2 Minute Medicine ® - Pediatrics

1. Efficacy: There was no significant difference in death or cerebral palsy at 2 years between those who received magnesium sulfate at 30-34 weeks’ gestation compared to the placebo group; albeit the study had limited power to detect minimally important differences. 2. Safety: Adverse effects (nausea, vomiting, flushing, dry mouth, dizziness, blurred vision) were greater in the pregnant individuals who received magnesium, but there were no serious cardiovascular or respiratory effects from the magnesium infusion...

1. Time to disease flare was significantly shorter in the placebo group versus baricitinib. 2. There was no difference in serious adverse events between the baricitinib and placebo groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Juvenile idiopathic arthritis (JIA) is defined by the onset of polyarticular joint pain before age 16 and can severely affect an individual’s quality of life. First-line treatment for JIA includes nonsteroidal anti-inflammatory drugs (NSAIDs) and biologic disease-modifying antirheumatic drugs (DMARDs), however, many patients with JIA continue to experience refractory symptoms...

1. In a survey study, transgender and gender-diverse adolescents reported barriers, inadequate psychosocial support, and discrimination when receiving gender-affirming care through primary care.  2. They also highlighted benefits, such as convenience, and called for greater care coordination between primary care providers and gender care specialists to improve their experiences. Evidence Rating Level:  4 (Below average) Study Rundown: While gender-affirming care is recommended as the standard of care by the American Academy of Pediatrics, transgender and gender diverse (TGD) adolescents still face many barriers to accessing it...

1. In a long-term follow-up study of an earlier randomized control trial, participants demonstrated sustained immunity 10 years after receiving a 3-dose series of human papilloma virus (HPV) vaccination. 2. There were no HPV-related malignancies or vaccine-related serious adverse events during the follow-up period. Evidence Rating Level: 1 (Excellent) Study Rundown: The risk of HPV-related cancer is lifelong, and therefore any benefit from HPV vaccination needs to be durable across time. This extension study sought to determine the long-term immunogenicity and safety of the 9-valent HPV (9vHPV) vaccine at 10 years following vaccination...

1. In this randomized controlled trial, a maternally administered vaccine for infant group B streptococcus (GBS) demonstrated a reduced risk of invasive GBS. 2. There was no significant difference in number of adverse events seen in patients who received the vaccine. Evidence Rating Level: 1 (Excellent) Study Rundown: GBS can cause sepsis and meningitis in newborns, with the primary risk factor being exposure to maternal rectovaginal group B streptococcal colonization during delivery. Often, pregnant women receive intrapartum antibiotic prophylaxis if they test positive for the GBS screen...

1. Children living in areas of North Carolina composed predominantly of non-Hispanic Black individuals had higher blood lead levels than children living in areas with fewer non-Hispanic Black individuals. 2. This relationship persisted from the early 1990s to 2015, despite the decline of blood lead levels over time in North Carolina. Evidence Rating Level:  2 (Good) Study Rundown: Racial residential segregation (RRS) — the geographic separation of racial or ethnic groups — has been linked to worse health outcomes and increased mortality...

1. In this randomized controlled trial, isolated cleft palate surgery at six months resulted in a reduced risk of developing velopharyngeal insufficiency at five years as compared to surgery at 12 months. 2. There was no difference in speech, dentofacial, or growth development between surgery completed at six months versus 12 months. Evidence Rating Level: 1 (Excellent) Study Rundown: Isolated cleft palate is a common condition worldwide, whereby the optimal timing, technique, and number of surgeries for optimal development are debated...

1. In this prospective cohort study, 1 out of 500 newborns were diagnosed with a medical condition that was detected via genetic sequencing but was missed by more commonly used biochemical screening tests.  Evidence rating level: 1 (Excellent) Newborn screening (NBS) is routinely performed across the world using biochemical testing methods. The effectiveness of genetic sequencing as an alternative method for NBS has not previously been studied. Researchers aimed to compare the ability of biochemical and genetic sequencing methods to detect disorders in newborns...

1. The offspring of individuals consuming a Mediterranean diet or engaging in a mindfulness-based stress reduction program during pregnancy had better neurodevelopmental outcomes in certain domains at age 24 months compared to the control group.  Evidence Rating Level: 3 (Average) Study Rundown: Prior studies have demonstrated that maternal high-fat diets, obesity, and psychological stress are associated with adverse fetal neurodevelopment. Researchers aimed to determine whether lifestyle interventions, specifically a consuming Mediterranean diet or engaging in mindfulness-based stress reduction (MBSR), can improve offspring neurodevelopment...

1. Compared to those consuming below the maximum tolerable daily intake of the mycotoxin deoxynivalenol, those consuming above this threshold were at a greater risk of giving birth to small-for gestational age infants.  Evidence rating level: 1 (Excellent) Deoxynivalenol (DON) is a mycotoxin found in certain agricultural products, such as wheat and corn. It has been found to cause fetal growth retardation in animals, but its effects have not previously been studied in humans. Researchers aimed to assess the effect of DON consumption on fetal growth...

