Cognitive difficulties compared to pre-injury performance • Trouble paying attention • Difficulty remaining on task • Slowed responses and or processing of information • Difficulty shifting attention from task to task • Organization challenges • Reduced academic performance Social behavior difficulties compared to pre-injury • Impulsive behaviors • Initiation difficulties (trouble starting things) • Changes in mood • Depression • Defiance • Fatigue • Confusion
Influenza-associated neurologic complications in children are rare but can be severe. Familiarity with the clinical presentation and frequency of specific neurologic findings can help pediatricians with early diagnosis and treatment.
Congenital Diaphragmatic Hernia (CDH) is a severe and life threatening condition which can occur in isolation or with associated malformations. Congenital Heart Disease may be associated in up to 40% of cases with these infants often having a poor prognosis. This chapter aims to explore the association between CDH and congenital heart disease exploring the frequency of association, echocardiographic findings, prenatal diagnosis, use of cardiovascular biomarkers, surgical management and finally long term outcomes.
The authors observed 6 cases of brain pseudotumours in children aged from 3 to 15 years. All patients had been referred with the diagnosis of brain tumour, with headaches, eye fundus changes fundus changes. Some children had nystagmus, squint, vomiting and dizziness. One child had pharyngitis, two had sinusitis. Contrast brain examinations gave normal results. Diet with salt and fluid restriction and oedema-reducing drugs (glycerol, mannitol, decadron) were used. In all patients the neurological and ophthalmological signs regressed within 3 to 12 weeks.
Electronic cigarettes are the tobacco products most commonly used by youths in the United States. The use of e-cigarettes, also known as vaping or JUULing, is a public health epidemic. This collection offers reviews and research to assist pediatric health care providers in identifying and treating adolescent use and exposure to e-cigarettes.https://shop.aap.org/pediatric-collections-vaping-effects-and-solutions-paperback/
Research Article| November 01 2018 Sudden Cardiac Death in Adolescent Athletes AAP Grand Rounds (2018) 40 (5): 58. https://doi.org/10.1542/gr.40-5-58 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Sudden Cardiac Death in Adolescent Athletes. AAP Grand Rounds November 2018; 40 (5): 58. https://doi.org/10.1542/gr.40-5-58 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: athlete, sudden cardiac death Source: Malhotra A, Dhutia H, Finocchiaro G, et al. Outcomes of cardiac screening in adolescent soccer players. N Engl J Med. 2018; 379(6): 524– 534; doi: https://doi.org/10.1056/NEJMoa1714719Google Scholar Investigators conducted a surveillance study of all youth players in the English Football Association (FA) to determine the incidence and causes of sudden cardiac death (SCD). From 1996 to 2016, the FA instituted a mandatory cardiac screening program for all adolescent players aged 15–17 years in its soccer league system. The program included a health questionnaire, physical examination, ECG, and echocardiography. Results were reviewed by an expert regional cardiologist and categorized as normal, evaluation needed, or cardiac disease detected. Those with cardiac disease detected were further classified as having disorders associated with SCD (hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, and Wolff-Parkinson-White [WPW] syndrome) or other (eg, congenital, valvular conditions). Those in need of evaluation received exercise stress testing, 24-hour Holter monitoring, and cardiovascular MRI before final categorization. Athletes with cardiac disorders associated with SCD were advised not to compete in the FA and referred to the National Health Service. The primary outcome was SCD, determined through voluntary FA reporting, surveys of FA clubs, and Internet searches. Death certificates of all deceased athletes in the cohort were obtained to assess cause of death. The incidence of SCD was reported both as person-years and cases per 100,000 athletes. There were 11,168 athletes who underwent cardiac screening over the study period and were included in analysis. Of these, 10,338 (92.6%) had results categorized as normal, and 42 (0.38%) had a disorder associated with cardiac death; 62% of those with a disorder associated with cardiac death had WPW syndrome. There were 8 SCDs over a total of 118,351 person-years, resulting in an incidence of 1 per 14,794 person-years or 6.8 per 100,000 athletes. Of these 8 deaths, 2 were in athletes identified as part of the screening program as having a disorder associated with SCD; both had hypertrophic cardiomyopathy and continued to compete against medical advice. The remaining 6 SCDs were among athletes who were screened and categorized as having normal results. Five of these 6 had cardiomyopathy. The investigators conclude that a cardiac screening program detected disorders associated with SCD in 0.38% of adolescent FA athletes. The incidence of SCD was 6.8 per 100,000, with most SCDs occurring in athletes categorized as having normal screening results. Dr Spar has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. SCD in young people is a rare event with a previously reported incidence of 1:40,000 to 1:80,000 per year (lower than found in the current study).1 The most common structural heart diseases in young athletes include hypertrophic cardiomyopathy, anomalous origins of the coronary arteries, and myocarditis.2,3 SCD occurs more commonly in young nonathletes than in athletes; therefore, focusing screening on athletes... You do not currently have access to this content.
