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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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March 30, 2022 | Volume 13 | Issue 13 |
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Diagnostic accuracy of the “Social Attention and Communication Surveillance – Revised“ with “Preschool Tool” for early Autism detection in very young children |
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It appears that up to 4% (or higher) of individuals worldwide may exhibit features of autism spectrum. Early identification is critical so that appropriate support and services can be directed which greatly improves outcomes. Unfortunately, the mean age of diagnosis for childhood autism is 4 years.
Early identification can be achieved via a single-time autism screening in either the general population or in a targeted group (e.g., siblings on the autism spectrum). Many early autism single screening tools however are of limited accuracy and sensitivity.
An alternate possibility which would appear beneficial to early diagnosis and treatment is to integrate autism-specific identification tools into the routine infant/child developmental surveillance program (where young children are routinely and repetitively monitored by a healthcare professional).
A diagnostic accuracy study (13,511 children, 11-42 months of age) where maternal and child health nurses trained to use the Social Attention and Communication Surveillance – Revised (SACS-R), SACS-Pre-School (PR)) assessed whether the developmental surveillance approach during routine care consultations could be used to train professionals to accurately identify infants, toddlers and preschoolers (at 12, 18, 24, and 42 months of age) on the autism spectrum.
The SACS-R with SACS-PR screening tools are easy to incorporate and administer during the routine periodic healthcare visits to the pediatricians’ office normally undertaken during infancy/childhood. They accurately identify autism early.
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Read the full article at JAMA Network Open
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Neurodevelopmental problems in children with febrile seizures followed to young school age |
“Febrile seizures are the most common type of seizures observed in the pediatric age group”. They usually occur in infancy/childhood between the ages of 3 months and 5 years (2-5% of children), have a familial history with no evidence of intracranial infection or defined cause (the diagnosis does not exclude children with prior neurocognitive impairment). Febrile seizures are divided into 2 types: Simple (generalized, last less than 15 minutes and do not reoccur within 24 hours) and Complex (prolonged, re-occur within 24 hours or are focal). Simple febrile seizures do not increase the risk of mortality or increase the likelihood of adverse effects on behaviors, scholastic performance or neurocognition.
A community-based cohort study of 73 children assessed the accumulated prevalence of neurodevelopmental problems in children (from preschool to school-age) with a history of febrile seizures.
41% (accumulated prevalence) of children with some type of first febrile seizure followed for 4-5 years/9-10 years of age fulfill a diagnostic criterion for a neurodevelopmental disorder (including ADHD, Autism, developmental coordination disorder, intellectual disability).
Pediatricians should be aware of the association between febrile seizures and neurodevelopmental problems so that early assessment, diagnosis and appropriate interventions can be implemented.
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Clinical features and outcomes of pediatric patients with isolated Colonic Crohn’s Disease (CD-L2) |
It appears that isolated CD can exhibit unique characteristics which differentiate it from patients with ileo-caecal (L1) CD and ulcerative colitis (UC).
A retrospective study of 300 children examined at different time points, outcomes (time to first flare, hospital admissions, initiation of anti-tumor necrosis factor-alpha, stricture formation and surgery) for L2, L1 and UC.
While the clinical features of pediatric patients with isolated colonic CD lie between those of children with ulcerative colitis and ileal CD, significant differences in clinical presentation and outcome occur. Hematochezia occurs in 14.1% 44.7% and 95.2% of L1, L2 and UC children respectively, while fever predominates in L2 children. Variations in skip lesions, strictures and need for colectomy plus positivity rates for ASCA and PANCA antibodies vary between the 3 groups of children.
Children with isolated colonic Crohn’s Disease have different presentations and outcomes compared to children with ileo-caecal CD or Ulcerative Colitis.
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Kikuchi Disease (KD) in children |
“KD is a rare and generally benign condition of uncertain etiology that presents with non-specific symptoms including fever and cervical lymphadenopathy,” usually in young women (20’s to 30’s).
A study of 34 publications and 670 children diagnosed with KD indicates that most (96.3%) have cervical lymphadenopathy and 77.1% present with fever. 56% are leukopenic and have an elevated erythrocyte sedimentation rate (ESR), >30% have a high C-reactive protein (CRP) and anemia. KD is self-limiting (steroids, hydroxychloroquine an intravenous immunoglobulin are used in protracted cases without sufficient evidence of efficacy).
And interesting case description of a 10-year-old girl who presented with a history of fever for 9 days, and painful legs, ankles, wrists, fingers and weight loss with KD outlines her physical examination, laboratory studies and outcome and reviews worldwide clinical presentations, treatments and prognosis.
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Psychiatric comorbidity in childhood onset immune-mediated diseases |
Approximately 24 million Americans suffer from an autoimmune disease (AD), (more commonly in females), with the frequency of autoimmune diseases in children recently doubling (overall) from 5% (2010-2018).
A retrospective systematic review and meta-analysis of multiple databases (23 studies) estimated the prevalence of psychiatric comorbidities/suicide associated with childhood onset immune-mediated inflammatory diseases (Inflammatory Bowel Disease – IBD, rheumatic diseases and autoimmune liver diseases).
Depending on whether assessed by pooled date or psychiatric assessment, 4-18% of children with IBD exhibit symptoms of anxiety and mood disorder, respectively.
For rheumatic disease the prevalence is 13% for anxiety disorder and 20% for mood disturbances.
Anxiety and depression are commonly reported in childhood onset immune-mediated inflammatory diseases.
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Outdoor pollen concentration and exercise-induced bronchoconstriction in children |
Running freely outdoors as an exercise test to diagnose asthma in childhood is well established. Whether outdoor pollens affect results is unknown.
A cohort study of 799 children with a reliable exercise challenge test (using impulse oscillometry – a simple lung function test to measure airway resistance - done between January 2012 and December 2014) which measured and compared exercise-induced bronchoconstriction to outdoor pollen concentration (birch and alder) indicates that outdoor air pollen concentration DOES NOT affect the reliability of exercise to induce bronchoconstriction in asthmatic children (outside air humidity plays a more significant role in varying the results of exercise induced asthma).
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Comparison of the medical burden of COVID-19 with seasonal influenza and measles outbreak |
From a population study of a large crowded city in Israel where 247 children were hospitalized with laboratory confirmed influenza, 65 with COVID-19 and 32 children with measles (2018-2021) and which compared the medical burden associated with each of those viral infections, it appears that the risk of hospitalization is significantly higher following measles or influenza infection compared to COVID-19 (children with influenza have the highest complication rates for pneumonia and renal/electrolyte disturbance with COVID-19 in hospitalized children being relatively benign).
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Registration is open!
The 57th Pediatric Postgraduate Course - Perspectives in Pediatrics is just around the corner. Register for this virtual event to be held on April 2-3.
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Coming Soon!
The 2nd Annual Pediatric Hospital Medicine Self-Assesment
May 12- 15, 2022
Will be held at W Hotel in Fort Lauderdale Beach, FL.
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REGISTER - LEARN - EARN CME CREDIT |
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"Cognitive preservation strategies in pediatric brain tumros "
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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Is It Safe For Children To Play Sports? - Pediatric Cardiologist Dr. David Drossner Answers |
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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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