Trauma patients in the pediatric ICU: rational use of a limited resource
Purpose of review Traumatic injuries are a leading cause of pediatric mortality; pediatric ICUs (PICUs) are an important but potentially limited resource associated with high costs. In an era of rising healthcare costs, appropriate resource utilization is important. Here, we examine evidence-based guidelines supporting the management of pediatric traumatic injury outside of the PICU. Recent findings Historical management of solid organ injury and traumatic brain injury was focused on operative management. However, over the past four decades, management of solid organ injury has shifted from invasive management t...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: SPECIAL COMMENTARY Source Type: research

Improving pediatric problem-based learning sessions in undergraduate and graduate medical education
Purpose of review Problem-based learning (PBL) sessions have become common alternatives to traditional didactic-style sessions in medical education, including within pediatric education. The creation and execution of PBL sessions, however, can vary among institutions and even between educators at a given institution. Coupling the personal experiences of a recently-graduated medical student with that of a knowledgeable medical educator, the authors sought to analyze two PBL session experiences of the medical student during her second year with the goal of pinpointing specific elements that add value for both learners an...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

An update on international practice variation in peanut introduction: conundrums, controversies, and a new direction
Purpose of review Introduction of peanut during the first year of life is associated with an 81% relative risk reduction of developing peanut allergy in infants with severe eczema, egg allergy, or both. However, significant international variation exists in risk stratification prior to peanut introduction. Recent findings A policy-level screening approach, such as the one in the United States, is not practical and is associated with higher costs and more cases of peanut allergy over time, in contrast to international models that recommend universal early introduction without prescreening. In Australia, populatio...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

‘Doc, will I ever eat steak again?’: diagnosis and management of alpha-gal syndrome
Purpose of review Alpha-gal syndrome encompasses a constellation of symptoms associated with immune-mediated hypersensitivity responses to galactose-alpha-1,3-galactose (alpha-gal). The purpose of this review is to discuss our current understanding of the etiology, clinical symptoms, natural history, epidemiology, and management of alpha-gal syndrome. Recent findings Sensitization to alpha-gal is associated with bites from ectoparasites like the lone star tick Amblyomma americanum. Allergic reactions in alpha-gal syndrome are often delayed and inconsistent. The magnitude of the allergic response depends on co-fa...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: ALLERGY, IMMUNOLOGY AND RELATED DISORDERS: Edited by Jordan S. Orange Source Type: research

Obesity and immune status in children
Purpose of review Childhood obesity, with persistent chronic inflammation, is a worldwide epidemic. Obesity causes dysregulation throughout the immune system, affecting the balance and levels of cytokines, adipokines, and innate and adaptive immune cells. The present review focuses on the impact of obesity on immune function in children: altering the baseline activation state of immune cells and affecting the ability of the host to combat pathogens and malignancy and respond appropriately to vaccination. Recent findings Obesity causes dysregulation of the immune system. Single-cell RNA-sequencing of adipose tiss...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: ALLERGY, IMMUNOLOGY AND RELATED DISORDERS: Edited by Jordan S. Orange Source Type: research

Diagnosis of primary immunodeficiencies in Peru
Purpose of review Primary immunodeficiencies (PIDs) are human inborn errors of immunity, leading to an increased susceptibility to infections, inflammatory manifestations, and malignancy. We estimate around 16 000 individuals with PIDs living in Peru who are still undiagnosed. The purpose of this review is to make a situational analysis of the diagnosis of PIDs in Peru. Recent findings There is an evident underdiagnosis of PIDs in Peru. Insufficient awareness and lack of diagnostic tools can be solved partially by expanding the number and expertise of Clinical Immunologists and specialized medical centers. The...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: ALLERGY, IMMUNOLOGY AND RELATED DISORDERS: Edited by Jordan S. Orange Source Type: research

