An update on allergic emergencies
Purpose of review To provide an updated framework of management for allergic emergencies. Recent findings The most frequent causes of anaphylaxis include medications, foods, and stinging insects. Early and appropriate administration of epinephrine is critical to managing anaphylaxis. Although epinephrine is well tolerated and there is no absolute contraindication to using epinephrine in first-aid management of anaphylaxis, many patients at risk for anaphylaxis still fail to carry and use the medication prior to seeking emergency care. Outcomes of allergic emergencies can be improved by educational efforts that focus o...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

Prevention of allergy with diverse and healthy microbiota: an update
Purpose of review Microbiota consist of symbiotic microscopic neighbors that interact on and within our bodies in diverse and incompletely understood ways throughout our lifetime. Though various associations with allergic disease have been described, clear effective therapeutic interventions to prevent allergy have been elusive. Recent findings The human microbiome is influenced by multiple factors, including: mode of infant delivery (vaginal vs. cesarean section), breastfeeding, diet, presence of siblings and pets, exposure to antibiotics and other medications (particularly antacids), lifestyle, and developmental con...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

Ethical challenges in regionalization of pediatric surgical care
Purpose of review Rapid advancement in the field of pediatric surgery has resulted in unprecedented opportunities to advance the care of children. However, assuring that the highest quality, most appropriate care is available to all pediatric patients remains challenging. Regionalization of care has been proposed as a means of obtaining this critical goal. In this review, we discuss the ethical challenges associated with regionalization of pediatric surgical care. Recent findings Regionalization of pediatric surgical care is associated with improved patient outcomes. Over half of pediatric surgeons favor regionalizati...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: SURGERY: Edited by Grace Z. Mak and Jessica J. Kandel Source Type: research

Who moved my fellow: changes to Accreditation Council for Graduate Medical Education fellowships in pediatric surgery and what may be yet to come
Purpose of review Over the past 15 years, the Accreditation Council for Graduate Medical Education (ACGME) has significantly altered the regulatory framework governing fellowship training in pediatric surgery. The daily experiences of pediatric surgical trainees have been impacted by these changes, but training program directors and faculty have not developed a consistent approach to managing this shift. This review highlights the changes, which have occurred, analyzes the current state of fellowship training, and proposes potential strategies for management. Recent findings The implementation of work hour restriction...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: SURGERY: Edited by Grace Z. Mak and Jessica J. Kandel Source Type: research

Global children's surgery: recent advances and future directions
Purpose of review Two-thirds of the world's population lacks access to surgical care, many of them being children. This review provides an update on recent advances in global children's surgery. Recent findings Surgery is being increasingly recognized as an essential component of global and child health. There is a greater focus on sustainable collaborations between high-income countries (HICs) and low-and-middle-income countries (HICs and LMICs). Recent work provides greater insight into the global disease burden, perioperative outcomes and effective context-specific solutions. Surgery has continued to be identified ...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: SURGERY: Edited by Grace Z. Mak and Jessica J. Kandel Source Type: research

Rural health, telemedicine and access for pediatric surgery
Purpose of review Access to care for children requiring pediatric general or specialty surgery or trauma care who live in rural areas remains a challenge in the United States. Recent findings The expertise of specialists in tertiary centers can be extended to rural and underserved areas using telemedicine. There are challenges to making these resources available that need to be methodically approached to facilitate appropriate relationships between hospitals and providers. Programs, such as the National Pediatric Readiness Project and the HRSA Emergency Medical Services for Children Program enhance the capability of t...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: SURGERY: Edited by Grace Z. Mak and Jessica J. Kandel Source Type: research

Ovary-sparing surgery for benign pediatric ovarian masses
Purpose of review This review highlights progress in the management of pediatric ovarian neoplasms. Recent research has identified disparities in the management of patients with benign ovarian neoplasms based on a variety of factors. However, the long-term effects of unilateral oophorectomy have prompted an emphasis on ovary-sparing surgery (OSS) for benign masses. One of the challenges still facing providers is the preoperative differentiation between benign and malignant masses. Recent findings Recent studies highlight the variability in practice patterns surrounding the management of benign ovarian neoplasms. Progr...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: SURGERY: Edited by Grace Z. Mak and Jessica J. Kandel Source Type: research

