Category: Paediatrics

Categories : PaediatricsTags :

Foetal Repair of Spina Bifida Improves Outcomes in Children

On By ModernMedia

A follow-up study found further evidence that foetal surgery for spina bifida extends benefits even further into childhood.

Adding to a growing body of research affirming the benefits of fetal surgery for spina bifida, new findings show prenatal repair of the spinal column confers physical gains that extend into childhood.

Spina bifida is a birth defect where the vertebral column is open (bifid), often involving the spinal cord. Myelomeningocele (MMC; open spina bifida) is the clinically most significant, where the spinal neural tube fails to close during development of the embryo. The exposed neural tissue degenerates in utero, causing a neurological deficit that varies with the amount of lesion. This occurs in 1 in 1000 births worldwide.

“This study shows that the benefits of fetal surgery for spina bifida extend beyond early childhood and well into a child’s first decade of life,” said co-author of the study N Scott Adzick, MD, Surgeon-in-Chief at Children’s Hospital of Philadelphia (CHOP), Director of CHOP’s Center for Fetal Diagnosis and Treatment. “This is especially important because of previously raised concerns that the advantages from fetal surgery may decrease over time. Contrary to those concerns, there appears to be a long-term benefit from neural protection in utero.”

The present study is a follow-on of the Management of Myelomeningocele Study (MOMS), which was co-led by investigators at CHOP, Vanderbilt University Medical Center, and the University of California, San Francisco, along with the data coordinating centre at the George Washington University Biostatistics Center. MOMS compared the outcomes of prenatal and traditional postnatal repair of myelomeningocele at 12 and 30 months, showing that there are considerable benefits from prenatal repair. Babies with spina bifida who received foetal surgery were less likely to need a shunt for the buildup of spinal fluid in the brain. Two and a half years after surgery, they walked better and had better overall motor function.

In MOMS2, the children from MOMS were comprehensively examined at ages from five to ten. They were assessed on a range of indicators, including fine motor skills and ability to do tasks unaided. The researchers found continuing benefits, including the foetal repair group being six times more likely to go to the toilet unaided than the postnatal repair group, and were 70% more likely to walk unaided, and twice as likely to walk without braces. They also had greater likelihood of engaging in self-care skills such as brushing teeth and using a fork.

“These data are important for demonstrating that fetal surgery for spina bifida improves mobility well into school age, but the implications of these results are even more profound,” said first author Amy J Houtrow, MD, PhD, MPH, Pediatric Rehabilitation Medicine Division Chief at UPMC Children’s Hospital of Pittsburgh. She said that when children are able to move around by themselves, it has significant positive impacts on their quality of life.

“When we began performing fetal surgery more than two decades ago, we did so with the hope that the procedure would improve lives for children and their families,” explained Dr Adzick. “As we continue to improve the technique, shortening surgery times and increasing the gestational age at birth, we are heartened by these results, which show the lasting benefits of fetal surgery.”

Source: Medical Xpress

Categories : Diseases, Syndromes and Conditions Hospitals PaediatricsTags :

Children with Sepsis Respond Better to ‘Relaxed’ Care Bundle

On By ModernMedia

Following a ‘relaxed care bundle’ was linked to lower 30-day mortality and shorter hospital stays among children with sepsis, according to preliminary data from the Improving Pediatric Sepsis Outcomes (IPSO) FACTO trial.

The study findings were presented virtually at the Society of Critical Care Medicine’s Critical Care Congress.

Sepsis is the leading cause of death in children, with an estimated 7.5 million deaths a year. Childhood sepsis includes severe pneumonia, severe diarrhoea, severe malaria, and severe measles. Some 25-40% of children who recover from sepsis still have long-term consequences.

The ‘relaxed’ sepsis bundle is based on a group of best evidence-based interventions. It involves an initial fluid bolus delivery within 60 minutes, as opposed to 20 minutes; and antibiotic delivery within 180 instead of 60 minutes. Accepted sepsis recognition protocols (screen, huddle, or care order) were also involved with the bundle.

This trial data came from about 40 000 patients with sepsis or suspected sepsis at a range of children’s hospitals across the US, from 2017 to 2019. Raina M Paul, MD, of Advocate Children’s Hospital, Illinois, USA reported the data, saying that the relaxed bundle saw better outcomes than the more original bundle which was more time-restrictive. 
Sepsis-attributable mortality fell by 48.9% among the relaxed bolus-compliant versus non-compliant group (3.1% vs 3.5%), and by 13.7% in original bundle-compliant vs non-compliant cases. Following all aspects of the relaxed bundle was associated with a reduction in median days in hospital from 9 to 6 days.

In a separate presentation, Kayla Bronder Phelps, MD, of CS Mott Children’s Hospital in Michigan, USA, reported the results of a study that showed children hospitalised for severe sepsis were likely to have longer hospital stays if they were from lower-income neighbourhoods. Using a national database, she identified 10 130 cases of children with severe sepsis. Severe sepsis hospitalisations were also highest among the lowest-income quartile, reflecting the fact that there were more children living in low-income neighbourhoods.