Can we prevent allergic disease? Understanding the links between the early life microbiome and allergic diseases of childhood
Purpose of review The microbiome and immune system are intrinsically linked, and during infancy these crucial biological systems undergo a concurrent and expansive maturation process. As these maturation processes progress, some children develop a sequence of IgE-mediated immune disorders termed the ‘Allergic March’, and unfortunately the prevalence of these lifelong and burdensome allergic conditions has increased over the past half century. Our current treatment strategies are unable to prevent or cure components of the Allergic March. However, recent discoveries have enhanced our mechanistic understandin...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: ALLERGY, IMMUNOLOGY AND RELATED DISORDERS: Edited by Jordan S. Orange Source Type: research

Genetic susceptibility to fungal infection in children
Purpose of review Fungal infections have steadily increased in incidence, emerging as a significant cause of morbidity and mortality in patients with iatrogenic immunosuppression. Simultaneously, we have witnessed a growing population of newly described inherited immune disorders that have enhanced our understanding of the human immune response against fungi. In the present review, we provide an overview and diagnostic roadmap to inherited disorders which confer susceptibility to superficial and invasive fungal infections. Recent findings Inborn errors of fungal immunity encompass a heterogeneous group of disord...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: ALLERGY, IMMUNOLOGY AND RELATED DISORDERS: Edited by Jordan S. Orange Source Type: research

Digital systems for improving outcomes in patients with primary immune defects
Purpose of review Healthcare has already been impacted by the fourth industrial revolution exemplified by tip of spear technology, such as artificial intelligence and quantum computing. Yet, there is much to be accomplished as systems remain suboptimal, and full interoperability of digital records is not realized. Given the footprint of technology in healthcare, the field of clinical immunology will certainly see improvements related to these tools. Recent findings Biomedical informatics spans the gamut of technology in biomedicine. Within this distinct field, advances are being made, which allow for engineering...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: ALLERGY, IMMUNOLOGY AND RELATED DISORDERS: Edited by Jordan S. Orange Source Type: research

Ethical and legal considerations related to disorders of consciousness
Purpose of review The purpose of this review is to describe ethical and legal issues that arise in the management of patients with disorders of consciousness ranging from the minimally conscious state to the coma state, as well as brain death. Recent findings The recent literature highlights dilemmas created by diagnostic and prognostic uncertainties in patients with disorders of consciousness. The discussion also reveals the challenges experienced by the disability community, which includes individuals with severe brain injury who are classified as having a disorder of consciousness. We review current guideline...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: NEUROLOGY: Edited by Robert C. Tasker Source Type: research

A review of current controversies in determining death by neurologic criteria in children
Purpose of review Death by neurologic criteria (DNC) is the irreversible cessation of all functions of the entire brain, including the brainstem. It is legally recognized as equivalent to cardiopulmonary death. Legal and ethical controversies surrounding DNC have emerged as a result of several highly publicized cases that have eroded public trust in our ability to declare DNC accurately. In this review, we focus on recently published primary data about DNC and address some of these controversies. Recent findings Approximately 21% of children who die in pediatric intensive care units (PICU) are declared DNC. Alth...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: NEUROLOGY: Edited by Robert C. Tasker Source Type: research

Defining catastrophic brain injury in children leading to coma and disorders of consciousness and the scope of the problem
Purpose of review Severe brain injury in children resulting in coma and disorders of consciousness (DOC) is a catastrophic event for the life and function of children and their families. The present article summarizes the recently published pediatric literature on validated diagnostic assessments, potential predictors of recovery, and outcome measures used in children with catastrophic brain injury (CBI). Literature search terms included variants of consciousness, diagnostic tests, predictors of outcome, and outcome measures. Recent findings Developmentally appropriate diagnostic tools, outcome predictors, and o...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: NEUROLOGY: Edited by Robert C. Tasker Source Type: research

Pediatric delirium: epidemiology and outcomes
Purpose of review Delirium is a frequent complication of serious medical illness in children. The purpose of this review is to highlight recent data on the epidemiology and outcomes related to pediatric delirium, and discuss prevention strategies. Recent findings Delirium rates in the pediatric ICU are greater than 25%. Delirium in children is associated with prolonged mechanical ventilation and hospital length of stay, increased costs, and excess mortality. Pediatric delirium may affect postdischarge cognition and quality of life. Recent initiatives targeting universal screening, early mobilization, and minimiz...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: NEUROLOGY: Edited by Robert C. Tasker Source Type: research

