Debora Porter

  OUT OF THE OLD BLACK BAG   Little Things for Little People (Part 2)   By  Anthony Kovatch, M.D.   Throughout history, it has been witnessed that adverse conditions can sometimes produce remarkable results. Take the raw oyster, for example.   When a grain of sand gets into the mollusk’s shell, the irritation causes the secretion of a unique substance (nacre) to coat the intruder. Over time — it can even take as long as 40 years — the process results in the formation of a pearl, one of the world’s most treasured jewels. The medical profession has always been occupied in the transferral of these nuggets of wisdom from generation to generation.   Here are my “pearls” for you: 1.  The best advice about work ethic I ever received was from a frustrated senior resident when I was an intern, and it proved to be highly beneficial: “Just Do Your Job and Shut Up!”     Draconian as it may sound, this piece of advice has generally held ...

  OUT OF THE OLD BLACK BAG   Little Things for Little People (Part 1)   By  Anthony Kovatch, M.D.     Musical Accompaniment:  “Both Sides Now” by Joni Mitchell (1969)   “Oh, but now old friends they’re acting strange And they shake their heads and they tell me that I’ve changed Well something’s lost, but something’s gained In living every day I’ve looked at life from both sides now From win and lose and still somehow It’s life’s illusions I recall I really don’t know life at all”     *   *   *   *   *   *   *   *   “Nothing ever goes away until it teaches us what we need to know” Pema Chödrön   *   *   *   *   *   *   *   *   On May 21, 2021 — my 70 th birthday — the idea struck me while I was running a virtual marathon (climbing Mount Everest, of all places) that for the sake of   “discipline,” I would create a diary...

Consumption of saturated (SAFA) and polyunsaturated fats (PUFA), cholesterol and fiber have been linked with cognitive function in adults; weevaluated these associations in children by leveraging data from the Special Turku Coronary Risk Factor Intervention Project (STRIP). source https://www.jpeds.com/article/S0022-3476(22)00296-7/fulltext?rss=yes

To identify key epidemiological factors relevant to fetal development that are associated with biliary atresia source https://www.jpeds.com/article/S0022-3476(22)00288-8/fulltext?rss=yes

  Pregnancy is an exquisitely sensitive period for mothers and their gestating fetuses. We know a lot of substances that inadvertently make their way into the bloodstream via inhalation or ingestion can interfere with maternal health and fetal growth and development, even at very low levels of exposure. That’s why health professionals who care for women who are pregnant advise “clean” living before, during, and after pregnancy during lactation, while stressing avoidance of chemicals that are present in our homes, in our food and water, and in the air we breathe. Exposure to some toxic substances, however, can be self-inflicted. Using tobacco, alcohol, and illicit drugs is clearly forbidden during pregnancy for reasons that are well known. Smoking during pregnancy increases the risk of pregnancy complications, including miscarriage, prematurity, low birth weight, and birth defects. Once born, babies whose mothers smoke are about three times more likely to die from sudden infant...

To evaluate how race, ethnicity, and social determinants of health (SDOH) are reported and discussed in three pediatrics journals. source https://www.jpeds.com/article/S0022-3476(22)00299-2/fulltext?rss=yes

A term infant was born at 39 weeks gestation by forceps vaginal delivery, and weighed 2500g. He received initial continuous positive airway pressure for two days, and was diagnosed with left sided Erbs palsy. He was discharged subsequently but readmitted 2 days later with increased work of breathing. His neurological examination was normal. Antibiotics were ceased after negative blood cultures. His chest radiograph (CXR) noted an elevated left hemi-diaphragm, and he was administered nasal high flow 8L/min but progressed to continuous positive airway pressure in view of increasing work of breathing. source https://www.jpeds.com/article/S0022-3476(22)00291-8/fulltext?rss=yes

To examine the association of age-appropriate maternal educational attainment in teenage and young mothers on infant health outcomes across racial/ethnic groups. source https://www.jpeds.com/article/S0022-3476(22)00295-5/fulltext?rss=yes

