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A decade after bariatric surgery, most teens maintained weight loss and reduced obesity-related conditions such as type 2 diabetes and hypertension.

Study: Exploring lasting benefits of bariatric surgery for teens with severe obesity

. He joined the brand in March of 2023 as an editor before being promoted to senior editor in January 2024. Fitch graduated from Youngstown State University in Youngstown, Ohio in 2020 with a degree in telecommunications and journalism. He started his career as a news and sports videographer before becoming an on-air sports anchor at the NBC-affiliated news station in Youngstown. Fitch briefly worked as a national content writer for a Chicago-based national television station before joining the 

team. He can be reached at: jfitch@mjhlifesciences.com.

The federal agency has not raised any concerns regarding safety and efficacy of tapinarof cream, 1%. 

FDA pushes PDUFA date of tapinarof cream, 1% for atopic dermatitis to 2025

Severe outcomes among children with pneumonia were uncommon, regardless of whether antibiotics were received based on study results. 

Pediatric pneumonia: Antibiotic use and treatment failure

Application acceptance was based on positive results with monthly and bi-monthly dosing data from a phase 3 trial. 

FDA accepts donidalorsen NDA for prophylactic hereditary angioedema

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A 9-year-old boy has developed an itchy vesicular rash on his left leg that has spread to his other leg and to both arms and hands. What is the diagnosis?

Linear rash leaves your patient itching

Brief but practical reminders to help prevent drowning in children from the perspective of an emergency medicine fellow. 

Practical reminders to prevent drowning among children

 interview, James Barry, MD, a pediatric emergency fellow in Rochester, New York, explained how drowning takes place and reminds providers of some common but practical safety tips to discuss with parents. 

From your position in emergency medicine, what about drowning is important to understand as summer is in full swing?

It is something that happens quickly, it happens usually insidiously, and it's really difficult to unwind the damage from drowning as time goes by. The best way to explain drowning to anybody honestly is when you're submerged in water, you have this kind of panic response and you start flailing and at some point, you take a breath. A breath leads to an aspiration or breathing in of the water, and that can disrupt the way that your body transitions oxygen and carbon dioxide across the lung and it actually disrupts the surface tension of the lungs so you experience a lot of collapse of the lung. That leads to hypoxemia, or low blood oxygen, which can lead to loss of consciousness or apnea. That leads to bradycardia, which leads to arrest and then you have a lot of pulmonary edema, you can have neurovascular compromise. There really are a lot of terrible sequelae of drowning if it's not treated quickly and not treated robustly. It's really important for any pediatrician, any provider, in the first 8 hours if the patient is showing pulmonary symptoms, could be a sign of a lead to pulmonary compromised. So it's really important for those children to get evaluated if they are having those pulmonary symptoms in the first 8 hours, even if you feel like it wasn't a real submersion.

Can you highlight some common water safety practices that providers can discuss with families?

The [American Academy of Pediatrics] (AAP) has really good guidelines they always put out for stuff like this, especially during injury prevention season. It's very important to have a fence around a pool. Very important to have your kids get swimming lessons, if at all possible whether or not you have a pool. [Wearing a] life jacket at all times in any kind of watercraft. A lot of pediatricians do a really good job of this, but it's always important to remind families with intellectually or cognitively delayed or impaired children, they should have a lifejacket on regardless of what body of water they're in. Regardless of who's with them. It's extremely important for those patients. I say this to every pediatrician as an emergency doctor, if you have a concern about the child after submersion incident, send them into the emergency department (ED). It's always important to just get that screened chest X ray to see if there's any kind of pulmonary injury to prevent a lot of that compromise later.

Though some drowning prevention strategies seem common or routine, data demonstrate drowning deaths among children have risen in recent years, which should prompt conversations with families on refreshers and new prevention initiatives.

Click here for CDC data related to a rise in drownings in the United States in recent years, more tips, and further discussion with James Barry, MD. 

Click here to explore the digital version of the July issue of Contemporary Pediatrics. 

News

In a public service announcement, the FDA is sharing Dynarex Corporation's expanded recall of Dynacare Baby Powder, 4 oz and 14 oz because they have the potential to be contaminated with asbestos.

According to Dynarex, the company is expanding a recall that began on September 19, 2024, to now include 373 cases of item number 4875 (14 oz) as well as 647 cases of item number 4874 (4 oz). 