Editorial: Delirium, coma, and death by neurological criteria
No abstract available (Source: Current Opinion in Pediatrics)
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: NEUROLOGY: Edited by Robert C. Tasker Source Type: research

Telegenetics
Purpose of review The aim of the article is to provide an update on recent evidence for utilization and challenges of implementation of telegenetics in the clinical practice. Recent findings Implementation of telegenetics in health systems is still limited, below 10%, somewhat higher for cancer genetic counseling. Nevertheless, telegenetic services have been shown useful in the COVID pandemic. Key factors for efficient implementation include a patient-centered approach, engaging the major stakeholders, and incorporating telegenetics into existing health policies. Main barriers remain: limitations to billing and ...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: GENETICS: Edited by Nathaniel H. Robin Source Type: research

Variants of significance: medical genetics and surgical outcomes in congenital heart disease
This article reviews the current understanding and limitations in knowledge of the effect genetics and genetic diagnoses have on perioperative and postoperative surgical outcomes in patients with congenital heart disease (CHD). Recent findings Presence of a known genetic diagnosis seems to effect multiple significant outcome metrics in CHD surgery including length of stay, need for extracorporeal membrane oxygenation, mortality, bleeding, and heart failure. Data regarding the effects of genetics in CHD is complicated by lack of standard genetic assessment resulting in inaccurate risk stratification of patients when ...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: GENETICS: Edited by Nathaniel H. Robin Source Type: research

Imprinting disorders in humans: a review
Purpose of review Mammals have two complete sets of chromosomes, one from each parent with equal autosomal gene expression. Less than one percentage of human genes are imprinted or show expression from only one parent without changing gene structure, usually by DNA methylation, but reversible in gametogenesis. Many imprinted genes affect fetal growth and development accounting for several human disorders reviewed in this report. Recent findings Disorders include Prader–Willi and Angelman syndromes, the first examples of imprinting errors in humans, chromosome 15q11.2-q13.3 duplication, Silver–Russell...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: GENETICS: Edited by Nathaniel H. Robin Source Type: research

Mitochondrial medicine therapies: rationale, evidence, and dosing guidelines
Purpose of review Primary mitochondrial disease is a highly heterogeneous but collectively common inherited metabolic disorder, affecting at least one in 4300 individuals. Therapeutic management of mitochondrial disease typically involves empiric prescription of enzymatic cofactors, antioxidants, and amino acid and other nutrient supplements, based on biochemical reasoning, historical experience, and consensus expert opinion. As the field continues to rapidly advance, we review here the preclinical and clinical evidence, and specific dosing guidelines, for common mitochondrial medicine therapies to guide practitioners ...
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: GENETICS: Edited by Nathaniel H. Robin Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pediatrics)
Source: Current Opinion in Pediatrics - November 11, 2020 Category: Pediatrics Tags: EDITORIAL INTRODUCTIONS Source Type: research

Current concepts of polycystic ovary syndrome pathogenesis
Purpose of review This review provides a model for understanding polycystic ovary syndrome (PCOS) pathophysiology and updates the evidence on which it is based. Then, it highlights complimentary molecular genetic and epigenetic advances in understanding PCOS cause. Recent findings Important studies into PCOS cause built on the 2014 discovery of a novel regulatory protein variant that underlies the typical PCOS steroidogenic abnormalities: DENND1A.V2 (differentially expressed in normal and neoplastic development, isoform 1A, variant 2). Over 30 DENND1A gene variants have been found, the vast majority upstream of the co...
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: SPECIAL COMMENTARIES Source Type: research

Training in pediatric surgical critical care
Purpose of review The purpose of this review is to describe education, training, certification of fellows in pediatric surgical critical care (PSCC). PSCC is a small but unique specialty within surgery. Education curricula focus on pediatric intensive care, neonatal intensive care, surgical intensive care, and pediatric surgical acute care. Attention is focused on the current state of SCC certification via the American Board of Surgery and future possibilities that could be implemented. Recent findings Because of the uniqueness of the specialty, the little literature that exists focuses on fellow experience including ...
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: SPECIAL COMMENTARIES Source Type: research

