Research

This study looked at a group of patients with ITP and attempted to identify potential risk factors to predict which patients may go on to develop chronic ITP.  The authors conducted a retrospective cohort analysis of 259 children diagnosed with ITP (defined in this study as having a platelet count of less than 50,000/uL and symptoms of thrombocytopenia).  Asymptomatic cases found on random blood draws were excluded, and chronic ITP was defined as platelet counts not recovered by six months after diagnosis.    The variables of gender, age, medication exposure, MMR vaccination exposure, acute illness prior to diagnosis, presenting symptoms, and presenting platelet count were assessed in this study.  Results indicated that patients who developed chronic ITP were more likely to be older at presentation (mean age 10.0 years versus 5.1 years), female (58% versus 42% male), and have a higher platelet count at time of presentation.  They also found that acute illness prior to ITP and mucosal bleeding symptoms were inversely related to the risk of developing chronic ITP.  This study was limited by its inclusion criteria to define ITP (it could have broadened to include platelet counts >150,000) and by stopping its follow-up at 6 months (because new data suggests that persistent thrombocytopenia may resolve between 7 and 12 months).  However, despite its limitations, the factors mentioned in this study are important to consider when discussing with families how soon symptoms and thrombocytopenia will take to resolve.

Several studies have shown that lower socioeconomic status and early life abusive and neglectful experiences may increase the incidence of cardiovascular disease, diabetes, and obesity. There is, however, a paucity of research looking at the relationship between childhood adversity and obesity and type 2 diabetes. This study followed a cohort of British children from birth into adulthood and sought to establish whether an emotionally stressful or neglectful childhood was related to adipostiy and glucose metabolism in mid-adulthood. The British cohort consisted of 17,638 infants born during the first week of March in 1958 in Great Britian. These children were interviewed at 3 intervals in childhood and adulthood. At age 45 these individuals were invited for a biologic assessment - 9377 individuals (78%) accepted and data was collected. Individuals with type 1 diabetes, those who died or emigrated, gave permanent refusal or were in the armed forces were excluded. At age 45 BMI, waist circumference, and HbA1c were obtained. Childhood adversity was assessed using a survey (retrospective at age 45 years, and prospective at various ages in childhood) and evaluated 4 areas: emotional neglect, physical neglect, household dysfunction, and abuse. Some severe forms of childhood adversity, such as physical abuse or witnessing abuse of a family member, were associated with increased risk of total or central obesity by 20% to 40% and were not fully explained by confounding from other childhood influences or mediation by adult socioeconomic or lifestyle factors. Strengths of this study include the large sample size and longitudinal design as well as objective measurements. Major limitations include the use of HbA1c instead of glucose tolerance tests as well as the use of a retrospective survey which could lead to recall bias. Also the prevalence of extreme adversity was low in this study, making it under-powered to detect a true difference. While this study cannot show an association between these factors it does raise the need for further research to look at the links between childhood adversity and impact on adult health.

This study sought to determine the prevalence and predictors of DKA at time of diagnosis of diabetes in youth in the United States.  They utilized data from Search of Diabetes in Youth Study, a multi-center, population-based registry of diabetes with diagnosis before age 20.  They identified 3666 patients diagnosed between 2002 and 2004.  Medical charts were reviewed in 77% of cases to evaluate the presence of DKA at the time of diagnosis using pH, serum bicarbonate, or ICD-9 code or mention of DKA in the chart.  Prevalence of DKA at time of diagnosis was 25.5%, decreasing with age: 37.3% in children age 0-4 years to 14.7% in children ages 15-19 years.  29% of patients with type 1 DM presented in DKA while 9.7% of patients with type 2 DM presented in DKA.  A higher rate of DKA at presentation was associated with age, lower parental education, lower socioeconomic status, and insufficient health insurance.  This study also shows that the presence of DKA does not exclude the diagnosis of type 2 DM.  The major limitation was that 23% of charts were not able to be viewed and health insurance and parental education information was only obtained on 53% of patients.  With about 1 in 4 children with diabetes presenting in DKA, more education to community physicians as well as parents and other caregivers about the signs and symptoms of diabetes mellitus needs to be undertaken.  Diagnosis of diabetes mellitus before progression to DKA could improve severity and cost of initial diabetes treatment in youth.

The goal of the study was to evaluate the effect of heliox and air oxygen (AO) administered with nasal CPAP (nCPAP) in infants with unresponsive severe acute bronchiolitis.  The prospective, single academic center crossover study included infants 1 month to 2 years of age admitted over a one year period with RSV bronchiolitis and M-WCAS clinical score >5, oxygen saturation <92%, or transcutaneous CO2 pressure >50mmHg, despite optimal supportive therapy, nebulized L-epinephrine, and heliox through a nonrebreathing reservoir face mask at 10-15L/min for >1 hour.  Twelve patients enrolled in the study received 30 minutes of treatment with either heliox-nCPAP or AO-nCPAP.  M-WCAS, tcPCO2, satO2, and RR values were measured at baseline, 30 minutes after treatment, at hourly intervals for 6 hours, and then every 8 hours until heliox-nCPAP was discontinued.  Both heliox and AO-nCPAP led to improvement from baseline scores (M-WCAS 7.7 and tcPCO2 61.6 mm Hg).  M-WCAS and tcPCO2 were better with heliox-nCPAP than with AO-nCPAP (5.58 versus 6.62 and 51.9 mm Hg versus 56.2 mm Hg, respectively).  Heliox and nCPAP seems to safe and beneficial to infants with severe bronchiolitis and helps avoid intubation and mechanical ventilation.  Further larger studies may determine other treatment and monitoring parameters, including time of intervention, duration of therapy, and detection of nonresponders.