Childhood epilepsy is often outgrown. The diagnosis of epilepsy should be restricted to those with at least two seizures. Population based studies from Olmstead County, MN; Uppsala, Sweden; Turku, Finland; and Nova Scotia, Canada, have developed schemes for prediction of long-term outcome. Although rates of remission are similar, each study notes different predictive factors. A scoring system developed in Nova Scotia has been validated in Turku, Finland, suggesting that age of onset, intelligence, neonatal seizures, and many seizures before treatment are useful predictors of remission. The syndromic approach to childhood epilepsy does not appear to be particularly powerful to predict outcome.
Research Article| May 01 2016 Fetal Surgery for Myelomeningocele AAP Grand Rounds (2016) 35 (5): 51. https://doi.org/10.1542/gr.35-5-51 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Fetal Surgery for Myelomeningocele. AAP Grand Rounds May 2016; 35 (5): 51. https://doi.org/10.1542/gr.35-5-51 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: fetal surgery, meningomyelocele Source: Danzer E, Thomas NH, Thomas A, et al. Long-term neurofunctional outcome, executive functioning, and behavioral adaptive skills following fetal myelomeningocele surgery. Am J Obstet Gynecol. 2016; 214(2): 269.e1– e8; doi: https://doi.org/10.1016/j.ajog.2015.09.094Google Scholar Investigators from the Children’s Hospital of Philadelphia sought to evaluate the long-term outcomes in a cohort of patients who have been followed since undergoing in utero repair of myelomeningocele (MMC) at their institution from 1998–2003. Parents completed questionnaires to measure patients’ functional and developmental status. Functional status was assessed by including questions about ambulatory status (classified as community ambulator [walks indoors and outside], household ambulator [able to walk indoors only but requires equipment and/or wheelchair for outside mobility], and nonambulatory [wheelchair dependent]), bladder and bowel function, and need for additional surgeries. Developmental status was assessed by measuring executive functioning using the Behavior Rating Inventory of Executive Function (BRIEF), and behavioral adaptive skills using the Adaptive Behavioral Assessment System II (ABAS-II). BRIEF and ABAS-II scores were categorized as average, borderline, or impaired, and the proportion of patients in each score category was compared to population norms. Among 54 patients who underwent in utero MMC repair, 42 (78%) were included in analysis. At a median follow-up of 10 years (range, 8–14 years), 79% of participants were community ambulators, 9% household ambulators, and 14% nonambulatory. Normal bladder function was reported in 26% and 31% had normal bowel function. A ventriculoperitoneal shunt was required in 43% of participants, all by 12 months of age. Although the proportion of participants who had average BRIEF scores was not significantly different than population norms, there were significantly more participants who had borderline and/or impaired BRIEF scores compared to population norms. There were also significantly fewer participants who had an average composite ABAS-II score compared to population norms. The need for a ventriculoperitoneal shunt was associated with lower ABAS-II composite scores. The authors conclude that in utero MMC repair probably improves functional outcomes but difficulties with adaptive skills and executive functioning in these patients remain considerable. Dr Iqbal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The management of myelomeningocele study (MOMS), a prospective, multicenter, randomized trial, demonstrated a significant decrease in the need for ventriculoperitoneal shunting by 12 months of age with in utero repair compared to “standard” postnatal therapy.1 The investigators for the MOMS trial also studied secondary outcomes at 30 months, such as mental development and motor function, all of which favored the fetal repair group.1 This study is important, as the fetal repair of MMC is the first non-life-threatening indication for a fetal surgical procedure that has been shown to dramatically impact the postnatal course. In most cases of fetal surgery, a life-threatening condition exists for the baby that justifies the maternal risk of the procedure. Utilizing percutaneous or minimally invasive techniques, risk to the mother can often be minimized.... You do not currently have access to this content.