The problem of vaccination refusal: a review with guidance for pediatricians
Purpose of review In the wake of multiple recent outbreaks of the measles and other vaccine-preventable diseases, it is crucial to understand and address parental concerns about vaccination. The purposes of this review are: to identify the causes of vaccine resistance, to elucidate the variables that have led to the success or failure of interventions to date, and to consider implications for pediatricians treating children whose parents are vaccination-resistant. Recent findings Recent research draws on insights from cognitive science to understand vaccine resistance and to develop more effective interventions. Studi...
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

Community health workers: improving population health through integration into healthcare systems
Purpose of review The purpose of this review is to describe the role, responsibilities, hiring, training, and retention of community health workers (CHWs) on clinical care teams in the United States. Recent findings CHWs are unique members of clinical care teams because of their ability to foster a deep trust and understanding with patients by sharing similar life experiences, participating in home visits, and providing constant support and advocacy. By partnering with CHWs, other clinical care members also gain a better understanding of their patients allowing them to deliver more culturally competent, patient/family...
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

Medications for constipation in 2020
Purpose of review Chronic constipation is a common problem that substantially impacts the quality of life of patients and families, healthcare professionals, and resources. The purpose of this review is to discuss the medications that are available for management of chronic constipation, including medications that have been approved by the FDA for adults, other been studied in pediatrics now, and might become available within the upcoming years. Recent findings Recent developments in the evaluation of childhood constipation are providing a better understanding into defecation disorders in children and not only new the...
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: GASTROENTEROLOGY AND NUTRITION: Edited by Bradley Barth Source Type: research

Pancreatic complications in children with cystic fibrosis
Purpose of review The pancreas is highly affected in cystic fibrosis, with complications occurring early in childhood. This review highlights recent research in exocrine pancreatic function in the era of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies and discusses how these are affecting pancreatitis and exocrine pancreatic insufficiency (EPI) in children. Additionally, new research into exocrine--endocrine interactions sheds light on how CFTR dysfunction in ductal cells may affect beta cells. Recent findings Ivacaftor has disproved the hypothesis that EPI in children with cystic fibros...
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: GASTROENTEROLOGY AND NUTRITION: Edited by Bradley Barth Source Type: research

Update on celiac disease
Purpose of review The purpose of this review is to describe current updates in celiac disease. Recent findings Recent developments in the understanding of the pathogenesis of celiac disease continue to emerge that may implicate the role of gluten exposure. Several studies have shown that the amount of gluten consumed by the infant may affect the age of onset of celiac disease in genetically predisposed individuals. New guidelines from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition allow serology-based celiac diagnosis, omitting endoscopic biopsies, in children. Recent data and updated gu...
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: GASTROENTEROLOGY AND NUTRITION: Edited by Bradley Barth Source Type: research

Prevention of adverse drug effects: a pharmacogenomic approach
Purpose of review Adverse drug reactions (ADRs) are a serious burden and can negatively impact patient quality of life. One of these ADRs, anthracycline-induced cardiotoxicity (ACT), occurs in up to 65% of treated patients and can lead to congestive heart failure. Pharmacogenetic studies have helped to reveal the mechanisms of ACT and, consequently, inform current strategies to prevent ACT in the clinic. Recent findings Many pharmacogenetic studies have been conducted for ACT, but few have led to the development of clinical practice guidelines and clinical genetic testing for ACT. This is, in part, because of lack of ...
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: CARDIOVASCULAR MEDICINE: Edited by Daniel Bernstein Source Type: research

CPR and AEDs save lives: insuring CPR--AED education and CPR--AED access in schools
Purpose of review Sudden cardiac arrest and sudden cardiac death are less common in children and adolescents than in the adult population. The outcomes from sudden cardiac arrest are generally quite poor in all ages and some data suggest that they are worse in the child and adolescent age group. In addition, the incidence of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use is generally quite low although it is somewhat variable across communities. This review has been written in order to review the data for pediatric bystander CPR and AED use as it relates to out-of-hospital ca...
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: CARDIOVASCULAR MEDICINE: Edited by Daniel Bernstein Source Type: research

