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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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December 29, 2021 | Volume 12 | Issue 52 |
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Septic arthritis of facet joint in children |
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The facet joints are articulations at the back of the spine between the paired bony projections (articular processes) connecting and supporting the spine’s vertebral bones. Lined with cartilage they allow the spine to bend and twist. “Facet joint septic arthritis is a rare condition first described in 1987”. Descriptions of septic arthritis of the facet joints (SAFJ) in children are scarce.
A 10-year consecutive SAFJ case series, combined with a 50-year systematic review of the literature aimed to estimate the incidence rate of SAFJ in children and specify the clinical, imaging and laboratory findings.
The incidence of pediatric SAFJ is 0.23/100,000 children-years (more common than expected from the literature). Common symptoms include “potty” refusal (in toddlers), painful sitting (78%) and lateralized signs (paravertebral tenderness/swelling – 88%). Diagnosis in 94% of children is by magnetic resonance imaging (MRI). Epidural extension of infection through a foramen occurs in 50% of children. Mean duration of antibiotic treatment is 5.1 weeks.
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Read the full article at Pediatric Infectious Disease Journal
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How common is Long-COVID in children and adolescents? |
The evidence for Long-Covid in children and adolescents is limited and all studies to date have substantial limitations, or do not show a difference between children infected by SARS-CoV-2 and those who are not.
A review of 14 studies (to date) that have reported on persistent symptoms following COVID in children and adolescents (headache, fatigue, sleep disturbances, concentration difficulties, abdominal pain, myalgia/arthralgia, congested/runny nose, cough/chest tightness/pain, disturbed smell, loss of appetite/weight and rash) indicates that though there is no clear definition for the syndrome in children, nor any agreement on the duration of symptoms that would justify the diagnosis, the time-frame for apparent symptoms that do persist ranges between 4-12 weeks after the acute infection.
“Long-term SARS-CoV-2 infection associated symptoms are difficult to distinguish from pandemic associated symptoms”.
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Prevalence and microbiol resistance of bacteria in children with acute otitis media (AOM) and ear discharge |
15-20% of children with AOM present with fever, ear pain, and feeling unwell with an acute onset of discharge from a spontaneous rupture of the tympanic membrane (AOMd) for which antibiotics are both effective and recommended for treatment.
A systematic search of multiple databases aimed to quantify the prevalence and antimicrobial resistance status of bacteria in children with AOMd (in the pneumococcal conjugate vaccine era).
Of 10,560 children with AOMd, Streptococcus pneumonia (26.1%), Haemophilus influenzae (18.8%), Staphylococcus aureus (12.3%) and Streptococcus pyogenes (11.8%) are the most prevalent organisms. Antibiotic resistance data is sparse but no increase in resistance over time has been noted.
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The impact of operative intervention in pediatric Lyme Disease |
Lyme disease is caused by a bite (peak period spring and summer months) from a variety of tiny black-legged ticks who inject a bacterium (Borrelia burgdorferi) into the skin resulting classically in a “bull’s eye” rash (single or multiple) 3-30 days later, and subsequently systemic symptoms of fever, fatigue and joint pain (flu-like symptoms). Lyme disease arthritis typically occurs as a late stage (Stage 3 - months to years later) with symptoms involving large joints, especially the knee.
A retrospective cohort study of 149 children diagnosed over a 10-year period with Lyme arthritis compared costs and outcomes between antibiotics alone vs. antibiotics plus operative debridement.
Operative management of Lyme arthritis is associated with an increased length of hospital stay and cost without improving time to resolution.
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Low grade intraventricular hemorrhage (IVH) in extremely preterm infants |
While the relationship between grade 3 and 4 IVH and worse neurological outcomes is well documented, a study of >500 infants which correlated neurodevelopmental outcomes at 8 years of age (corrected) with grades 1 and 2 IVH in extremely preterm infants reminds us that the risk of cerebral palsy/poorer developmental outcomes is substantially increased even at the lower grades of IVH.
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Inhaled corticosteroids (ICS) alone and in combination with long-acting β2 receptor agonists (LABA) to treat reduced lung function in preterm-born infants |
Preterm birth is frequently association with increased respiratory symptoms/lung function deficits, especially following the development of bronchopulmonary dysplasia (chronic lung disease of prematurity). “Treatment recommendations during childhood and beyond remains largely unknown”.
A double blind randomized, placebo-controlled trial of 144 preterm born children (ages 7-12 weeks; gestational age <34 weeks at birth) randomized to one of three cohorts (fluticasone propionate 50 μg with placebo; fluticasone propionate 50 μg with salmeterol 25 μg or placebo inhaler, 2 puffs twice daily for 12 weeks) was utilized to assess whether inhaled corticosteroids alone or in combination with LABA improves lung function and exercise tolerance.
ICS/LABA combined treatment of children born preterm improves airway resistance/lung function (but does not improve exercise capacity).
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Exercise intervention and academic achievement among children |
Physical activity reduces obesity in school-age children and adolescents, enhances physical and psychological well-being and appears to improve children’s academic achievement, though strong evidence for the latter is lacking.
A population-based cluster randomized trial of 2,101 fourth grade primary school students, randomized from urban and mixed residential areas examined the effect of an exercise program intervention (twice weekly over 10 weeks of 10-20 minutes sessions) vs. a matched control group (undertaking their usual physical education program) on academic achievement assessed by scores on a National examination.
An exercise intervention program significantly improves children’s academic achievement by 8.36 points (for urban children) and 9.55 points for those from a mixed residential area (with no exercise-associated injuries noted).
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