Debora Porter

*This post originally appeared on The PediaBlog on December 30, 2020.   Resolved: 2021  2022 Will Be Better     It’s been a rough year, so it’s not farfetched to expect that 2021 (The Year of the Ox on the Chinese zodiac calendar) will be far better in every respect than 2020 ( The Year of the Rat , fittingly). [2022 is the Year of the Tiger.] Having made it through intact, KidsKonnect encourages parents to keep the enthusiasm and optimism high, “to give hope to our kids for the things that follow in the new year.” One way is to help them make a list of New Year’s resolutions: To do this, we have to remind children to look favorably to the future, and making New Year’s resolutions for kids is a great way to achieve this. For kids, resolutions are more than just goals, although this really depends on their age. Commonly, New Year’s resolutions for kids is a way for children to create healthy habits and achieve milestones in their development.   New ...

Bronchopulmonary dysplasia (BPD) is a severe chronic respiratory disease that develops over the first months after birth in preterm infants.1 Since the first description of BPD by Northway et al2, clinicians, investigators, and families of preterm infants have devoted substantial resources and effort towards preventing this consequential disease. During the past three decades, more than 25,000 very preterm infants have been enrolled into over 60 randomized trials of ∼40 different therapies that targeted BPD prevention as a primary or secondary outcome. source https://www.jpeds.com/article/S0022-3476(21)01275-0/fulltext?rss=yes

  Little baby River was born in the time of coronavirus and climate change. His father is already apologizing to his newborn son: My dearest River, Against all odds you were conceived in a lighthouse, born during a pandemic and will taste just enough of Life as We Knew It to resent us when it’s gone. I’m sorry. I’m sorry we broke your sea and your sky and shortened the wings of the nightingale. I’m sorry that the Great Barrier Reef is no longer great, that we value Amazon more than the Amazon and that the waterfront neighborhood where you burble in my arms could be condemned by rising seas before you’re old enough for a mortgage.   Bill Weir is River’s dad. He is also CNN’s Chief Climate Correspondent. He’s done what so many have resisted: he’s actually read the science. For generations, scientists told us that if we weren’t careful, a different kind of invisible enemy would come out of our farms, factories, homes and cars, get into the sea and the sky and end Li...

Coronavirus disease 2019 (COVID-19) vaccines, approved by the U.S. Food and Drug Administration1 (FDA) and the European Medicine Agency2 (EMA) have been shown to be safe and effective3,4 in the adult population at preventing severe disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide5,6. The use of COVID-19 vaccination in children aged 12-17 years old has been the subject of extensive debate, as the assessment of risks and benefits was considered more complex than in adults7,8. source https://www.jpeds.com/article/S0022-3476(21)01273-7/fulltext?rss=yes

  While the world in 2021 continued to battle the pandemic for the second year in a row — a brutal plague caused by an invisible virus that has killed 5.4 million human beings so far — international health experts reported important progress earlier this year on tackling another major global health challenge. In October, the World Health Organization announced its endorsement of the recently approved, first-ever malaria vaccine: “For centuries, malaria has stalked sub-Saharan Africa, causing immense personal suffering,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We have long hoped for an effective malaria vaccine and now for the first time ever, we have such a vaccine recommended for widespread use. Today’s recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease and we expect many more African children to be protected from malaria and grow into healthy adults.”   The new malaria vaccine, RTS,S/...

To assess whether Family Integrated Care (FICare) in the neonatal intensive care unit (NICU) improves maternal chronic physiological stress and child behavior at 18-months of corrected age (CA) for infants born preterm. source https://www.jpeds.com/article/S0022-3476(21)01262-2/fulltext?rss=yes

To develop and validate a prediction model for fat mass in infants ≤ 12 kg using easily accessible measurements such as weight and length. source https://www.jpeds.com/article/S0022-3476(21)01265-8/fulltext?rss=yes

To determine whether pharmacological treatment for neonatal abstinence syndrome (NAS) is associated with changes in DNA methylation (DNAm) of the mu-opioid receptor gene (OPRM1) and improvements in neonatal neurobehavior. source https://www.jpeds.com/article/S0022-3476(21)01264-6/fulltext?rss=yes