Management of familial hypercholesterolaemia in childhood
Purpose of review All guidelines for the management of heterozygous familial hypercholesterolaemia in children and young people recommend statins to lower LDL-cholesterol (LDL-C) concentrations, to reduce the individual's adult risk of developing cardiovascular disease (CVD). Here, we review recent findings regarding the efficacy and safety of the use of stains in childhood. Recent findings As expected from their safety profile in adults, there is no evidence from short-term trials or long-term follow-up that statin use in children is associated with any adverse effects on growth, pubertal development or muscle or liv...
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: CARDIOVASCULAR MEDICINE: Edited by Daniel Bernstein Source Type: research

The benefit of exercise in children with congenital heart disease
Purpose of review Children and adolescents with congenital heart disease (CHD) often have decreased exercise capacity and muscle mass. Exercise has numerous health benefits and can improve exercise capacity and muscle mass. As such, guidelines recommend 60 min of daily physical activity in the majority of pediatric CHD patients. Despite these known benefits and guidelines, children and adolescents with CHD often do not exercise regularly. The purpose of this review is to summarize the current literature on exercise in this population. Recent findings With recent advancements in the field, clinical focus in pediatric...
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: CARDIOVASCULAR MEDICINE: Edited by Daniel Bernstein Source Type: research

Editorial: Advances in Pediatric Cardiology 2020
No abstract available (Source: Current Opinion in Pediatrics)
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: CARDIOVASCULAR MEDICINE: Edited by Daniel Bernstein Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pediatrics)
Source: Current Opinion in Pediatrics - September 10, 2020 Category: Pediatrics Tags: EDITORIAL INTRODUCTIONS Source Type: research

Fetal surgery and neonatal ICU admissions
Purpose of review Fetal intervention is a dynamic field with wide-reaching implications on neonatal ICU admissions and the care of neonates with congenital anomalies. The aim of this review is to summarize recent advancements in fetal surgery and provide a broad understanding of how these topics interrelate. Recent findings Advancements in prenatal imaging and diagnosis have dramatically expanded the indications for fetal intervention. Most recently, there has been a large focus on evaluating minimally invasive strategies of fetal intervention, notably fetoscopic surgery, and the use of stem cells for fetal treatment ...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: SPECIAL COMMENTARY Source Type: research

Management of neonates after postpartum discharge and all children in the ambulatory setting during the coronavirus disease 2019 (COVID-19) pandemic
Purpose of review The present coronavirus disease 2019 (COVID-19) pandemic has created additional challenges with an increased number of presumed healthy, full-term newborns being discharged at 24 h after delivery. Short lengths of stay raise the possibility of mother–infant dyads being less ready for discharge, defined as at least one of the three informants (i.e., mother, pediatrician, and obstetrician) believing that either the mother and/or infant should stay longer than the proposed time of discharge. This public health crisis has reduced the number of in-person well child visits, negatively impacting vaccin...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

Recent advances in addressing vaccine hesitancy
Purpose of review To offer healthcare providers current, evidence-based approaches for addressing vaccine hesitancy to increase vaccine coverage and reduce the frequency of vaccine-preventable disease outbreaks. Recent findings Vaccine hesitancy is a growing problem with profound societal, economic, and medical consequences. Understanding the complexity of vaccine hesitancy can inform approaches to increasing vaccine uptake on both the individual and population levels. Notably, pediatricians play a critical role in increasing vaccine uptake due to their relationships with families. This doctor–patient relationsh...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

Adolescent suicide: what can pediatricians do?
This article will review the changing rates of suicide, discuss recent literature on risk factors, identify methods to screen for suicidal thoughts and suggest an approach to counseling a suicidal patient. Finally, there will be a brief discussion on safety planning and public health measures to help reduce suicide rates. Recent findings Rates of attempted suicide and death by suicide have been increasing for more than a decade. Risk assessment of potential suicidality remains very challenging, as the risk factors are multifactorial. However, some common risk factors persist including sexual minority identification and ...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

