Severe Skin Reactions TEN/SJS: Children Generally Do Better Than Adults

MedicalResearch.com Interview with:
CDC imageJames W. Antoon, MD, PhD

Pediatric Primary Care
University of Illinois Hospital

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis?

Response: Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially fatal skin conditions, most commonly caused by medications and infections. Early symptoms include fever, blistering and peeling of the skin and mucus membranes and can affect any organ system including the eyes, lungs, kidneys and intestines. While rare, the conditions often result in life-long effects. The rarity and severity of these diseases have made it a challenge for researchers and clinicians to study, especially in a pediatric population. As a result, much of the information used to drive our care for children is derived from adult studies.

MedicalResearch.com: What are the main findings? 

Response: Using the Pediatric Health Information System, a large pediatric database containing information from 45 U.S. children’s hospitals, we studied the treatment and outcomes of SJS and TEN in children. This is one of the first large-scale to benchmark clinical outcomes the conditions in children. We characterized outcomes such as cost of hospital care, length of hospital stay, mortality, recurrence, hospital readmission as well as short-term complications like kidney failure, respiratory failure and sepsis.

Overall, we found that these outcomes in children were better than in adults. We also found that children with SJS and TEN received different kinds of treatment and that treatment strategies varied by region of the country. Expensive or combination treatments did not necessarily result in better outcomes.

MedicalResearch.com: What should readers take away from your report?

Response: Overall, these findings suggest we can be cautiously optimistic about SJS and TEN outcomes in children. Mortality and short-term morbidity in children with SJS and TEN is lower than in adults. Our results also suggest we can potentially reduce the cost of care for families by selecting lower-cost treatments to achieve the same outcomes. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: We identified a large variation in the treatment kids with SJS and TEN received, yet outcomes did not differ between treatments. This usually indicates an area for improvement in the quality of care doctors provide. Further research focusing on strategies that reduce complications, hospital stays and the cost of care would help provide physicians with better evidence on how to treat these conditions. 

MedicalResearch.com: Is there anything else you would like to add?

Response: The study was performed in collaboration with Drs. Jennifer Goldman and Brian Lee of Children’s Mercy Hospital and Clinic in Kansas City, Missouri, and Dr. Samir Shah of Cincinnati Children’s Hospital Medical Center. Dr. Goldman’s work was supported in part by a grant (KL2TR000119) from the National Center for Advancing Translational Sciences, part of the National Institutes of Health.

Citation:

J Allergy Clin Immunol Pract. 2018 May 30. pii: S2213-2198(18)30346-5. doi: 10.1016/j.jaip.2018.05.024. [Epub ahead of print]
A Retrospective Cohort Study of the Management and Outcomes of Children Hospitalized with Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis.
Antoon JW1, Goldman JL2, Shah SS3, Lee B4. 

Jul 16, 2018 @ 8:24 pm

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How Doctors Communicate Empathy Critical to Family-Physician Partnership

MedicalResearch.com Interview with:

Dr. Tessie W. October. MD, MPH Critical Care Specialist Children’s National Health System

Dr. October

Dr. Tessie W. October. MD, MPH
Critical Care Specialist
Children’s National Health System 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: This is a qualitative study that examines the impact of empathetic statements made by doctors on the ensuing conversation with families of critically ill children. We know families are more satisfied when doctors show empathy, but until this study, we did not know how these empathetic statements are received by families. In this study we found that doctors frequently respond to a family’s emotions by responding with empathy, but how the doctor presented that empathetic statement mattered. When doctors made an empathetic statement, then paused to allow time for a family’s response, the family was 18 times more likely to share additional information about their fears, hopes or values. Conversely, when doctors buried the empathetic statement within medical talk or if a second doctor interrupted, the empathetic statement frequently went unheard by the family.