(Click image to enlarge)   Seasonal influenza activity in the United States is increasing, including indicators that track hospitalizations. The amount of activity varies by region. — CDC FluView  (Key Updates for Week 50, ending December 18, 2021)   Just as the 2021-22 flu season is getting started, a new study published last week and awaiting peer-review suggests a “major mismatch” between the H3N2 influenza A strain currently circulating in the northern hemisphere and the H3N2 strain included in this year’s flu vaccine. This could leave people who receive a flu shot vulnerable to getting symptoms if they are exposed to the virus. Every spring, scientists analyze the influenza viruses circulating in the southern hemisphere during their early winter season and make a prediction about which ones will make the trip North to pay us a visit during our cold and flu season. But every few years the virus undergoes an unexpected mutation, rendering the vaccine less ef...

Although there are concerns regarding children’s health in immigration detention, there is little data regarding hospitalizations from this population. Using 2015-2018 Texas inpatient data, we identified 95 hospitalizations from children in detention, finding that most (60%) were driven by infectious causes and 37% were admitted to an ICU or intermediate-ICU. source https://www.jpeds.com/article/S0022-3476(21)01263-4/fulltext?rss=yes

A 7-month-old girl with a complex past medical history, including chromosome 1q21.1 duplication and gain of band 19p13.3, OSA, GERD, dysphagia, seizure disorder, and NGT dependence presented with a sublingual ulcer with white discharge. The mother noted that it had been present and worsening over at least the last week; she also reported that the patient had been tongue thrusting recently. The review of systems was only notable for some increased drooling. The patient had normal vital signs, was well-hydrated and well-appearing and the examination was notable for a sublingual, ulcerated lesion. source https://www.jpeds.com/article/S0022-3476(21)01267-1/fulltext?rss=yes

To assess whether ‘treatment day’ is a significant predicting factor in Kawasaki disease and imposes a risk for coronary artery aneurysms (CAAs) in a per-day analysis. CAA formation can be reduced from 25% to 10% when treated with intravenous immunoglobulin (IVIG). source https://www.jpeds.com/article/S0022-3476(21)01261-0/fulltext?rss=yes

  Two years of providing medical care during a dangerous and heartbreaking pandemic isn’t enough for Meredith Barrett, M.D. to lose her love of medicine despite all the ups and downs: Medicine, you are hard to describe to someone who doesn’t know your ways. The long hours, the absent holidays, the missed weddings and funerals. The pager that can go off at any minute. The standardized tests that seem unnecessarily expensive and stressful. You aren’t always fair and sometimes you seem incredibly cruel — the unresectable cancer, the tragic accident, the misdiagnosis that results in unintended harm. These are all part of you, medicine, they keep me up at night and often make me question if you are right for me.   As Omicron pushes Delta out of the way as the dominant SARS-CoV-2 variant, physician offices and hospitals have once again reached their breaking points. Relentless stress has taken a toll on doctors, nurses, and other health professionals, and many of them have l...

To investigate the rates of radiographic pneumonia and clinical outcomes of children with suspected pneumonia and subcentimeter, subpleural consolidations (SSCs) on point-of-care lung ultrasound (LUS). source https://www.jpeds.com/article/S0022-3476(21)01259-2/fulltext?rss=yes

Over the Hedge by T Lewis and Michael Fry ( GoComics.com )             source http://www.thepediablog.com/2021/12/26/sunday-funnies-486/

To assess sex-specific differences in early brain structure and function of preterm infants after red blood cell (RBC) transfusions. source https://www.jpeds.com/article/S0022-3476(21)01258-0/fulltext?rss=yes

To determine whether procedure specific provider volume is associated with outcomes for patients undergoing repair of pectus excavatum () at tertiary care children’s hospitals. source https://www.jpeds.com/article/S0022-3476(21)01260-9/fulltext?rss=yes

Doc Morris – Take Care from Agentzoo on Vimeo .   The PediaBlog wishes everyone a Merry Christmas!     source http://www.thepediablog.com/2021/12/25/cool-video-of-the-week-486/

*This post originally appeared on The PediaBlog on December 24, 2019.   All Aboard!     Yesterday on The PediaBlog , Chastity Menner and Dr. Tony Kovatch shared Total Spectrum’s list of “Ten Tips for Traveling with an Autistic Child.”  Before leaving home, parents are advised to discuss travel plans with teachers and therapists to help in preparation for what can be an immensely challenging activity for children and families. For example: If possible, do some role-playing at home to show the child what he or she can expect in a plane or train or long car ride. Talk about what the child will see and hear and experience to defuse any anxiety.   While the art of traveling is learning to take things as they come and go with the flow, this can be a difficult task for all children, not only those with autism spectrum disorder. Here are some other suggestions that can help all  young children, especially ones with family holiday travel plans: • Ta...