Pediatric postoperative opioid prescribing and the opioid crisis
Purpose of review The purpose of this review is to explore the effects of the opioid crisis on pediatric patients in the postoperative setting and provide recommendations for well-tolerated opioid prescribing practices. Recent findings Opioid overdoses have increased among all age groups, predominantly related to overprescribing and accessibility of opioids in the home. Adverse risks of prescribed opioids include respiratory depression, gastrointestinal distress, accidental ingestion, intentional misuse, new chronic use, diversion to another user, and overdose. Well-tolerated opioid prescribing practices include multi...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: SURGERY: Edited by Grace Z. Mak and Jessica J. Kandel Source Type: research

An update in the management of pediatric sarcoma
Purpose of review Nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) is a rare subgroup of malignancy in childhood that is composed of a variety of soft tissue and bony tumors. Prognosis for resectable localized disease is usually good and improved with systemic treatment. However, survival from locally advanced and metastatic disease remains poor. There have been numerous preclinical and clinical studies to define histopathology, biology, and genetic alteration of sarcomas. The purpose of this review is to clarify the progress in the management of NRSTS. Recent findings Genomic analysis, including the use of next-genera...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: SURGERY: Edited by Grace Z. Mak and Jessica J. Kandel Source Type: research

Editorial: Changing paradigms in pediatric surgery
No abstract available (Source: Current Opinion in Pediatrics)
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: SURGERY: Edited by Grace Z. Mak and Jessica J. Kandel Source Type: research

Long-term ventilation for children with chronic lung disease of infancy
Purpose of review Modern medical advances have resulted in an increased survival after extremely preterm birth. However, some infants will develop severe bronchopulmonary dysplasia (BPD) and fail to wean from invasive or noninvasive positive pressure support. It remains unclear which infants will benefit from tracheostomy placement for chronic ventilation. Once the decision to pursue chronic ventilation has been made, questions remain with respect to the timing of tracheotomy surgery, optimal strategies for mechanical ventilation, and multidisciplinary care in both the inpatient and outpatient settings. The appropriate t...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: PULMONOLOGY: Edited by David N. Cornfield Source Type: research

Asthma in children with sickle cell disease
Purpose of review Asthma is common in children with sickle cell disease (SCD) and appears to be associated with increased morbidity. Providers caring for children with SCD have struggled with the question of whether asthma exists as a true comorbidity or whether certain aspects of the chronic inflammatory disease gives children with SCD an asthma-like phenotype. Recent findings Clinical signs and symptoms seen in children with asthma in the general population, such as wheezing, airway hyperresponsiveness, atopy, elevated leukotrienes, and abnormal lung function are seen in children with SCD both with and without a dia...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: PULMONOLOGY: Edited by David N. Cornfield Source Type: research

Asthma severity, nature or nurture: genetic determinants
This article reviews the progress in the search for the genetic determinants of severe asthma. Recent findings Twin studies estimate that approximately 25% of the phenotypic variability in asthma severity is determined by genetic factors, with the remainder determined by nongenetic factors including environmental and psychosocial factors, behavioral traits, and comorbidities. Most genetic association studies of asthma severity performed to date are underpowered and not designed to clearly distinguish asthma severity variants from asthma susceptibility variants. However, the most recent genome-wide asthma severity associ...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: PULMONOLOGY: Edited by David N. Cornfield Source Type: research

Genetic causes of surfactant protein abnormalities
Purpose of review Mutations in genes encoding proteins critical for the production and function of pulmonary surfactant cause diffuse lung disease. Timely recognition and diagnosis of affected individuals is important for proper counseling concerning prognosis and recurrence risk. Recent findings Involved genes include those encoding for surfactant proteins A, B, and C, member A3 of the ATP-binding cassette family, and for thyroid transcription factor 1. Clinical presentations overlap and range from severe and rapidly fatal neonatal lung disease to development of pulmonary fibrosis well into adult life. The inheritanc...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: PULMONOLOGY: Edited by David N. Cornfield Source Type: research

Editorial: Pediatric pulmonology, ever changing, but happily in the same, old boat
No abstract available (Source: Current Opinion in Pediatrics)
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: PULMONOLOGY: Edited by David N. Cornfield Source Type: research