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Infants Are Lips Experts With Prominent Neural Map of Lips

MedicalResearch.com Interview with:

Andrew N. Meltzoff Ph.D. Job and Gertrud Tamaki Endowed Chair Co-Director, Institute for Learning & Brain Sciences (I-LABS) Professor of Psychology Elected member of the American Academy of Arts & Sciences. University of Washington, Box 357920 Seattle, WA 98195

Dr. Meltzoff

Andrew N. Meltzoff Ph.D.
Job and Gertrud Tamaki Endowed Chair
Co-Director, Institute for Learning & Brain Sciences (I-LABS)
Professor of Psychology
Elected member of the American Academy of Arts & Sciences.
University of Washington, Box 357920
Seattle, WA 98195

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: We are applying safe, noninvasive neuroscience techniques to examine the development of young children. We are especially interested in social-emotional learning and cognitive development. The way the body is represented in the brain is well-studied topic in cognitive neuroscience using adults, for example, the classical studies by W. Penfield on the ‘sensorimotor homunculus’ in the adult brain. The development of neural body map in human infants is, however, deeply understudied.

We think that the way the body is represented in the brain will provide important information about infant learning prior to language. For example, one of the chief avenues of learning in human infants is through observation and imitation. Infants watch what adults do and imitate those behaviors, rapidly learning about people, things, and causal relations. The mechanisms of imitation themselves are interesting. In order to imitate, infants need to know what part of their body to move and how to move it. We wanted to explore the representations of the human body in the infant brain prior to language. Continue reading

Young Survivors of Cancer at Increased Risk of Endocrine Disease

MedicalResearch.com Interview with:
“Cancer awareness” by Susan Roberts is licensed under CC BY 2.0Mette Vestergaard Jensen, MD

Danish Cancer Society Research Center

MedicalResearch.com: What is the background for this study?

Response: Cancer survival rates have improved and it is necessary to explore the long-term consequences of cancer treatment. Adolescents and young adults with cancer are at risk for several therapy-related late effects; however, these have not been studied extensively. We investigatet the lifetime risks of endocrine late effects of cancer and cancer treatment in adolescent and young adult cancer s

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Over 2 Millions Pediatric ER Visits For Bike Accidents Annually

MedicalResearch.com Interview with:
“Bikes” by Britta Frahm is licensed under CC BY 2.0
Lara McKenzie, PhD
Principal investigator in the Center for Injury Research and Polic
Nationwide Children’s Hospital.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Bicycling is a great way for families to get outside and be active together, but certain precautions need to be taken to keep everyone safer. This study looked at bicycle-related injuries among children age 5-17 years treated in hospital emergency departments in the United States from 2006 through 2015 and found that, despite a decrease in the rate of injuries over the 10-year study period, there were still more than 2.2 million injuries. This averages 608 cases per day or 25 every hour.

The majority of injuries involved children 10 to 14 years of age (46%) and boys (72%). The most commonly injured body region was the upper extremities (36%), followed by the lower extremities (25%), face (15%), and head and neck (15%). The most common types of injury were bruises and scrapes (29%) and cuts (23%). Overall, traumatic brain injuries (TBIs) represented 11% of total injuries and were most common among patients 10-14 years of age (44%). About 4% of patients were hospitalized.

Injuries most frequently occurred in the street (48%) or at home (37%). Helmet use at the time of injury was associated with a lower likelihood of head and neck injuries and hospitalizations, but there was no significant change in the rate of injury among helmet users over the study period. Motor vehicle involvement increased the odds of bicycle-related TBIs and injury-related hospitalizations.  Continue reading

Buprenorphine Exposures Among Children and Adolescents

MedicalResearch.com Interview with:

Gary Smith, MD, DrPH Director, Center for Injury Research and Policy Nationwide Children’s Hospital Columbus, OH

Dr. Smith

Gary A. Smith, MD, DrPH
Director, Center for Injury Research and Policy
Nationwide Children’s Hospital
Columbus, OH

MedicalResearch.com: What is the background for this study?

