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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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April 27, 2022 | Volume 13 | Issue 17 |
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Fine particulate matter exposure from secondhand cannabis bong smoking |
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In 1981 the first major epidemiologic studies on the nonsmoker effects of secondhand cigarette smoking was published followed by, in 1986 the US Surgeon General concluding that secondhand smoke was a major health risk to nonsmokers. Second hand tobacco smoke (increases respiratory and cardiovascular disease, preterm birth, decreased immune function, etc.) is now classified as a Group A carcinogen.
Secondhand cannabis smoke (SHCS) is uncharacterized in homes but is known to contain health risk factors (several hundred toxic chemicals, carcinogens and fine particulate matter (PM 2.5) many at higher concentration that in tobacco smoke). This information however appears to be largely ignored as 27% of young adults believe SHCS exposure is safe (1 minute of cannabis bong smoking exposure causes significant endothelial damage in rats).
A cohort study examined levels of PM 2.5 before, during and after 8 cannabis social smoking sessions in a room where a nonsmoker may sit, to quantify SHCS levels from social cannabis smoking in the home setting.
Air concentrations of PM 2.5 particulate matter increases dramatically in a home where social cannabis is smoked, potentially exposing nonsmokers to levels hazardous to health significantly greater than that experienced in cigarette smoking homes. “SHCS in the home is not safe”.
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Read the full article at JAMA Network Open
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Newborn clavicle fractures: Does clavicle fracture morphology affect brachial plexus injury? |
“Brachial plexus palsy and fractured clavicles are fetal injuries that often result from difficult vaginal deliveries” (usually from shoulder dystocia of a relatively large infant). The clavicle fracture appears to result from forceful manipulation of the arm and shoulder (some data indicates no association between clavicular fractures and shoulder dystocia or a manipulated vaginal delivery).
A study retrospectively reviewed 55 newborn infants with perinatal clavicular fractures to assess the clinical relationship between fracture morphology (spiral, oblique, etc.) and brachial plexus damage.
60% of newborn clavicular fractures occur in males with the right side being injured in 56.4%.
Shoulder dystocia is present in 58.2%.
Only spiral and oblique newborn clavicular fractures appear to be associated with the development of brachial plexus injury.
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Association of COVID-19 vaccination during EARLY pregnancy with the risk of congenital fetal anomalies |
“Whereas data suggests that COVID-19 vaccines are safe and effective during pregnancy, there is concern whether the vaccines are associated with risk to the fetus”.
A retrospective study of 2,622 pregnant women who received at least 1 vaccine dose and 1,146 who were vaccinated during the teratogenic window (30 days before conception to 14 weeks gestation) evaluated the association between COVID-19 unvaccinated, vaccinated outside and within the teratogenic window, and congenital anomalies in the fetus.
After controlling for potential confounders, COVID vaccination of pregnant women within the teratogenic window (30 days prior to conception - 14 weeks gestation) appears NOT TO BE ASSOCIATED with the presence of additional congenital anomalies.
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Association between residential proximity to hydraulic fracturing sites and adverse birth outcomes |
Hydraulic fracturing (also called “fracking”, “hydrofracking” and “hydrofracturing”) is the cost effective technology to extract natural gas or oil from shale and other forms of “tight” rock formations where a fracture is created, opened and/or enlarged by pumping large quantities of fluids (water, proppant and chemical additives) at high pressure down a well bore into the rock formation.
Concern has been expressed whether residential proximity to hydraulic fracturing is associated with adverse birth outcomes.
From a population-based retrospective cohort study of 34,873 unique pregnancies delivered within 10km of one or more wells that were hydraulically fractured during 1 year preconception or during pregnancy, and where spontaneous and indicated preterm birth, small-for-gestational age (SGA), major congenital anomalies and severe neonatal morbidity or mortality was assessed, it appears that pregnant women exposed to >100 wells within 10kms are at significantly increased risk for preterm birth and the delivery of SGA babies (mechanism unclear to date, Ed.).
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School outcomes among children following death of a parent |
At least 5.2 million children globally (and more than 140,000 US children) have lost a parent or caregiver during the present COVID-19 pandemic. This loss is linked to mental health problems, shorter schooling, lower self-esteem, risky sexual behavior and an increased risk of substance abuse, suicide, violence, sexual abuse and exploitation.
A population-based sibling cohort study with linkage between family members examined whether parental death is associated with poorer school outcomes (independent of factors unique to the family) and whether children of a certain age are particularly vulnerable.
Bereaved children following the loss of a parent have lower school grades and less chance for upper secondary education. Independent of birth order losing a parent at younger age is associated with lower grades within the family.
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Longitudinal analysis of Substance Use Disorder (SUD) symptoms at 18 years and Substance Use Disorder in adulthood |
“Drug overdose deaths are the leading cause of injury-related deaths in the US accounting for >100,000 deaths in 2021”. “The prevalence of SUD is highest during young adulthood. Little is known about the long-term trajectory of SUD symptoms from adolescence through adulthood.
A study which evaluated the association in 5,317 adolescents with SUD symptoms, with later use/misuse of prescription drugs (i.e., opioids, sedatives and tranquilizers) and SUD symptoms at 35-50 years of age indicates that most adolescents with SEVERE SUD SYMPTOMS continue to abuse drugs into adulthood (compared to those with no or low severity). Physicians should be aware!
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Real-life performance of Multiplex Celiac Antibody Test in the diagnosis of Pediatric Celiac Disease (CD) |
Tissue-transglutaminase antibodies (TGA) in the blood, the immune protein against small bowel found in high levels in children with celiac disease “may be used to diagnose CD without biopsy in selected cases”.
A retrospective review study which evaluated 538 children, (256 with a positive TGA and a positive intestinal biopsy (85.5%) and 282 with a negative TGA) to correlate TGA level and intestinal biopsy result indicates that the Multiplex assay has a very high diagnostic accuracy in real-life with few false positives above a TGA level 10 plus normal.
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Early Bird Registration ends April 27!
The 25th 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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Registration Now Open!
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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"Not talkin' 'bout my generation: Social Media for the Health Professional"
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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Underwriting Opportunities
Advertising in this e-journal in no way implies endorsement of a product by Nicklaus Children's Hospital.
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