Precision medicine in pediatric sepsis
Purpose of review Pediatric sepsis is a heterogeneous state associated with significant morbidity and mortality, but treatment strategies are limited. Clinical trials of immunomodulators in sepsis have shown no benefit, despite having a strong biological rationale. There is considerable interest in application of a precision medicine approach to pediatric sepsis to identify patients who are more likely to benefit from targeted therapeutic interventions. Recent findings Precision medicine requires a clear understanding of the molecular basis of disease. ‘Omics data’ and bioinformatics tools have enabled ide...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: EMERGENCY AND CRITICAL CARE MEDICINE: Edited by Jean E. Klig and Clifford W. Bogue Source Type: research

Rethinking what constitutes a diagnosis in the genomics era: a critical illness perspective
Purpose of review The purpose of this review is to highlight the significant advances in the testing, interpretation, and diagnosis of genetic abnormalities in critically ill children and to emphasize that pediatric intensivists are uniquely positioned to search for genetic diagnoses in these patients. Recent findings Ten years following the first clinical diagnosis made through whole exome sequencing, we remain in the dark about the function of roughly 75% of our genes. However, steady advancements in molecular techniques, particularly next-generation sequencing, have spurred a rapid expansion of our understanding of...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: EMERGENCY AND CRITICAL CARE MEDICINE: Edited by Jean E. Klig and Clifford W. Bogue Source Type: research

Diagnosis of appendicitis in the paediatric emergency department: an update
Purpose of review Concern regarding appendicitis is a common reason for presentation to the paediatric emergency department. We review recent progress in the use of biomarkers, imaging and clinical scoring systems in improving diagnostic accuracy in suspected appendicitis in children. Recent findings Use of ultrasound, often performed at the bedside, is becoming more widespread with a parallel reduction in computed tomography (CT) use. Protocols for image acquisition and interpretation have been shown to improve diagnostic accuracy. Novel biomarkers have been explored and clinical diagnostic algorithms refined but non...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: EMERGENCY AND CRITICAL CARE MEDICINE: Edited by Jean E. Klig and Clifford W. Bogue Source Type: research

Pediatric disaster preparedness: identifying challenges and opportunities for emergency department planning
Purpose of review To review the current literature on best practices for pediatric disaster preparedness in an emergency department (ED). Recent findings Children have unique anatomical, physiologic, immunologic, and psychosocial needs that impact their vulnerability to and resilience in a disaster, yet they have been historically underrepresented in disaster planning at local and national levels. Lessons learned from recent disaster events, disaster research, and disaster experts provide guidance on pediatric disaster preparedness for ED. Summary All EDs should include children in their disaster plans and exercise...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: EMERGENCY AND CRITICAL CARE MEDICINE: Edited by Jean E. Klig and Clifford W. Bogue Source Type: research

Quality improvement and crisis resource management in pediatric resuscitation
Purpose of review The pediatric resuscitation environment is a high-stakes, environment in which a multidisciplinary team must work together with patient outcomes dependent, at least in part, on the performance of that team. Given constraints of the environment and the nature of these events, quality improvement work in pediatric resuscitation can be challenging. Ongoing collection of accurate and reliable data on team performance is necessary to inform and evaluate change. Recent findings Despite the relative difficulty of quality improvement analysis and intervention implementation in the resuscitation environment, ...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: EMERGENCY AND CRITICAL CARE MEDICINE: Edited by Jean E. Klig and Clifford W. Bogue Source Type: research

Cannabis-related emergencies in children and teens
Purpose of review To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population. Recent findings There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use. The range of presentations documented in the recen...
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: EMERGENCY AND CRITICAL CARE MEDICINE: Edited by Jean E. Klig and Clifford W. Bogue Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pediatrics)
Source: Current Opinion in Pediatrics - May 16, 2019 Category: Pediatrics Tags: EDITORIAL INTRODUCTIONS Source Type: research

Addressing adverse childhood experiences in diverse racial and ethnic settings: a review
This article reviews the current literature on adverse childhood experiences (ACEs) with particular focus on racial and ethnic factors. Recent findings Limited research exists with respect to ACEs and certain racial and ethnic groups. In this article, we highlight the unique challenges specific populations may face in their lives. Further research on ACEs in these and other racial and ethnic groups is needed to help clinicians contextualize their cases in the clinical setting. Summary As the US population continues to diversify, it is pivotal that clinicians and researchers understand some of the challenges faced by ...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

