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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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March 23, 2022 | Volume 13 | Issue 12 |
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Long term growth and final adult height outcome in childhood onset Systemic Lupus Erythematosus (SLE) |
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SLE is a life-long autoimmune disease that may present in children (average age 12 years; rarely before 5 years). The exact cause is unknown however genetic factors (family history) triggered by environmental influences (e.g., infection, drug reaction, sun exposure, cigarette smoke, extreme stress etc.) appear to be involved. Clinically children may present with fever, fatigue, loss of appetite, weight loss, a red rash on the cheeks and bridge of nose (33%), disc-rashed patches, sun exposure rash, muscle pain and/or arthritis in 2 or more joints (often fingers and toes), headache, seizures, memory problems and other organ involvement (kidneys, heart and lungs).
“Growth impairment is the most common complication in patients with childhood onset SLE”. There is limited data on the risk factors affecting growth outcome in children (Asian) with SLE.
A retrospective cohort study of all patients (106; 82% female; aged <15 years) diagnosed with SLE in a single institution over a 10-year period investigated the risk factors associated with growth impairment.
23.6% of children with SLE have growth impairment. Predictors include male sex, duration of disease before menarche in girls/adult voice in boys and cumulative corticosteroid dose given before the late phase of puberty.
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Read the full article at Pediatric Rheumatology
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Tick paralysis case series |
“Tick paralysis is an uncommon, non-infectious, neurologic syndrome characterized by acute ataxia that progresses to ascending paralysis (it is often confused with Guillen-Barre syndrome). Symptoms occur 3-7 days after the tick attaches which are caused by a salivary neurotoxin (only produced by female ticks during feeding) of several species…” (most cases occur in North America (40 species – most commonly the “American Dog Tick” and “Rocky Mountain Wood Tick”) and Australia. If recognized early and promptly treated with tick removal and supportive care, complete recovery can be expected (untreated, it can progress to respiratory failure and death).
A retrospective chart review of children 0-18 years of age examined information on patients with a diagnostic code of toxic effect of venom, tick-borne viral encephalitis, Guillen-Barre syndrome, acute infective polyneuritis or abnormality of gait (2005-2016) to identify and describe pediatric tick paralysis presenting to an Emergency Department (ED) in southern Louisiana.
Children (9) who present to an ED with tick paralysis most commonly present with lower limb weakness, varying degrees of upper extremity ataxia or paralysis, areflexia, diplopia or petechia. Almost half have a delay in diagnosis with misdiagnosed cases being exposed to multiple unnecessary investigations, treatments and costs. With appropriate early identification (44% of ticks are discovered by a patient’s relative, the rest usually by a primary care or emergency care physician), all children recover after tick removal.
Videos
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High-dose rifapentine with or without moxifloxacin for shortened treatment of pulmonary tuberculosis |
“Phase 2 clinical trials of tuberculosis treatment has shown that once daily regimens where rifampin is replaced by high-dose rifapentine (a rifamycin with a much longer half-life) have potent antimicrobial activity that may be sufficient to shorten overall treatment duration”.
A phase 3 non-inferiority, multi-center randomized 4 month controlled trial that tested the hypothesis that once daily regimens of high-dose rifapentine in combination with other anti-tuberculosis drugs is as effective as a conventional 6 month regimen indicates that outcomes are equally good.
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Psychological adjustment in emerging adults with and without spinal bifida (SB): a 14 year follow-up study |
Emerging adults (ages 22-23 years) with SB lag across a number of developmental milestones. These include “decision making responsibilities, social and romantic relationships, sexual intimacy, educational and vocational achievements, financial independence and engagement in health-related behaviors” (while showing significant resilience by having fewer problem behaviors like alcohol/substance abuse and by having positive identity development and enhanced quality of social support).
Videos
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Association of post-traumatic epilepsy (PTE) with 1-year outcomes after traumatic brain injury (TBI) |
2.8% of adults with TBI (from a prospective, multicenter, cohort study of 3,296 adults) self-diagnose with PTE at 1 year post trauma; this is associated with unfavorable somatic, cognitive and psychological outcomes.
Videos
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Assessment of long-term outcomes after Pediatric Intensive Care Unit (PICU) admission |
From a systematic review and metanalysis of 31 independent studies involving 7,786 children (mean age 7.3 years) that examined the long term effects of PICU admission on children, it appears that overall 1:19 children (5.3%) to 14 of 16 children (88.0%) experience psychological issues (e.g. post-traumatic stress disorder, depressive disorder, conduct disorder, emotional and behavioral problems and neurodevelopmental deficits) 3 months – 15 years later. In addition they have poorer memory and lower IQ scores 5 years post-admission.
Admission to a PICU carries a high psychological burden. Early intervention is particularly warranted for those at high-risk (eg. post cardiac arrest, congenital heart disease, or having been placed on Extracorporeal life support).
(PICU admission for respiratory failure in early childhood (< 8 years of age), without neurocognitive disfunction, also appears to be associated with a small but significant decrease in subsequent IQ up to 4 years later).
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Azithromycin treatment and recurrent wheeze among infants hospitalized with Respiratory Syncytial Virus (RSV) infection |
Azithromycin has non-antimicrobial immune modulatory properties which appear to be mediated by decreases in interleukin (IL)-8, IL-6, IL-1Beta, tumor necrosis factor-alpha, neutrophilic number, eosinophil cationic protein and matrix metalloproteinase 9.
“About half of infants admitted to a hospital with RSV will be diagnosed with asthma by age 7 years”.
An open-label study of 200 otherwise healthy babies (median age 3.9 months) hospitalized with RSV bronchiolitis who received oral azithromycin, another antibiotic, or a placebo for 14 days and were followed for 2-4 years for recurrent episodes of wheezing indicates that receiving azithromycin (or other non-macrolide antibiotic) does not decrease the likelihood of subsequent recurrent wheezing in childhood.
Beigelman A. Abstract 456. Presented at: AAAI Annual Meeting, February 25-28 2022; Phoenix (hybrid meeting)
Videos
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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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"Weight Loss (Metabolic and Bariatric) Surgery for Adolescents with Obesity"
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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MR Guided Focused Ultrasound Research Study at Nicklaus Children's Hospital |
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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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