Research Article| October 01 2016 Human Papillomavirus-Associated Cancers AAP Grand Rounds (2016) 36 (4): 40. https://doi.org/10.1542/gr.36-4-40 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Human Papillomavirus-Associated Cancers. AAP Grand Rounds October 2016; 36 (4): 40. https://doi.org/10.1542/gr.36-4-40 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cancer, human papilloma virus vaccine, papillomavirus, human papillomavirus Source: Viens LJ, Henley J, Watson M, et al. Human papillomavirus-associated cancers—United States, 2008–2012. MMWR. 2016; 65(26): 661Google Scholar Investigators from the Centers for Disease Control and Prevention (CDC) reviewed data from a national registry to estimate the annual national rates of cancers attributable to human papillomavirus (HPV). For the study, they analyzed information from the National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results initiative. Data from 2008–2012 were reviewed. Invasive cancers catalogued in the databases were flagged as HPV-associated cases if they occurred in anatomic locations, including the cervix, vulva, vagina, penis, oropharynx, anus, and rectum, and were of cell types in which HPV DNA is frequently found. To determine the number of HPV-attributable cases, the researchers multiplied the number of each type of HPV-associated cancer cases by the percentage of these cancers attributable to HPV. Rates were compared in males and females for different cancer types. In addition, the numbers of cancers attributable to specific HPV types, including types 16 and 18, which can be prevented by the HPV vaccines, were calculated. The authors estimated that an average of 38,793 HPV-associated cancers were diagnosed each year from 2008–2012, including 23,000 cases annually among females and 15,793 among males. There were more oropharyngeal cancer cases in males, and more anal and rectal HPV-associated cancers in females. Overall, it was estimated that 79% of HPV-associated cancers were attributable to HPV. Of the 30,700 HPV-attributable cancers diagnosed per year from 2008–2012, 28,400 were caused by HPV types that can be prevented with the 9-valent HPV vaccine and 24,600 were tied to HPV types 16 and 18, which can be prevented with all current HPV vaccines. The authors conclude that surveillance for HPV-associated cancers using reliable population-based registries should continue so that the effect of HPV vaccines and/or different screening guidelines for cervical cancer can be monitored. Dr. Wong has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. HPV is the most common sexually transmitted disease in the United States, with three-quarters of sexually active women infected with a high-risk HPV strain by age 50.1 Though the first HPV vaccine was introduced in 2006, vaccine uptake has been slower than expected, with only 42% of girls and 28% of boys 13–17 years old having received all 3 HPV vaccine doses in 2015.2 The current study provides further data on the potential protective effect of the HPV vaccine against over 70% of the HPV-associated cancers in women and men, including cancers of the cervix, vulva, vagina, penis, anus, rectum, and oropharynx. The main study limitation is the use of a population-based cancer registry that does not record the HPV status of each case; hence, the investigators relied on estimates for the proportion of each cancer caused by the various HPV strains. Prior studies in the United States examining... You do not currently have access to this content.
