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Recent Updates in Pediatrics

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Dr KK Aggarwal, Group Editor-in-Chief IJCP Group    16 January 2018

  1. Early (before 8 days of age) administration of erythropoietin (EPO) in preterm infants resulted in a small reduction in use of red cell transfusions, which was of limited clinical benefit (Cochrane Database Syst Rev. 2017; 11:CD004863.).
  2. In a subsequent analysis of data from a randomized trial of neonates (gestational age 35 to 42 weeks) at risk for hypoglycemia in the first 48 hours after birth, administration of buccal dextrose gel was associated with a greater increase in blood glucose level than placebo gel in hypoglycemic infants who were breastfed, formula-fed, or fed expressed breast milk (J Pediatr. 2017;190:136-41.).
  3. Delayed cord clamping has been recommended for vigorous preterm infants to decrease infant morbidity and increase iron stores, based on meta-analyses of a few small randomized trials. Now, the largest randomized trial of delayed versus immediate cord clamping in over 1,500 infants <30 weeks of gestation found no reduction in death or major morbidity from the intervention (N Engl J Med. 2017;377(25):2445-55.).
  4. A risk assessment protocol that included serial procalcitonin measurements reduced the duration of antibiotic therapy in neonates with suspected early-onset sepsis (Lancet. 2017;390(10097):871-81.).
  5. Nasal continuous positive airway pressure (nCPAP) is the preferred initial intervention to manage neonatal respiratory distress syndrome versus a more invasive regimen (e.g., endotracheal intubation and surfactant administration). However, an observational study of extremely preterm survivors (gestational age <28 weeks) has shown that the use of nCPAP is associated with long-term morbidity (N Engl J Med. 2017;377(4):329-37.).
  6. In a 12-week randomized trial in 400 children (aged 6-11 years) with severe symptomatic asthma, once-daily tiotropium 5 µg, but not 2.5 µg, improved lung function compared with placebo and was well tolerated as add-on therapy to inhaled glucocorticoids and other maintenance therapies (J Allergy Clin Immunol. 2017.).
  7. The traditional six-food (cow’s milk, hen’s egg, soy, wheat, peanut/tree nuts and fish/shellfish) elimination diet resolves eosinophilic esophagitis in around three-quarters of children but is challenging and can have negative nutritional consequences. In a prospective study of four-food elimination (milk, soy, egg, wheat) in 78 children with eosinophilic esophagitis, histologic remission was achieved in 64%, with decreased symptoms in 91% of children (Clin Gastroenterol Hepatol. 2017;15(11):1698-1707.e7.).
  8. A recent randomized trial provides further evidence of the lack of effectiveness of probiotics for eczema prevention (Pediatrics. 2017;140.).
  9. In children aged 3-18 years who were treated with appendectomy for appendicitis within 24 hours of arrival to the emergency department, duration of time between initial evaluation and operation was not associated with an increase in appendiceal perforation (Pediatrics. 2017;139.).
  10. The 2017 update of guidelines from the American Academy of Allergy, Asthma, and Immunology (AAAAI)/American College of Allergy, Asthma, and Immunology (ACAAI) Joint Task Force on Practice Parameters no longer recommend inquiring about egg allergy before influenza vaccine administration (Ann Allergy Asthma Immunol. 2018;120(1):49-52.).

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