To identify demographic, clinical, and hospital factors associated with mortality on readmission within 180 days following an inpatient hospitalization. source https://www.jpeds.com/article/S0022-3476(22)00290-6/fulltext?rss=yes

The timing of the introduction of complementary foods and beverages (CFB) to infants has been an ongoing area of controversy, often separated from the issue of the types and amounts of CFB to feed, once they are introduced.1,2 Such is the nature of the report In this volume of The Journal by Robinson et al. 3 Utilizing a longitudinal cohort of infants from upstate New York, the authors found an association between the timing of the introduction of juice (before age 6 months, but not after 6 months) and an increased risk of developing overweight/obesity or obesity by 7- 9 years of age. source https://www.jpeds.com/article/S0022-3476(22)00300-6/fulltext?rss=yes

This work was funded by Vestfold Hospital Trust. Vestfold Hospital Trust had no role in the design or conduct of the study. The authors declare no conflicts of interest. source https://www.jpeds.com/article/S0022-3476(22)00298-0/fulltext?rss=yes

Ljungblad et al1 conducted a cross-sectional study in healthy term-born infants to establish continuous reference intervals, including a 10th centile cut-off, for the Hammersmith Infant Neurological Examination (HINE), for the age range 3-7 months. The data have been carefully analyzed, and the calculation of reference intervals and a 10th centile cut-off is an important and valuable addition to the existing body of information. source https://www.jpeds.com/article/S0022-3476(22)00297-9/fulltext?rss=yes

To implement a quality improvement (QI) scorecard as a tool for enhancing quality and safety efforts in level 1 and 2 in community hospital nurseries affiliated with Nationwide Children’s Hospital. source https://www.jpeds.com/article/S0022-3476(22)00283-9/fulltext?rss=yes

To assess the outcomes of neonates in a contemporary multi-institutional cohort who receive renal replacement therapy (RRT) for hyperammonemia. source https://www.jpeds.com/article/S0022-3476(22)00293-1/fulltext?rss=yes

From 2009‒2015 to 2016‒2019, the proportion of U.S. infants with congenital cytomegalovirus (cCMV) treated with valganciclovir roughly doubled for infants enrolled with employer-sponsored insurance (from 16% to 29%) and Medicaid (from 16% to 36%). The proportion treated with valganciclovir increased for all cCMV disease severity groups. source https://www.jpeds.com/article/S0022-3476(22)00292-X/fulltext?rss=yes

To provide a systematic review of studies examining the proportion of children with persistent post-concussive symptoms (PPCS) and to examine potential moderators of prevalence. source https://www.jpeds.com/article/S0022-3476(22)00289-X/fulltext?rss=yes

To analyze the impact of acute pancreatitis on mortality and hospital outcomes among the pediatric population following HSCT. source https://www.jpeds.com/article/S0022-3476(22)00287-6/fulltext?rss=yes

To determine whether youth with white coat hypertension (WCH) on initial ambulatory blood pressure monitoring (ABPM) continue to demonstrate the same pattern on repeat ABPM. source https://www.jpeds.com/article/S0022-3476(22)00286-4/fulltext?rss=yes

We investigated the impact of prolonged co-trimoxazole prophylaxis on growth in 2,848 HIV-exposed uninfected children enrolled in the Mpepu study, a randomized, placebo-controlled trial in Botswana. No significant differences in mean weight-for-age, length-for-age, or weight-for-length z-scores between placebo and co-trimoxazole arms were observed overall through 18 months. source https://www.jpeds.com/article/S0022-3476(22)00281-5/fulltext?rss=yes

To determine if, among infants evaluated for physical abuse, medical encounters for infant distress are correlated with physical abuse or a history of sentinel injuries. source https://www.jpeds.com/article/S0022-3476(22)00272-4/fulltext?rss=yes

