SHARE:  
Join Our Email List
https://www.nicklauschildrens.org/NCH/media/img/global-navigation-redesign/logo-clear.png?ext=.png
Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
header with photos of various children
January 12, 2022 | Volume 13 | Issue 2
Exposure to head impacts and cognitive and behavioral outcomes in youth tackle football players across 4 seasons
“Repetitive sub-concussive head impacts during childhood have been implicated in the development of chronic cognitive and behavioral problems”. Retro- and prospective studies however have yielded conflicting results.

The American Academy of Pediatrics (AAP) doesn’t specify what age is appropriate for children to participate in tackle football but states “Delaying the age at which tackle is introduced to the game would likely decrease the risk of these injuries”. The Concussion Legacy Foundation “strongly recommends you delay enrolling your child to tackle football until age 14 years”. Some previous retrospective studies have suggested that exposure to repetitive head impacts in tackle football before the age of 12 years is associated with neurobehavioral and cognitive problems later in life. Other studies have not confirmed this.

A prospective cohort study of 70 boys aged 9-12 years undertaking youth tackle football over 4 seasons examined (before and after each football season) the association between 10 cognitive and behavioral outcomes and head impact (using helmet-based sensors to yield cumulative head impact gravitational force equivalents per season).

After correcting for multiple comparisons no association is found between impacts and cognitive/behavioral outcomes. (There is however an association between head impacts, premorbid conditions including ADHD, anxiety and depression and worse cognitive/behavioral outcomes.
Efficacy of cell-culture-derived Quadrivalent influenza vaccine in children
Viruses are an increasingly frequent cause of pneumonia; prior to the present COVID-19 pandemic rhinovirus (23.6%), parainfluenza (20.8%), metapneumovirus (18.1%), influenza (16.7%) and respiratory syncytial virus (13.9%) were the primary causes. “Severe viral pneumonia is a significant cause of morbidity and mortality globally”.

Other than immunization there is a paucity of direct therapies to both prevent or treat viral infections/pneumonia.

The majority of influenza vaccines are produced in embryonated eggs, but mutations occur during this process which may alter the virus immunogenicity. “Culture-cell-derived influenza vaccine may enable a closer antigenic match to circulating strains of influenza virus by avoiding egg-adapted mutations”. The canine kidney cell line-derived quadrivalent inactivated influenza vaccine IIV4c (Flucelvax Quadrivalent) is currently the only US Food and Drug Administration-approved cell-derived flu vaccine for people aged 6 months or older.

A study which enrolled 4,514 participants randomly assigned to receive either IIV4c (or a meningococcal vaccine) and which measured first occurrence laboratory-confirmed type A or B influenza indicates that IIV4c vaccine has an efficacy of 80.7% against influenza A/H1N1, 42.1% against A/H3N2 and 47.6% against influenza B.

“IIV4c vaccine provides protection against influenza in healthy children…”.
 
 
Jumping on the bandwagon: Comparing the efficacy of Chlorhexidine (CH) vs. Povidone-Iodine (P-I) preoperative skin antiseptic in preventing surgical site infections following pediatric orthopedic infections
“Adult literature has demonstrated CH superiority at preventing surgical site infections when compared to P-I”.

A retrospective study which compared post-operative infections after sports/upper extremity, lower extremity and trauma-related pediatric orthopedic procedures and CH/P-I use indicates that CH and P-I overall appear to be equally protective against post-operative infections (P-I however may offer more protection for upper extremity/sports-related procedures).
 
Bradycardia without hypertension – Is it a common clinical presentation of ventriculoperitoneal (VP) shunt malfunction in children?

“Mechanical shunting of cerebrospinal fluid is an effective treatment for hydrocephalus” from a variety of causes. VP shunt complications include blockage and infection. Prompt diagnosis of shunt dysfunction is vital as delay may lead to significantly raised intracranial pressure, coning and death. Common signs of raised intracranial pressure include an impaired Glasgow coma score, bradycardia, hypertension, papilledema and “sun-setting eyes”.


Some studies suggest bradycardia without hypertension may be observed.


A retrospective observational study of 64 children with confirmed shunt pathology (vs. a matched control group) indicates that most children with VP shunt malfunction present with vomiting, and lethargy/apathy, and that bradycardia is not a common presentation, often occurring only as a late sign.
Austere Foreign Body (FB) injuries in children and adolescents
FB injuries to the nose, ears and/or mouth are well documented. Descriptions of FB injuries involving the rectum, vagina or penis are uncommon.

The National Electronic Injury Surveillance System was utilized to characterize austere foreign body injuries (AFB) by children and adolescents presenting to Emergency Departments (ED’s) in the US (27,755 estimated ED visits for AFBs; 7,756 vaginal FBs, 7,138 penile FB’s and 8,359 rectal FB’s over a 10-year period).

“Most austere FB injuries cluster around the age of 7 years” – most children are treated and released from the ED; rectal FB injuries are increasing over time and more often require admission.
Semaglutide for weight loss
Glucagon – peptide -1 (GLP-1) is a natural hormone produced after eating a meal which reduces the feeling of hunger, makes one feel full and improves the body’s ability to regulate sugar levels.

Semaglutide is a medication similar to and functions like GLP-1 and has been approved (since 2017) for blood glucose control in type 2 diabetics. In June 2021 the US Food and Drug Administration approved Semaglutide for chronic weight management.

A recent double-blind trial of overweight/obese adults without diabetes, treated weekly with subcutaneous injections of Semaglutide (plus a reduced calorie-meal plan and increased physical exercise) indicates that Semaglutide treatment produces clinically relevant weight loss (>15%) which is sustained over a 2-year period.

 
How COVID-19 affects the brain
COVID-19 may present with respiratory and/or gastrointestinal symptoms that are often (20%-70%) accompanied by short- and long-term neuropsychiatric symptoms (NPs – anosmia, cognitive and attention deficits, “brain fog,” new-onset anxiety, depression, psychosis, seizures and even suicidal behavior) and long-term (months) brain sequalae.

An interesting article explores the various ways (brain invasion, cytokine and microglia activation, increased inflammatory activation of enzymes in parts of the brain as well as activation of coagulation pathways/microthrombi deposition) COVID-19 impacts the brain (well worth reading, Ed.).

 
REGISTER - LEARN - EARN CME CREDIT
"Brief Resolved Unexplained Events: Evolution of a Complex Diagnosis"

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).
Monthly Features
map
Underwriting Opportunities
With a circulation of over 2000, Updates in Pediatrics offers an excellent opportunity to promote your brand at affordable rates. Contact Riccardo.Firmino@nicklaushealth.org


Advertising in this e-journal in no way implies endorsement of a product by Nicklaus Children's Hospital.
Contact the Editor | jackwolfsdorf@gmail.com