Debora Porter

  We’ve noted over the last couple of weeks how overweight and obesity in children — a dangerous medical condition already on the increase for decades in the United States — has rocketed upward during the pandemic. One of the serious health consequences of overweight and obesity is type 2 diabetes. A new study published in JAMA last month found that from 2001 to 2017, the incidence of type 2 diabetes practically doubled in children ages 10 and older. (As you can see in the graphic above, cases of type 1 diabetes, which is more common in children and typically not a result of abnormal weight gain, also increased. Type 2 diabetes is much more common in adults.) The study found that Black and Hispanic youth saw the biggest increase in type 2 diabetes. The rise coincides with a decades-long epidemic of overweight and obesity in the U.S.: Black and Mexican American teenagers experienced the greatest increase in prevalence of obesity/severe obesity from 1999 to 2018, which may co...

Safe Fish Intake For Women and Children By  Jennifer Yoon, RDN, LDN, IBCLC AHN Pediatrics —  Pediatric Alliance St. Clair     Fish is a low-fat, high-quality protein. Fish is rich in vitamins such as D and B2 (riboflavin), and a great source of minerals, such as calcium, phosphorus, iron, zinc, iodine, magnesium, and potassium. Fish is filled with the omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) which keep our heart and brain healthy. The American Heart Association recommends eating fish at least two times per week as part of a healthy diet. Some good choices are salmon, trout, sardines, herring, canned mackerel, canned light tuna, and oysters. Though fish has many health benefits, it can contain contaminants and mercury. Women who are pregnant, might become pregnant, or are breastfeeding, and young children must use caution with eating fish. Toxic chemicals can disrupt a child’s developing brain and immune system. Too much me...

In a prospective, multicenter cohort of infants hospitalized with bronchiolitis, we found infants born late pre-term (ie, gestational age 34-36.9 weeks) had 35% higher odds of having asthma by age 5 years as compared with infants born at full-term. source https://www.jpeds.com/article/S0022-3476(21)00913-6/fulltext?rss=yes

A 15-month-old boy presented to the emergency department for evaluation of irritability and shortness of breath. Upon initial presentation, he was notably cyanotic with an oxygen saturation of 75%, which dropped precipitously to 15% with oxygen administration and agitation. He also had a short, harsh, III/VI early systolic ejection murmur loudest at the left sternal border that terminated mid-systole and prominent digital clubbing. The patient was calmed by parental soothing and intravenous medication. source https://www.jpeds.com/article/S0022-3476(21)00912-4/fulltext?rss=yes

To explore the relative risks of preterm birth—both overall and stratified into three groups (late, moderate and extreme prematurity)—associated with maternal race, ethnicity and nativity (ie, birthplace) combined. source https://www.jpeds.com/article/S0022-3476(21)00911-2/fulltext?rss=yes

To evaluate the prognostic information derived from the daily measurements of proBNP in neonates with congenital diaphragmatic hernia (CDH) undergoing extracorporeal life support (ECLS). source https://www.jpeds.com/article/S0022-3476(21)00910-0/fulltext?rss=yes

Calvin and Hobbes by Bill Watterson ( GoComics.com )             source http://www.thepediablog.com/2021/09/26/sunday-funnies-473/

MTJF / DIXIE from More Than Just Forests on Vimeo : Located in southwestern Utah, the Dixie National Forest spans almost two million acres and stretches for nearly 170 miles, making it the largest national forest in the state. Winding your way through the stunning landscapes of southern Utah, the Dixie National Forest offers spectacular scenery that easily rivals that of it’s neighbors Bryce Canyon, Zion, and Capitol Reef National Parks.     source http://www.thepediablog.com/2021/09/25/cool-video-of-the-week-473/

*This post originally appeared on The PediaBlog on September 24, 2020.   Cancer Prevention — Act Now     For the last 50 years, the incidence of childhood cancer has been steadily rising in the United States. The amount of concern among scientists and medical professionals that environmental chemicals are contributing to the rising cancer rates has also been growing. An important new report released yesterday by the Childhood Cancer Prevention Initiative finds “cross sector” opportunities for doctors, scientists, businesses, and policymakers to reduce hazardous chemicals entering the environment and preventing cancer: While adults and young people can breathe in, swallow, and absorb hazardous chemicals through their skin, children face added risks through maternal or paternal transfer of toxics. Reducing production and use of chemicals that can cause cancer is an opportunity for childhood cancer prevention.   Even though survival rates of child...

