Hemophagocytic Lymphohistiocytosis
Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of extreme, systemic immune activation characterized by prolonged fever, hepatosplenomegaly, cytopenias, and elevated markers of inflammation. This constellation of clinical and laboratory findings results from dysregulation of the pathways that govern the immune system ’s inflammatory response, leading to persistent activation of lymphocytes and macrophages. The mortality rate is high, and prompt recognition and treatment initiation are essential for survival. However, diagnosis can be challenging because HLH is rare and can present with nonspecific clinical fin din...
Source: Pediatrics in Review - October 1, 2022 Category: Pediatrics Source Type: research
Persistent Tachycardia in a 10-year-old
(Source: Pediatrics in Review)
Source: Pediatrics in Review - October 1, 2022 Category: Pediatrics Source Type: research
Leukocytosis in the Newborn
(Source: Pediatrics in Review)
Source: Pediatrics in Review - October 1, 2022 Category: Pediatrics Source Type: research
Rhabdomyosarcoma
(RMS) is a rare disease with an incidence in children of 4.5 cases per million per year. Yet, although rare, this is the most common soft tissue sarcoma in children. RMS arises from mesenchymal tissue, which typically differentiates to form striated muscle. Per the World Health Organization 2013 classification, there are now 4 major histologic subtypes of RMS: embryonal, alveolar, pleomorphic, and spindle cell/sclerosing. These subtypes differ significantly in their underlying clinical features and molecular mechanisms. The 2 major subtypes in children are embryonal RMS and alveolar RMS. (Source: Pediatrics in Review)
Source: Pediatrics in Review - October 1, 2022 Category: Pediatrics Source Type: research
Paternal Perinatal Depression in Modern-Day Fatherhood
Postpartum depression in new mothers has become a widely recognized public health concern. Paternal perinatal depression (PPND) and the mental health of fathers in the perinatal period continues to receive significantly less public attention. Overall prevalence rates of up to 25% have been documented in first-time fathers. The presence of maternal depression, unsatisfactory couple relationships, and certain psychosocial and biological risk factors are associated with poor paternal bonding and increased depression risk. Depressed fathers experience excessive self-criticism, restlessness, irritability, and aggression rather ...
Source: Pediatrics in Review - October 1, 2022 Category: Pediatrics Source Type: research
Inability to Bear Weight and Fever in a 16-year-old Boy
(Source: Pediatrics in Review)
Source: Pediatrics in Review - October 1, 2022 Category: Pediatrics Source Type: research
Fever and Pleuritic Chest Pain in a 16-year-old Girl with Ulcerative Colitis
(Source: Pediatrics in Review)
Source: Pediatrics in Review - October 1, 2022 Category: Pediatrics Source Type: research
Acute Kidney Injury in a Previously Healthy 15-year-old Patient
(Source: Pediatrics in Review)
Source: Pediatrics in Review - October 1, 2022 Category: Pediatrics Source Type: research
How to Perform Quality Improvement Projects
Safety and efficiency remain salient concerns for the US health-care system, especially in the face of growing health-care costs and morbidity from low-quality care. Current estimates suggest that more than 20% of health-care costs in the United States represent waste and low-value care, presenting numerous improvement opportunities. Although current guidelines and standards aim to address these problems, system processes and clinician behavior must also change to fill care gaps in the health-care system. Quality improvement (QI) is a systematic approach to safety or value gaps in care that uses data measured over time and...
Source: Pediatrics in Review - October 1, 2022 Category: Pediatrics Source Type: research
Cerebral Palsy: Current Concepts and Practices in Musculoskeletal Care
Cerebral palsy is a neurologic disorder characterized by a spectrum of motor and cognitive deficits resulting from insults to the developing brain. The etiologies are numerous and likely multifactorial; an increasing portion of cases may be attributable to genetic causes, although the exact mechanisms responsible remain poorly understood. Major risk factors include intrauterine stroke and prematurity and neonatal infection, trauma, and hypoxia, which may occur in the prenatal, perinatal, or postnatal period. The Gross Motor Function Classification System (GMFCS) is a widely used tool to establish a child ’s level of func...
Source: Pediatrics in Review - October 1, 2022 Category: Pediatrics Source Type: research
Histiocytic Disorders of Childhood
Histiocytic disorders of childhood represent a wide spectrum of conditions that share the common histologic feature of activated or transformed “histiocytes.” Langerhans cell histiocytosis (LCH) is the most common, with an incidence of approximately 5 per million children. LCH may be difficult to distinguish from more ubiquitous causes of skin rashes, bone pain, or fever. Current chemotherapy fails to cure more than 50% of children with multifocal disease, and treatment failure is associated with increased risks of long-term sequelae. Somatic activating mitogen-activated protein kinase (MAPK) pathway–activating mutat...
Source: Pediatrics in Review - October 1, 2022 Category: Pediatrics Source Type: research
Management of Type 1 Diabetes in Children in the Outpatient Setting
(Source: Pediatrics in Review)
Source: Pediatrics in Review - March 1, 2022 Category: Pediatrics Source Type: research
Fever, Rash, Cytopenia, and Disseminated Intravascular Coagulation in a 6-year-old
(Source: Pediatrics in Review)
Source: Pediatrics in Review - March 1, 2022 Category: Pediatrics Source Type: research
Right-Sided Heart Failure and Cor Pulmonale in the Pediatric Patient
Cor pulmonale was defined in 1961 by the World Health Organization as “hypertrophy of the right ventricle resulting from diseases affecting the function and/or the structure of the lung, except when these pulmonary alterations are the result of diseases that primarily affect the left side of the heart or of congenital heart disease.” (1) Over time, this term has b een misapplied to describe the presence of right-sided heart failure, making it important to distinguish among cor pulmonale, pulmonary hypertension, and right-sided heart failure and to understand their causes. (Source: Pediatrics in Review)
Source: Pediatrics in Review - March 1, 2022 Category: Pediatrics Source Type: research
Attention-Deficit/Hyperactivity Disorder
This article offers an approach to the evaluation, presentation, and management of ADHD with a focus on guiding primary care pediatricians. (Source: Pediatrics in Review)
Source: Pediatrics in Review - March 1, 2022 Category: Pediatrics Source Type: research