Physiologic diagnosis of congenital heart disease in cyanotic neonates
Purpose of review We aim to improve diagnosis of congenital heart disease (CHD) with cyanosis by physiology for general practitioners to reduce time to appropriate treatment. Recent findings New implementation of the critical congenital heart disease (CCHD) pulse oximetry screen has improved rate of diagnosis of CHD in recent years. However, many infants with cyanotic heart lesions often decompensate before screening in the newborn nursery, or have lesions that are not amenable to pulse oximetry screening and that present later in the emergency room. Recent literature has shown preoperative acidosis because of delayed...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

Neurotoxicity of general anesthetics in children: evidence and uncertainties
Purpose of review Compelling evidence in animal models that, under some conditions, general anesthetics and sedatives produce changes in the brain and persistent impairments in learning, memory, and behavior. The present review summarizes recent clinical studies investigating whether the use of these agents in children causes similar neurotoxicities. Recent findings Although the results of retrospective studies are somewhat mixed, multiple exposures to general anesthesia were generally found to confer greater risk than single exposures with regard to learning disability, attention deficit hyperactivity disorder, schoo...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: THERAPEUTICS AND TOXICOLOGY: Edited by Robert Wright Source Type: research

What is new in electronic-cigarettes research?
Purpose of review Electronic cigarettes (e-cigarettes) and other vaping devices have seen extraordinary growth in use in the past 10 years, and companies are accelerating their development of new products and marketing efforts. In turn, researchers have increased their efforts to determine how e-cigarettes affect health, how marketing these products impacts adolescents and how the use of e-cigarettes may affect adolescents’ use of other tobacco products. Products like Juul were not on the market 2 years ago; thus, frequent updates on the topic are essential. Recent findings Studies have begun to demonstrate that...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: THERAPEUTICS AND TOXICOLOGY: Edited by Robert Wright Source Type: research

Cannabinoid toxicity in pediatrics
Purpose of review The advent of legalized cannabis in multiple regions of the United States has rendered the drug more accessible to pediatric patients. Pediatricians and Pediatric Emergency Medicine Providers face new challenges in counseling both patients and their parents, diagnosing exploratory ingestions of cannabinoids in toddlers, and managing complications of prolonged, heavy cannabis use in adolescents. The purpose of this review article is to provide clinicians a succinct summary of recent literature regarding tetrahydrocannabinol (THC) pharmacokinetics, pharmacodynamics, impacts on development, as well as pres...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: THERAPEUTICS AND TOXICOLOGY: Edited by Robert Wright Source Type: research

Chimeric antigen receptor T-cell toxicity
Purpose of review Chimeric antigen receptor -(CAR) T-cell therapy has become a commonly used immunotherapy originally used in the treatment of B-cell leukemias but which are now applied broadly across tumor classes. Although high rates of remission are associated with CAR T-cell therapy, toxicities associated with these novel treatment regimens can be lethal if not recognized in a timely manner. Recent findings Cytokine release syndrome and neurotoxicity are the two most common toxicities associated with CAR T-cell therapy. Cytokine release syndrome is characterized by a flu-like illness accompanied by significant hem...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: THERAPEUTICS AND TOXICOLOGY: Edited by Robert Wright Source Type: research

Use of earth observations for temperature exposure assessment in epidemiological studies
Purpose of review Low, high, extreme, and variable temperatures have been linked to multiple adverse health outcomes, particularly among the elderly and children. Recent models incorporating satellite remote sensing data have mitigated several limitations of previous studies, improving exposure assessment. This review focuses on these new temperature exposure models and their application in epidemiological studies. Recent findings Satellite observations of land surface temperature have been used to model air temperature across large spatial areas at high spatiotemporal resolutions. These models enable exposure assessm...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: THERAPEUTICS AND TOXICOLOGY: Edited by Robert Wright Source Type: research

