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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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March 16, 2022 | Volume 13 | Issue 11 |
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Efficacy and safety of enteral recombinant human (rh) insulin in preterm infants |
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Recombinant (biosynthetic) human insulin is a form of insulin produced by the insertion of genetic information for a proinsulin fusion (F) protein into microorganisms -Escherichia coli and yeast, which is superior to animal (extracted from pancreatic tissue) or semisynthetic insulin (modified and purified animal insulin) products.
Feeding preterm infants is difficult because of the immaturity/intolerance of their gastrointestinal (GI) tracts (poor motility and deficient lactase activity).
Previous studies have demonstrated the beneficial effects of breastmilk on gut maturation due to a number of factors; one of these is insulin which is present in maternal milk 3-4-fold higher than in maternal blood.
A randomized, multicenter, double-blind, placebo controlled clinical trial of 303 preterm infants (gestational age 26-32 weeks; birth weight >500g) randomly assigned them to receive, orally, either a low dose rh insulin, a high dose rh insulin or placebo for 28 days to assess efficacy to enhance feeding, and safety. Outcomes were measured as “Time to full enteral feeds” (150ml/kg/day on >3 consecutive days).
Enteral feedings of 2 different rh-insulin dosages in preterm infants appears safe and to be associated with a significantly reduced “Time to full feeds”.
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Read the full article at JAMA Pediatrics
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Development of cancer among patients with pediatric-onset Inflammatory Bowel Disease (IBD) |
The incidence of pediatric-onset pediatric Inflammatory bowel disease is increasing due to a host of genetic (>150 genes increase risk), environmental and microbial influences which results in a chronically dysregulated mucosal immune response, gastrointestinal inflammatory disease, progressive intestinal injury and systemic inflammation. “Inflammatory bowel disease is associated with an increased risk of several types of cancer including colon, small bowel and upper gastrointestinal tract cancers”. For children with IBD the risk of subsequent cancer development is not well investigated.
A meta-analysis of 5 unselected, population-based cohort studies of 19,812 children (from multiple databases) evaluated the long-term risk of cancer (over 283,540 person/years) among children with pediatric-onset IBD.
Pediatric-onset IBD confers a 2.4-fold increased risk of subsequent cancer (higher among males) primarily due to an increased rate of liver, colorectal and small bowel cancer (Colonoscopy is recommended 6-8 years after diagnosis with colitis extending beyond the rectum, and annually for those with primary sclerosing cholangitis. Annual screening for skin cancer is currently recommended for all patients with IBD).
Videos
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Interventions to prevent bronchopulmonary dysplasia (BPD) in preterm infants |
BPD is a disease of multifactorial origin (arrested development of the lung at the alveolar phase, ventilation-induced lung injury, oxygen toxicity, pulmonary edema secondary to a Patent ductus arteriosus, inadequate nutrition, etc.) with long-term adverse consequences (pulmonary, cardiac, neurodevelopmental etc.).
“With improved survival of neonates born at <28 weeks gestation the number of survivors with BPD is increasing”.
An umbrella review of 154 systematic reviews with 251 comparisons evaluated the evidence for preventing BPD or mortality at 36 weeks post-menstrual age in preterm neonates.
“Delivery room continuous positive airway pressure, early selective surfactant therapy, early inhaled corticosteroids, early systemic hydrocortisone, avoiding invasive ventilation, and volume targeted ventilation are associated with a decreased risk of BPD and mortality at 36 weeks post menstrual age”. (Other treatment strategies may increase risk of mortality).
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Clinical characterizations of Copy Number Variants (CNV’s) associated with neurodevelopmental disorders (NDD) in a large-scale multi-ancestry biobank |
“Copy Number Variants refers to the genetic trait involving the number of copies of a particular gene present in the genome of an individual. CNV’s that include insertions, deletions and duplication of segments of DNA are also collectively referred to as Copy Number Variants”. These account for a significant proportion of the genetic variation between individuals.
A healthcare system-derived biobank of diverse ancestry was utilized to identify the prevalence of CNV’s that are known risk factors for NDD, to identify other clinical presentations associated with these CNVs.
The overall prevalence of NDD CNVs from 28,877 individuals is 2.5%. These includes risk factors for congenital disorders and major depressive disorders as well as appear to be associated the development of hypertension, obesity and obesity-related phenotypes (e.g., obstructive sleep apnea).
CNV’s associated with neurodevelopmental disorders (including schizophrenia, autism spectrum disorder and intellectual disability) are also associated with other medical conditions including obesity. (An area of future research which has important translational and therapeutic applications).
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Mortality associated with Influenza and Respiratory Syncytial Virus (RSV) in the US,1999-2018 |
Influenza and RSV infection has been associated with substantial mortality among young children and the elderly. No study has assessed long-term changes in RSV or Influenza excess deaths over the past 2 decades in spite of substantial changes in demographics, healthcare access, patient management and increased influenza vaccination coverage in children.
From a cross-sectional study using information from 50.3 million US death certificates from 1999 to 2018, it appears that 6,549 excess respiratory deaths occur each year from RSV and 10,171 from Influenza.
Highest mortality for both viruses occur among the elderly (>65 years of age); with RSV mortality 5-fold higher than Influenza mortality among children <1 years of age (Influenza vaccination for children 6-23 months of age increased from 7.4% to 61-67% over this time).
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Nirsevimab for prevention of Respiratory Syncytial Virus (RSV) in healthy late-Preterm and Term infants |
RSV causes a respiratory infection in 64 million people per year, hospitalizes 3 million <5 year old, and costs the US $5.45 billion/yr. (estimate).
Palivizumab (Synagis) is an RSV-specific prophylactic used to prevent RSV infection in high-risk infants but treatment requires monthly injections through the RSV season, and only modestly reduces hospitalization. “Nirsevimab is a monoclonal antibody to the RSV fusion (F) protein, with an extended half-life, developed to protect infants for an entire RSV season with a single dose”.
A randomized trial assigned 1,490 infants (in 2:1 ratio) born at a gestational age of at least 35 weeks to receive a single intramuscular injection of Nirsevimab or placebo prior to the start of an RSV season to assess efficacy and safety.
A single injection of Nirsevimab given to healthy late-Preterm and Term infants before a RSV season has a 74.5% efficacy and significantly reduces hospitalization for RSV-associated lower respiratory tract infections, with no increase in adverse incidents.
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Global prevalence of Depressive and Anxiety symptoms in children and adolescents during COVID-19 |
As we begin to emerge from this COVID-19 pandemic it is of great importance to remember that there has been a doubling of the pre-pandemic rates of clinically apparent anxiety (1:5; 20.5%) and depressive (1:4; 25.2%) symptoms in youth.
Awareness, referral to appropriate professionals and resource availability to address child and adolescent mental health concerns are essential.
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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 Tumors"
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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Breastfeeding: Is your baby eating enough? |
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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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