In this volume of The Journal, Vinit et al report their 18 year experience of caring for children with gastroschisis at the Necker-Enfants Malades Hospital in Paris1. This descriptive study includes 155 inborn patients and 25 referred patients from 2000 to 2017. The large number of subjects included, the extended follow-up and the clinical details from this center with a high level of expertise and experience in intestinal rehabilitation further our understanding of the natural history of one of the four major causes of pediatric short bowel syndrome(along with necrotizing enterocolitis, intestinal atresia and malrotation with volvulus). source https://www.jpeds.com/article/S0022-3476(21)01256-7/fulltext?rss=yes

Kawasaki disease is an acute vasculitis that preferentially affects small- and medium-sized arteries, particularly the coronary arteries1. Coronary artery aneurysms (CAA) are the most serious long-term complication of KD. Long-term cardiovascular outcomes are directly related to the extent of enlargement of the CAs in the first month of illness1,2. Coronary artery involvement can range from transient, mild dilatation to giant CAAs. In the pre-intravenous immunoglobulin (IVIG) era, CAA occurred in ∼ 25% of patients3. source https://www.jpeds.com/article/S0022-3476(21)01255-5/fulltext?rss=yes

  Even before the pandemic began, the average body mass index (BMI) for young adults 18-25 years of age was 27.7 — well within the range of overweight. We recently discovered that more children have joined the ranks of the overweight and obese during the pandemic. Nearly half (46%) of American children between 5 and 11 years old were found to be either overweight or obese in 2020. Only a year before (prior to the start of the pandemic), 36% of kids 5-11 were considered overweight or obese. That’s a gain of ten percentage points in just one year!   Kristen Monaco points to new research showing that more than half of young American adults are now overweight or obese: In 1976-1980, only 6.2% of young adults had obesity (BMI of 30 or higher). However, this number more than quintupled by 2017-2018, as nearly 33% of this age group had obesity, the analysis showed. The trend was likewise paired by a jump in overweight prevalence — increasing from 17.7% of this p...

To determine the safety, pharmacokinetics, and immunomodulatory effects of two- to six-weeks of anakinra in patients with acute KD Kawasaki disease with coronary artery aneurysms (CAA). source https://www.jpeds.com/article/S0022-3476(21)01242-7/fulltext?rss=yes

An 11-year-old boy presented with stiffness of his gait since early childhood. Stiffness was noted upon initiating movement leading to falls and frequent toe walking; symptoms would improve after a few minutes with movement. Family history was negative. Physical examination revealed generalized muscular hypertrophy (Figure) and mild proximal and distal muscle weakness. There was grip myotonia (delayed relaxation after contraction) (Video; available at www.jpeds.com) and percussion myotonia of different muscles. source https://www.jpeds.com/article/S0022-3476(21)01246-4/fulltext?rss=yes

Genomic copy number variations (CNVs), including deletions and duplications, contribute to human phenotypic diversity and disease.1 Detection of CNVs by chromosomal microarray analysis (CMA) has been recommended as a first-line diagnostic test for developmental delay, intellectual disability, autism spectrum disorders, or multiple congenital anomalies since 2010.2,3 Unfortunately, CMA tests are frequently inconclusive and reported as having non-actionable variants of uncertain significance (VUSs). source https://www.jpeds.com/article/S0022-3476(21)01243-9/fulltext?rss=yes