Dynarex stated that the products were sent to distributors via direct deliver after January 18, 2024, to 35 states and Amazon.com. The states include: AL, AR, AZ, CA, CO, DE, FL, GA, IA, IL, IN, KY, LA, MA, MD, MN, MO, MS, MT, NC, NE, NJ, NM, NY, OH, OK, OR, PA, TN, TX, UT, VA, VT, WA, WI. 

Asbestos, a naturally occurring mineral that is typically found near talc, is an ingredient in many cosmetic products, however, it is a known carcinogen with well-documented health risks. "If talc mining sites are not carefully chosen or if proper steps are not taken to adequately purify the talc ore, it may contain asbestos," the company stated in the recall. 

Both recalled products are packaged in plastic bottles, in which there are 24 bottles per case for the 14 oz containers and 48 per case for the 4 oz containers. Lot and batch numbers are located on the bottom of the bottle and on each case (pictured below).

As of October 28, 2024, there have been no illnesses or adverse events reported. 

Provided by Dynarex, see products and lots of Dynacare Baby Powder below. Consumers should discontinue use immediately and return for a full refund.

Please contact Dynarex Corporation at 888-396-2739 or 845-365-8200 during business hours of 8:30 AM to 5:00 PM Eastern Standard Time, or via email at recall@dynarex.com if you have any questions or need information on how to return the product or receive a full refund.  

All images courtesy of Dynarex Corporation via an FDA MedWatch alert.  

The product was sent to distributors by direct delivery in 35 states and Amazon.com. 

Dynacare Baby Powder recalled because of potential asbestos contamination

A recently-published, retrospective study suggested that 

nirsevimab (Beyfortus; Sanofi and AstraZeneca)

 for the prevention of respiratory syncytial virus (RSV) may be associated with a decrease in pediatric ICU utilization.

, noted that these preventive measures were implemented in 2023. "Bronchiolitis is the most common diagnosis necessitating respiratory support and pediatric intensive care, and RSV is the most common cause of bronchiolitis," wrote the study investigators, led by Alice Shanklin, MD, of the Division of Pediatric Critical Care Medicine, Children’s National Hospital, Washington, DC; Now with Division of Pediatric Critical Care Medicine, Cohen Children’s Medical Center, New York, New York.

"We conducted a retrospective analysis of a national multicenter database to determine the proportion of pediatric ICU encounters with RSV infection and the proportion of ICU encounters with RSV infection eligible for RSV prevention," wrote Shanklin and colleagues. "We also explored the differences in clinical variables and markers of illness severity between these groups."

Octavio Ramilo, MD, highlights key developments in the effort to prevent RSV disease in recent years, highlights vaccines and monoclonal antibodies. 

The evolution of RSV disease prevention in infants

In the study, the investigators examined pediatric ICU encounters in the United States with and without RSV from January 1, 2017, to June 1, 2023, using the national electronic health record database, Oracle Cerner RealWorld data.1 

All children, who were aged older than 1 day to younger than 18 years and admitted to an ICU amid the study period were included in the analysis, which was performed from February to May 2024.

Of the 13,702 ICU encounters with RSV (11.4% of total ICU encounters), 38.6% were eligible for prevention. "Encounters with RSV accounted for 21.1% (109 334) of ICU days, of which 43.8% (47 888) were eligible for prevention (9.2% of total ICU days)," stated the study authors.

RSV encounters were associated with a greater use of positive pressure ventilation (4074 [29.7%] vs 18 821 [17.7%]; 

 < .001) and vasoactive medications (3057 [22.3%] vs 18 570 [17.5%]; 

 < .001) compared with those without RSV, according to study results.

Regarding prevalence and resource utilization associated with RSV infection, the respiratory disease was associated with a greater illness severity. This included following compared to encounters without RSV, according to study results:

Longer median ICU length of stay (2.8 [1.5-6.2] vs 1.7 [0.9-3.7] days; 

 Median (IQR) hospital length of stay (5.5 [3.0-11.9] vs 3.5 [2.0-7.0] days; 

Higher proportion of respiratory failure (9723 [70.9%] vs 34 477 [30.5%]; 

Positive pressure ventilation (4074 [29.7%] vs 18 821 [17.7%]; 

Vasoactive medication (3057 [22.3%] vs 18 570 [17.5%]; 

"Encounters with RSV infections accounted for 21.1% of ICU days, of which 43.8% were eligible for RSV prevention," wrote the authors. "Therefore, 4.4% of ICU encounters and 9.2% of ICU days represent encounters that have RSV and are eligible for RSV prevention." Among patients aged 0 to 2 years, RSV infection accounted for 10.9% of ICU days and 72.3% were eligible for RSV prevention.