To assess the relation between leisure screen time and emotional and behavioural problems in Spaniards aged 4-14 years. source https://www.jpeds.com/article/S0022-3476(21)00907-0/fulltext?rss=yes

To determine the time to RT-PCR negativity after the first positive RT-PCR test, factors associated with longer time to RT-PCR negativity, proportion of children seroconverting after proven SARS-CoV-2 infection, and factors associated with the lack of seroconversion. source https://www.jpeds.com/article/S0022-3476(21)00905-7/fulltext?rss=yes

To identify predictors of changes in height, weight, and BMI in children with ADHD starting Central Nervous System (CNS) stimulants. source https://www.jpeds.com/article/S0022-3476(21)00906-9/fulltext?rss=yes

To explore the relationship between well child visit (WCV) attendance during early childhood and age at autism spectrum disorder (ASD) diagnosis using data drawn from a statewide all-payer claims database. source https://www.jpeds.com/article/S0022-3476(21)00904-5/fulltext?rss=yes

To assess the odds of a psychiatric or neurodevelopmental diagnosis among youth with a diagnosis of gender dysphoria compared with matched controls in a large electronic health record dataset from six pediatric health systems, PEDSnet. We hypothesized that youth with gender dysphoria would have higher odds of having psychiatric and neurodevelopmental diagnoses than controls. source https://www.jpeds.com/article/S0022-3476(21)00908-2/fulltext?rss=yes

  Researchers analyzing surveys completed by more than half a million tweens and teens in Europe and North America have concluded what should be painfully obvious to everyone: Higher levels of screen time and lower levels of physical activity were associated with lower life satisfaction and higher psychosomatic complaints among adolescents from high-income countries. Public health strategies to promote adolescents’ mental wellbeing should aim to decrease screen time and increase physical activity simultaneously.   Denise Mann says more “green time” and less screen time help boost kids’ feelings of mental well-being: Boys who spent about 90 minutes a day on their screens — including TV, cellphones, computers and video games — and girls who spent an hour on devices were more likely to feel sad about their lives, the surveys found. And the more screen time they logged, the worse they tended to feel. But the more active they were, the happier they were. What’s more, ph...

Dr. Harki Kaur and Dr. Aaron Vazquez hosted a Facebook live event recently and discussed Suicide prevention and provided an update on what is happening inside Psychiatry today. Dr. Kaur is a 4th year resident in Psychiatry and Dr. Vazquez is a practicing Psychiatrist. Both are graduates of the University of Medicine and Health Sciences and were happy to share their knowledge and expertise in this area in celebration of National Suicide Prevention Month. Please check out their recent interviews on the UMHS Blog. You can find the interview with Dr. Kaur here: https://www.umhs-sk.org/blog/umhs-alum-dr.-harki-kaur-on-psychiatry-national-suicide-prevention-week-2021 You can find the interview with Dr. Vazquez here: https://www.umhs-sk.org/blog/dr.-aaron-vazquez-colleagues-host-facebook-live-on-psychiatry-during-national-suicide-prevention-week If you are wanting information about how to become a Psychiatrist, please check out this article: https://www.umhs-sk.org/blog/become-a-psychiatrist ...

Dr. Harki Kaur and Dr. Aaron Vazquez hosted a Facebook live event recently and discussed Suicide prevention and provided an update on what is happening inside Psychiatry today. Dr. Kaur is a 4th year resident in Psychiatry and Dr. Vazquez is a practicing Psychiatrist. Both are graduates of the University of Medicine and Health Sciences and were happy to share their knowledge and expertise in this area in celebration of National Suicide Prevention Month. Please check out their recent interviews on the UMHS Blog. You can find the interview with Dr. Kaur here: https://www.umhs-sk.org/blog/umhs-alum-dr.-harki-kaur-on-psychiatry-national-suicide-prevention-week-2021 You can find the interview with Dr. Vazquez here: https://www.umhs-sk.org/blog/dr.-aaron-vazquez-colleagues-host-facebook-live-on-psychiatry-during-national-suicide-prevention-week If you are wanting information about how to become a Psychiatrist, please check out this article: https://www.umhs-sk.org/blog/become-a-psychiatrist ...