The Piñata King from Tripod City on Vimeo : On the outskirts of Mexico City, over 50 years ago, a family began making and selling piñatas to the local community. Nowadays, the whole town is involved. The Piñata King takes a look inside the life of this town, and the head of the family who started it all.     source http://www.thepediablog.com/2022/03/26/cool-video-of-the-week-499/

newborns who are considered to be “at risk” for low glucose concentrations (“hypoglycemia”), include preterm infants, infants of diabetic mothers, large for gestational age infants, small for gestational age infants with intrauterine growth restriction, and infants with marked stress around the time of birth such as those with hypoxic-ischemic encephalopathy. However, even in apparently healthy term infants, studies have noted apparent associations of moderately low glucose concentrations with later neurodevelopmental and cognitive deficiencies. source https://www.jpeds.com/article/S0022-3476(22)00294-3/fulltext?rss=yes

Myopericarditis, , has emerged as an important adverse event following COVID-19 mRNA vaccination, particularly in adolescents [1]. Patients typically exhibit chest pain and an elevated serum troponin level in the days following the COVID-19 mRNA vaccine. They usually are hemodynamically stable, and symptoms and cardiac biomarkers normalize within a few days [2]. cardiac magnetic resonance studies, when performed early, frequently demonstrate abnormalities such as edema and late gadolinium enhancement (LGE), meeting Lake Louise Criteria for diagnosing myocarditis noninvasively [2,3]. source https://www.jpeds.com/article/S0022-3476(22)00282-7/fulltext?rss=yes

The c.211G>A (p.G71R) variant is one of the most common polymorphisms in UGT1A1 and has been reported as a risk factor for neonatal hyperbilirubinemia, and might reduce its enzymatic activity.1-5 Our study is part of the China Neonatal Genomes Project (CNGP),6-8 focused on exploring the proportion and the spectrum of diagnostic genetic disorders in neonatal hyperbilirubinemia. We did not annotate c.211G>A in UGT1A1 as a diagnostic pathogenic variant in neonatal hyperbilirubinemia. In 2010, we conducted a meta-analysis to evaluate the association between UGT1A1 gene polymorphisms and neonatal hyperbilirubinemia. source https://www.jpeds.com/article/S0022-3476(22)00285-2/fulltext?rss=yes

Mei, et al assessed genetic variation present in a cohort of 1412 neonates with unconjugated hyperbilirubinemia in China.1 A genetic variant was observed in 55 participants (4%); 45 had variants in genes associated with unconjugated hyperbilirubinemia, including 18% with variants in UGT1A1. source https://www.jpeds.com/article/S0022-3476(22)00284-0/fulltext?rss=yes

*This post originally appeared on The PediaBlog on March 25, 2019.   Treat The Kid, Not The Number     In reviewing the pros and cons of acetaminophen (Tylenol) vs. ibuprofen (Advil, Motrin), pediatrician Jennifer Trachtenberg hits all the right notes that parents typically hear ad nauseam from their board-certified pediatrician: Mainly, it is not necessary to treat the number on the thermometer, nor is it always necessary to bring the temperature down.   Don’t let “fever phobia” get to you, says Dr.Trachtenberg: What is important is to address how the child is feeling and behaving regardless of their temperature. Are they happy, playful drinking fluids or are they cranky, irritable and uncomfortable? If the former, then no fever-reducing medicine is even necessary. What pediatricians want parents to know is not to be scared of fever, it’s the body‘s way of fighting off the infection. The goal of a fever reducer is to make a kid feel better so they c...

  After the Sunshine Protection Act was introduced in the U.S. Congress last March, The PediaBlog examined the pros and cons of making daylight saving time (DST) permanent. The stated benefits of year-round DST were mostly economic: More late afternoon and early evening light means higher consumer spending, giving the overall economy a boost. On the other hand, medical research tells us that DST interferes with the body’s natural circadian rhythm, which sleep experts say can lead to significant physical and mental health consequences. Simply keeping things the way they are — turning the clocks forward one hour in March and back one hour in November — also has its drawbacks: Anne Buckle argues that simply changing the clocks twice a year can make people sick: Changing the time, even if it is only by one hour, disrupts our body clocks or circadian rhythm. For most people, the resulting tiredness is simply an inconvenience. For some, however, the time change can have mo...

