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Welcome to the July 23 edition of The Differential. Created by physicians for physicians, this high-quality pediatrics briefing is designed to be quick (skim it in just a few minutes) and thorough (all the information you need is in this email).

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Single-Sentence Summaries

1. Children who use portable music players once or twice a week are twice as likely to have hearing loss compared to children who don’t. JAMA Otolaryngology.

2. The more preterm the baby, the more likely they are to develop hearing impairment — a 7x increased incidence in very-preterm, 2x in moderately-preterm, and 1.5x in late-preterm babies. Pediatrics

3. Prenatal exposure to selective serotonin reuptake inhibitors (SSRI) affects fetal brain development, particularly regions critical to emotional processing. JAMA Pediatrics

4.  Using a whiteboard when talking to a patient’s family about their care plan significantly increases understanding. Hospital Pediatrics

5. Increasing weekday digital media exposure has an inverse dose-dependent relationship with multiple childhood flourishing markers. Journal of Pediatrics

Clinical Quiz

A five-year-old male with a four-day history of fever presents with a new erythematous rash. His mother says he has been coughing and sneezing for the past few days. Examination reveals conjunctivitis, grayish elevations on the buccal mucosa opposite his molar teeth, and a maculopapular rash on his trunk and extremities. Which of the following is a long-term complication of this patient’s condition?

A. Mitral valve disease
B. Subacute sclerosing panencephalitis
C. Cataracts
D. Infertility

Answer at the bottom of this email, or click here to see the full case and discussion on Figure 1.

Editor’s Pearl

This week’s pearl comes from @MikeGinnyMD, a pediatrician on Figure 1. In response to this case featuring a three-year-old with a rash, he said: “If a rash appears contact related and is not bothering the child, then: 1) HANDS OFF. No lotions, no potions. 2) WATCH AND WAIT. Let the disease come to you (or vanish mysteriously). In other words: Don’t just do something; stand there!”

CLINICAL QUIZ ANSWER:

B. Subacute sclerosing panencephalitis

This patient’s symptoms and examination findings are consistent with a diagnosis of measles. Subacute sclerosing panencephalitis (SSPE)—a progressive neurodegenerative disease—is an uncommon, but fatal long-term complication of the condition that can occur 7 to 10 years after the initial measles virus infection. While the pathogenesis is not fully understood, SSPE may be caused by a persistent infection of the central nervous system with a genetic variant of the measles virus. The severity of SSPE reinforces the importance of the measles vaccination for preventing measles and its associated complications.

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