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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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September 8, 2022 | Volume 13 | Issue 36 |
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Self-sampling for SARS-CoV-2 detection in children |
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With an expected increase in SARS-CoV-2 infection coming during these Fall and winter months, diagnosis of SARS-CoV-2 infection in asymptomatic exposed and symptomatic children becomes an important facet of the pandemic management.
Previous studies which compared the efficacy of adults’ nasal sampling to Health Care Worker (HCW) acquired standard sampling, have shown a 93-97% concordance.
A study of 196 children from kindergarten to 8th grade (4-14 years of age) referred for SARS-CoV2 testing due to symptoms compatible with COVID-19 examined samples (after a short instructional video plus handout) obtained by the children (with no assistance) and subsequent HCW for SARS-CoV-2.
Symptomatic children younger and older than 8 years of age who self-sample nasal swabs for SARS-CoV-2 have a 97.8% concordance with samples obtained by a HCW (Larger studies would be helpful, Ed.).
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Read the full article at JAMA Network
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Association between maternal antenatal corticosteroid treatment and psychological developmental and neurosensory disorders in children |
“Corticosteroid administered to women at risk of imminent preterm birth is one of the most effective ways to improve the prognosis of infants born preterm”. Data that exists on long-term neuro-developmental and neurosensory outcomes are mixed and vary depending on whether the children are born preterm or at term.
A population-based retrospective analysis of all singleton live births (in Finland) examined whether antenatal corticosteroid treatment is associated with specific psychological developmental outcomes (speech and language, scholastic skills, motor function, pervasive developmental disorder plus vision/hearing/epilepsy and cerebral palsy) in children followed from birth to 1-12 years of age.
Term-born infants exposed (vs. nonexposed) to corticosteroids in-utero are at greater risk for poorer speech and language, scholastic skills, motor function, pervasive developmental disorder, epilepsy and cerebral palsy outcomes.
Preterm treatment exposed vs non-exposed infants do not differ significantly in outcome risk.
(Both full-term and preterm data adjusted for multiple covariants).
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Comparing kidney health outcomes in children, adolescents and adults with Focal Segmental Glomerular Sclerosis (FSGS) |
FSGS occurs when scar tissue develops in the glomeruli as a result of a variety of causes (idiopathic, secondary to a pre-exiting medical conditions) or autoimmune disease (sometimes linked to a hereditary gene) involving the kidney and presents clinically as one of the most common causes of nephrotic syndrome and end-stage kidney disease (ESKD). While no cure exists medical care (immunosuppressants steroids, ACE-inhibitors, dialysis, plasmapheresis, kidney transplantation) can improve a patient’s quality of life.
From a cohort study of children, adolescents, and adults with FSGS which examined the natural history of pediatric/adolescent vs. adult health outcomes, it appears that there is no difference between the 3 groups for risk to kidney survival and function (“time to ESKD: 11.9 years”).
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Outcomes of living unrelated donor (LURD) kidney transplants (Tx’s) in children |
“There are conflicting data on long-term outcomes of pediatric LURD renal transplants compared to transplants of kidneys from other donor sources”.
An analysis of the Organ Procurement and Transplant Network database conducted in children (<18 years of age) who had received a first kidney transplant, of whom 2.7% received kidneys form LURDs, 30% from living related donors (LRDs) and 61% form deceased donors (DDs) which measured and compared “time to graft failure” or death indicates that LURD grafts have a similar 1-year survival rate (vs. LRDs) with DDs recipients having a 26% increase in graft failure.
“Living unrelated transplantation of kidneys is a viable option for children preferable to deceased donor kidneys”.
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Microwave heating of human milk with direct temperature monitoring |
Cytomegalovirus (CMV) spreads by contact with body fluids like blood, saliva, urine, semen and breastmilk. For infants who may be at risk for transmission of the virus during breastfeeding, microwave heating of the milk may an effective measure.
A study which evaluated temperature changes of milk during microwaving using different containers, in different areas inside the container (plus a sachet) and using milk from different mothers indicates that temperature changes are highest at the surface, with microwaving at 500-600W for 60 seconds resulting in similar temperature changes (sufficient to prevent Cytomegalovirus transmission) across containers (a sachet containing 100 ml of milk) and milks from different mothers.
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Heritability of psychological traits and developmental milestones in infancy |
From a large and interesting systematic review of multiple databases which reviewed 139 twin studies for genetic and shared and non-shared environmental correlation estimates of psychological traits and developmental milestones in infancy (10 categories of functioning, disability and health) it appears that moderate/high genetic correlates are found for inheritance in 8, (psychomotor function, attention and complex interpersonal interactions are highest), with several categories of traits showing environmental influences (e.g. mental function and language). Emotional function and family relations appear to be the highest non-shared traits, with some traits having overlapping estimates.
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Single maintenance and reliever therapy (SMART) in treatment of asthma exacerbations |
From multiple studies which evaluated the efficacy of SMART therapy (corticosteroid and long-acting beta agonist together) rather than a daily inhaled corticosteroid and an inhaled short acting bronchodilator for exacerbations, it appears that “while no all studies demonstrate the effectiveness of SMART, most reveal a substantial reduction in asthma exacerbations and severity”.
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REGISTER - LEARN - EARN CME CREDIT |
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Enhancing Your Documentation
At the completion of this activity, participants are expected to:
[1] Understand Florida law on informed consent, [2] Be aware that consent for minors must be in writing and detailed, [3] Learn about Florida’s new regulatory provision specific to pelvic exams.
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