  We’ve noted several times on The PediaBlog how much the COVID-19 pandemic is negatively impacting the mental health of young people. Pointing to “soaring rates of mental health challenges among children, adolescents, and their families over the course of the COVID-19 pandemic, exacerbating the situation that existed prior to the pandemic,” the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association felt compelled last October to declare a “National Emergency in Child and Adolescent Mental Health.” While emergency visits continue to rise for children and adolescents experiencing anxiety, depression, obsessive compulsive disorders, and grief from losing acquaintances and loved ones to COVID-19, we learned earlier this month that mental health visits for eating disorders doubled during the pandemic in adolescent females. Lambeth Hochwald discovered that boys are under just as much pressure as girls from...

  Even though COVID-19 tends to be mild or asymptomatic when children are infected with SARS-CoV-2, the fact is it can produce quite severe symptoms and complications in infants and children under 5 who are not yet eligible for getting the vaccine. CDC researchers last week published a study showing how badly young children were impacted by the Omicron wave that began in late December 2021 and which is only now fading in amplitude and intensity — and in our collective consciousness, at least for the time being. As Omicron was peaking in January, hospitalizations from COVID-19 in children 0-4 years old were five times higher than during the peak of the Delta surge in late summer 2021. ICU admissions were 3.5 times higher. Moreover, infants under 6 months of age had a hospitalization rate during Omicron that was six times higher compared with Delta — the highest rate of hospitalizations in children under 5 who aren’t yet eligible to receive a vaccine. We know that the presence o...

In this volume of The Journal, Whalen et al 1, provide a roadmap for the conduct of works regarding the validation of educational assessment instruments. The authors provide evidence to support a validity argument for the use of the pBMV tool, a novel assessment tool which measures pediatric bag-mask ventilation skill in a wide array of medical trainees. The authors present data describing a rigorous design approach, internal consistency of the tool’s scoring, consistent reliability between different raters, and correlation with other meaningful metrics. source https://www.jpeds.com/article/S0022-3476(22)00263-3/fulltext?rss=yes

  A solid body of scientific evidence accumulated since the beginning of the pandemic two years ago reveals a number of important points that young parents dreaming of starting a family should keep in mind: • Pregnancy is a major risk factor for serious COVID-19 infections, complications, and death. • All three COVID vaccines currently available in the United States have proven to be safe and effective for women who are pregnant and who are planning to be pregnant. • None of the three COVID vaccines threaten fertility . (No plausible mechanism has been suggested for causing such harm.) However, COVID-19 infection  can affect fertility, particularly male fertility. • Pregnant women who are vaccinated transfer protective antibodies through the umbilical cord, protecting their newborns and young infants from getting sick with COVID-19. • Vaccinated new mothers who go on to breastfeed continue to pass along protective antibodies to their infants and toddlers. In this con...

An 11-month-old male infant WHO presented with excessive crying and constipation of five days duration developed vomiting after admission. Physical examination revealed an irritable baby with a distended abdomen and digital rectal examination revealed an empty rectum. The abdominal radiograph showed bowel filled with feces and the ultrasound showed dilated large bowel loops filled with feces and fluid. In view of the inconclusive nature of these reports, an abdominal computed tomography (CT) was done which revealed dilatation of the proximal large bowel proximal to the sigmoid colon along with dilated proximal small bowel loops. source https://www.jpeds.com/article/S0022-3476(22)00257-8/fulltext?rss=yes

Dog Eat Doug by Brian Anderson ( Arcamax.com/thefunnies )           source http://www.thepediablog.com/2022/03/20/sunday-funnies-497/

ALIVE / Canada 4K from Flo Nick on Vimeo : I travelled 5500 km in six weeks exploring the vast landscapes of British Columbia and Alberta in Canada, always looking to place my camera gear in the most beautiful sceneries possible. With 54.000 single photos shot along the way I created ALIVE – a timelapse film which takes you on a vivid journey through wild forests, along the shores of crystal lakes and up the hills of massive mountains. By making this project, I want to raise awareness of our wonderful planet earth which we have the privilege to be part of. That’s why we have to take responsibility for it – for the place where we are alive.     source http://www.thepediablog.com/2022/03/19/cool-video-of-the-week-498/

