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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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October 27, 2021 | Volume 12 | Issue 43 |
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Does the presence of symptoms affect pregnancy outcomes in third trimester in women with SARS-CoV-2? |
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“Pregnant women with symptoms of COVID-19 have an increased risk for neonatal adverse outcomes compared to those who are asymptomatic or who are SARS-CoV-2 negative”.
A retrospective study of 2,299 COVID-19 negative pregnant women and 172 pregnant women with confirmed COVID-19 (median gestational age 39 week - symptomatic and asymptomatic) assessed and compared maternal and neonatal outcomes.
There is no difference in caesarian delivery, maternal outcomes or incidence of preterm delivery, severe neonatal asphyxia or death between those mothers who are COVID-19 negative, or positive (asymptomatic or symptomatic), however neonatal respiratory complications (TTN/RDS/PPH) are significantly higher in neonates of COVID-19 positive symptomatic mothers, with composite neonatal and overall adverse outcomes being significantly increased in COVID-19 cases (with a trend of decreasing poor neonatal outcomes from COVID-19 mothers with symptoms, to asymptomatic COVID-19 positive to non-infected).
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Read full article at The Journal of Maternal-Fetal & Neonatal Medicine
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Room to read: The effect of extra-large letter spacing and colored overlays on reading in adolescents with dyslexia |
Dyslexia is a common learning disorder affecting a child’s ability to recognize and manipulate the sounds in language which results in difficulties in reading, writing and spelling. Young children may present with delayed talking, be slow in learning new words, have difficulty forming words correctly, reverse letters and struggle with naming/remembering numbers, letters and colors. They have trouble following directions and may find it difficult to tell left from right. “ Dyslexia is not a reflection of a child’s intelligence”.
Color overlay and extra-large letter spacing may improve reading speed and accuracy in children with dyslexia.
A study of 32 dyslexic children (matched to a non-affected group) aged 13 years (average) investigated whether reading material modifications would be beneficial.
Extra-large letter spacing significantly improves reading speed in dyslexic children and reduces the number of missed-word errors. (Colored overlays do not appear to have any significant beneficial effect).
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The removal of SARS-CoV-2 and other microbial bioaerosols by air filtration on COVID-19 surge units |
“Hospital-acquired COVID-19 is a recognized problem among both patients and staff with growing evidence for the relevance of airborne transmission”.
The COVID-19 pandemic has overwhelmed the capacity of many respiratory isolation areas in hospitals with hospitals repurposing wards without high-frequency air changes to manage patients with COVID-19.
A crossover study examined the effect of portable air filtration/ultraviolet (UV) light sterilization on detectible airborne SARS-CoV-2 and other microbial bio-aerosols over a 5 day period.
From a pre-print study it appears that air filtration/UV devices significantly reduce the amount of SARS-CoV-2 and other microbials in the air and are potentially of great value in reducing the risk of hospital-acquired SARS-CoV-2 infection.
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Effect of a hybrid closed-loop (HCL) system on glycemic and psychosocial outcomes in children/adolescents with Type 1 Diabetes |
Good glucose management of Type 1 Diabetes enhances health and decreases complications (short and long-term). An insulin pump improves glucose control in eligible children/adolescents with A1C levels >7%, are poor adherers to conventional therapy, have frequent hypoglycemic episodes, etc.
A hybrid closed-loop pump system is any insulin pump able to deliver variable automated basal insulin requirements using an algorithm and real-time blood glucose levels (from a glucose sensor), combined with manual mealtime insulin boluses. Efficacy on glycemic and psychosocial outcomes (vs. conventional therapy) has not been established.
From a 6-month clinical trial of 135 children/adolescents (mean age 15.3 years) with Type 1 Diabetes randomly assigned to either a control group receiving conventional insulin, or HCL therapy, it appears that the HCL system increases the percentage of time blood glucose levels remain in the desired glucose range (70-180mg/dl), reduces time spent in hypoglycemia, enhances glycemic variability and improves diabetes-specific quality-of-life.
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Virologic features of SARS-CoV-2 infection in children |
Respiratory swabs with viral load quantification collected form 110 COVID-19 positive children (median age 10 years) which compared viral load with age, symptom duration, and disease severity, indicates that children’s age does not impact viral load, children are most infectious within the first 5 days of illness, and severe disease does not correlate with viral load.
“Symptomatic and asymptomatic children can carry high quantities of live replicating SARS-CoV-2 creating a potential reservoir for transmission and evolution of genetic variants”.
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Infectious mononucleosis in childhood and adolescence and the risk of subsequent multiple sclerosis among siblings |
Multiple sclerosis (MS) is a disease of the central nervous system characterized by inflammation, blood-brain barrier breakdown, demyelization and neuronal lesion formation/axonal damage. The exact cause is unknown, however environmental and genetic factors appear to be associated with its development.
Epstein-Barr virus (EBV), low-level of vitamin D, obesity and smoking etc. are well-established environmental factors increasing the risk for MS.
From a population-based cohort study of 2,492,980 individuals in Sweden which examined whether a diagnosis of infectious mononucleosis in childhood/adolescence is associated with an increased risk of subsequent MS diagnosis (over a 15.38 year follow up period) it appears that being female, first born, having an older maternal age at birth and/or having infectious mononucleosis in childhood/adolescence is associated with an increased risk for the development of MS independent of shared measures or unmeasured family factors.
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A teenager with palpitations |
“Palpitations can result from cardiac awareness or from a fast or irregular cardiac rhythm”. Palpitations can be caused by a variety of factors which include:
- Anxiety/stress/lack of sleep.
- Exercise.
- Fever/illness/medications/caffeine-nicotine-illegal drugs (like cocaine).
- Medical conditions like dehydration, anemia, hypothyroidism and/or hypoglycemia.
Though rare, palpitations can be a sign of a serious cardiac abnormality.
An interesting case history outlines the presentation and diagnosis of a teenager who arrived to an Emergency Department with a 1-day history of intermittent palpitations, chest pain and shortness of breath.
While palpitations in teenagers are not uncommon, when associated with other signs or symptoms, cognizance should be taken and a cardiologist consulted.
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REGISTER - LEARN - EARN CME CREDIT |
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"Childhood Grief and Bereavement: Developmental and Conceptual Approaches"
This Virtual Grand Round was recorded LIVE and includes the post-session Q&A portion. This content is available for free - without CME credit (Fee may apply for those who wish to claim CME).
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Mayo Clinic COVID-19 Vaccine Tracker |
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