Using a clinically actionable threshold for alanine aminotransferase to define suspected non-alcoholic fatty liver disease (NAFLD) in US children with obesity, the risk of suspected NAFLD was highest for Asian and Hispanic race/ethnicity, male sex, and severe obesity. source https://www.jpeds.com/article/S0022-3476(21)00909-4/fulltext?rss=yes

  Dental caries (cavities) are the most common infections seen in children. They are easily prevented by practicing good dental hygiene and regular visits to a dentist. Pediatricians Puneet Tung and Lindsay A. Thompson explain  to parents how dental cavities form, and how to preserve oral health: Childhood caries are an infection that happens when mouth bacteria and sugars interact with teeth. Over time, these bacteria create acids from sugars that break down tooth enamel. Protective factors like fluoride can help strengthen teeth after acid exposures. Other preventive measures include avoiding sugary foods and drinks, brushing teeth twice daily, and visiting the dentist regularly.   According to the Centers for Disease Control and Prevention, the consequences of dental cavities can be enormous and lifelong : Oral health is often taken for granted, but it is an essential part of our everyday lives. Good oral health enhances our ability to speak, smile, smell...

A previously healthy 6-year-old girl presented with a complaint of intermittent “fuzzy” vision provoked by reading. There was no history of eye pain, redness, or tearing; headache; ataxia; weakness; or vomiting. Examination revealed decreased visual acuity (best estimate 20/50 OU with variable performance), irregular responses to questions about the number of objects being displayed, and an abnormal finger-nose-finger test. The patient accurately touched the first stationary finger target, but as the examiner’s finger moved, she consistently pointed to the previous location where the finger had been and then traced the path to the current location of the finger (Figure and Video [available at www.jpeds.com]). source https://www.jpeds.com/article/S0022-3476(21)00897-0/fulltext?rss=yes

  Although pediatricians have been battling the ongoing epidemic of childhood obesity for more than two decades, the results of a new study examining the eating habits of American children weren’t all that surprising to many of us: From 1999 to 2018, the estimated percentage of total energy from consumption of ultraprocessed foods increased from 61.4% to 67.0% (difference, 5.6%), whereas the percentage of total energy from consumption of unprocessed or minimally processed foods decreased from 28.8% to 23.5% (difference, −5.3%).   Come again? Two-thirds of the calories consumed by a child in America come from foods and beverages that are highly processed (in other words, not real food). Kristen Monaco tells us what “ultraprocessed” means: Ultraprocessed foods are defined as pre-made ready-to-eat or ready-to-heat foods, and are mainly made up of refined ingredients with additives and little whole foods. As such, this category often is high in sugar, trans fat, sodium...

A 3-year-old girl presented to the emergency department for evaluation of one week of fevers, nasal congestion, and rhinorrhea following a minor fall with nasal impact at school. She was uncomfortable with a challenging intranasal examination due to pain which made it difficult to clearly visualize the medially based swelling of the septum obstructing the nasal passages (Figure, A). The history and examination were suggestive of septal hematoma with progression to abscess, although septal deformity, neoplasm, and polyps were also considered. source https://www.jpeds.com/article/S0022-3476(21)00903-3/fulltext?rss=yes

To characterize a multi-institutional cohort of pediatric patients who underwent colectomy for familial adenomatous polyposis (FAP). source https://www.jpeds.com/article/S0022-3476(21)00896-9/fulltext?rss=yes

We compared cardiac findings in patients with MIS-C and Kawasaki disease in the first 6 months of the 2020-COVID-19 pandemic to patients with KD during 2016-2019. We saw a high rate of coronary aneurysms in 2020, with a similar rate of coronary involvement but higher volume and incidence of cardiac dysfunction compared with prior years. source https://www.jpeds.com/article/S0022-3476(21)00901-X/fulltext?rss=yes

  You may be familiar with the “Quarantine 15” — unwanted weight suddenly sedentary adults packed on during lockdowns in the early days of the pandemic. A study published last year in JAMA confirmed that shelter-in-place orders in March and April 2020 coincided with “changes in physical activity and patterns of daily living, as well as concurrent self-reported increases in snacking and overeating” to help tip the scales in the wrong direction. Research from California published in the same journal last month revealed that children have also experienced unwanted weight gain during the pandemic. Laura Reiley reports on a significant rise of childhood obesity, which affects close to 20%, or 1 in 5 American children (another 20% meet the criteria for overweight). Especially disturbing were the numbers involving children between 5 and 11 years old: The greatest change was among children ages 5 to 11, who gained an average of more than five pounds, adjusted for height, accor...