A 2-year-old boy presented with extensive skin lesions on his scalp, neck, back, and arms, lasting for 5 months. He had been previously diagnosed with psoriasis and had received oral methotrexate, topical corticosteroids, and phototherapy. The lesions waxed and waned, and occasionally worsened. On physical examination, there were widespread figurate, annular or polycyclic patches and plaques with an active scaly border on the face, trunk, and arms (Figure 1, A). There were multiple patches of alopecia with scales and follicular pustules on the scalp (Figure 1, B). source https://www.jpeds.com/article/S0022-3476(21)01241-5/fulltext?rss=yes

To assess longitudinal neurocognitive development after liver transplantation and evaluate factors associated with neurocognitive performance. source https://www.jpeds.com/article/S0022-3476(21)01240-3/fulltext?rss=yes

A five-year-old girl presented with paroxystic abdominal pain, vomiting and constipation. She had no previous surgical history or significant family history. The physical examination was normal. Ultrasonography revealed an abdominal multiloculated septated cystic mass. CT-scan showed a 125x35x71mm abdominopelvic cystic mass. It was multilocular with polycyclic edges molding the intestinal loops (Figure 1). The patient was operated on with laparoscopy-assisted procedure. Exploration showed a yellowish butterfly-shaped multilocular cystic mass that originated from the small-bowel mesentery with small bowel dilatation. source https://www.jpeds.com/article/S0022-3476(21)01239-7/fulltext?rss=yes

To investigate the clinical and genetic causes of neonatal unconjugated hyperbilirubinemia (NUCHB). source https://www.jpeds.com/article/S0022-3476(21)01245-2/fulltext?rss=yes

To identify risk factors for febrile recurrence of urinary tract infections (UTIs) in children with a history of UTI. source https://www.jpeds.com/article/S0022-3476(21)01244-0/fulltext?rss=yes

  If your college student hasn’t received a flu vaccine yet, there won’t be a better time than winter break to run them to their doctor’s office, pharmacy, or vaccine clinic to get one, urges pediatrician Flor Muñoz, M.D.: You may have heard of recent flu outbreaks on college campuses. Flu viruses are known to spread quickly among college students and teens. Group social activities, crowded classrooms and shared living spaces make it easier for the flu to be passed around to others. If you are a college student or the parent of a college student or teen, be sure that they get their flu vaccine as soon as possible.   With the more contagious SARS-CoV-2 Omicron variant quickly  overtaking Delta’s dominance in the U.S., and influenza cases beginning to rise , there is no more time to waste to protect all young adults against two viruses that are dangerous to them and the people they come in contact with: Don’t wait. It is not possible to know when flu season will...

In this survey study of institutions across the US, marked variability in evaluation, treatment, and follow-up of adolescents 12 through 18 years of age with mRNA COVID-19 vaccine-associated myopericarditis (VAM) was noted. Only one adolescent with life-threatening complications was reported with no deaths at any of the participating institutions. source https://www.jpeds.com/article/S0022-3476(21)01231-2/fulltext?rss=yes

To report on long-acting reversible contraception (LARC) experience and continuation rates in the Adolescent Medicine (AM) LARC Collaborative. source https://www.jpeds.com/article/S0022-3476(21)01238-5/fulltext?rss=yes

  With Delta raging throughout Pennsylvania and across the nation, Omicron gaining traction  towards its inevitable rise to become the pandemic’s dominant strain, and Christmas just a few days away, families are wondering how they can celebrate the holidays together with friends and loved ones and still stay safe and healthy. In Allegheny County over the weekend, 1,595 new cases of COVID-19 were reported by COVID testing sites to the county’s health department. 21% of new cases were in children 18 and under, 40% occurred in 25 to 49-year-olds (ie. parents), and 26% in the 50-and-older age group (grandparents), according to Allegheny Alerts. Undoubtedly, many more cases detected by home testing went unreported to ACHD. Breakthrough cases in vaccinated people are rising, most likely due to the Omicron “tidal wave” , “blizzard” , “wildfire” , or any other disaster metaphor you choose to use to describe the growing anxiety felt by many about the never-ending pandemic. It’s ha...