Overall, 8.4% of children in the cohort died of sepsis during hospitalisation, with no association between mortality rates and income level. However, children in the lowest-income areas spent a median 9 days in the hospital, while children from the highest-income areas spent 8 days.

Bronder Phelps noted that the study is among the first to examine the impact of poverty on paediatric sepsis outcomes. Poverty is a known risk factor for a wide range of paediatric diseases, such as neonatal bacterial infection, asthma, and migraine, and in adults, poverty is associated with poorer outcomes including higher mortality rates.

Source: MedPage Today

Presentation information 1: Paul R, et al “Improving pediatric sepsis outcomes for all children together (IPSO FACTO): Interim results” SCCM 2021; Abstract 32.

Presentation information 2: Phelps K, et al “The association of socioeconomic status and pediatric sepsis outcomes” SCCM 2021; Abstract 37.

Categories : Addiction PaediatricsTags :

Misuse of Psychiatric Meds Common in Teens

On By ModernMedia

A study into the use and misuse of psychoacttive drugs by US teens has found that about a fifth report misusing their prescribed medications.

Israel Agaku, PhD, of Harvard School of Dental Medicine in Boston, and colleagues used data from a survey of adolescents aged 12-17 prescribed opioids, stimulants, tranquilizers, or sedatives, and found that 20.9% reported using them not as prescribed or directed. There has been considerable concern in recent years over whether adolescents in the United States were being overprescribed psychiatric medication, although a 2018 study concluded that they are not. However, as with adults, the prospect of misuse, possibly leading to substance use disorders is a concern.
Of these youths, 3.4% reported having substance misuse disorders, and this proportion increased to nearly half when youths were taking two or more prescribed medications.

Some 25% of 12-17 year olds reported receiving a psychiatric prescription in the past year. The most common psychoactive prescription in the past year was opioids in 19% of all youth, followed by stimulants (7.2%), tranquilisers (4.3%), and sedatives (2.2%). Tranquilisers were the most commonly misused (40.1%), with substance use disorder in 7%. Stimulants were misused by 24.2%, 3% having a substance use disorder.
Among adults aged 18-25, 41% had been prescribed and had used psychoactive medication, with a third saying they had used opioids in the past year, Similarly to the 12-17 age group, stimulants and tranquilisers were most likely to be misused. 

“The largely overlapping population profiles for medical use versus misuse indicates the high abuse liability of these prescription substances,” the researchers noted. “Having serious psychological distress was consistently associated with misuse of every assessed psychoactive prescription medication.”

The researchers suggested that an open-minded, collaborative approach by healthcare providers was the best approach to dealing with the situation.

“Rather than asking only about cigarette smoking, pediatric practitioners should screen for different commonly used substances, including ‘social use.’ Specifically asking youth and young adults if they have used certain substances, including occasional use, is important as those who use such substances infrequently or only occasionally may not self-identify as users if asked in generic terms,” the researchers explained.

Source: MedPage Today

Journal information: Agaku I, et al “Medical use and misuse of psychoactive prescription medications among US youth and young adults” Fam Med Com Health 2021; DOI: 10.1136/ fmch-2020-000374.

Categories : Exercise Injury & Trauma PaediatricsTags :

Young Athletes’ Recovery Helped by New Concussion Guidelines

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A study has found that the adoption of new concussion guidelines, which emphasises a more active form of rest, reduced the duration of symptoms among athletes aged 11 to 18.

Concussions are the most common form of traumatic brain injury, often occurring either as a direct result of a blow to the head, or from forces experienced by the body that impart an acceleration to the head. Symptoms include mood changes, cognitive changes, sensory phenomena such as headaches or dizziness, and changes in sleep pattern.

The researchers compared medical records from 2016-18, which used the newer guidelines, to a set from 2011-13, which used the older guidelines.

Lead researcher John Neidecker, DO, and Sports Concussion Specialist, explained: “The most significant change in care involved a shift from strict rest or cocoon therapy to a return to low-intensity physical or cognitive activity after 24 to 48 hours. Our results show active rest dramatically improved recovery times among young athletes with first-time concussions.”

Active rest involves light activity that steadily increases under supervision, with minimal head movement.

“If diagnosis of a pre-existing condition has never been given, patients cannot be expected to report one during our concussion assessment,” said Dr. Neidecker. “This is especially true in the adolescent age group, as some may have a condition that they are not aware of yet. This makes screening for preexisting conditions more complex, yet even more essential for this age group.”

For example, intolerance to 3D movies could indicate an unrelated pre-existing condition. Information from parents about preinjury personality and behaviour could uncover anxiety.

“This more individualised, osteopathic approach in screening the athletes’ past medical history helped us identify health issues that may have been overlooked in the past,” said Dr Neidecker. This allows treatment to be more effectively tailored, he explained.

