Updates in Pediatrics from Nicklaus Children's Hospital: June 9 issue

June 9, 2021 | Volume 12 | Issue 23

Rectal biopsy techniques for the diagnosis of Hirschsprung Disease (HD) in children

“The diagnosis of Hirschsprung disease depends on the histopathological analysis of rectal biopsies.”

From a study which compared 4 different rectal biopsy techniques (open, suction, punch and endoscopic) to diagnose HD, it appears that open, suction and punch biopsies give comparable results (with the punch biopsy having a significantly higher complication rate).

Journal of Pediatric Gastroenterology and Nutrition

See related video below:

Hirschsprung Disease, Colitis, and Fecal Incontinence

Acute ataxia in children

“Ataxia can be defined as a disturbance in the smooth, accurate coordination of movements.” According to etiology it may be acquired, inherited or sporadic. Its course may be acute, intermittent and recurrent, chronic non-progressive or chronic progressive. Most commonly acute ataxia manifests as an unsteady gate and in children refusal to walk. As a common presenting complaint in the Emergency Department (ED) most causes are found to be benign and self-limiting (usually associated with cerebella dysfunction but can be the result of abnormalities in other parts of the nervous system). Life-threatening conditions like intra-cranial hemorrhage, tumors, stroke and infections may also present with ataxia.

A study of 39 children <18 years of age presenting with ataxia to a tertiary pediatric neurology clinic examined etiology, clinical presentation and prognosis.

The most common cause of ataxia seen in a pediatric neurology clinic is post-infectious cerebella ataxia (no virus identified in 87.2% of patients); rotavirus, varicella-zoster, herpes simplex and hepatitis A virus may be identified (other common causes of acute ataxia in children include excessive drug ingestion, drug intoxications, and various others such as alcohol, ethylene glycol, etc. Ed.).

Pediatric Emergency Care

See related video below:

What is pediatric ataxia?

Effectiveness of a vaping “cessation text messaging program” among Young Adult (YA) e-cigarette users

“The US Surgeon General has declared e-cigarette use among young adults an epidemic,” with e-cigarette users having nearly 5 times greater odds of subsequent initiation of cigarette smoking.

A clinical trial of 2,588 YA-e-cigarette users (which promoted abstinence among users 18-24 years of age who owned a mobile phone -2 groups, double-blind individually randomized) examined whether an active monthly “antivape-using text-messaging program” (that delivers social support and cognitive and behavioral coping skills training) is effective.

“A text message vaping cessation program is effective in promoting abstinence among YA e-cigarette users.”

JAMA Internal Medicine

Virus shedding in children with Hand, Foot and Mouth Disease (HFMD)

HFMD is a common, highly contagious viral infection (most commonly due to coxsackievirus A16) that spreads rapidly in children; presenting after an incubation period of 3-6 days with fever, sore throat (from painful red blister-like lesions on the tongue, gums and inside of cheek), poor appetite and a rash on the palms of hands and soles of feet. While isolation is the most effective way to control its spread, studies on duration of virus shedding and what a reasonable quarantine period might be, are inconsistent.

From a study of 626 children studied in the first 5 weeks after onset of HFMD, it appears that coxsackieviruses A16 and A6 continue to be shed for 3 weeks, while enterovirus 71 may continue to be positive 4 weeks post clinical onset.

Virus shedding in HFMD is high among children released following quarantine (usually after symptoms disappear, 5-7 days).

Pediatric Infectious Disease Journal

See related video HERE and below:

Hand, Foot and Mouth Disease - Akron Children's Hospital

Comparative performance of head ultrasound (HUS) and magnetic resonance imaging (MRI) in detecting preterm brain injury and predicting outcomes

A systematic review of multiple databases identified 46 studies which evaluated HUS, MRI and neurodevelopmental outcomes in preterm infants.

Neonatal neuroimaging predicts outcomes with “high negative predictive value” (which depends on modality used, timing of imaging and tools used to grade brain injury; MRIs detect more detail on severity of brain injury).

Acta Paediatrica

SARS-CoV-2-specific antibodies in breast milk after COVID-19 vaccination of breastfeeding women

A prospective study of 84 to be vaccinated against COVID-19 breastfeeding women (mean age 34 years) had breast milk samples (504) collected and analyzed for SARS-CoV-2 antibodies before vaccine administration and then once weekly for 6 weeks. Infant demographics, interim well-being and vaccine related adverse events were recorded.

Breast milk of mothers vaccinated against COVID-19 have IgA specific antibodies which increase rapidly and are significantly elevated by 2 weeks post first vaccine (61.8% of samples). After the first week post second vaccination 86.1% of mothers’ milk samples contain the antibodies which remain elevated to the 6-week follow-up mark. No mother or infant experiences a serious adverse event.

The milk of breastfeeding women who are vaccinated against COVID-19 have significant IgA specific antibody elevation 2 weeks after the first dose of a mRNA vaccine; a spike level occurs 1 week post-second dose and elevation of IgA levels remain high for at least 6 weeks.

JAMA

Prenatal, early post-natal or current exposure to secondhand smoke (SHS) and Attention Deficit/Hyper-activity Disorder (ADHD) symptoms in children

A cross-sectional study of 45,562 children, ages 6-18 years (mean age 11.0 years) examined via questionnaire to parents/guardians and school teachers (using a validated tool) SHS exposure (vs. non-exposed children) during pregnancy and childhood, and ADHD symptoms (and subtypes).

Being exposed to secondhand smoke from pregnancy (particularly during the prenatal and early post-natal period) to childhood is associated with a greater risk of childhood ADHD symptomatology. Secondhand smoke exposure is a public health issue.

JAMA Network Open

Are mRNA COVID-19 vaccines safe for pregnant women?
Can you describe the potential adverse consequences associated with long-term use of oral corticosteroids?
What is the incidence rate of clavicular fractures in children?

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COVID-19

Current Situation in Florida

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Florida's COVID-19 Data and Surveillance Dashboard

Florida Department of Health, Division of Disease Control and Health Protection

Mayo Clinic's COVID-19 Vaccine Tracker - Click HERE to view.

Dear Reader:

I am sure many of you, like I, are feeling great relief at the improving outcomes following the various public health measures and SARS-CoV-2 immunization programs being undertaken in the USA to date. It seems that while there are many unanswered questions remaining, and firm answers not yet available on many interesting aspects, at present there is significant optimism that the mRNA vaccines will provide not only substantial (but not total) protection against the worst results of COVID-19 but will also minimize spread while appearing to be effective against the variants circulating.

Nevertheless I would urge all to remember that there are places and situations that place us at increased risk for infection, like hospitals, nursing homes, prisons and homeless shelters or while traveling. Some immunocompromised people will remain vulnerable to COVID-19. Continue to take care, wear a mask when appropriate, in addition wash hands or use a sanitizer when in risky situations, continue to cough or sneeze into ones elbow and be aware and cautious in balancing risks and benefits.

Best of luck.

Jack Wolfsdorf, MD, Editor

Staff NCH