The study looked at 44 healthy patients presenting to an ER with facial lacerations.  Each was randomized to either receive fast-absorbing catgut or nylon sutures for repair.  All patients were seen at 5 days, 7 days, and 3 months.  Three blinded observers and parents used a scale to rate scarring.  In the end there was no statistical difference in the suture types.  The study concludes that fast-absorbing catgut suture is a viable alternative to nonabsortable suture in repair of facial laceration.  However, this was a very small study, half of the patients initially enrolled chose not to complete the study, and while they had a scale for rating scarring, this is a subjective outcome.

This was a retrospective study of 198 inpatients hospitalized at the major Italian Centre for the management of eating disorders in pediatric and adolescent age groups over a 10 year period.  Group A (53%) received oral and parenteral refeeding and Group B (47%) received oral refeeding alone.  The authors found weekly weight gain to be higher in Group A with rehospitalization and recovery rates similar between the two groups.  Complication rates, all of which resolved, were higher in group B (p=.004).  Failure of first nutritional rehabilitation requiring parenteral nutrition was greater in Group B.

The goal of the study is to determine how much evaluation is necessary for a child with a history of multiple fractures.  In the observational study, case subjects were healthy children 3 to 18 years old with > 2 fractures from low-energy trauma.  Control subjects were healthy siblings and unrelated healthy children.  DXA scans, anthropometric measurements, weight-bearing activity scores, nutritional assessments, and biochemical analyses were done on all children and statistical analysis comparing the two groups was completed.  Bone mineral density (BMD) scores were significantly lower for the case subjects compared to the controls.  No difference was found between the two groups’ activity scores, nutritional assessments, and general laboratory results.  Significant idiopathic hypercalcuria (IH) was found in both groups.  Analysis showed that 25-OH vitamin D was higher and PTH was lower in the control group with IH than in the control group without IH or the case group with or without IH.  Case subjects with IH had lower BMD z scores, compared to the case subjects without IH and the control subjects with or without IH.  The authors concluded that the cause of the IH was different between the groups.  In the case group, the IH was of renal pathogenesis, associated with reduced BMD, and a reason for increased fractures.  In the controls, IH was primarily absorptive and not associated with low BMD.  They recommend the following: (1) In children with a history of multiple fractures, a diet history targeting calcium and vitamin D intake should be obtained.  If the history suggests deficiency, then levels of 25-OH vitamin D and PTH and a DXA scan are appropriate.  (2) The child should be examined and if pubertal delay is noted then the child should be referred to an endocrinologist.  (3) A random urine sample is needed to check for an elevated calcium/creatinine ratio, in which case DXA and further evaluation of the hypercalcuria should be done.

This study used data from the National Health and Nutrition Examination Survey (NHANES) to look for trends in BMI (expressed as a percentile for age on the CDC year 2000 growth charts.)   Two year time blocks were then compared to each other for the years 1999-2000, 2001-2002, 2003-2004, and 2005-2006.  Data was analyzed for three different BMI levels (>97%, >95%, and >85%) as well as separated by gender and race.  Data trends were not expressed separately by age, and the study encompassed children ages 2-19.  In the most recent time period 2005-2006, 19.9% of children had BMI greater than the 97th percentile, 15.5% of children had BMI greater than the 95th percentile, and 30.1% of children had BMI greater than the 85% percentile.  Analysis of the trends showed no difference between the time periods, suggesting that the rate of obesity was stable over the observed years.  High BMI was found to vary by age and racial group, but not by sex.  In addition, 12-19 year olds were more likely to have high BMI than 2-5 year olds. Also, Non-Hispanic white females were less likely to have a high BMI than Mexican American and Non-Hispanic black females. 

Authors conducted a retrospective electronic chart review of all infants and children who had hypertrophic pyloric stenosis over the last 30 years at Toronto's Sick Children’s Hospital to determine the number of patients with recurrent pyloric stenosis.  Based on a review of operative records and clinic notes, authors only found 2 cases of true recurrent pyloric stenosis.  The majority of patients who had recurrent symptoms were due to failure of the initial surgical procedure.  Basically there were not enough cases to determine if there were any prognostic factors which might indicate true recurrence versus surgical failure.  Thus far, surgeons/pediatricians will have to rely on timing of recurrence of symptoms.