RSV was associated with decreased mortality in the age group of 0 to 2 years (251 [3.5%] vs 1461 [4.2%]; 

 = .005), not associated with mortality in the aged group of 2 to 5 years (149 [5.8%] vs 917 [5.2%]; 

 = .21), and associated with increased mortality in the age group of 5 years and older (335 [8.7%] vs 2741 [5.1%]; 

The cross-sectional study led authors to suggest that a 2.1% to 2.8% reduction in ICU encounters and a 4.5% to 5.9% reduction in ICU days could be observed if a 65% to 85% uptake in novel RSV prevention strategies is achieved for eligible children. This could also lead to an estimated 3.6% to 4.7% reduction during the North American RSV peak in December and January.1 

"The novel RSV prevention strategies may reduce ICU morbidity and mortality for children," the study authors concluded. "The results suggest that efforts to increase availability and acceptance of these therapies are warranted. Further expansion of the population eligible for RSV prevention could have a substantial impact."

1. Shanklin A, Olson T, Patel AK, Trujillo Rivera EA, Pollack MM. Respiratory Syncytial Virus and US Pediatric Intensive Care Utilization. 

 2024;7(10):e2440997. doi:10.1001/jamanetworkopen.2024.40997

2. Fitch, J. The evolution of RSV disease prevention in infants. 

. October 22, 2024. Accessed October 28, 2024. https://www.contemporarypediatrics.com/view/the-evolution-of-rsv-disease-prevention-in-infants 

"The novel RSV prevention strategies may reduce ICU morbidity and mortality for children," the study authors concluded. 

Typical RSV vaccine uptake could lead to fewer pediatric ICU encounters

Paul Helmuth, MD, joined us to discuss potentially practical ways to implement AI in practice, as well as the importance of being transparent with families when using the evolving technology. 

Implementing artificial AI and the importance of transparency for patients

video interview, Paul (PJ) Helmuth, MD, practicing pediatrician, Valley Medical Associates, physician clinical executive, Elsevier, Springfield, Massachusetts, discussed how artificial intelligence (AI) is being incorporated in various ways throughout the health care space, including in pediatric care.

Helmuth shared insights on the potential of AI in clinical settings and addressed the concerns of pediatricians who may be skeptical about adopting AI tools in their practice. 

"We realize that we can't hold back the tide. It's coming into our exam rooms. It's coming into the way that we take care of patients," Helmuth noted. While many health care providers are optimistic about AI’s potential to improve care quality, Helmuth acknowledged that there are concerns about the reliability of AI-driven tools. Pediatricians, like many other health care providers, are cautiously navigating this shift, balancing their own expertise with the new technology. 

One application Helmuth discussed is Elsevier’s ClinicalKey AI, which, according to its website, "combines trusted, evidence-based clinical content with conversational search powered by generative AI to support clinicians in delivering high-quality patient care."

Helmuth recounted a recent experience with a patient’s mother who had concerns about her child’s inhaler potentially stunting growth. "I said, 'Hey, we've got this AI tool, let’s ask it.' So I turned it around, I asked the question... and it [gave] an answer, and it also gave the references so we could see transparently where that happened," Helmuth said.

This example demonstrates how AI can enhance transparency and support shared decision-making between clinicians and families. “She didn’t want a computer to take care of her child," added Helmuth. "She still wants me to take care of her, but she wants to also know that I’m using the best information available to do that.” 

Helmuth highlighted that while AI can streamline tasks such as knowledge retrieval, summarizing medical records, and assisting with diagnosis, its role in pediatrics goes beyond technical functionality. The human aspect of care remains crucial. “You’re not just taking care of the child, you’re taking care of the family,” Helmuth emphasized, pointing out the importance of clear communication and collaboration with families when using AI tools. 

As AI continues to evolve, Helmuth envisions its broader integration into clinical workflows, such as aiding with diagnoses or supporting remote monitoring. He concluded, "There’s a whole lot of work being done across lots of different areas within medicine," signaling that AI will likely increasingly play a role in pediatric care while still complementing traditional approaches.

World class clinical information meets artificial intelligence. Elsevier. Accessed October 23, 2024. https://www.elsevier.com/products/clinicalkey/clinicalkey-ai?utm_campaign=US_ClinicalKey+AI+Launch2202NA240021NA&utm_source=GO_NA&utm_medium=PS&utm_content=&campid=2202NA240021&dgcid=HS_NA_US_ClinicalKey+AI+Launch_2202NA240021_GO_PS_CS&2202NA240021&gad_source=1&gclid=Cj0KCQjwveK4BhD4ARIsAKy6pMJmFeQkG6NpL4lItWwzbWS4SX2z0eMRNHAvTVkBRz9cHFYLF-dIFM8aAthsEALw_wcB 

Implementing artificial intelligence and the importance of transparency for patients

Brittany Bruggeman, MD, highlights the importance of newer, easier-to-use glucagon formulations in treating severe hypoglycemia in patients with type 1 diabetes.