1. This analysis of a prospective cohort of moderate and late preterm (MLPT) children found both MLPT-specific and MLPT-sex-specific neurodevelopmental delays. The gross motor and personal-social domains of development were most affected, particularly in males. 2. Two placental genes, apolipoprotein E (APOE) and cystatin c ( CST 3 ), were identified as predictive of neurodevelopmental delay in MLPT children and postulated to be part of a placenta-brain axis in fetal development.  Evidence Rating Level: 2 (Good) Preterm birth is defined as delivery before 37 weeks gestation according to the World Health Organization...

1. The prevalence of Hepatitis C infection during pregnancy increased between 1998 and 2018, coinciding with the opioid epidemic.  2. Individuals of White race, lower socioeconomic status, and a history of substance use were more likely to be infected with Hepatitis C during pregnancy.  3. Hepatitis C Infection was associated with a greater risk of gestational hypertension, cesarean delivery, preterm labour, poor fetal growth, and fetal distress . Evidence Rating Level: 2 (Good) Study Rundown: Hepatitis C virus (HCV) is the most prevalent chronic bloodborne infection in the United States...

1. In a cross-sectional study, adolescent survivors of childhood cancers were more sedentary than age-matched controls. 2. Age, gender, BMI, cancer relapse, and central nervous system tumors were all associated with less physical activity and more sedentary time. Evidence rating: 2 (Good) Study Rundown: Childhood cancer survivors are at increased risk for chronic medical conditions such as cardiovascular disease and diabetes mellitus.  Higher levels of physical activity are associated with a variety of long-term health benefits and an improved quality of life in the general population...

1. This population-based cohort study is the first to establish an evidence-based recommendation of delivery at 39 weeks for females with pregnancies conceived via infertility treatments and assisted reproductive technology (ART).  Evidence Rating Level: 2 (Good) The proportion of females between the ages of 15 to 49 receiving infertility therapies has risen over recent years. Assisted reproductive technology (ART) more specifically, although useful, is also associated with the risk for low birth weight, perinatal mortality, and stillbirth...

1. There was no difference in cardiovascular health between adolescents who received a 2 or 4-year-long school-based health promotion intervention compared to those who received the standard curriculum. 2. Despite the neutral statistical effect, adolescents reported positive experiences following this comprehensive program that involved individual empowerment in making healthy life decisions. Evidence Rating Level: 1 (Excellent) Study Rundown: Adolescence represents a pivotal phase when foundational lifestyle patterns take root, offering a window of opportunity for preventive measures against modifiable risk factors affecting cardiovascular health (CVH), such as diet, physical activity and tobacco use...

1. A secondary  analysis of a randomized clinical trial found that when correcting for fluid balance, AKI was more commonly diagnosed in extremely premature neonates.  2. A diagnosis of fluid-corrected AKI resulted in a significantly higher risk of requiring mechanical ventilation, longer hospital stay, and bronchopulmonary dysplasia (BPD). Evidence Rating Level: 1 (Excellent) Acute kidney injury (AKI) is a common condition in premature neonates, particularly those of extremely low gestational age. The potential complications of AKI do not exist solely in the short term; AKI in neonates also increases the risk of future chronic kidney disease...

1. Implementation of ‘Water First’, a program consisting of classroom lessons, water promotion, and water stations, was associated with a lower increase in overweight prevalence compared to the control group. 2. No significant change was seen in obesity prevalence in schools exposed to the intervention. Evidence Rating Level:  1 (Excellent) Study Rundown: Childhood obesity is a major risk factor for the development of chronic illnesses in adulthood. Given that sugar-sweetened beverages (SSBs) are linked to childhood overweight and obesity, this cluster-randomized control trial sought to examine if a school-based drinking water promotion program could address overweight prevalence in elementary school students by reducing SSB consumption...

 1.  In a prospective cohort study, white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin (PCT) were elevated in pediatric patients with a musculoskeletal infection. 2. WBC count, ANC, CRP, ESR, and PCT were distinguished musculoskeletal infections from Lyme arthritis and other types of inflammatory arthritis. Evidence Rating Level: 2 (Good) Study Rundown: Bacterial musculoskeletal infections (MSKI) are serious conditions that require rapid recognition and treatment...

1. In a randomized control trial of the social care screening program WE CARE, health benefits for children ages 0 to 3 were mixed, with improvements in immunization uptake but increased ED visits and hospitalizations. 2. Implementation of the WE CARE program by community health clinics was poor, with fewer than one-third of eligible visits documenting a screener. Evidence Rating Level: 1 (Excellent) Study Rundown: Screening for social risk factors has become increasingly common in pediatric practice. However, despite such screening being formally recommended by the American Academy of Pediatrics, there have been few studies evaluating the impact of screenings in real-world settings...

1. Important components of the endocannabinoid system (ECS) were isolated in the developing human fetal testis, implying that the development of this organ could be impacted by cannabinoid consumption.  2. Early testis exposure to phytocannabinoids directly and negatively impacted male gonadal development and physiology ex vivo.  Evidence Rating Level: 1 (Excellent) Study Rundown:  Cannabis is the most commonly consumed recreational drug by women in pregnancy, and the presence of THC (Δ9-trans-tetrahydrocannabinol) and cannabidiol (CBD) in the fetal blood and/or meconium suggest that this substance crosses the placenta...