Treatment of cardiometabolic risk factors in patients with type 1 diabetes
This article reviews recent evidence on cardiometabolic risk factors and their management in youth with T1D. Recent findings Adolescents with T1D show early signs of vascular complications, as a result of several cardiometabolic risk factors. Poor glycemic control is one of the main risk factors and the main target of treatment. However, only a minority of adolescents with T1D reaches recommended targets for glycemic control. Hypertension, dyslipidemia, smoking, alcohol use, obesity and insulin resistance are other common cardiometabolic risk factors in this age group. Recent data confirm that screening for these risk f...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: ENDOCRINOLOGY AND METABOLISM: Edited by Sally Radovick Source Type: research

Obesity and insulin resistance in children
Purpose of review It is well known that obesity represents the main modifiable risk factor for insulin resistance in children and adolescents; obesity-induced insulin resistance in children is the most important risk factor for developing cardiovascular diseases and type 2 diabetes in adulthood. The mechanisms through which obesity causes insulin resistance are complex and not completely known to date. Recent findings In children, global adiposity is the main factor determining insulin resistance. Excessive fatty acids play a determinant role in the pathogenesis of insulin resistance in obese children, inducing an inc...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: ENDOCRINOLOGY AND METABOLISM: Edited by Sally Radovick Source Type: research

Update on adrenarche
Purpose of review Adrenarche is the pubertal maturation of the innermost zone of the adrenal cortex, the zona reticularis. The onset of adrenarche occurs between 6 and 8 years of age when dehydroepiandrosterone sulfate (DHEAS) concentrations increase. This review provides an update on adrenal steroidogenesis and the differential diagnosis of premature development of pubic hair. Recent findings The complexity of adrenal steroidogenesis has increased with recognition of the alternative ‘backdoor pathway’ and the 11-oxo-androgens pathways. Traditionally, sulfated steroids such as DHEAS have been considered to...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: ENDOCRINOLOGY AND METABOLISM: Edited by Sally Radovick Source Type: research

Diagnosis and management of pediatric metabolic bone diseases associated with skeletal fragility
Purpose of review The goal of this review is to give an overview of diagnosis and up-to-date management of major pediatric metabolic bone diseases that are associated with bone fragility, including nutritional rickets, hypophosphatemic rickets, osteogenesis imperfecta, Ehlers--Danlos syndrome, Marfan's syndrome, hypophosphatasia, osteopetrosis and skeletal fluorosis. Recent findings During the past decade, a number of advanced treatment options have been introduced and shown to be an effective treatment in many metabolic bone disorders, such as burosumab for hypophosphatemic rickets and asfotase alfa for hypophosphata...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: ENDOCRINOLOGY AND METABOLISM: Edited by Sally Radovick Source Type: research

Clinical expression of endocrine disruptors in children
Purpose of review Health status is the result of complex interaction between individual factors, general environmental factors and specific factors as nutrition or the presence of chemicals. Aim of this review is to point out the more recent knowledge covering the role of the endocrine disrupting chemical (EDC) on pediatric population wellbeing. Recent findings Prenatal, postnatal life and puberty are the three main temporal windows of susceptibility when EDCs may act. The mechanism is independent from dose or duration of exposition, sex, age or combination of chemicals and may also be transgenerational, affecting bot...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: ENDOCRINOLOGY AND METABOLISM: Edited by Sally Radovick Source Type: research

Use of sleeve gastrectomy in adolescents and young adults with severe obesity
Purpose of review The prevalence of pediatric obesity and its associated complications is increasing around the world. Treatment of obesity is challenging and metabolic and bariatric surgery (MBS) is currently the most effective treatment for this condition. At this time, vertical sleeve gastrectomy (VSG) is the most commonly performed bariatric procedure in adolescents. However, knowledge regarding the efficacy, safety, and durability of VSG in adolescents is still evolving. This review summarizes the most recent updates in the field of MBS particularly VSG in adolescents. Recent findings MBS is recommended to treat ...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: ENDOCRINOLOGY AND METABOLISM: Edited by Sally Radovick Source Type: research

