Doxycycline Sclerotherapy Is Superior in the Treatment of Pediatric Lymphatic Malformations.

PURPOSE: To evaluate efficacy of sclerotherapy with doxycycline versus sodium tetradecyl sulfate (STS) for treatment of macrocystic and mixed lymphatic malformations (LMs). MATERIALS AND METHODS: This single-center retrospective review identified 41 children (17 boys; 24 girls; age range, 1 month to 15.4 y) who underwent sclerotherapy with doxycycline (n = 32) or STS (n = 9) for macrocystic (n = 31) or mixed (n = 10) LMs. There were 114 treatments performed, averaging 2.8 treatments (range, 1-8 treatments) per patient. Average follow-up time was 10 months (range, 1-59 months). Clinical response was deemed excellent or moderate if > 90% or > 50% of LMs resolved based on visual estimate. RESULTS: With doxycycline, 87% of patients (28 of 32) had excellent or moderate response with an average of 2.8 treatments (range, 1-7 treatments); 13% required subsequent resection. With 3% STS monotherapy, only 55% of patients (5 of 9) had excellent or moderate response with an average of 2.8 treatments (range, 1-8 treatments), and 33% required subsequent resection. Significantly fewer patients treated with STS responded well compared with patients treated with doxycycline (P = .03). Patients treated with STS had significantly longer follow-up than patients treated with doxycycline (27 months vs 6 months, P = .0001). CONCLUSIONS: Doxycycline monotherapy resulted in a high rate of excellent clinical outcomes after a few treatments without increased need for subsequent operative resection. These results support use of doxycycline sclerotherapy as primary treatment for macrocystic and mixed LMs in children.

A New Injury Prevention Target: Summer Hair Braids.

Scald injuries caused by hair braiding have become increasingly common in our pediatric burn center's African-American population. This injury mechanism has received little attention in the medical literature. To guide prevention, the present study aims to characterize this novel mechanism of injury and identify patterns underlying its frequency. A retrospective cohort analysis was performed on all cases of scald injury due to hair braiding in African-American girls treated at our burn center from 2000 to 2016. Data were gathered from the patient's medical records to determine demographics, details of the injury, and treatment rendered. Patterns of injury frequency were identified and statistically analyzed. Thirty-four patients suffered scald injuries associated with hair braiding. The mean patient age was 8.4 years (SD ± 5 years). The majority of injuries (90%) occurred in the home. The frequency of injuries significantly increased starting in the year 2012, rising from less than 3% to more than 10% of evaluated injuries in African-American girls (P = .0015). Injuries were significantly more frequent in summer months. Injuries resulted in considerable usage of medical resources, including ambulance transport, hospital admission, clinic visits, prolonged wound care, and surgery. Complications developed in 41% of injured children; the most frequent complication was scarring. Pediatric scald injuries caused by braiding practices are morbid, have recently become increasingly frequent, tend to occur in the summer, and may be related to a new do-it-yourself style trend among African-American girls.

Colonization with Escherichia coli EC 25 protects neonatal rats from necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is a significant cause of morbidity and mortality in premature infants; yet its pathogenesis remains poorly understood. To evaluate the role of intestinal bacteria in protection against NEC, we assessed the ability of naturally occurring intestinal colonizer E. coli EC25 to influence composition of intestinal microbiota and NEC pathology in the neonatal rat model. Experimental NEC was induced in neonatal rats by formula feeding/hypoxia, and graded histologically. Bacterial populations were characterized by plating on blood agar, scoring colony classes, and identifying each class by sequencing 16S rDNA. Binding of bacteria to, and induction of apoptosis in IEC-6 enterocytes were examined by plating on blood agar and fluorescent staining for fragmented DNA. E. coli EC 25, which was originally isolated from healthy rats, efficiently colonized the intestine and protected from NEC following introduction to newborn rats with formula at 106 or 108 cfu. Protection did not depend significantly on EC25 inoculum size or load in the intestine, but positively correlated with the fraction of EC25 in the microbiome. Introduction of EC25 did not prevent colonization with other bacteria and did not significantly alter bacterial diversity. EC25 neither induced cultured enterocyte apoptosis, nor protected from apoptosis induced by an enteropathogenic strain of Cronobacter muytjensii. Our results show that E. coli EC25 is a commensal strain that efficiently colonizes the neonatal intestine and protects from NEC.