Updating the healthcare maintenance visit for children with medical complexity: applying lessons learned from the coronavirus disease 2019 pandemic
This article uniquely describes how pediatric providers in various clinical settings can adapt routine healthcare maintenance visits to meet the needs of CMC in the era of COVID-19. We also discuss unique visit components important to address when providing primary care to CMC, including caregiver support, disaster preparedness, long-term care planning, and telemedicine. Recent findings Although some children may be less severely affected by COVID-19 than adults, current literature suggests that CMC may be at higher risk for severe disease. In addition, the COVID-19 pandemic has highlighted the value in consistent, ...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

Recognizing vitamin A deficiency: special considerations in low-prevalence areas
Purpose of review Although vitamin A deficiency (VAD) is rare in well resourced countries, there is a growing trend of VAD in at-risk pediatric populations. Early diagnosis is critically important to prevent its associated morbidity and mortality. This review highlights key lessons for evaluation, diagnosis, and management of children with xerophthalmia in the United States. It synthesizes the latest findings from the literature on the pathophysiology, epidemiology, risk factors, evaluation, and management of VAD in low-prevalence areas. Recent findings Vitamin A is crucial for maintaining the functional integri...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

Kidney transplantation in pediatric patients with rheumatologic disorders
Purpose of review Providers caring for children with end-stage kidney disease from rheumatologic conditions face questions such as when to proceed with kidney transplantation, how common is disease recurrence posttransplant, how does recurrent disease impact patient and allograft outcomes, and what approaches are available to prevent and treat recurrent disease. We discuss recent developments and relevant literature that address these questions for the most common rheumatologic disorders that lead to end-stage kidney disease in childhood namely, systemic lupus erythematosus, IgA nephropathy, IgA Vasculitis/Henoch Schoe...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEPHROLOGY: Edited by Michel Baum Source Type: research

Polyarteritis nodosa
Purpose of review The aim is to review recent reports on childhood polyarteritis nodosa, including recent reports on treatment and outcome. Recently deficiency of adenosine deaminase-2 (ADA2), which may present as a polyarteritis nodosa-mimic, is becoming an important part of our practice. We also aim to highlight differences of childhood polyarteritis nodosa with deficiency of ADA2 as well as adult-onset disease. Recent findings The few recent childhood series confirm the systemic nature of this vasculitis with predominantly medium-vessel involvement. American College of Rheumatology Vasculitis foundation has s...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEPHROLOGY: Edited by Michel Baum Source Type: research

Childhood-onset Takayasu arteritis
Purpose of review Takayasu arteritis is a rare chronic granulomatous large vessel vasculitis that predominantly affects the aorta and its branches. The purpose of this review is to unite the current knowledge regarding the pathophysiology, cause, and epidemiology as well as diagnosis, prognosis, and treatment of this condition in children. Recent findings Although the etiopathogenesis is not fully understood, studies suggest an autoimmune basis for the disease as well as a genetic predisposition. It is a disease primarily affecting young women with up to a third of cases with onset in childhood. There are distin...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEPHROLOGY: Edited by Michel Baum Source Type: research

Updates in childhood Sjogren's syndrome
Purpose of review Childhood Sjogren's syndrome (cSS) is a rare, chronic autoimmune disease characterized by inflammation of the exocrine glands. cSS is underrecognized because of differences in clinical presentation compared with adults. Until recently, publications describing clinical manifestations in cSS were limited to case reports and case series with small numbers of patients. Diagnostic studies to assess glandular symptoms in adults, are less commonly obtained in children. Recent findings Recent cohort studies describe presenting diagnostic clinical features in large populations of cSS and demonstrate how...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEPHROLOGY: Edited by Michel Baum Source Type: research

IgA vasculitis nephritis
Purpose of review The purpose of this update is to summarize current knowledge on the pathophysiology of immunglobulin A (IgA) vasculitis nephritis (IgAVN) as well as to critically review evidence for established therapeutic regimes and available biomarkers. An additional purpose is to raise the discussion what could be done to further improve our understanding of IgAVN, identify patients at risk for adverse outcome and increase the evidence for therapy recommendations. Recent findings Clinical and experimental studies have established the concept of a multilevel pathogenesis. Toll-like-receptor activation, B ce...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEPHROLOGY: Edited by Michel Baum Source Type: research

Renal manifestations of paediatric systemic lupus erythematosus
Purpose of review Systemic lupus erythematosus is a lifelong, multisystemic disease. Around a fifth of patients present during childhood. Children are recognized to have a more active disease course with more renal involvement (lupus nephritis) when compared with adults. This review article summarizes the current literature surrounding the management of paediatric lupus nephritis. Recent findings International recommendations agree that active, proliferative forms of lupus nephritis are treated with a period of intense induction therapy aimed at inducing remission followed by maintenance immunosuppressive therap...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEPHROLOGY: Edited by Michel Baum Source Type: research