PIK3CA vascular overgrowth syndromes: an update
Purpose of review Over the past decade many previously poorly understood vascular malformation disorders have been linked to somatic activating mutations in PIK3CA, which regulates cell survival and growth via activation of the mTOR1-AKT pathway. The goal of this article is to describe and provide an update on the clinical features, complications, and management strategies for the PIK3CA-related overgrowth spectrum (PROS). Recent findings PROS encompasses a heterogenous group of disorders with complications related to the tissues harboring the mutation. Vascular malformation syndromes, such as Klippel–Trenaunay ...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research

Pediatric mastocytosis
Purpose of review The current article highlights recent developments in the field of pediatric cutaneous mastocytosis. Mastocytosis is a spectrum of conditions that range from fleetingly benign to aggressively malignant. Through recognizing the natural progression of disease, the role of biomarkers and mutational analysis, treatment and risk of triggers, physicians can confidently stage, counsel and manage patients with pediatric cutaneous mastocytosis. Recent findings Many lesions of cutaneous mastocytosis are chronic with some resolving around the mid-teenage years. KIT mutations are found in the majority of pediatr...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research

Pediatric contact dermatitis: what's new
Purpose of review Allergic contact dermatitis (ACD) was once thought to be rare in children but recent studies have demonstrated that the prevalence of ACD is common and appears to be increasing in children. Current trends including toys, hobbies, and personal care products may play a role in potentially new allergen exposure or resurgence of certain allergens, making ACD a moving target in children. Recent findings ACD and atopic dermatitis can coexist and certain clinical features can help differentiate ACD from endogenous atopic dermatitis in children. It is important to consider ACD in children with recalcitrant a...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research

Trends in pediatric skin cancer
Purpose of review To inform pediatric providers of the clinical characteristics, underlying genetic drivers, and therapeutic options for skin cancer arising in childhood and adolescence. Recent findings The incidence of melanoma in pediatric patients has been declining in the past decades. Pediatric-specific diagnostic criteria should be utilized when assessing lesions concerning for melanoma to better account for the different presentations seen in pediatric disease compared with adults, such as an increased prevalence of amelanotic melanoma or frequent mimic of benign pediatric lesions. Pediatric melanoma often pres...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research

Pediatric nail disorders: a review
Purpose of review Nail disorders represent an uncommon subset of complaints seen in pediatric dermatology. There is a wide array of disorders that can affect the nail unit in children, including infectious, inflammatory, neoplastic, congenital, and traumatic processes. In order to enhance familiarity with pediatric nail conditions, we review the background and treatment of the more common entities seen in pediatric onychology, including onychomycosis, onychomadesis, nail psoriasis, trachyonychia, longitudinal melanonychia, onychophagia, and onychocryptosis. Recent findings Nail involvement in pediatric patients with p...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research

Hemangioma-related syndromes
Purpose of review There is a growing understanding of complications and anomalies associated with infantile hemangiomas. The current review will discuss recent clinical advances in syndromes associated with segmental hemangiomas, including PHACE and LUMBAR syndrome. In addition, the importance of recognizing visceral hemangiomatosis is highlighted. Recent findings Ongoing longitudinal studies of PHACE and LUMBAR syndromes associated with segmental infantile hemangiomas have led to improved diagnosis and recommendations for screening for associated anomalies. Characterization of a growing spectrum of associated anomali...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research

Congenital melanocytic nevi
Purpose of review To update pediatric providers on new developments in our understanding of the clinical presentation, genetics, and systemic risks associated with congenital melanocytic nevi (CMN). Recent findings CMN are primarily caused by sporadic postzygotic somatic mutations, most frequently in NRAS, and studies of the genetic underpinnings of CMN have demonstrated a diverse array of genetic drivers. The primary complications of large and giant CMN include neurocutaneous melanocytosis and malignant melanoma. Abnormalities in CNS MRI may predict a worse clinical course for patients and increased risk of melanoma....
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research

Editorial: Pediatric dermatology: skin signs of systemic disease
No abstract available (Source: Current Opinion in Pediatrics)
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research