Pediatric News
Incidence of Delayed Intracranial Hemorrhage in Children After Uncomplicated Minor Head Injuries
This study sought to determine the incidence of delayed diagnosis of intracranial hemorrhage in the general population and the proportion of children who presented to emergency departments (EDs) with uncomplicated minor head injuries who received delayed diagnoses of intracranial hemorrhage. The proportions of children with uncomplicated minor head injuries with delayed diagnoses of intracranial hemorrhage with and without deterioration in level of consciousness were 0.00% (0 of 17 962 children [upper limit of 95% CI: 0.02%]) and 0.03% (5 of 17 962 children [95% CI: 0.01%–0.07%]), respectively. On the basis of population data for the Calgary Health Region, the incidences of delayed diagnosis of intracranial hemorrhage with and without deterioration in level of consciousness were 0.14 and 0.57 cases per 100 000 children per year, respectively. Overall the occurrence of delayed diagnosis of intracranial hemorrhage among children who present with uncomplicated minor head injuries is rare.
Measles-Mumps-Rubella-Varicella Combination Vaccine and the Risk of Febrile Seizures
In February 2008, we alerted the Advisory Committee on Immunization Practices to preliminary evidence of a twofold increased risk of febrile seizures after the combination measles-mumps-rubella-varicella (MMRV) vaccine when compared with separate measles-mumps-rubella (MMR) and varicella vaccines. Now with data on twice as many vaccine recipients, our goal was to reexamine seizure risk after MMRV vaccine. It was found that among 12- to 23-month-olds who received their first dose of measles-containing vaccine, fever and seizure were elevated 7 to 10 days after vaccination. Vaccination with MMRV results in 1 additional febrile seizure for every 2300 doses given instead of separate MMR + varicella vaccines. Providers who recommend MMRV should communicate to parents that it increases the risk of fever and seizure over that already associated with measles-containing vaccines.
Probiotics may help babies with constipation
Some probiotics may help treat chronic constipation in babies, according to a new study. In this study, the researchers used a bacterium called Lactobacillus reuteri, which is found naturally in the intestines of some people. The bug was named after the German microbiologist who discovered it, Gerhard Reuter. Babies taking probiotics had significantly more bowel movements than babies on the placebo after two, four, and eight weeks, suggesting an improvement in their constipation. At the beginning of the study, the probiotic babies had, on average, less than three bowel movements per week. By week eight, they had an average of almost five.
While not going so far as to recommend that parents of infants with constipation run to the pharmacy for probiotics, the authors conclude that "probiotics as a natural, safe, and well-tolerated treatment may provide a simple and attractive way" to treat chronic constipation in babies.
The Presence of Urinary Nitrites Is a Significant Predictor of Pediatric Urinary Tract Infection Susceptibility to First- and Third-Generation Cephalosporins
Previous studies in adults have refuted the use of nitrites as a predictor of bacterial resistance to both trimethoprim-sulfamethoxazole and cephalosporins. Some centers now consider first-line outpatient therapy with an oral third-generation cephalosporin appropriate for young children. The objective of this study was to determine if nitrite-negative pediatric urinary tract infections (UTIs) were more likely than nitrite-positive UTIs to be resistant to cephalosporins. The absence of urinary nitrites is a significant indicator for potential resistance to cephalosporins in pediatric UTIs. Due to low levels of pediatric UTI resistance, cephalosporins continue to represent useful empiric therapy in the general pediatric population. However, in high-risk patients, physicians may opt to alter their empiric choice of antibiotic based on the presence of urinary nitrites.
Infant Overweight Is Associated with Delayed Motor Development
This article in the Journal of Pediatrics examined how infant overweight and high subcutaneous fat relate to infant motor development. It found that motor delay was 1.80 times as likely in overweight infants compared with non-overweight infants and 2.32 times as likely in infants with high subcutaneous fat compared with infants with lower subcutaneous fat . High subcutaneous fat was also associated with delay in subsequent motor development.
Repeat Epinephrine Treatments for Food-Related Anaphylaxis in Children
An article in this months Journal of PEDIATRICS sought to establish the frequency of receiving >1 dose of epinephrine in children who present to the emergency department (ED) with food-related anaphylaxis. A medical chart review at Boston hospitals of all children presenting to the ED for food-related acute allergic reactions between January 1, 2001, and December 31, 2006 and focused on causative foods, clinical presentations, and emergency treatments. It found that among children with food-related anaphylaxis who received epinephrine, 12% received a second dose. These results suggest the support of the recommendation that children at risk for food-related anaphylaxis carry 2 doses of epinephrine.
Effects of exposure to smoking on the microbial flora of children and their parents
The effects of exposure to direct and indirect smoking on the colonization with pathogenic bacteria and organisms that interfere with their growth were examined in an article in this months International Journal of Pediatric Otolaryngology. It found parents that smoked were more often colonized by potential pathogens than parents that did not smoke. The flora of healthy children of Smoking parents contained high number of potential pathogens similar to the one found in their parents and Otitis Media Prone children. Since Smoking parents harbor more potential pathogens and less interfering organisms they may serve as a source of pathogens that can colonize and/or infect their children. These studies illustrate the adverse effects of direct and indirect exposure to smoking on colonization with potential pathogens.