Antineutrophilic cytoplasmic antibody-associated vasculitis and the kidney
Purpose of review The purpose of this review is to highlight recent studies that have emerged on the topic of ANCA-associated vasculitis with some historical context. The review also discusses how the adult data is relevant to pediatric patients. Recent findings Pediatric studies on AAV are lacking. Therapies targeted to the inflammatory cascade specifically implicated in AAV, such as MPO inhibitors and complement mediators, are emerging. The PEXIVAS study recently called into question the routine use of plasma exchange (PLEX) in severe AAV, with no difference in ESKD or mortality found between patients who did ...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEPHROLOGY: Edited by Michel Baum Source Type: research

Neonatal lymphatic flow disorders: central lymphatic flow disorder and isolated chylothorax, diagnosis and treatment using novel lymphatic imaging and interventions technique
Purpose of review Neonatal lymphatic disorders (NLDs) are conditions that are relatively rare and difficult to treat. The recent development of lymphatic imaging, such as Dynamic Contrast-Enhanced MR Lymphangiography and Intranodal Lymphangiography has led to a new, better understanding of the anatomical substrate and pathophysiological mechanisms of the diseases. Consequently, this has allowed the development of new targeted therapeutic interventions as well as prognostication for this population with lymphatic flow disorders. Recent findings The underlying causes of all NLD is an obstruction or altered flow of...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEONATOLOGY AND PERINATOLOGY: Edited by Tara M. Randis and Thomas A. Hooven Source Type: research

Intestinal failure-associated liver disease in the neonatal ICU: what we know and where we’re going
Purpose of review Parenteral nutrition is an integral part of the care of infants in the neonatal ICU. However, prolonged use of parenteral nutrition can be associated with adverse outcomes, most notably parenteral nutrition-associated liver disease, now known as intestinal failure-associated liver disease (IFALD). This review highlights pertinent developments in the epidemiology of IFALD as it pertains to neonates and showcases recent advances in the pathophysiology, treatment, and outcomes of neonates with IFALD. Recent findings The role of intravenous lipid emulsions in the pathogenesis, prevention, and treat...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEONATOLOGY AND PERINATOLOGY: Edited by Tara M. Randis and Thomas A. Hooven Source Type: research

Surgical management of complex neonatal airway abnormalities
Purpose of review The neonatal airway is subject to a variety of developmental abnormalities with a wide range of complexity. Symptomatic pathologies present in a spectrum ranging from simple noisy breathing or poor feeding to frank respiratory distress. Diagnosis requires a high index of suspicion, characterization of noisy breathing, and identification of obstructive symptoms such as increased work of breathing, retractions, and difficulty feeding. Surgical management is directed by the pathology. Recent findings The past several years have seen an expansion of surgical innovation as endoscopic and open techni...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEONATOLOGY AND PERINATOLOGY: Edited by Tara M. Randis and Thomas A. Hooven Source Type: research

Toward greater nuance in delayed cord clamping
Purpose of review For over a decade, the International Liaison Committee on Resuscitation has recommended delayed cord clamping (DCC), but implementation has been variable due to lack of consensus on details of technique and concerns for risks in certain patient populations. This review summarizes recent literature on the benefits and risks of DCC in term and preterm infants and examines alternative approaches such as physiologic-based cord clamping or intact cord resuscitation (ICR) and umbilical cord milking (UCM). Recent findings DCC improves hemoglobin/hematocrit among term infants and may promote improved n...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEONATOLOGY AND PERINATOLOGY: Edited by Tara M. Randis and Thomas A. Hooven Source Type: research

First intention high-frequency jet ventilation for periviable infants
Purpose of review Ventilation of periviable infants born at 22–23 weeks gestation remains a challenge in neonatology. This review highlights the evidence surrounding the use of first intention high-frequency jet ventilation (HFJV) in infants born near the limits of viability with a review of pulmonary fetal development and a focused overview of HFJV strategies including an in-depth analysis of the management strategies used in the initial randomized trials. Recent findings A paucity of recent trials exists, with no randomized control trials assessing the use of first intention HFJV performed in the last 25 yea...
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEONATOLOGY AND PERINATOLOGY: Edited by Tara M. Randis and Thomas A. Hooven Source Type: research

Editorial: Neonates deserve more research funding
No abstract available (Source: Current Opinion in Pediatrics)
Source: Current Opinion in Pediatrics - March 10, 2022 Category: Pediatrics Tags: NEONATOLOGY AND PERINATOLOGY: Edited by Tara M. Randis and Thomas A. Hooven Source Type: research