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Abstract

Source: JAMA (The Journal of the American Medical Association)
Effect of minimally invasive surfactant therapy versus sham treatment on death or bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome. The OPTIMIST-A randomized clinical trial.
Dargaville PA, Kamlin COF, Orsini F, et al. Effect of Minimally Invasive Surfactant Therapy vs Sham Treatment on Death or Bronchopulmonary Dysplasia in Preterm Infants With Respiratory Distress Syndrome: The OPTIMIST-A Randomized Clinical Trial. JAMA. Published online December 13, 2021. doi:10.1001/jama.2021.21892

Abstract
Importance: The benefits of catheter-based surfactant administration (minimally invasive surfactant therapy [MIST]) in premature infants with respiratory distress syndrome are uncertain. Purpose: To examine the effect of selective application of MIST to a low fraction of the inspired oxygen threshold on bronchopulmonary dysplasia (BPD)-free survival. Design, Setting, and Participants: Randomized clinical trial involving 485 preterm infants with a gestational age of 25 to 28 weeks who received continuous positive airway pressure (CPAP) support and required an inspired oxygen fraction of 0.30 or greater within 6 hours after birth. The trial was conducted in 33 tertiary-level neonatal intensive care units worldwide, with blinding of physicians and outcome assessors. Enrollment took place between December 16, 2011, and March 26, 2020; follow-up was completed on December 2, 2020. Interventions: Infants were randomized to the MIST group (n = 241) and received exogenous surfactant (200 mg/kg poractant alfa) via a thin catheter or to the control group (n = 244) and received sham (control) treatment; CPAP was subsequently continued in both groups unless specified intubation criteria were met. Main Outcomes and Measures: The primary outcome was the composite of death or physiologic BPD assessed at 36 weeks postmenstrual age. The components of the primary outcome (death before 36 weeks postmenstrual age and BPD at 36 weeks postmenstrual age) were also considered separately. Results: Among the 485 infants randomized (median gestational age, 27.3 weeks; 241 [49.7%] females), all completed follow-up. Death or BPD occurred in 105 infants (43.6%) in the MIST group and 121 (49.6%) in the control group (risk difference [RD], -6.3% [95% CI, -14.2% to 1.6%]; relative risk [RR], 0.87 [95% CI, 0.74 to 1.03]; P = 0.10). The incidence of death before 36 weeks postmenstrual age did not differ significantly between groups (24 [10.0%] in MIST vs. 19 [7.8%] in control; RD, 2.1% [95% CI, -3.6% to 7.8%]; RR , 1.27 [95% CI, 0.63 to 2.57]; P = 0.51), but the incidence of BPD in survivors up to 36 weeks postmenstrual age was lower in the MIST group (81/217 [37.3%] vs. 102/225 [45.3%] in the control group; RD, -7.8% [95% CI, -14.9% to -0.7%]; RR, 0.83 [95% CI, 0.70 to 0.98]; P = 0.03). Serious adverse events occurred in 10.3% of infants in the MIST group and 11.1% in the control group.
Conclusions and Relevance: Among preterm infants with respiratory distress syndrome supported with CPAP, minimally invasive surfactant therapy compared with sham (control) treatment did not significantly reduce the incidence of the combined outcome of death or bronchopulmonary dysplasia at 36 weeks postmenstrual age. However, given the statistical uncertainty reflected in the 95% CI, a clinically important effect cannot be excluded.