Knowledge about concussions has improved; in the 2011-13 dataset, the counselling given was more cautious and ominous, Dr Neidecker noted. Adequate communication and a positive outlook may have helped reduce reported symptoms, and may be essential for patients with anxiety. 

Source: News-Medical.Net


Journal information: Neidecker, J. M., et al. (2021) First-time sports-related concussion recovery revisited: management changes and impact on recovery. Journal of Osteopathic Medicine. doi.org/10.1515/jom-2020-0106.

Categories : Allergies PaediatricsTags :

Black American Children Have Higher Rates of Shellfish and Fish Allergies

On By ModernMedia

A study from Rush University Medical Center in the US has shown that black children in that country are more likely to have allergies to fish and shellfish than white children.

Some 8% of children in the US suffer from food allergies, which can result in signs and symptoms such as hives, breathing and digestive problems or anaphylaxis, sometimes severe enough to be life-threatening.

Lead author Dr Mahboobeh Mahdavinia at Rush University Medical Center, explained: “Food allergy is a common condition in the U.S., and we know from our previous research that there are important differences between African-American and white children with food allergy, but there is so much we need to know to be able to help our patients from minority groups.”

The study found that the black children were more likely to have an allergy to shellfish and fin fish, and also higher odds of having a wheat allergy, compared to the white children. The researchers believe the reason for this is environmental and socioeconomic: in the US, black children are more likely to be exposed to cockroaches than white children due to the increased probability of living in more socioeconomically deprived areas.

Tropomyosin, a protein found in two common household allergens, dust mite and cockroaches, share 80% of amino acid sequencing with shellfish. Some 72-98% of individuals allergic to prawns have an immunoglobin E response to tropomyosin. It has also been found in fin fish. Although the exact mechanism by which the allergy is established is not known, it provides evidence as to the importance of reducing the exposure of black children to cockroaches.

The study also showed that shellfish allergy was associated with increased asthma risk in black children. “This information can help us care for not only a child’s food allergy, but all of their allergic diseases, including asthma, allergic rhinitis and atopic dermatitis,” said co-author Susan Fox, PA-C, MMS, an allergy and immunology physician assistant at Rush University Medical Center.

The increased risk of asthma combined with food allergies can prove a lethal combination for children. “A major concern is that there is a higher prevalence of asthma in African-American children with food allergies when compared with white children with food allergies. Approximately 70% of fatal food anaphylaxis is accompanied by asthma. African-American children are at a two- to threefold risk of fatal anaphylaxis compared to white children,” Dr Mahdavinia said. “By knowing this information, it can identify [our] most at risk patients.

“We need to conduct further research to identify food allergies and food sensitivities among all races and ethnicities so we can develop culturally-sensitive and effective educational programs to improve food allergy outcomes for all children,” Dr Mahdavinia concluded.

Source: News-Medical.Net

Categories : Exercise PaediatricsTags :

Coordination in Children Does Not Predict Aerobic Fitness

On By ModernMedia

Even though clumsy children find it hard to perform as well in sports that require a lot of coordination, they are no less aerobically fit than their more agile peers.

This finding comes from a new study from the Faculty of Sport and Health Sciences of the University of Jyväskylä and the Institute of Biomedicine of the University of Eastern Finland. The general view is that children who have poor motor coordination tend to be overweight and have a low level of aerobic fitness – but this turns out not to be the case.

The study participants consisted of 332 children aged 7 to 11 years, with the study’s aim being to explore the association between aerobic fitness, body fat content, and motor skills. A maximum bicycle ergometer test was used to measure aerobic fitness and bioimpedance and DXA devices measured body composition. Common methods were used to gauge motor skills.

Eero Haapala, PhD, Faculty of Sport and Health Sciences, University of Jyväskylä, said: “Our study clearly demonstrated that aerobic fitness is not linked to motor skills when body composition is properly taken into account.”

She added: “Also, aerobic fitness was not strongly associated with overweight or obesity. Therefore, it seems that the role of poor aerobic fitness as a risk factor for poor motor skills and excess body weight has been strongly exaggerated.”

Earlier studies had shown that varied physical exercise can develop motor skills, regardless of body weight or aerobic fitness, and that less sedentary behaviour and more exercise protects against becoming overweight.

“The key message of our study is that even a child who is unfit can be motorically adept and the heart of a clumsier kid can be as fit as her or his more skilful peer,” Haapala concluded. “In addition, high levels of varied physical activity and reduced sedentary behaviour are central to the development of motor skills and the prevention of excess weight gain since childhood.”

Source: News-Medical.Net

Journal information: Haapala, EA, Gao, Y, Lintu, N, et al. Associations between cardiorespiratory fitness, motor competence, and adiposity in children. Transl Sports Med. 2021; 4: 56– 64. https://doi.org/10.1002/tsm2.198