Congenital diaphragmatic hernia (CDH) is a relatively common birth defect, affecting approximately one in 2500-3000 live births, with a slight male predominance (1.5:1).1-17 CDH is characterized by a herniation of the abdominal viscera through a defect in the diaphragm, leading to significant pulmonary hypoplasia and pulmonary hypertension and substantial morbidity and mortality.6,8,11,18-25,34 Prenatal diagnosis, referrals to high volume tertiary care centers, and treatment advances in the Neonatal Intensive Care Unit (NICU) have significantly improved survival rates to about 70%. source https://www.jpeds.com/article/S0022-3476(22)00208-6/fulltext?rss=yes

Despite scientific advancement, hypoxemic respiratory failure remains a major challenge in contemporary neonatal intensive care. Dysregulation of the pulmonary vascular bed and failure of the normal postnatal decline in pulmonary vascular resistance (PVR) lead to acute pulmonary hypertension (PH), traditionally referred to as persistent pulmonary hypertension of the newborn (PPHN). The hemodynamic consequences of excessive right ventricular (RV) afterload due to elevated PVR include RV dysfunction, reduced left ventricular (LV) preload, low cardiac output and systemic hypoperfusion with associated low systemic arterial pressure (SAP). source https://www.jpeds.com/article/S0022-3476(22)00207-4/fulltext?rss=yes

to investigate the relative contributions of obesity and obstructive sleep apnea (OSA)to unfavorable blood pressure in children. source https://www.jpeds.com/article/S0022-3476(22)00209-8/fulltext?rss=yes

Objective to identify predictors of impaired executive function (EF) in adolescents after surgical repair of critical congenital heart disease (CHD). source https://www.jpeds.com/article/S0022-3476(22)00206-2/fulltext?rss=yes

A 7-day-old girl, born at term following an uncomplicated pregnancy and delivery, presented to the dermatology clinic for evaluation of a blistering rash present since birth. Examination revealed numerous erythematous vesicles and pustules, some with associated crusting, arranged in a Blaschkolinear pattern across all four extremities (Figures 1-3). Review of systems was negative for fever, lethargy, irritability, or seizure-like activity. Although a diagnosis of incontinentia pigmenti (IP) wassuspected, she was admitted for empiric antiviral treatment and comprehensive infectious workup given the potential significance of an untreated neonatal infection. source https://www.jpeds.com/article/S0022-3476(22)00210-4/fulltext?rss=yes

*This post originally appeared on The PediaBlog on March 18, 2016.   Ask Us Anything     The other day, while explaining to a mother that her 5-year-old son was about to receive a chickenpox vaccine, the little boy asked me:  “Why do they call it ‘chickenpox’?”   Silence. My mind draws a blank on this particular subject. “Uh… I’ve got nothing. Let me do some research and post the answer on The PediaBlog this week, so be sure to read it,” I told him. Let’s start with the “pox” first. According to the Collins English Dictionary and TheFreeDictionary.com : pox (pɒks) n 1. (Pathology) any disease characterized by the formation of pustules on the skin that often leave pockmarks when healed 2. (Pathology) the pox an informal name for syphilis 3. a pox on someone (interjection) archaic an expression of intense disgust or aversion for someone   We’ll go with number one. Chickenpox (varicella), its bovine counterpart, cowpox (vacc...

  Did you know that the state of Pennsylvania can kick-start your child’s college education fund? Keystone Scholars , a program run by the Pennsylvania Treasury Department through its 529 College and Career Savings Program, will invest $100 for every baby born to a PA family on or after January 1, 2019 for future educational expenses after high school. As the account value grows through the years, the money can be used for qualified higher education expenses including tuition, fees, books, and more at a vocational or technical school, apprenticeship, community college, or four-year university anywhere in the United States and at many schools abroad. Once a child turns 18, the funds will become available in order to achieve the following objectives: Our commonwealth’s future economic stability and job growth will be stronger if more families expect and plan for their child’s future education, whether that be vocational training, apprenticeships, community college, or ...