Air pollution, ambient temperature, green space and preterm birth
Purpose of review Preterm birth is the leading cause of global child mortality, and survivors are at increased risk of multiple morbidities that can continue into adulthood. Recent studies have suggested that maternal exposure to air pollution and high and low ambient temperatures may increase the risk of preterm birth, whereas proximity to green space may decrease it. This review summarizes these findings and suggests avenues for further research. Recent findings Particulate matter may be associated with an increased risk of preterm birth, but the magnitude of the effect remains unclear. Heat and cold likely increase...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: THERAPEUTICS AND TOXICOLOGY: Edited by Robert Wright Source Type: research

Living or deceased donor kidney transplantation in children
Purpose of review Kidney transplantation is the preferred treatment modality for children with end-stage renal disease. In this review, we discuss the factors affecting the selection of the appropriate donor to ensure the best possible short and long-term outcomes. Recent findings Outcomes of pediatric renal transplantation from living donors are superior to those obtained from deceased donors. Despite this, the rate of living donor kidney transplantation has declined over the last decade. Living donation is considered to be safe but long-term outcomes, especially for parents who are often young donors, are not well u...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: NEPHROLOGY: Edited by Michel Baum Source Type: research

Renal transplantation and predisposition to opportunistic infections
Purpose of review Infections represent a significant source of morbidity and mortality after kidney transplantation in children. We review recent advances in epidemiology, assessment, prevention and treatment for several different infections. Recent findings Infections, such as bacterial urinary tract infection or opportunistic viral infection remain common, may be increasing and represent a large proportion of hospitalization. Extended antiviral agent use reduces the incidence of cytomegalovirus disease but its efficacy to reduce Epstein–Barr virus disease remains controversial. Human herpesvirus-6 and hepatiti...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: NEPHROLOGY: Edited by Michel Baum Source Type: research

Nonadherence after pediatric renal transplantation: detection and treatment
Purpose of review Nonadherence is a problem in adolescents and young adults. Risk factors are classified as those of the individual, family, health-care-system, or community. I present the latest reports and how to tackle nonadherence. Recent findings Nonadherence risk is independent of one's origin in a high-poverty or low-poverty neighborhood or having private or public insurance in respect to African Americans. Females with male grafts have higher graft-failure risks than do males. Female recipients aged 15–24 with grafts from female donors have higher graft-failure risk than do males. In study of nonadherenc...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: NEPHROLOGY: Edited by Michel Baum Source Type: research

Pathogenesis and treatment of electrolyte problems post transplant
Purpose of review Electrolyte abnormalities posttransplant are common occurrences that can have significant short-term and long-term effects on graft outcome and patient quality of life. Understanding the pathophysiology of these electrolyte derangements can help guide management to optimize bone health and minimize cardiovascular disease. This review explores the pathogenesis of the most common postrenal transplant electrolytes abnormalities as well as current treatment options. Recent findings Clarifications of the role of FGF-23 has improved our understanding of posttransplant bone disease in addition to the known ...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: NEPHROLOGY: Edited by Michel Baum Source Type: research

Editorial: Renal transplantation: a brief history and outlook for the future
No abstract available (Source: Current Opinion in Pediatrics)
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: NEPHROLOGY: Edited by Michel Baum Source Type: research

The neurointensive nursery: concept, development, and insights gained
We describe the development of the first neurointensive care nursery (NICN) as a model for comanagement of neonates with identified neurologic risk factors by a multidisciplinary team constituted of neurologists, neonatologists, specialized nurses, and others with the goal of optimizing management, preventing secondary injury and maximizing long-term outcomes. Recent findings Optimizing brain metabolic environment and perfusion and preventing secondary brain injury are key to neurocritical care. This includes close management of temperature, blood pressure, oxygenation, carbon dioxide, and glucose levels. Early developm...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: NEONATOLOGY AND PERINATOLOGY: Edited by Thomas A. Hooven and Tara M. Randis Source Type: research

Arguments against routine administration of probiotics for NEC prevention
Purpose of review Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality among premature neonates. Although randomized trials have shown that probiotics may be efficacious in the prevention of NEC, their use has not been universally adopted in the neonatal intensive care unit (NICU). Caveats regarding routine probiotic supplementation for the prevention of NEC are summarized in this review. Recent findings Accumulating evidence indicates that prophylactic probiotic supplementation in preterm infants can reduce the incidence of NEC. However, substantial knowledge gaps, regulatory issues, and impl...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: NEONATOLOGY AND PERINATOLOGY: Edited by Thomas A. Hooven and Tara M. Randis Source Type: research

