Open Nissen or Laparoscopic fundoplicaton in Newborns?

Journal of Pediatric Surgery- 25 laparoscopic and 32 open. The time to goal feeds was significantly shorter for the laparoscopic group (4.3 ± 0.4 vs 6.1 ± 0.6 days, P = .04). The 24-hour postoperative narcotic requirement was significantly lower in the laparoscopic group (0.24 ± 0.05 vs 0.55 ± 0.08 mg/kg, P = .007). Operation times (111 ± 5 [open] vs 113 ± 5 minutes, P = .76) and estimated blood loss (13 ± 2 [open] vs 11 ± 1 mL, P = .33) were comparable for both groups. http://www.jpedsurg.org/article/PIIS0022346809008720/abstract?rss=yes

Levetiracetam- Newborn seizures

A small series of 6 newborns with seizures were followed in Seizure-European Journal of Epilepsy on Levetiracetam. All six patients treated with oral LEV became seizure free within 6 days. Five patients remained seizure free after 3 months with ongoing LEV monotherapy. One infant developed pharmacoresistent epilepsy. Seizures relapsed later in the clinical course of two more patients, one of whom was no longer under LEV therapy.
This drug is beginning to be used more often in neonatal population. We are now seeing some studies.

Cars and Technology

Cars-Technology
I think by now everyone knows that I am a lover of technology. If I bought a luxury model car, it is because it had all the technology I love. Previously, Radha and I used to fight, whenever we took a long journey before, as I used to insist on her to give me the directions, and I used to get mad. She had a knack; a unique extra sensory perception to turn around and talk to kids or bend down to collect something from the floor just before she needed to inform me about an exit, and I used to be upset. After having lost the exit I used to rely on her again for rerouting instructions. This used to put her under a lot of stress.
Hence, we decided to buy a GPS. However, I wanted to use my older discarded pocket pc and install GPS software on that. Since it was an earlier generation PDA, it had very low memory and after warning us CAUTION, exceeding the speed limit; it used to get frustrated and freeze. I never knew that older PDAs were prone to DEPRRESION leading to no EXPRESSION culminating in DIGRESSION with multiple exits being missed . I needed to stop and provide anti-depressants (reset the old pocket pc) and it used to function well for some time. We, therefore, decided to go for higher end GPS and bought a car with all bells and whistles.

Cool! On one day, I was driving to the hospital. Shoots! I slapped my forehead! Where are my car keys? Did I forget them at home? Car keys had my office room key attached and wondered how would I get in? It then struck me, how could I be driving without the keys? This car had a button start and keys were in my pocket. I proudly smiled despite my stupidity.

It was our marriage anniversary. I booked at an exotic restaurant by the river side far from the madding crowd. I entered the address and set to go. We took the exit and drove through woods. I was happily humming Tom Jones song. Then I saw the road dividing into three ways. Just then my GPS announced "No more mapping directions available beyond this follow your local map Hee, HEE, HEE". I thought it was mocking at me! I remembered Robert Frost's poem " TWO roads diverged in a yellow wood,
And sorry I could not travel both.....
I took the one less traveled by,
And that has made all the difference.
This fellow talked about two roads, Man! I have three roads to choose. Reading poetry is of no use when you have to navigate on country roads. I looked at Radha with meek expression and asked her to call the restaurant. Lo!

We were in a dead-zone. No cell phone signal...

The other day, I was training the voice commands in my car and successfully entered some phone numbers. Even Srinidhi was impressed and excited. She played with it for some time, and it was COOL! I was a proud father now catering to children's futuristic needs as well. It was time to demonstrate this to Radha. As we were driving, I pressed the voice command button and said "Call wife". It immediately responded "Calling SUSAN!"

I was shocked! What! Susan! Who is she? Am I dead now? Radha must have thought this new car knew more things than she did! Srinidhi was laughing aloud in the back seat. The voice command declared, “No number found". I was very much relieved. I immediately turned into a parking lot, stopped and pressed the button with all burning anger and commanded "call wife", It promptly responded, "calling Radha". Radha was smiling all through; I did not dare to look at her all that time. It was the ambient noise when driving fast interfering with the clear interpretation by the software.