Response: Buprenorphine is a prescription opioid medication commonly used to treat opioid use disorder. From 2005 to 2010, the annual number of individual patients who received a buprenorphine prescription increased from 100,000 to more than 800,000. Although buprenorphine is important for the treatment of opioid use disorder, pediatric exposure to this medication can result in serious adverse outcomes.

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Immaturity Plays Leading Role in Late Preterm Complications

MedicalResearch.com Interview with:

Melissa Lorenzo MD Pediatric medical resident

Dr. Lorenzo

Melissa Lorenzo MD
Pediatric medical resident
Dr. Lorenzo is currently training at the University of Toronto, however the research was conducted while a medical student at Queens University

MedicalResearch.com: What is the background for this study?

Response: Preterm infants are born before 37 weeks gestation, with late preterm neonates defined as infants born between 34 weeks to 37 weeks gestation. Of all preterm births, over 70% of babies are born in the late preterm period. Late preterm births are common, affecting 12.5% of all births in the United States.

Compared to infants born at term, late preterm neonates are at increased risk for many common complications following birth such as jaundice, low blood sugar, and respiratory distress, prolong hospital stay, admission to the neonatal intensive care unit, and increase readmission rate after hospital discharge. There are many causes for preterm delivery- two important ones are early onset of labour either spontaneous or after premature rupture of membranes, and medically indicated delivery prior to full term gestation due to chronic diseases in mother affecting her health in pregnancy, fetal medical reasons, or placental insufficiency. There is a debate that the risk of neonatal complications is affected by the causes of preterm delivery with immaturity acting as a contributing factor. The relative contribution of immaturity versus the reason for delivery and the resulting neonatal complications is unclear.

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Animal Model Suggests BPA May Have Multigenerational Effect On Communication Patterns

MedicalResearch.com Interview with:

Cheryl Rosenfeld PhD DVS Professor of biomedical sciences in the College of Veterinary Medicine investigator in the Bond Life Sciences Center, and  research faculty member for the Thompson Center for Autism and Neurobehavioral Disorders University of Missouri

Dr. Rosenfeld

Cheryl Rosenfeld PhD DVS
Professor of biomedical sciences in the College of Veterinary Medicine
investigator in the Bond Life Sciences Center, and
research faculty member for the Thompson Center for Autism and Neurobehavioral Disorders
University of Missouri

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: My laboratory has been examining the effects of developmental exposure to the endocrine disrupting chemical (EDC), bisphenol A (BPA) on later neurobehavioral responses in a variety of rodent models, including California mice. This species is unique in that both parents rear the pups and they have monogamous social structure, similar to most human societies.

We had previously found that developmental exposure to BPA or another EDC, ethinyl estradiol (EE), disrupted later maternal and paternal care by F1 offspringto their F2 pups. Rodent pups use vocalizations both in the range of human hearing (20,000 hertz or below) and outside of the range of human hearing (20,000 hertz) to communicate with each other and their parents, and for the latter, such communications serve as a trigger to provide additional parental care in the form of nutrition or warmth to the pups.

Thus, in the current studies we sought to determine if exposure of the grandparents to BPA or EE could lead to disruptions in their grandoffspring (F2 generation) pup communications that might then at least partially account for the parental neglect of their F1 parents.

We found that early on female BPA pups took longer to call to their parents but later during the neonatal period they vocalized more than pups whose grandparents were not exposed to either chemical. Such vocalization changes could be due to multigenerational exposure to BPA and/or indicate that the pups are perceiving and responding to the reduced parental care and attempting but failing to signal to their F1 parents that they need more attention.

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Both Honey and Carafate® May Slow Damage to Esophagus from Button Battery Ingestion

MedicalResearch.com Interview with:

“button battery of Apple Remote” by tsurutakoji is licensed under CC BY 2.0

Example of Button Battery

Kris R. Jatana, MD, FAAP, FACS
Associate Professor
Director, Pediatric Otolaryngology Quality Improvement
Department of Otolaryngology-Head & Neck Surgery
Nationwide Children’s Hospital & Wexner Medical Center
at Ohio State University

MedicalResearch.com: What is the background for this study?  

