preterm birth and neonatal outcomes
"Cholestasis is defined as an impairment in the excretion of bile which can be caused by defects in intrahepatic production of bile, transmemebrane transport of bile or mechanical obstruction to bile flow. An increase in serum conjugated bilirubin (direct hyperbilirubinemia) is characteristic and varies depending on the underlying disorder." Cholestasis occurs 10-20% of preterm infants and is usually due to a combination of factors, is frequently transient but if persistent may be indicative of severe liver disease e.g. biliary atresia.

A population-based retrospective control study of very preterm infants, gestational age <30 weeks, surviving for 28 days with neonatal cholestasis examined outcomes.

Perinatal factors associated with infant cholestasis include maternal pre-eclampsia and being born small for gestational age. Cholestatic preterm infants have 3 times more bronchopulmonary dysplasia, 8 times more retinopathy of prematurity and 5 times higher mortality than unaffected matched controls (preterm survivors of cholestatic jaundice are not associated with chronic liver disease).


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Atopy and pulmonary function among healthy -weight and overweight/obese children with asthma

A retrospective chart review of 200 predominantly minority children (47.5% Hispanic and 39.5% African American) which compared the prevalence of atopy and its association with pulmonary function in overweight/obese to healthy-weight children, indicates that "atopy is associated with poorer, lower lung function in healthy-weight asthmatics, but not in overweight/obese asthmatics, supporting the role of non-allergic mechanisms in disease burden in pediatric obesity-related asthma."
Antibiotic exposure during pregnancy and childhood asthma

While it has previously been suggested that there is a relationship between antibiotic exposure during pregnancy and childhood asthma, past studies have differed significantly in design, sample size, etc.

From a Danish National Birth Cohort (32,651 children studied) which investigated antibiotic exposure during pregnancy and the subsequent diagnosis of asthma in offspring, it appears that there is a 17% increased risk of childhood asthma when pregnant mothers are exposed to an antibiotic during their second to third trimester and their infant's are delivered vaginally.


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Assessment of maternal and neonatal cord blood SARS-CoV-2 antibodies and placental transfer ratios

A cohort study of 83 mother newborns dyads (where the mother was seropositive for SARS-CoV-2 antibodies) examined the association between maternal and neonatal SARS-CoV-2-specific antibody concentrations.

Neonatal cord blood IgG concentrations are directly related to maternal antibody concentrations (amounts dependent on the time elapsed between maternal infection and delivery; no maternal IgM antibodies detected in cord sera).

Maternal SARS-CoV- 2 IgG antibodies efficiently cross the placenta providing the potential for neonatal protection from SARS-CoV-2 infection.
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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
Dear Reader:

Though there may be many among you who have undergone immunization against COVID-19, this pandemic may by no means be over. We should be cautious as new mutant strains have arisen which make certainty about the absolute protection afforded by vaccination unclear, their response to treatment uncertain and there is the possibility that the variant viruses may spread even from those who are immunized.

Please continue to take care, wear a mask whenever in public, wash hands well and often, use sanitizer if available, cough or sneeze into elbow and socially distance yourself (preferably at least 6 feet from any person), outdoors, or in a well ventilated area whenever and where ever possible.
 
Best of luck.

Jack Wolfsdorf, MD, Editor
Staff NCH
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