We thank Drs Noori and Seri for their thoughtful review of our study findings.1 We agree that the echocardiography data suggest that systemic hypotension in our study subjects may have been due to reduced systemic vascular resistance or a significant patent ductus arteriosus (PDA) shunt with unloading of the left heart due to an interatrial shunt. These physiological explanations carry the potential to represent states of uncompensated low afterload, which may imply a state of systemic hypoperfusion. source https://www.jpeds.com/article/S0022-3476(21)00899-4/fulltext?rss=yes

We read with interest the report by Aldana-Aguirre et al on the mechanisms of hypotension in extremely preterm infants during the first postnatal day.(1) Compared with the case-control group, the hypotensive group had larger patent ductus arteriosus (PDA) size, higher rate of peri/intraventricular hemorrhage (PIVH), higher indices of left ventricular (LV) systolic function, and lower afterload but similar left ventricular output (LVO). The preservation of LV systolic function is consistent with our findings in extremely preterm infants who developed PIVH on the second or third postnatal day.(2) source https://www.jpeds.com/article/S0022-3476(21)00898-2/fulltext?rss=yes

KIF12 has been identified as a cholestasis-associated candidate gene. We describe 6 cases from 4 unrelated families with diverse cholestatic phenotypes carrying two different homozygous KIF12 truncating variants. Immunofluorescence investigations of paraffin-embedded liver sections suggest that KIF12-associated impaired functional cell polarity may be the underlying cause. source https://www.jpeds.com/article/S0022-3476(21)00893-3/fulltext?rss=yes

Daddy’s Home by Gary Markstein and Anthony Rubino Jr. ( arcamax.com/thefunnies )             source http://www.thepediablog.com/2021/09/19/sunday-funnies-472/

The Wild: Capturing Our Planet in Dolby Vision  from Aaron Lieber on Vimeo: The Wild is a short film inspired by the idea that we need to co-exist and protect nature. It’s Noah Beschen’s journey through our beautiful world captured and shared with the crisp clarity and vibrancy of Dolby Vision. Because every moment should look like this.     source http://www.thepediablog.com/2021/09/18/cool-video-of-the-week-472/

To evaluate the predictive performance of urine biomarkers for acute kidney injury (AKI) in neonates with hypoxic ischemic encephalopathy (HIE) receiving therapeutic hypothermia. source https://www.jpeds.com/article/S0022-3476(21)00895-7/fulltext?rss=yes

We developed a brain and spine magnetic resonance (MR) scoring system based on MR assessment of 9 patients with Mucopolysaccharidosis type I-Hurler (MPSI-H) who underwent hematopoietic stem-cell transplantation. The score is reliable and correlates with long-term clinical and cognitive outcome in MPSI-H patients. source https://www.jpeds.com/article/S0022-3476(21)00894-5/fulltext?rss=yes

Within pediatric graduate medical education, care of transgender youth presents opportunities for deepening learners' understanding of equity, access, the role of the physician as advocate, and health disparities caused by stigma and minority stress. But when a pediatric resident objects to providing health care to this uniquely vulnerable population, due to their personal beliefs and values, how should pediatrician-educators respond? Important reasons to respect healthcare professionals’ conscience have been described in the scholarly literature; however, equally important concerns have also been raised about the extent to which conscientious objection should be permitted in a pluralistic society, particularly given power differentials that favor healthcare professionals and grants them a monopoly over certain services. source https://www.jpeds.com/article/S0022-3476(21)00892-1/fulltext?rss=yes

To characterize the relationship between surgical volume and postoperative outcomes in congenital heart surgery, we used a national cohort to assess costs, readmissions and complications in children undergoing cardiac operations. source https://www.jpeds.com/article/S0022-3476(21)00891-X/fulltext?rss=yes

To determine the prevalence of adverse childhood experiences (ACEs) and healthcare utilization patterns of children seen in pediatric emergency departments (PEDs). source https://www.jpeds.com/article/S0022-3476(21)00890-8/fulltext?rss=yes

*This post originally appeared on The PediaBlog on September 17, 2019.   Who Will You Trust?     First, the good news: A nationwide survey of more than 1,500 adults found that a huge majority — 84% — support rules requiring schoolchildren to be immunized against vaccine-preventable childhood diseases. I guess it shouldn’t be surprising that, according to the poll, 13% of American adults are skeptical about vaccine efficacy and safety and, therefore, opposed  to such requirements. After all, other polls have shown that many Americans believe Earth is flat (2%), the Moon landings were faked on a Hollywood soundstage (6%), and climate change is a hoax perpetrated by greedy, scheming climate scientists (7%). (For what it’s worth: As I write this, it seems about a quarter of my “Twitterverse” (an unscientific sampling to be sure) believes Big Ben is faking his season-ending elbow injury. “No one saw it happen!” I’ve been reading. Go figure.) Here’s the bad news...