Response: More than 2,500 pediatric button battery ingestions occur annually in the United States. When lodged in the esophagus, rapid injury can occur from the tissue and saliva connecting the circuit of the battery. Serious injury can occur in a matter of hours. This results in a highly alkaline caustic injury that dissolves tissue, a process called liquefactive necrosis. There was a need for novel mitigation strategies to slow the progression of esophageal injury caused by presence of a button battery. This study aimed at identifying a palatable liquid that can be given at home or hospital setting to reduce esophageal injury until the battery can be removed. Continue reading

Children With Amblyopia and Strabismus Take Longer To Complete Answer Forms

MedicalResearch.com Interview with:
multiple choice test takingKrista Kelly, PhD

Postdoctoral Fellow
Crystal Charity Ball Pediatric Vision Evaluation Center
Retina Foundation of the Southwest
Dallas, TX 75231

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We were interested in seeing whether the fine motor deficits typically seen in amblyopia (lazy eye) and strabismus (crossed eyes) translate to an academic setting. Namely, transferring answers to a multiple choice answer form widely used in standardized testing in schools.

Children with amblyopia and strabismus took about 28% longer than their peers transferring answers to a multiple choice answer form, even though they have good vision in one or both eyes.  Continue reading

Food Allergies More Common in Children With ASD

MedicalResearch.com Interview with:

Wei Bao, MD, PhD Assistant Professor, Epidemiology College of Public Health University of Iowa

Dr. Wei Bao

Wei Bao, MD, PhD
Assistant Professor, Epidemiology
College of Public Health
University of Iowa

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous studies indicated a possible link between immunologic dysfunction and autism. The current study, based on nationally representative large-scale surveys, showed that food allergy, respiratory allergy, and skin allergy, all relevant to immunological dysfunction, were associated with autism spectrum disorder among US children.

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If Maternal Grandmother is Obese, So is Grandchild?

MedicalResearch.com Interview with:
“Great Grandmother” by David Amsler is licensed under CC BY 2.0Rebecca Somerville MB BCh BAO, BMedSci, MRCPI, MPH, PhD
School of Public Health, Physiotherapy and Sports Science
University College Dublin
Dublin, Ireland 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Rates of obesity in the Western world have increased dramatically over recent decades. The negative health consequences of obesity are well known and significant amounts of research have been conducted into the causes and possible solutions. While it is clear that there have been massive changes in diet and physical activity at a societal level that are primarily responsible for this ‘obesity epidemic’, it is less clear the extent to which obesity, once established, or risk factors for same, can be perpetuated down generations. Family studies lend opportunity to explore these questions, however there are few world wide which incorporate 3 generations.

We therefore sought to examine patterns of central adiposity, as measured by waist circumference, between grandparents and their grandchildren, separately in maternal and paternal lines. We were able to utilize prospectively collected data from the Lifeways Cross-Generation Cohort Study. This is a longitudinal birth cohort, established in Ireland in 2001, involving up to 7 members of the same family (mother, father, child and 4 grandparents). In the 589 families where a child had a waist circumference measurement we found that, at the age of both 5 and 9, there was a direct relationship between the waist circumference of the maternal grandmother and her grandchild (both male and female). This remained after adjustment for a wide range of confounding variables including mother’s waist circumference. There was no relationship seen with any of the other grandparents.

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Preterm Infants Need Optimized Nutrition For Maximal Brain Growth

MedicalResearch.com Interview with:
Katherine Ottolini MD, lead study author

Children’s National Health System and

Catherine Limperopoulos, Ph.D., senior study author

Dr. Limperopoulos

Catherine Limperopoulos, Ph.D., senior study author and
Director of Developing Brain Research Laboratory
Children’s National Health System

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Nutrition is an important modifiable factor for brain development in premature infants, however few studies have evaluated the impact of nutritional interventions in the neonatal intensive care unit (NICU) on structural brain development in very premature infants using advanced, quantitative MRI techniques.