New glucagon formulations simplify emergency treatment for type 1 diabetes patients

Brittany Bruggeman, MD, a pediatric endocrinologist at the University of Florida and type 1 diabetes (T1D) physician scientist, highlighted crucial advancements in diabetes management, particularly regarding the use of glucagon for severe hypoglycemic events. 

Bruggeman emphasized the critical importance of having glucagon readily accessible for patients with T1D. “Glucagon is what I like to think of as the EpiPen of diabetes, and so it's very important that everybody with T1D, or even type 2 on insulin, has glucagon immediately available to them,” she said during an interview at the 

2024 American Academy of Pediatrics National Conference & Exhibition.

Recent developments in glucagon formulations have made it much easier to administer, especially in emergency situations. Bruggeman noted that older versions required users to mix a powder and liquid before injection, a process that could be confusing and time-consuming. “What we used to have to do is mix a powder and a liquid together before injecting the person with glucagon, which made it really tough for people in the lay public to know how to use this, and even, like school nurses and things, had to have special trainings,” she explained. 

However, new formulations of glucagon have simplified the process, making it more accessible to non-medical personnel. “Now there's a formulation that is a nasal spray, and so literally, you just spray the powder into the person's nose,” Bruggeman said, highlighting how this change has improved usability. Additionally, there are now shelf-stable liquid versions of glucagon that function similarly to an EpiPen, allowing for a quick injection without needing to mix anything.

Bruggeman stressed the importance of awareness among healthcare professionals and the public regarding these advancements. “It's really important that the lay public, pediatricians, [and] everyone knows about glucagon, and that if someone with T1D is on insulin, they need to have access to this in order to treat them if they had a severe hypoglycemic event,” she said. 

New glucagon formulations simplify emergency treatment for T1D patients

 video interview, Octavio Ramilo, MD, chair, Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, highlighted challenges and breakthroughs to prevent respiratory syncytial virus (RSV) among the infant population. 

RSV is the leading cause of infant hospitalization in the United States, with an estimated 58,000–80,000 children younger than 5 years hospitalized each year because of the disease, according to the Centers for Disease Control and Prevention (CDC).

The CDC also notes that "nearly every child will get RSV by the time they are 2 years old."

"For 60 years, we've been trying to develop new preventive strategies for RSV in children, and it has been very difficult because [of] the immune system of children," Ramilo said. "We cannot use the traditional vaccine strategy of 2, 4 and 6 months, because, number one, this infection affects the very early in life... even before they can get their routine vaccines. Second, the immune system of infants is immature, so they cannot respond so well to these attempts to do a traditional vaccination."

Developments in recent years have moved the needle in a big way for the prevention of RSV disease.

"A few years ago, there was a major observation in the RSV field, and it was the development of the clarification of the structure of the RSV fusion protein, or RSV F," explained Ramilo, who noted there are 2 forms of the protein.

"One is the pre-fusion form, and the other is the post-fusion and that allows [us] to understand what part of the protein induced more protein-neutralizing antibodies, which led to No. 1, the development of the maternal vaccines using this protein F in the pre-fusion conformation, and also to develop new monoclonal antibodies against different targets that induce very potent neutralizing antibodies," said Ramilo. 

The FDA approvals of the monoclonal antibody 

nirsevimab (Beyfortus; Sanofi and AstraZeneca) 

 have for the first time allowed for the prevention of RSV disease in this patient population, says Ramilo. In addition, 

 (Merck) is being investigated as another potential monoclonal antibody tool to prevent RSV disease.

Click here to listen to Ramilo discussing the clinical development and recently-released clinical data for clesrovimab.

"The first one that was approved is nirsevimab," said Ramilo. "These antibodies are very unique compared to the previous antibodies that we used to have. They are more potent, and they have been genetically engineered so they can last longer. They have a prolonged half life, so one dose of the antibody will cover the whole the complete 5, 6 months of the RSV season. That has been really important, and we begin to experience improvements with this strategy."

Octavio Ramilo, MD, highlights key developments in the effort to prevent RSV disease in recent years, highlights vaccines and monoclonal antibodies.

Howard Fischer, MD

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