Research Article| November 01 2016 Infant Sleep Environments AAP Grand Rounds (2016) 36 (5): 55. https://doi.org/10.1542/gr.36-5-55 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Infant Sleep Environments. AAP Grand Rounds November 2016; 36 (5): 55. https://doi.org/10.1542/gr.36-5-55 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: sleep Source: Batra EK, Teti DM, Schaefer EW, et al. Nocturnal video assessment of infant sleep environments. Pediatrics. 2016; 138(3): e20161533;doi: https://doi.org/10.1542/peds.2016-1533Google Scholar Investigators at Penn State University videotaped sleeping infants within family homes to determine the frequency of known environmental risk behaviors for sleep-related infant death (SIDS). Mothers were approached 48 hours after the birth of their newborn, and completed a demographic questionnaire at enrollment. When their infant was 1, 3, and 6 months old, study staff visited each parent participant’s home to set up video equipment in the areas of the home where the infant commonly slept. Videotaping occurred for a single night at each of the 3 infant ages. Videotapes were then subsequently coded for 4 variables: (1) sleep surface (AAP-recommended sleep surface [crib, cradle, bassinet, playpen] versus non-recommended surface [adult bed, sofa, car seat, co-sleeper, or swing]), (2) sleep location (parent room, own room, other), (3) sleep position (supine, side, prone, indeterminate), and (4) presence of non-recommended loose items on or around the sleep surface (loose bedding, bumper pad, stuffed animal). Of 167 participants enrolled, 162 had at least 1 videotape and were included in analysis; 147 had videotapes from all 3 time-points. Most parent participants were white, married, and had at least some college education. At 1, 3, and 6 months, 21%, 10%, and 12% of infants, respectively, were initially put to bed on non-recommended sleep surfaces; 14%, 18%, and 33% were placed in non-supine positions; and 91%, 87%, and 93% were surrounded by non-recommended loose items on the sleep surface. Among 1-month-old infants, 28% slept in at least 2 locations during the night, with 36% placed in a non-supine position at the second location and 67% sharing the sleep surface of the second location with another person. Among the 18% of 3 month olds and 12% of 6 month olds who slept in 2 locations during the night, 67% and 78% were placed in a non-supine position at the second location, respectively. The authors conclude that most parents place their infants in sleep environments with established risk factors and, among infants moved during the night, many were placed in the non-supine position in the second location. Dr. Phillipi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The 1992 Back to Sleep Campaign was rebooted in 2011 by the American Academy of Pediatrics with additional evidence-based recommendations to promote safe infant sleep and reduce the risk of infant sleep-related deaths.1 Some of these recommendations, like placing infants on their backs for sleep and breastfeeding, are met with universal accord, whereas others, such as pacifiers and bed-sharing, are debated. Exhausted new parents are the recipients of conflicting recommendations from their health care providers, their family and friends, the media, and retailers. Pediatricians who are clearly in a position to impart evidence-based information are opting out; 1 in 5... You do not currently have access to this content.
Dr LeLeiko has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.In October 2015, 22 scientists from 10 countries evaluated the results from about 800 studies on the relationship between cancer and processed and unprocessed meat. The meeting was held in Lyon, France as part of the International Agency for Research on Cancer (IARC), the cancer agency of the World Health Organization (WHO). Although the working group’s conclusions have been summarized,1 the full report is in press.2 In 2014, a similar group had recommended that red meat and processed meat be evaluated as possible causes of cancer based on the increasing consumption of these foods worldwide, especially in low- and middle-income countries.3Red meat was classified as “probably carcinogenic to humans” based on limited evidence from epidemiological studies linking its consumption to developing colorectal cancer.Processed meat was classified as “carcinogenic to humans,” based on evidence from epidemiological studies. Tobacco smoking and asbestos are similarly classified but they are not equally dangerous. The IARC assessment does not assess level of risk, just that an association is or is not established.The WHO, referencing the Global Burden of Disease Project, estimates that about 34,000 cancer deaths per year worldwide can be attributed to diets high in processed meat. They also estimated that smoking causes 1,000,000 deaths, alcohol 600,000 deaths, and air pollution about 200,000 deaths worldwide annually.4The IARC group acknowledged nutritional benefits from red meat. With regard to vegetarian diets, advantages and disadvantages were noted. Because there may be many other variables involved, no substantive comment was offered regarding the health benefits/risks of switching to a vegetarian diet. Common examples of processed meats include frankfurters, sausage, ham, smoked and canned meat preparations, and commercially prepared meat sauces.No data were available on the relative risks for different groups or ages of people. Nor were there adequate data regarding cooking methods or temperatures (including consumption of raw meat.)The risk of colorectal cancer associated with consumption of processed meat was estimated (based on 10 studies) as increasing by 18% for every 50 gram portion eaten daily.We are constantly provided with “information” about what constitutes the best (or worst) diets. It now seems prudent to strongly advise the elimination or at least moderation of the ingestion of processed meats for our patients.
Dr LeLeiko has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. ### Objective To promote dialogue among readers and between readers and editors, we offer here brief reports and observations on topics of interest authored by members of the AAP Grand Rounds editorial team. A recent study, although performed in adults, intrigued us because of the promise it holds …