To systematically describe the short stature of patients with Diamond-Blackfan anemia and to explore factors affecting the height development of patients with DBA. source https://www.jpeds.com/article/S0022-3476(21)00889-1/fulltext?rss=yes

  OUT OF THE OLD BLACK BAG The Return of the Magi   By  Anthony Kovatch, M.D. AHN Pediatrics —  Pediatric Alliance Arcadia     “So, I love you because the entire universe conspired to help me find you.” ― Paulo Coelho,   The Alchemist   Smiling for the Magi!   Musical accompaniment: “True Love” written by Cole Porter. Sung by Bing Crosby and Grace Kelly.   In the time of  King Herod , after Jesus was born in  Bethlehem  of  Judea , wise men from the East came to Jerusalem, asking, “Where is the child who has been born for we observed his star at its rising, and have come to pay him homage.” […]When they saw that the star had stopped, they were overwhelmed with joy. On entering the house, they saw the child with Mary his mother; and they knelt down and paid him homage. Then, opening their treasure chests, they offered him gifts of gold, frankincense, and myrrh. — Matthew 2:1-12 (New Internati...

To examine demographic and clinical characteristics of individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) with and without joint hypermobility We hypothesized that JH+ patients would have an earlier onset of ME/CFS symptoms as well as increased severity, greater number of co-morbid conditions, and lower health related quality of life. source https://www.jpeds.com/article/S0022-3476(21)00887-8/fulltext?rss=yes

We explored gender diverse youth’s experiences seeking and receiving gender-affirming care in various health system locations. Results provide evidence for system-, clinic-, and provider-level improvements to promote the development of affirming environments and to improve health outcomes for gender diverse youth. source https://www.jpeds.com/article/S0022-3476(21)00888-X/fulltext?rss=yes

  Is it possible that those of us who have been publicly and privately pleading for people to protect themselves and others from a global pandemic virus by wearing face masks and getting vaccinated have been barking up the wrong tree? Aside from people who flat-out deny the wisdom of getting a vaccine to prevent a life-changing and life-threatening disease like COVID-19, Joyce Frieden found other reasons why folks have balked: “Our nation’s unvaccinated are not a monstrous monolith,” [pediatrician Rhea] Boyd said. “This is not a group who is adverse to science, or medical care. We have seen that this is a group who is more likely to be our nation’s working poor; they’re more likely to lack the resources to actually access any type of healthcare, let alone a vaccination. And so if we’re going to vaccinate them, we have to talk about what we’re going to do to address access barriers both to the vaccines and other types of medical care, but also to information about vaccines.” ...

To evaluate the effectiveness and safety of non-pharmacological interventions for the treatment of childhood functional constipation functional constipation. source https://www.jpeds.com/article/S0022-3476(21)00883-0/fulltext?rss=yes

Since its first appearance in the Wuhan region of China in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a public health and a socio-economic crisis worldwide1. According to the WHO Coronavirus (COVID-19) dashboard, as of September 2021, there have been more than 217 million confirmed cases and 4.5 million deaths reported2. Mass vaccination campaigns against SARS-CoV-2 are ongoing worldwide. Currently, 5.38 billion doses have been administered globally, 39.9% of the world population has received at least one dose of a COVID-19 vaccine and about 40 million are administered each day. source https://www.jpeds.com/article/S0022-3476(21)00886-6/fulltext?rss=yes

  Since the start of the pandemic, SARS-CoV-2 has undergone many mutations. This doesn’t surprise epidemiologist Katelyn Jetelina: SARS-CoV-2 is mutating every two weeks due to the high levels of transmission across the globe. Only 36% of the globe is vaccinated with low adherence to public health measures in some countries, which allows this virus to jump from person-to-person at a high rate. Contrary to misinformation circulating on the web, vaccines do not promote mutations. We actually saw the opposite in a recent study. Scientists looked at the rate in which Delta made small changes as it spread throughout 20 countries between June 20 to July 3 2021. They found that vaccination coverage was inversely related to the mutation frequency. In other words, the more a country was vaccinated, the less fast the virus changed.   Facing a strong surge caused by the Delta variant, the United States is an unfortunate exception. Jetelina says this is most likely due to the fa...