Arguments for routine administration of probiotics for NEC prevention
Purpose of review Probiotic administration to premature infants for the purpose of prevention of necrotizing enterocolitis is common in many parts of the world but uncommon in the United States. The present review will emphasize recent findings in support of routine administration of probiotics to this highly vulnerable population. Recent findings Additional evidence from animal models describing mechanisms of protection of probiotics in the immature gut and updated meta-analyses of randomized placebo-controlled trials and observational cohorts are presented (now including more than 40 000 premature infants from count...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: NEONATOLOGY AND PERINATOLOGY: Edited by Thomas A. Hooven and Tara M. Randis Source Type: research

Deliveries at extreme prematurity: outcomes, approaches, institutional variation, and uncertainty
Purpose of review Medical decision making and practices surrounding extremely premature birth remains challenging for parents and care providers alike. Recently, concerns have been raised regarding wide practice variation, selection bias, and the limitations of outcomes data in this population. The purpose of this review is to summarize the recent literature relevant to deliveries at extreme prematurity with a focus on outcomes, approaches, and institutional variation. Recent findings Newer data suggest that evidence-based clinical guidelines and protocols for both pregnant women and infants at extreme prematurity are...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: NEONATOLOGY AND PERINATOLOGY: Edited by Thomas A. Hooven and Tara M. Randis Source Type: research

Ultra-short bowel syndrome during infancy: improving outcomes and novel therapies
Purpose of review Ultra-short bowel syndrome is relatively rare and has not yet been extensively reported. In ultra-short bowel syndrome, poor absorption of nutrients and dysmotility, interfere with fluid, energy, electrolyte and micronutrient balance. Patients with this disorder are managed through prolonged parenteral nutrition with the ultimate goal of achieving enteral autonomy. Overall outcomes of these patients are dependent on postsurgical bowel anatomy (residual length, intact colon, ostomy closure timing), incidence of sepsis, and care by a multidisciplinary specialized team. Recent findings Over the years, s...
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: NEONATOLOGY AND PERINATOLOGY: Edited by Thomas A. Hooven and Tara M. Randis Source Type: research

Editorial: Untangling the knottiest neonatal challenges
No abstract available (Source: Current Opinion in Pediatrics)
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: NEONATOLOGY AND PERINATOLOGY: Edited by Thomas A. Hooven and Tara M. Randis Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pediatrics)
Source: Current Opinion in Pediatrics - March 7, 2019 Category: Pediatrics Tags: EDITORIAL INTRODUCTIONS Source Type: research

Chronic Monteggia
Purpose of review The chronic Monteggia may lead to pain, mobility limitation, progressive valgus deformity, lateral elbow instability, late ulnar nerve paralysis, and degenerative changes. In this review, we discuss the current procedures in the literature focused on correcting chronic Monteggia to avoid these complications. Recent findings Correction of the ulnar deformity with elongation and angulation of the ulna in the opposite direction of the dislocation of the radial head is the most important factor for the reduction and consequent preservation of the radial head. This correction reestablishes the relation of...
Source: Current Opinion in Pediatrics - February 1, 2019 Category: Pediatrics Tags: ORTHOPEDICS: Edited by Daniel W. Green Source Type: research

New stimulant formulations for pediatric attention-deficit/hyperactivity disorder: a case-based approach for the primary care provider
Purpose of review To provide an up-to-date clinical review of U.S. Food and Drug Administration (FDA)-approved stimulant medications for attention-deficit/hyperactivity disorder (ADHD), including a framework for individualized treatment by primary care pediatric providers. Recent findings Stimulant medications are first-line agents for pediatric ADHD. Since 2012, 11 novel stimulant medications have been approved by the FDA for the treatment of ADHD. Because of an expanded formulary of available methylphenidate-based and amphetamine-based stimulants, primary care providers may be unfamiliar with some novel medications ...
Source: Current Opinion in Pediatrics - January 8, 2019 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