The goal of this study was to utilize quantitative MRI to evaluate the impact of macronutrient (carbohydrate, protein, fat) and energy intake throughout the duration of the NICU stay on brain volumes and white matter development in very premature infants at term-equivalent age (TEA).

We prospectively enrolled 68 very low birthweight infants (< 1500g) admitted to Children’s NICU within the first 7 days of life. We found significant negative associations between cumulative macronutrient and energy intake on both the brain’s white matter microstructural development (in the superior cerebellar peduncle, corpus callosum) and regional brain volumetric growth (cortical gray matter and cerebellum).

In contrast, when evaluating average nutritional intake, we found significant associations between lipid and energy intake and regional brain volumes in the cortical gray matter, brainstem and cerebellum.  Continue reading

Fewer US Children Taking Prescription Medications

MedicalResearch.com Interview with:

Craig M. Hales, MD, MPH, MS CDR, U.S. Public Health Service Division of Health and Nutrition Examination Surveys National Center for Health Statistics Centers for Disease Control and Prevention

Dr. Hales

Craig M. Hales, MD, MPH, MS
CDR, U.S. Public Health Service
Division of Health and Nutrition Examination Surveys
National Center for Health Statistics
Centers for Disease Control and Prevention

MedicalResearch.com: What is the background for this study?

Response: Monitoring trends in prescription medication use among children and adolescents is an important part of understanding the health of youth in the U.S. and the healthcare they receive.

For this study we used data from the National Health and Nutrition Examination Survey or NHANES, which is a nationally representative survey of the US population and as part of this face-to-face survey in the home, we ask participants about their prescription medication use in the last 30 days and collect information about the prescription directly from the medication package.

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Parents More Willing To Lets Kids Watch ‘Justified’ Violence on TV

MedicalResearch.com Interview with:
“Crime Scene _MG_4847” by thierry ehrmann is licensed under CC BY 2.0Daniel Romer, PhD

Research Director Annenberg Public Policy Center and
Director of its Adolescent Communication Institute (ACI)
University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have been studying the steady increase in gun violence that has been occurring in popular PG-13 movies since the new rating was adopted in 1984.  It has recently even surpassed the amount of gun violence in R-rated movies.  Since these movies are open to the public at any age, we are concerned that they promote the use of guns and potentially socialize youth to believe that using guns to defend oneself is an appropriate way to handle threats and other conflicts.

We knew that the rating requires the omission of graphic consequences, such as blood and suffering, that can make the violence more acceptable.  But we also wondered whether the motivation for the violence might make a difference as well.  Many of the characters in PG-13 movies are seen as heroic (e.g., Bruce Willis and Liam Neeson).  Could that also be a factor that makes such films more acceptable to parents despite their concerns about their children seeing so much violence in the movies.  So, we conducted this experiment to see if parents are less upset by justified violence in PG-13 style movies.  Continue reading

NICU Babies’ Parents at Risk For Depression

MedicalResearch.com Interview with:

Karen Fratantoni, M.D., M.P.H. Pediatrician and lead study author Children’s National Health System

Dr. Fratantoni

Karen Fratantoni, M.D., M.P.H.
Pediatrician and lead study author
Children’s National Health System

MedicalResearch.com: What is the background for this study?

Response: We looked at the prevalence of depressive symptoms at NICU discharge and at six months after discharge among 125 parents randomized to the control group of a larger PCORI-funded trial of peer-to-peer support after NICU discharge. Determining factors associated with parental depressive symptoms at NICU discharge may help to identify at-risk parents who could benefit from mental health support.

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How Many Diseases Should Newborns Be Screened For?

MedicalResearch.com Interview with:
“Newborn” by Brad Carroll is licensed under CC BY 2.0Dr Sian Taylor-Phillips MPhys, PhD
Associate Professor Screening and Test Evaluation /
NIHR Career Development Fellow
Division of Health Sciences
Warwick Medical School
University of Warwick Coventry

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In newborn blood spot screening a small amount of blood is taken from newborn babies heels, and this is tested for a range of rare diseases. The idea is to detect each disease earlier when it is more treatable. However, it would be better not to test for some diseases, for example if the test is inaccurate so worries parents that their baby may have a serious illness when they do not. Some countries test for as few as 5 diseases and others as many as 50. In this study we investigated how different countries choose which diseases to test for.