Maternal Preeclampsia Predicts the Development of Bronchopulmonary Dysplasia
An article published in this months Journal of Pediatrics tested the hypothesis that exposure to preeclampsia is associated with an increased risk of bronchopulmonary dysplasia (BPD). Of the 107 infants studied, 27 (25%) developed BPD. The bivariate odds ratio (OR) for the relationship between pre-eclampsia and BPD was 2.96 (95% confidence interval [CI] = 1.17 to 7.51; P = .01). BPD is increased for infants exposed to preeclampsia. This has possible implications for the prevention of BPD with proangiogenic agents, such as vascular endothelial growth factor.
Identifying Children at Low Risk for Bacterial Conjunctivitis
A study out of the Archives of Pediatrics and Adolescent Medicine conducted a prospective observational cohort study to identify a population of children at low risk for bacterial conjunctivitis on the basis of history and physical examination findings. Age 6 years or older, presentation in April through November, no or watery discharge, and no glued eye in the morning were the clinical factors found to be independently associated with a negative conjunctival culture. If 3 factors were present, 76.4% (95% confidence interval, 63.6%-85.6%) of patients had a negative culture. If all 4 factors were present, 92.3% (95% confidence interval, 66.1%-98.2%) of patients had a negative culture.
Age of mother affects child's autism risk: study
Being an older mother significantly increases the risk of having a child with autism, but being an older father only increases the risk when the mother is under the age of 30, U.S. researchers said on Monday. But being an older father -- 40 or older -- only contributes significantly to autism risk when the mother is under 30.
Vaccine-Autism Study Is Retracted
A major British medical journal on Tuesday retracted a flawed study linking the measles, mumps and rubella vaccine to autism and bowel disease. The retraction by The Lancet comes a day after a competing medical journal, BMJ, issued an embargoed commentary calling for The Lancet to formally retract the study. The commentary was to have been published on Wednesday.
Imaging Recomendations for new-onset afebrile seizures in infants
To investigate the presenting characteristics of new-onset afebrile seizures in infants (age 1–24 months) a prospective trial was conducted. It was found half of the infants had partial features to their seizures, yet evidence for primary generalized seizures was rare. The majority had more than 1 seizure upon presentation. Seizures in this age group tended to be brief, with 44% lasting less than 1 minute. EEG abnormalities were found in half. One-third of CTs were abnormal, with 9% of all CTs requiring acute medical management. Over half of MRIs were abnormal, with cerebral dysgenesis being the most common abnormality (p < 0.05). One-third of normal CTs had a subsequent abnormal MRI—only 1 resulted in altered medical management. Infantile seizures are usually brief, but commonly recurrent, and strong consideration should be made for inpatient observation. Acute imaging with CT can alter management in a small but important number of infants. Due to the superior yield, strong consideration for MRI should be given for all infants, as primary generalized seizures are rare, and there is a high rate of cerebral dysgenesis.
Ibuprofen Bests Acetaminophen/Codeine for Kids' Broken Arms
Children treated for arm fractures said ibuprofen reduced the pain as effectively as a combination of acetaminophen and codeine (Tylenol 3), with fewer adverse effects, in a randomized, double-blind trial.
Bacteria May Be Connected to Colic
A bacterium normally found in the mouth, skin and intestines might play a role in the still-mysterious cause of colic in babies, a new study says. Researchers found the bacterium Klebsiella along with gut inflammation in the intestines of all babies in their study who had colic, a condition characterized by uncontrollable crying.
More Dairy, Calcium in Childhood Could Mean Longer Life
A 65-year-long study finds that people who took in lots of calcium and dairy products as children tended to avoid stroke and live longer than those who didn't. "This study shows a modest protective effect of dietary calcium intake in childhood against stroke risk later in life, and a modest protective effect against mortality from any cause from higher intake of milk in childhood,"
Serious Bacterial Infections in Febrile Infants in the Post–Pneumococcal Conjugate Vaccine Era
Academic Emergency Medicine
A cohort study with nested case-controls was undertaken at a tertiary care military hospital emergency department (ED) from December 2002 through December 2003. Irrespective of clinical findings at the initial encounter, patients were included if they were under 3 months of age and had a home or ED temperature of ≥100.4°F or if they were between 3 and 24 months of age with a temperature of ≥102.3°F. The WBC count and height of fever were not found to be accurate predictors of SBI in infants age 3 to 24 months. UTI and pneumonias made up the vast majority of SBI in this population of infants. The overall bacteremia frequency was well below 1%. This calls into question the continued utility of obtaining routine complete cell counts and blood cultures in the febrile infant in the post-PCV7 era.
A novel role of HLA class I in the pathology of medulloblastoma
MHC class I expression by cancer cells enables specific antigen recognition by
the immune system and protection of the host. However, in some cancer types MHC class I
expression is associated with an unfavorable outcome. We explored the basis of MHC class I
association with unfavorable prognostic marker expression in the case of medulloblastoma.
Anticoagulation In Patient Following Prosthetic Heart Valve Replacement
To identify optimum International Normalization Ratio (INR) levels and required warfarin doses and anticoagulation related complications in patients following mechanical prosthetic valve replacment.
Medications in the Breast-Feeding Mother
Prescribing medications for a breast-feeding mother requires weighing the benefits of medication use for the mother against the risk of not breast-feeding the infant or the potential risk of exposing the infant to medications. A drug that is safe for use during pregnancy may not be safe for the nursing infant.