Promoting resilience in vulnerable populations: focus on opioid-exposed children, siblings of children with special healthcare needs and support for children through school-based interventions
This article discusses recent literature related to promoting resilience in opioid-exposed children and siblings of children with special healthcare needs. It also addresses ways that school systems can foster childhood resilience. Recent findings Rising rates of opioid-exposed newborns have necessitated the development of multiple strategies to address the medical and social needs of this vulnerable pediatric population. Siblings of children with special healthcare needs are a growing but sometimes overlooked group who have unique challenges that can be supported by healthcare providers. School programs that reward pos...
Source: Current Opinion in Pediatrics - January 8, 2019 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

New age technology and social media: adolescent psychosocial implications and the need for protective measures
Purpose of review In recent years, breakthroughs and advancements in new age technology have revolutionized the way children communicate and interact with the world around them. As social media platforms such as Facebook, Instagram, and Snapchat continue to grow in popularity, their usage has raised concerns about their role and impact on adolescent development and behavior. This review examines the psychosocial implications of social media usage on youth outcomes related to body image, socialization, and adolescent development. It discusses ways that clinicians and parents can effectively safeguard their children from t...
Source: Current Opinion in Pediatrics - January 8, 2019 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research

The future of careers in pediatric infectious diseases: a call to action
Purpose of review The purpose of this review is to describe some current challenges facing the field of pediatric infectious diseases and discuss strategies for enhancing recognition of the value of infectious disease services and for recruiting new talent to the field. Recent findings Pediatric infectious disease programs are currently filling approximately half of their fellowship positions, and salaries are among the lowest in medical subspecialties. Research-intensive careers in pediatric infectious diseases are threatened by low the National Institutes of Health paylines for career development awards. Despite thi...
Source: Current Opinion in Pediatrics - January 8, 2019 Category: Pediatrics Tags: INFECTIOUS DISEASES AND IMMUNIZATION: Edited by Yvonne J. Bryson Source Type: research

Advances in pediatric antimicrobial agents development
Purpose of review Rising rates of multidrug-resistant organisms has necessitated the development of novel antimicrobials. In this review, we will highlight agents that have recently received licensure and those that are in clinical development. Recent findings In recent years, development of novel antimicrobial agents has accelerated. Although most studies have targeted the adult population, studies in pediatric patients are underway. Adequately powered clinical trials are needed to establish the safety and role of these new drugs. Summary The recent development of novel antimicrobials to combat multidrug-resistant...
Source: Current Opinion in Pediatrics - January 8, 2019 Category: Pediatrics Tags: INFECTIOUS DISEASES AND IMMUNIZATION: Edited by Yvonne J. Bryson Source Type: research

Strategies to improve antibiotic use in the neonatal ICU
Purpose of review Neonates are at a high risk of infection and may have nonspecific signs of sepsis. Accordingly, they are heavily exposed to antimicrobials. Neonates are also uniquely at risk of both short-term and long-term complications from antibiotic exposure. This review discusses advances in antibiotic stewardship in the neonatal population. Recent findings Antimicrobial utilization is highly variable among NICUs in excess of case-mix variation. Rates of early-onset sepsis because of Group B Streptococcus have decreased substantially with the introduction of intrapartum antibiotic prophylaxis. Recent epidemiolo...
Source: Current Opinion in Pediatrics - January 8, 2019 Category: Pediatrics Tags: INFECTIOUS DISEASES AND IMMUNIZATION: Edited by Yvonne J. Bryson Source Type: research

Pediatric influenza and illness severity: what is known and what questions remain?
Purpose of review Influenza causes a range of illnesses in children, from uncomplicated self-limited illness to severe disease and death. This review provides an update on the severity and burden of influenza in US children over recent seasons. Recent findings The 2017–2018 influenza season was widespread and severe across all ages, including children. Disease severity is influenced by influenza virologic characteristics and host factors, as well as public health interventions such as influenza vaccination and antiviral treatment. In recent influenza A (H3N2)-predominant seasons (2016–2017 and 2017–2...
Source: Current Opinion in Pediatrics - January 8, 2019 Category: Pediatrics Tags: INFECTIOUS DISEASES AND IMMUNIZATION: Edited by Yvonne J. Bryson Source Type: research