A case of a 16-year-old girl presented to the dermatology clinic with erythema on the dorsal aspect of her hands. She had recently visited Peru for three weeks, where the erythema initially started. She was taking doxycycline, 100mg twice daily, for her acne throughout her trip as her malaria prophylaxis. Physical exam revealed erythematous patches with vesicles over the dorsal aspect of the first and second digits of both hands (Figure 1). Further history indicated that while hiking in Peru, she was utilizing hiking poles that positioned the affected areas in direct exposure to intense sunlight. source https://www.jpeds.com/article/S0022-3476(21)01237-3/fulltext?rss=yes

To establish the superiority of blood flow-based circulatory management over conventional blood pressure-based management strategies used for preventing intraventricular hemorrhage (IVH) in very-low birth weight (VLBW) infants. source https://www.jpeds.com/article/S0022-3476(21)01226-9/fulltext?rss=yes

To assess the association between early empirical antibiotics and neonatal adverse outcomes in very preterm infants without risk factors of early-onset sepsis. source https://www.jpeds.com/article/S0022-3476(21)01223-3/fulltext?rss=yes

To determine the impact of the (COVID-19) quarantine on baseline health, medication use, health anxiety, and healthcare utilization in pediatric aerodigestive patients, and to evaluate for associations of commonly prescribed medications with risk of COVID-19 illness. source https://www.jpeds.com/article/S0022-3476(21)01228-2/fulltext?rss=yes

  When the FDA and CDC approved Pfizer’s COVID-19 vaccine for emergency use in 5 to 11-year-olds last month, we asked a logical question: Now that kids who are 5 and over are getting the vaccine, much to the relief of pediatricians and parents everywhere, when will their younger siblings be able to get their chance for immunological protection against SARS-CoV-2?   In September, Pfizer’s CEO promised  results of clinical trials in kids under 5 would be available by the end of the year. On Friday, Pfizer broke some disappointing news: Parents will have to wait another few months before there is enough data to confirm with confidence that the vaccine is effective and safe for their younger children. The Pfizer vaccine is authorized in the United States for people age 5 and older. But it said on Friday that its study in children between the ages of 2 and 4 who were given two 3-microgram doses of the vaccine found it did not create the same immune response that a l...

To Address challenges in clinical care, quality improvement, research, and public policy for prenatally opioid-exposed neonates by standardizing the clinical definition of opioid withdrawal. source https://www.jpeds.com/article/S0022-3476(21)01227-0/fulltext?rss=yes

Although GnRH analogs (GnRHas) are standard of care for the treatment of central precocious puberty, they are not approved for children under age 2 years. We reviewed experience with the use of GnRHas in 47 children under age 2, which revealed efficacy and safety comparable with that in older children. source https://www.jpeds.com/article/S0022-3476(21)01236-1/fulltext?rss=yes

A 15-year-old male was referred to the dermatology clinic for evaluation of a new pigmented lesion on the right sole that was noticed 1 week prior. He denied pain, bleeding, itch, or preceding injury. Upon further questioning, he endorsed walking barefoot on his driveway, and it was uncovered that his neighbor’s yard contains a black walnut tree. Physical examination of the right heel revealed a poorly demarcated 22 x 14 mm brown patch with an uninflamed, light brown periphery. There was uniform pigmentation on dermoscopy, and the patch was unaltered by alcohol wipe. source https://www.jpeds.com/article/S0022-3476(21)01234-8/fulltext?rss=yes

A 17-year-old African male with homozygous sickle cell disease was admitted with a vaso-occlusive crisis of the lower limbs and lower back, further complicated with an acute thoracic syndrome. After 6 days of treatment with intravenous fluids, analgesics and antibiotics, he developed holocranial headache, nausea and photophobia. Physical examination showed biparietal painful boggy masses (Figure 1). Neurological examination was unremarkable and there were no signs of intracranial hypertension. Skull ultrasound showed two heterogeneous fluid collections, compatible with subgaleal hematomas. source https://www.jpeds.com/article/S0022-3476(21)01229-4/fulltext?rss=yes

Zits by Jerry Scott and Jim Borgman ( Arcamax.com/thefunnies )           source http://www.thepediablog.com/2021/12/19/sunday-funnies-485/

LOUIS’ SHOES from Ecole MoPA on Vimeo: Louis, 8-and-a-half years old, is autistic. He arrives at his new school and is about to introduce himself.     source http://www.thepediablog.com/2021/12/18/cool-video-of-the-week-485/

