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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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July 20, 2022 | Volume 13 | Issue 29 |
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Stir, shake or blend: A comparison of methods used to reduce viscosity of Blenderized tube feedings (BTFs) |
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“Blenderized tube feeding (BTF) refers to formula composed of whole foods and purees blended to a consistency that can be administered through an enteral feeding device”. BTFs have become increasingly popular as an enteral feeding option for both children and adult patients. BTFs can be home-prepared, however commercially prepared ones have several advantages including ease of preparation, simplicity of transport, the ability to be used in schools and hospitals while also reducing gastrointestinal symptoms, hospitalization rates and improving quality of life.
Though a higher viscosity feed appears to result in less reflux/respiratory illness, it poses challenges when being administered through an enteral feeding tube.
A study of a variety of commercially available BTFs compared changes in viscosity associated with stirring, shaking or blenderizing.
“The viscosity of BTFs’ is independent of stirring or shaking (blenderizing produces variable results) which change depending on the percent of water by volume added to the formula, as well as the presence of additional non-food ingredients.”
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Read the full article at JPGN
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Differences in clinical presentations of Eosinophilic Esophagitis (EoE) in pediatric patients with Ulcerative Colitis (UC) and Crohn’s disease (CD) |
“Eosinophilic Esophagitis is an inflammatory condition of the esophagus characterized by vomiting, dysphagia and reflux symptoms with characteristic endoscopic findings which includes the presence of white exudates with >15 eosinophils per high power field”. It is characterized by the presence of T helper-2 (TH2) cytokines and has been associated with UC and DC, both inflammatory bowel diseases (IBD’s) having different clinical and immune profiles.
A study of 30 children with inflammatory bowel disease and EoE collected demographic, clinical, laboratory, endoscopic and histologic data to assess the differences in associations between EoE with UC and CD.
8.8% of IBD children have EoE and 9.4% of EoE children have IBD.
More children with UC have EoE and EoE is present at UC diagnosis.
EoE is more often diagnosed after CD diagnosis and improves with CD status.
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Efficacy and safety of saline nasal irrigation (SNI) plus theophylline for treatment of COVID-19-related olfactory dysfunction (OD) |
“Evidence of COVID-10-related anosmia and dysgeusia continues to accumulate daily”, with up to 80% of patients reporting subjective post-viral olfactory dysfunction. Recent studies suggest the pathogenesis of the anosmia may be related to abnormalities in olfactory signaling associated with secondary messenger cAMP and cGMP levels, both of which can be elevated by theophylline (a phosphodiesterase inhibitor).
A triple-blinded, placebo-controlled, phase 2 trial randomly assigned 40 adult patients with OD to receive either SNI with theophylline or placebo for 6 weeks.
Though many post-COVID-19 anosmic participants report subjective improvement associated with saline/theophylline nasal irrigation, a mixed-model analysis of their “Smell identification test – UPSIT” utilized, proved inconclusive. (Larger studies needed. Ed)
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Analysis of COVID-19-related croup and SARS-CoV-2 variant predominance in the US |
Though children infected with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) have predominantly lower respiratory tract involvement, recent variants appear to have a predilection for the upper airway.
A cross-sectional study of 5,152 children (3 months – 8 years) with COVID-19 croup (data from 43 US hospitals) investigated whether/which SARS-CoV-2 variant/s are associated with croup (as well as hospital/intensive care unit (ICU) admissions and racemic epinephrine (RE) treatment).
Omicron variant infection with SARS-CoV-2 significantly increases the likelihood of croup in children (10.9% vs. Alpha or other variants: 4.1% and Delta: 3.6%) with no significant differences noted for odds of hospitalization or ICU admission (treatment with RE was less likely during the Delta wave).
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HIV pre-exposure prophylaxis: What do pediatricians need to know? |
A “Special Issue Article” which defines not only what “Pre-exposure prophylaxis” includes, also identifies potential candidates, evaluation, HIV- and other testing requirements, discuses STI screening, pregnancy, prescribing and follow-up evaluation and reminds us that Pediatricians play an important role in the health (including sexual) and well-being of adolescents, and need to remember that HIV remains of great concern to them (21% of new HIV diagnosis occur in this age group) and that pre-exposure prophylaxis for adolescents with high risk factors of HIV acquisition can not only prevent transmission of HIV to the uninfected but has been shown to be safe and effective. (A useful article: Ed)
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Early childhood allergy and attention deficit/hyperactivity disorder (ADHD) and autism (ASD) |
From a retrospective comparative study of a large (117,022) database of allergic (asthma, rhinitis, conjunctivitis, skin, food or drug) children 0-18 yrs. of age (and 116,698 non-affected children) which investigated whether allergic disorders are associated with an increased risk of ADHD/ASD, it appears that allergic disorders diagnosed early in childhood (mean 4.5 years) significantly increases the risk for both ADHD/ASD (particularly for ADHD) in both boys and girls, and that more than 1 allergic comorbidity further increases that risk.
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Assessment of perioperative outcomes among surgeons who operated the night before |
I’m sure all will be pleased to note (Ed.) that from a cross-sectional study of 498,234 daytime operations performed by 1,131 surgeons at 20 US institutions which examined whether operating overnight is associated with worse operative outcomes for surgical procedures performed by the (same) attending physician the following day, it appears that composite outcomes are no worse for next day surgeries performed.
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REGISTER - LEARN - EARN CME CREDIT |
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Up All Night: Optimizing Human Performance in Residency
At the completion of this activity, participants are expected to: [1] Understand general definitions, [2] Learn about the International Classification of Function Model, [3] Review the Disability Laws, [4] Understand the role of Pediatric Physical Medicine and Rehabilitation providers.
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