Did you all have anything similar?
Pradeep

Better visual acuity with DHA Supplementation?

As per DIAMOND study published in Am J Clin Nutr (February 3, 2010). doi:10.3945/ajcn.2009.28557, showed that 0.32% Docasahexanoic acid supplementation to term infants improved visual acuity at 12 months. We need longer follow up to see if this effect persists.

Maternal Smoking during Pregnancy and Regional Brain Volumes in Preterm Infants

J.Peds has lot of NICU related articles this month. They noted "Prenatal smoking exposure was associated with significantly smaller frontal lobe and cerebellar volumes in the brains of preterm infants".

Lactulose-A Promising Prebiotic?

J.Peds Feb 2010 issue has an artcile showing some promising utility of lactulose as a prebiotic when used in 23- to 34-weeks premature infants. They noted in their results "The lactulose group tended to have less intolerance to enteral feedings, to reach full oral feeds earlier, and to be discharged home earlier. They also tended to have fewer episodes of late-onset sepsis, lower Bell stage necrotizing enterocolitis, and their nutritional laboratory indices were better, especially calcium and total protein".

Cholestasis And Omegaven

Cholestatsis treatment with parenteral fish oil (Omegaven) was noted to be quite useful in some case reports but this case report should allow us to exercise some caution while using this for cholestasis.

Hemangiomas-Propranolol

Propranolol for the Treatment of a Life-Threatening Subglottic and Mediastinal Infantile Hemangioma
found to be useful giving rise to resolution of symptoms in 2 days and 50% reduction in size in 1 week. J.Peds Feb 2010. Seems promising.

Chorio amnionitis-Asthma?

Study published in Archives of Pediatrics and Adolescent Medicine; In a 16 year follow up showed that if mother's pregnancy is complicated by Chorio and has a preterm birth, baby is more likely to have asthma by age 8. Chorio is known to increase BPD and reduce the efficacy of surfactant if associated with fetal inflammation.

Lenticulostraite vasculopathy in preterms-Implications?

Recent article reassures us that lenticulostriate vasculopathy is a benign temporary phenomenon seen in 20% of preterms <32 weeks. It is seen on cranial ultrasound and not on MRI surprisingly. The link http://fn.bmj.com/content/95/1/F42.abstract

How much colostrum?

It is surprising that a term baby who is purely breast fed takes an average of 15+/- 11 grams in first 24 hours! The study is published in Jan issue of J.Peds 2010.

Beta Stimulants in Pregnancy-Any Harm?

Recent review in AJOG points to possible association between beta stimulants used for tocolysis (>2 weeks) as well as oral beta stimulants used in asthma with possible autism and other psychiatric disorders. They caution to limit the terbutaline to a max of 48 hours and use only inhaled albuterol. They discuss shift of balance between sympathetic and parasympathetic activity due to over stimulation of beta2 receptors during nervous system formation. Interesting buy, I feel it needs more evidence and research.

Hemangiomas-Propranolol

Propranolol was used suucessfully in treating infantile hemangiomas (Pediatrics September 2009). It allowed even stopping of systemic steroids. http://pediatrics.aappublications.org/cgi/content/abstract/124/3/e423

Delayed Cord Clamping-is It Good for Preterm baies?

JS.Mercer et.al n Journal of Perinatology Jan 2010 issue showed that delaying the cord clamping in 24-31 week preterm births improves neurological outcome in short term (7 months follow up). Immediate is <10secs and delayed is defined as 30-45 secs and the baby held 10-15 inches below the placenta. Males had an advantage compared to female infants. Incidence of IVH was 17% in delayed vs 34% in immediate clamping group (statistically not significant though!)

Is Hereditary Spherocytosis underdiagnosed?

In a recent article by Dr. Christensen in Pediatrics Jan 2010 found that at least babies might have missed the diagnosis of HS. They speculated that if MCHC is more than or equal to 36gm/dl could prompt the physicians to the possibility of HS.