We read with interest the report by Minocha et al [1], in which the authors describe a case of a 17-year-old male with recurrent myocarditis. The second episode began 48 hours after receiving the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) messenger ribonucleic acid (mRNA) vaccine. This occurred 4 months after a previous episode of idiopathic myocarditis. source https://www.jpeds.com/article/S0022-3476(21)01232-4/fulltext?rss=yes

To evaluate the association between bronchopulmonary dysplasia (BPD) severity and risk of neurodevelopmental impairment (NDI) at two- and five years corrected age (CA) and to examine if this association changes over time. source https://www.jpeds.com/article/S0022-3476(21)01196-3/fulltext?rss=yes

To determine blood gas exchange is altered during the transition in the first hour of life in infants with congenital diaphragmatic hernia (CDH) source https://www.jpeds.com/article/S0022-3476(21)01187-2/fulltext?rss=yes

*This post originally appeared on The PediaBlog on December 17, 2012.   Quote Of The Day   “This is our first task — caring for our children. It’s our first job. If we don’t get that right, we don’t get anything right. That’s how, as a society, we will be judged. And by that measure, can we truly say, as a nation, that we are meeting our obligations? Can we honestly say that we’re doing enough to keep our children — all of them — safe from harm? Can we claim, as a nation, that we’re all together there, letting them know that they are loved, and teaching them to love in return? Can we say that we’re truly doing enough to give all the children of this country the chance they deserve to live out their lives in happiness and with purpose? I’ve been reflecting on this the last few days, and if we’re honest with ourselves, the answer is no. We’re not doing enough. And we will have to change.” “We can’t tolerate this anymore. These tragedies must end. And to end them, we mu...

To evaluate the impact of layering routine child abuse screening on top of a pre-existing electronic health record-embedded child abuse clinical decision support system (CA-CDSS) in a pediatric emergency department. source https://www.jpeds.com/article/S0022-3476(21)01185-9/fulltext?rss=yes

A previously healthy 15-year-old Hispanic male presented to the Emergency Department with a 2-day history of acute abdominal pain. Located in his lower abdomen, the pain was intermittent and exacerbated by being recumbent. On the day of admission, he experienced four episodes of vomiting, which contained no bile or blood. There were no prior episodes of unexplained abdominal pain, use of medications, illicit drugs or alcohol. source https://www.jpeds.com/article/S0022-3476(21)01195-1/fulltext?rss=yes

  Data from the Johns Hopkins Coronavirus Resource Center marked a terrible milestone yesterday: 800,000 deaths from COVID-19 in the United States in just under 24 months. Let’s remember that one year ago on December 14, 2020, the day when the very first vaccine was given in the U.S., more than 300,000 Americans had already died. Despite the easy availability of three different vaccines — all of which have been proven remarkably safe and effective in preventing serious illnesses and deaths from COVID — and the development of new therapies to treat sick patients, another half-million have succumbed to the disease in the last 12 months. Why? One reason is that despite excellent uptake of the vaccines by the American public ( today , 77% of those 5 and over who are eligible to receive a COVID vaccine have received one shot; 65% have received two doses), there is still considerable vaccine hesitancy and outright refusal in a large enough percentage of the population to block the h...

To describe parent-reported healthcare service use at five years of age in children born very preterm and investigate whether perinatal and social factors and the use of very preterm follow-up services are associated with high service use. source https://www.jpeds.com/article/S0022-3476(21)01177-X/fulltext?rss=yes

  Air Quality Index 12/14/21 Liberty-Clairton  // Airnow.gov   Some people living and working just a few miles southeast of downtown Pittsburgh found it difficult to breathe yesterday: An Air Pollution Warning has been issued for the Mon Valley for the remainder of today [12/14] and all of tomorrow [12/15]. The 24-hour PM2.5 standard for the Mon Valley has been exceeded at an official monitoring station in the Mon Valley and is likely to continue.   Children who live in the Mon Valley already have higher rates of asthma compared with the rest of the state and country. What does the warning from Allegheny Alerts mean for  them and other local residents trying to enjoy these unseasonably warm and sunny mid-December days? Young children, the elderly, and those with respiratory problems, such as asthma, emphysema, and bronchitis, are especially vulnerable to the effects of air pollution and should limit outdoor activities during this time.   So ...