We found that many national recommendations on whether to screen newborn babies for rare diseases do not assess the evidence on the key benefits and harms of screening. Evidence about the accuracy of the test was not considered in 42% of recommendations, evidence about whether early detection at screening has health benefits was not consulted in 30% of recommendations, and evidence around the potential harm of overdiagnosis where babies have variants of the disease that would never have caused any symptoms or ill effects was not considered in 76% of recommendations.

We also found through meta-analysis that when a systematic review was used to bring together the evidence then countries were less likely to recommend screening for the disease.

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Should Kids With Traumatic Injuries Be Screened For Mental Health Issues?

MedicalResearch.com Interview with:

Dr-Julie-Leonard

Dr. Leonard

Dr. Julie Leonard MD MPH
Nationwide Children’s Hospital
Columbus, OH

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We looked at children with unintentional injuries who were hospitalized to see if there was an increase in their mental health needs. We saw an average 63% increase in mental health diagnoses and a 155% increase in medications prescribed to treat a mental illness.

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Over 2.5 Million US Kids Diagnosed With Anxiety and Depression

MedicalResearch.com Interview with:
Rebecca H. Bitsko, PhD

National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: CDC’s National Center on Birth Defects and Developmental Disabilities(https://www.cdc.gov/ncbddd/index.html) (NCBDDD) is committed to helping children who have mental, emotional, and behavioral disorders. Anxiety and depression are both internalizing mental disorders that often start during childhood, and that frequently occur together.

In this study, we show that more than 1 in 20, or 2.6 million, US children aged 6-17 had a current diagnosis of anxiety or depression, by parent report, in 2011-12. We also found an increase of diagnosed anxiety in these children from 1 in 28 in 2007 to 1 in 24 in 2011-12.

Further, in 2011-12, approximately 1 in 5 children with current anxiety or depression did not receive mental health treatment in the past year.

Children with current anxiety or depression were more likely than those without to have:

  • Another mental, behavioral, or developmental disorder such as ADHD, learning disability, or speech or language problems
  • School problems
  • Parents who report high levels of stress and frustration with parenting
  • Unmet medical and mental health service needs

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Severely Malnourished Children May Benefit From Vitamin D Supplement

MedicalResearch.com Interview with:
Dr Javeria Saleem PhD

Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry
Queen Mary University of London
London, United Kingdom

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Severe acute malnutrition is the most extreme and visible form of undernutrition. Affected children have very low weight for their height and severe muscle wasting; they may also have swollen feet, face and limbs. Around 20 million children suffer from severe acute malnutrition worldwide of whom an estimated 1.4 million live in Pakistan. The condition is a major cause of death in children under 5 in Asia and Africa. The standard treatment is to give a high-energy, micronutrient enhanced paste called ready-to-use therapeutic food (RUTF).

Vitamin D deficiency has been reported to be a risk factor for severe wasting in children with severe acute malnutrition Ready-to-use therapeutic food contains relatively modest amounts of vitamin D. However, the effects of adding high-dose vitamin D to this standard treatment have not previously been evaluated.

We therefore did a clinical trial to assess whether high-dose vitamin D hastened recovery in 185 children aged 6-58 months who were receiving standard treatment for severe acute malnutrition in Southern Punjab, Pakistan. The 93 children in the active arm of the study received two doses of 5 mg vitamin D by mouth, while the 92 children in the control arm received placebo (a dummy medicine containing no vitamin D).

Our findings were very striking: after 2 months of treatment, the children who received high-dose vitamin D in addition to standard therapy had significantly better weight gain, and significantly better motor and language development, than those who received standard treatment alone.

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