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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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July 13, 2022 | Volume 13 | Issue 28 |
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Neutralization escape by SARS-CoV-2 Omicron subvariants BA.2.12.1, BA.4 and BA.5 |
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This year Omicron and its sub-variants have continued to spread throughout many countries with the Omicron subvariants BA.2.12.1, BA.1, BA.2, BA.4 and BA.5 now dominant. In the US, BA.4 and BA.5 (to date) account for at least 56% of the SARS-CoV-2 genomes.
A study evaluated neutralizing antibody titers against a reference plus Omicron subvariants BA.1, BA.2, BA.2.12.1, BA.2 and BA.5 in 27 participants who had been vaccinated and boosted with messenger RNA vaccine BNT162b2 (Pfizer-BioNTech) and in 27 participants who had been infected with BA.1 or BA.2 subvariants 29 days (median) earlier.
6 months after the initial 2 doses of the vaccine, neutralizing antibodies against all Omicron subvariants are minimal (with only mild/modest increases after a booster dose).
BA.2.12.1, BA.4 and BA.5 subvariants substantially escape neutralizing antibodies induced by both vaccination and infection which provides an immunologic context for the current surges in infection in populations with high frequency of vaccination and BA.1 or BA.2 infection.
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Read the full article at New England Journal of Medicine
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Treatment of Bardet-Biedl Syndrome (BBS) |
Bardet-Biedl Syndrome is a rare condition (approximately 1:100,000 US/Northern European newborns), typically inherited as an autosomal recessive gene (from mutations in more than 20 genes) which results in abnormalities of the structure and function of cilia (found in many types of cells). These structures are involved in cell movement and many different chemicals signaling pathways as well as the “perception of sensory input” (such as sight, hearing and smell) which causes signs and symptoms (6 features classically) to vary among affected individuals.
Hyperphagia/truncal obesity are characteristic of BBS (beginning in early childhood), as are vision loss (leading to blindness in adolescence), polydactyly, intellectual disability/learning problems, renal abnormalities and infertility. There are other conditions that resemble BBS. Treatment is of specific symptoms and usually requires a coordinated multidisciplinary team.
The FDA has now approved Setmelanotide (IMCIVREE®) to treat BBS, which targets impairments in the melanocortin-4 receptor (MC4R) pathway, and which is the root cause of the severe early-onset obesity and hyperphagia in BBS.
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An ESPGHAN position paper on the use of FODMAP diet in pediatric gastroenterology |
“FODMAP is an acronym for a certain class of carbohydrates called fermentable short-chain carbohydrates” (oligosaccharides, disaccharides, and polyols) e.g., fructose, lactose, fructans, galactans and sugar alcohols found in apples, avocados, cherries, figs, peaches and plums. “Excluding FODMAPS from the diet has been increasingly used to treat children with gastrointestinal complaints”.
From a systematic literature search and review by members of the Gastroenterology Committee, the Nutrition Committee, and the Allied Health Professionals Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) which examined clinical questions related to FODMAP use, it appears that there is little evidence to support the use of a low-FODMAP diet in children with Irritable bowel syndrome, and NO evidence to recommend its use in other gastrointestinal diseases and complaints in children.
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Association of patient characteristics with post-operative mortality in children undergoing tonsillectomy in 5 US States |
There appears to be 340,000 (estimated) ambulatory and 10,000 in-patient tonsillectomies performed each year in the US with “pediatric tonsillectomy being the first-line surgical treatment for children with obstructive sleep-disordered breathing and recurrent throat infections”. Risks associated include severe pain, dehydration, respiratory failure and bleeding and while severe complications/deaths in healthy children are rare, they remain a concern of all participating physicians. Risk factors and incidence of severe complications remain unclear.
A retrospective cohort study of 504,262 children examined the frequency and patient characteristics associated with post-tonsillectomy deaths.
7 children in 100,000 die post-operatively following a tonsillectomy (median 4.5 days) and most occur after surgical discharge. Children with complex chronic conditions (neurologic/neuromuscular or congenital/genetic disorders) are at significantly increased risk and account for 44% of post-operative deaths.
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Childhood “bronchitis” and respiratory outcomes in middle-age: A prospective cohort study from age 7 to 53 years |
“Severe early childhood bronchitis manifests by recurrent episodes of protracted wet cough and is associated with asthma and bronchiectasis in later childhood”; what occurs to these children later in life is unknown.
A study of 3,202 adults aged 53 years, participants of the Tasmanian Longitudinal Health Study cohort, first investigated at 7 years of age, evaluated the association between early respiratory symptomatology (47.5% had >1 episode of bronchitis) and mid-life respiratory outcomes.
At age 53 years, adults with a history of recurrent bronchitis as a child have an increased prevalence of doctor-diagnosed current asthma and pneumonia (particularly among those children classified as having “recurrent protracted bronchitis”).
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Association between BNT162b2 (Pfizer-BioNTech) vaccination and long COVID after infections NOT requiring hospitalization |
An interesting observational study of 739 individual adult health care workers with polymerase chain reaction (PCR) positive COVID of whom 31% had long COVID (89 asymptomatic) and who had all received 3 doses of BNT162b2 vaccine indicates (during 3 waves of infection; “wild type” Alpha and Delta/Omicron) that the prevalence of long COVID varies across pandemic waves, the number of vaccine doses is directly associated with decreased long COVID prevalence, and older age, allergies and obstructive lung disease appear (in adults) to be associated with long COVID.
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Incidence of new-onset Type 1 Diabetes (T1D) among children during the COVID-19 global pandemic |
From a single tertiary care pediatric center which investigated and compared the case-rate for children presenting with new-onset T1D in a 12-month period after the onset of the COVID-19 pandemic to the 5-year period prior to the pandemic, it appears that the pandemic has significantly increased T1D case rate hospital diagnosis/admissions (as measured by the presence of diabetic ketoacidosis).
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REGISTER - LEARN - EARN CME CREDIT |
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Lymphatic Imaging and Interventions In Children: New Paradigm
At the completion of this activity, participants are expected to: [1] Understand general definitions, [2] Learn about the International Classification of Function Model, [3] Review the Disability Laws, [4] Understand the role of Pediatric Physical Medicine and Rehabilitation providers.
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Underwriting Opportunities
Advertising in this e-journal in no way implies endorsement of a product by Nicklaus Children's Hospital.
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