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The International Society for the Study of Vascular Anomalies classifies vascular anomalies into vascular tumors and vascular malformations. Vascular tumors are endothelial cell neoplasms, among which infantile hemangiomas (IH) are the most common and occur in 5% to 10% of infants. The expression of glucose transporter protein-1 in IHs differs from that of other vascular tumors or vascular malformations. IHs are not present at birth, but are usually diagnosed between one week and one month of age, proliferate rapidly between one and three months, mostly fully proliferate by five months, and then slowly involute into adipose or fibrous tissue. Approximately 10% of IH cases require early treatment. The 2019 American Academy of Pediatrics clinical practice guideline for the management of IH recommends that primary care physicians frequently monitor infants with IH, educate parents about the clinical course, and refer infants with high-risk IH to IH specialists, ideally at one month of age. High-risk IHs include those with life-threatening complications, functional impairment, ulceration, associated structural abnormalities, or disfigurement. In Korea, IHs are usually treated by pediatric hematologists-oncologists with the cooperation of pediatric cardiologists, radiologists, dermatologists, and plastic surgeons. Oral propranolol, a nonselective beta-adrenergic antagonist, is the first-line treatment for IHs at a dose of 2 to 3 mg/kg/day divided into 2 daily doses maintained for at least 6 months and often up to 12 months of age. Topical timolol maleate solution, a topical nonselective beta-blocker, can be used for small surface-type IHs at a dose of 1 to 2 drops of a 0.5% gelling ophthalmic solution applied twice daily. Pulsed dye laser therapy or surgery is useful for the treatment of residual skin changes after involution of IH.

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Source: Archivos Argentinos de Pediatría
Incidence of morbidity and associated factors in a Pediatric Intensive Care Unit.
Alvarez JP, Vazquez EN, Eulmesekian PG. Incidence of morbidity and associated factors in a Pediatric Intensive Care Unit. Arch Argent Pediatr 2021;119(6):394-400. {

Abstract
Introduction. The functional status scale (FSS) was developed to measure acquired morbidity in pediatric patients. Objective. To estimate the incidence of acquired morbidity in the pediatric intensive care unit (PICU), the presence of associated factors, and to describe functional status after hospital discharge. Population and methods. Prospective cohort. All PICU admissions between August 2016 and July 2017. FSS was used to measure morbidity acquired during hospitalization and up to 1 year after discharge. Univariate analysis was performed to investigate factors associated with morbidity. Results. A total of 842 patients were included. The incidence of PICU morbidity was 3.56% (30/842) and persisted in 0.7% of the entire cohort at hospital discharge (6/842). Before 1 year, 3 of the 6 patients had improved functional status. Univariate analysis showed association between PICU-acquired morbidity and PIM2 score (odds ratio [OR]: 1.04; 95 % confidence interval [95 % CI]: 1.01- 1.07; p = 0.007), age younger than 1 year (OR: 2.93; 95 % CI: 1.36-6.15; p = 0.004), use of mechanical ventilation (MRA) (OR: 7.83; 95%CI: 3.31-18.49; p = 0.0001) and central venous catheter (CVC) (OR: 38.08; 95%CI: 5.16-280.95; p = 0.0001), and prolonged hospitalizations (OR: 9.65; 95%CI: 4.33-21.49; p = 0.0001). Conclusions. The incidence of morbidity was 3.56 % and was associated with age less than 1 year, severity of patients at admission, use of MRA and CVC, and prolonged hospitalizations.

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Source: Current Problems in Pediatric and Adolescent Health Care.
A pediatrician's guide to climate change-informed primary care.
Philipsborn RP, Cowenhoven J, Bole A, et al. A pediatrician's guide to climate change-informed primary care. Current Problems in Pediatric and Adolescent Health Care. Volume 51, Issue 6, 2021, 101027, ISSN 1538-5442,https://doi.org/10.1016/j.cppeds.2021.101027.

Abstract
Despite the urgency of the climate crisis and mounting evidence linking climate change to child health harms, pediatricians do not routinely engage with climate change during consultation. Every primary care visit offers opportunities to detect and support children burdened by health risks that are increasingly intense due to climate change. Routine promotion of healthy behaviors also aligns with some necessary, and powerful, solutions to the climate crisis. For some patients, including those with athletics, those with asthma and allergies, or those with complex health care needs, preparing for environmental risks and disasters exacerbated by climate change is a critical component of disease prevention and management. For all patients, preventive guidance topics, already pillars of pediatric best practices, are closely related to the guidance needed to keep children safe and promote health in the context of compounded risks due to climate change. By considering climate change in routine care, pediatricians will update practice to align with evidence-based literature and better serve patients. This article provides a framework for pediatricians to provide climate-informed primary care during the structure of pediatric well-child and other consultations.