Join us this evening at 7 pm EST for a special livestream event, featuring three UMHS alumni all in their first year of residency. Celebrating Match Week 2022, these three residents reflect on their lives one year post Match Week 2021, when they first learned of their residencies. They'll share their experiences as well as give advice to the newly matching students. The event will be streamed on the UMHS YouTube, Facebook, LinkedIn and Twitter channels, then archived and made available for immediate viewing. from University of Medicine and Health Sciences https://www.youtube.com/watch?v=c0PUDBUezsY via UMHS YouTube Channel

Join us this evening at 7 pm EST for a special livestream event, featuring three UMHS alumni all in their first year of residency. Celebrating Match Week 2022, these three residents reflect on their lives one year post Match Week 2021, when they first learned of their residencies. They'll share their experiences as well as give advice to the newly matching students. The event will be streamed on the UMHS YouTube, Facebook, LinkedIn and Twitter channels, then archived and made available for immediate viewing. from University of Medicine and Health Sciences https://www.youtube.com/watch?v=c0PUDBUezsY via UMHS YouTube Channel

    Maternal and infant mortality rates are important indicators of a healthy society. In the United States in 2022, both indictors show troubling signs. Maternal mortality is defined by the World Health Organization as “the death of a woman while pregnant or within 42 days of termination of pregnancy[…] from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” A recent study  from researchers at the CDC found that the number of women who died during pregnancy or soon after birth in the United States rose 14% during the first year of the pandemic. Maternal mortality is already much higher in the U.S. (23.8 deaths per 100,000 live births in 2019) compared to other developed countries (New Zealand and Norway had 2 deaths per 100,000; France and Canada had 9 deaths per 100,000, for example). Roni Caryn Rabin  points out concerning inequities in the data: Black women in America experienced the ...

To evaluate 13-year outcomes of a randomized controlled trial of preventive care (VIBeS Plus) for infants born very preterm and their parents, and whether effects of intervention varied by family social risk. source https://www.jpeds.com/article/S0022-3476(22)00193-7/fulltext?rss=yes

  The AAP has a simple message to remind parents of the importance of developing structure to a child’s nighttime routine. At the end of the day, it begins by helping the little ones brush their teeth: All young children need help with brushing from an adult to make sure a good job is done. When possible, teach children to spit out extra toothpaste, but don’t rinse with water first. The little bit of toothpaste left behind is good for their teeth!   Reading a favorite book before bedtime is a great way to snuggle while helping spark early literacy skills: After toothbrushing and before bed, find a comfortable spot to sit and read with your child. Spending some time, even just 15 minutes each day, to read aloud together will help improve your child’s language development and social-emotional skills. Make up your own stories, use silly voices, sing songs, and just enjoy this special bonding time with your child. Visit your local library or bookstore, and give your chil...

To describe the trend in costs over 10 years for tertiary level neonatal care of infants born 220/7 – 286/7 weeks’ gestation during an ongoing Canadian national quality improvement project. source https://www.jpeds.com/article/S0022-3476(22)00192-5/fulltext?rss=yes

To assess radiographic brain abnormalities and investigate volumetric differences in adults born preterm at very low birth weight (VLBW; < 1500 g), using siblings as controls. source https://www.jpeds.com/article/S0022-3476(22)00189-5/fulltext?rss=yes

  From a public health and commonsense standpoint, mask mandates for school students, teachers, and staff were never really controversial when COVID-19 was on the rampage. Today, with most people in the United States having acquired immunity from either the vaccine or natural infection with SARS-CoV-2 (the most recent Omicron tidal wave took care of that), the risk is now diminished and the masks have come off in most primary, secondary, and post-secondary schools in America. Two recent studies indicate that students and teachers will want to keep their masks close by and ready for action in case immunity wanes or new variants emerge. (The American Academy of Pediatrics is still advising masking in school for children with special health care needs and students under 5 years of age who are too young to receive a COVID vaccine.) The first study , published last week in Pediatrics, compared schools with universal masking policies to those where masking was optional. More than o...