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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
header with photos of various children
November 10, 2021 | Volume 12 | Issue 45
Point-of-care ultrasound (POCUS), visit time and cost of care for infants with Developmental Dysplasia of the Hip (DDH)

“DDH is the most common pediatric orthopedic condition in newborns” with a reported incidence of approximately 5.5% (with a wide range probably associated with variability in screening methods). Unfortunately a missed diagnosis of DDH leads to accelerated hip joint degeneration which can result in total hip arthroplasty earlier in life.
 

Recently POCUS has become the most common screening method utilized, and as this can be used in the hospital or outpatient setting, or in the Orthopedic surgeon’s office there is potential to improve efficiency and lowering costs.

A retrospective review of prospectively collected data of 532 patient encounters (over a 2-year period) of infants <10 months of age (mean 4.4 months) assessed whether the duration and cost of care for a diagnosis of DDH differed when POCUS was performed in a surgical office vs. a radiology suite.

Office POCUS significantly reduces costs and the time required to diagnose infant DDH, while also demonstrating the potential benefits for both patients and healthcare systems. 
Less-invasive surfactant administration for Neonatal Respiratory Distress Syndrome; A consensus guideline
Respiratory distress syndrome (RDS) can affect infants of all gestational ages but is most common in preterm infants affecting all born <28 weeks gestation.

“Exogenous surfactant administered after intubation followed by mechanical ventilation (MV) has been the established,evidence-based cornerstone of RDS treatment for decades”. MV however is a major risk factor for bronchopulmonary dysplasia (BPD) so variations in surfactant application methods have been developed to minimize it. LISA (less invasive surfactant therapy) is one of these. Recent guidelines recommend LISA for breathing infant with RDS.

A literature search (53 articles) formed the basis of these recommendations for the implementation of LISA in the management of an infant with RDS. This informative article outlines the practical, and clinical steps required to implement LISA in a neonatal unit.
 
 
Bacterial immunotherapy and kids’ wheezing
“Over the last three decades respiratory infections have been reported as the greatest contributing factor to asthma exacerbations in both children and adults”. Allergen-specific immunotherapy (SIT) may modify the disease and is often recommended for children whose asthma cannot be adequately controlled with medication/environmental changes.

A phase III trial of 120 children <3 years of age who had >3 wheezing attacks during the previous year randomly assigned 2 matched groups to receive either a pineapple-flavored investigational immunotherapy (6 heat-inactivated gram positive and gram-negative bacteria sprayed under the tongue) or a placebo daily for 6 months.

Bacterial immunotherapy appears to stimulate innate immune cells and T-cell responses resulting in decreased wheezing episodes/days of wheezing in young asthmatic children, without treatment-related adverse events.
 
 
Hypovitaminosis D and risk factors in pediatric epileptic children
The active metabolite of Vitamin D (25(OH)D) functions via an intracellular receptor present across many bodily tissues with multiple physiological actions.

Vitamin D is important for bone health and Vitamin D deficiency may contribute to many other disorders (e.g., autoimmune, infectious, cancer, depression, chronic fatigue, neuro-degenerative disorders, diabetes and vascular disease). Multiple studies with adult epilepsy patients have demonstrated vitamin D deficiency; few reports are available for children.

A cross-sectional retrospective cohort study of 138 pediatric epileptic patients on anticonvulsants examined demographic data, seizure type, puberty status, physical activity, and duration and type of anti-seizure medication.

Vitamin D deficiency occurs in 23.2% and insufficiency 47.8% of epileptic children on anticonvulsants. Two risk factors – entering puberty and the use of non-enzyme inhibiting anti-seizure medication (e.g. clonazepam, gabapentin, etc.) are particularly associated with hypovitaminosis D. Regular monitoring of Vitamin D status in children on anticonvulsants is recommended.
 
 
Appetite-regulating hormones in human milk: a plausible biological factor of obesity risk reduction?
Early life modifiable factors may play a role in obesity risk. Breast feeding may result in a 12-26% reduction of obesity risk during childhood and adolescence, usually explained by the consumption of fewer calories, improved ability of breast-fed infants to self-regulate intake and growth at a slower rate after 2-3 months of infancy.

A study of 22 mother-infant dyads which examined whether human milk appetite-regulating hormones influence infant growth and obesity risk indicates that while the content of appetite hormones in milk varies, levels of human milk ghrelin, glucagon-like peptide-1 and leptin in lower concentrations are associated with slower infant growth patterns over the first year of infancy.

The content of appetite-regulating hormones in human milk (which may be influenced by maternal factors) appears to play a role in infant growth and obesity.
Do children with functional abdominal pain benefit more from a pain-specific Cognitive Behavioral Therapy intervention (CBT) than from an unspecific Attentional Control (AC) intervention?
A prospective, multicenter, randomized controlled efficacy trial of 127 children (7-12 years of age) who received CBT or AC for functional constipation (“Attentional Control” refers to an individuals’ capacity to choose what they pay attention to and what they ignore) indicates (over 4 time points; before intervention, after intervention, and at 3 months and 12 months follow-up) that while both are effective in reducing abdominal pain, CBT produces greater pain intensity and duration reduction, improved coping strategies and quality of life.
Fist and elbow greetings!
“During the pandemic there has been a major shift from the handshake to alternative greetings like the fist bump and elbow bump”.

A study of 40 methicillin-resistant staphylococcus aureus (MRSA) colonized patients tested whether the elbow bump may be a safer greeting then the fist bump.

“Fist bump and elbow bump greetings both result in the frequent transfer of MRSA from colonized patients” – “fist bump” transfer being worse than that of the elbow.
 
 
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Contact the Editor | jackwolfsdorf@gmail.com