Advances and Current Issues in Adolescent Sleep
This article aims to review and highlight recent advances in these areas.Recent FindingsThere is a greater understanding of the natural tendencies of adolescent sleep towards circadian phase delay. New research has better delineated the effects of artificial light and school start times, on sleep and circadian phase. There have also been updates about the diagnosis and management of narcolepsy, obstructive sleep apnea, and idiopathic hypersomnia.SummaryGreater understanding of how light exposure affects the circadian system allows for more concrete recommendations about managing electronics exposure. Growing evidence sugge...
Source: Current Pediatrics Reports - July 9, 2020 Category: Pediatrics Source Type: research

Medication-Induced Nephrotoxicity in Children
AbstractPurpose of ReviewThe purpose of this article is to review common mechanisms of drug-induced nephrotoxicity (DIN) while highlighting some of the common medications in each category, as well as risk factors and preventative strategies with a focus on mitigating the risks of kidney injury with the use of potentially nephrotoxic medications in children.Recent FindingsThere have been recent reports about DIN associated with well-established and newer medications based on pathogenic mechanisms, new biomarkers being researched to identify DIN, and the recent development of standardized phenotypes to characterize DIN.Summa...
Source: Current Pediatrics Reports - July 5, 2020 Category: Pediatrics Source Type: research

Telemedicine: a Bridge Over Knowledge Gaps in Healthcare
AbstractPurpose of the ReviewThe purpose of the review is to describe the Brazilian Telemedicine University Network RUTE concerning the Special Interest Group of Children and Adolescents, the new SIG-COVID19-BR activities for continuing medical education, and to update relevant information regarding diagnosis and treatment, using digital technologies.Recent FindingsA total of 145 sessions of video and webconferences were held with the participation of 6575 health professionals, including medical students, interns, and residents. Major topics involved the healthcare of children and adolescents were combined with the emergen...
Source: Current Pediatrics Reports - July 1, 2020 Category: Pediatrics Source Type: research

Pediatric Delirium: a Review of Current Diagnosis and Management in the Intensive Care Setting
We describe preventative management, current screening tools, and treatment strategies for pediatric intensive care unit (PICU) delirium.Recent FindingsWhile there is ongoing research regarding medication efficacy for the treatment of delirium, there has been an increased emphasis on screening and prevention strategies.SummaryPICU delirium is an underappreciated diagnosis that is associated with increased morbidity and increased length of stay. Strategies to minimize risk of delirium, early recognition of delirium, and mitigation strategies combined with education and engagement of both medical staff and families are of ut...
Source: Current Pediatrics Reports - June 27, 2020 Category: Pediatrics Source Type: research

Correction to: The ICU Liberation Bundle and Strategies for Implementation in Pediatrics
Table 2 of the original version of this article unfortunately was not formatted well, making it unclear for readers. (Source: Current Pediatrics Reports)
Source: Current Pediatrics Reports - June 23, 2020 Category: Pediatrics Source Type: research

New Decade: “New” Devices for “Old” Drugs
This article reviews e-cigarettes and how they are changing the use and abuse of nicotine and THC and discusses the latest knowledge of the effects of these substances upon adolescents. Concurrent trends in the increased potency and legality of marijuana in the USA are discussed as well as suggestions for how to proactively work with adolescents around the issue of substance use.Recent Findings“Vaping” is changing the usage patterns of nicotine and marijuana, exposing youth to new dosages and potential effects.SummaryIncreased nicotine and THC exposure is erasing public health gains, leading to new drug-related...
Source: Current Pediatrics Reports - June 21, 2020 Category: Pediatrics Source Type: research

The Future of Paediatric Nephrology —Genomics and Personalised Precision Medicine
AbstractPurpose of ReviewThis review aims to outline the current state of precision medicine in paediatric nephrology with a focus on how genomics will impact on patient care in the future.Recent FindingsBroader availability of genomic sequencing, direct-to-consumer genetic testing, a growing list of genes implicated in childhood-onset kidney disease, patient-specific kidney organoid models of disease and pharmacogenomics will all shape the future for patients with kidney disease.SummaryThere is a bright future for patients with kidney disease as greater understanding of the pathogenetic mechanisms of disease will result i...
Source: Current Pediatrics Reports - June 9, 2020 Category: Pediatrics Source Type: research

Cyberbullying and Adolescents
AbstractPurpose of ReviewCyberbullying is an aggressive behavior involving a type of electronic communication intending to harm a victim that can have profound effects on adolescents. This review examines the epidemiology, issues from cyberbullying, presentation to care of its victims, and proposed interventions to this behavior.Recent FindingsThere are a variety of physical and psychological effects on victims of cyberbullying that can include recurrent abdominal pain, headaches, and difficulty with sleep. In addition, victims have higher rates of anxiety, depression, suicidal ideation, and a lower level of well-being. Un...
Source: Current Pediatrics Reports - June 3, 2020 Category: Pediatrics Source Type: research

The ICU Liberation Bundle and Strategies for Implementation in Pediatrics
AbstractPurpose of ReviewWe briefly review post-intensive care syndrome (PICS) and the morbidities associated with critical illness that led to the intensive care unit (ICU) liberation movement. We review each element of the ICU liberation bundle, including pediatric support data, as well as tips and strategies for implementation in a pediatric ICU (PICU) setting.Recent FindingsNumerous studies have found children have cognitive, physical, and psychiatric deficits after a PICU stay. The effects of the full ICU liberation bundle in children have not been published, but in adults, bundle implementation (even partial) resulte...
Source: Current Pediatrics Reports - May 16, 2020 Category: Pediatrics Source Type: research

Strategies in the Management of Adolescent Obesity
AbstractPurpose of ReviewWe review the current options to manage adolescent obesity which include nutrition, physical activity, behavior modification, sleep management, pharmacotherapy, and surgery. Since lifestyle interventions alone are often not effective in adolescents, a multi-disciplinary treatment approach is necessary in management.Recent FindingsMedications (often used off-label) and metabolic/bariatric surgery are effective treatment strategies to treat adolescents with severe obesity.SummaryThe use of pharmacotherapy and surgery is limited due to lack of pediatric obesity tertiary care centers. With more centers...
Source: Current Pediatrics Reports - April 27, 2020 Category: Pediatrics Source Type: research

Long-Term Metabolic Consequences of Intrauterine Growth Restriction
AbstractPurpose of ReviewTo summarize recent findings on the associations of intrauterine growth restriction (IUGR) and long-term metabolic consequences such as obesity, type 2 diabetes (T2D), and cardiovascular diseases and the underlying mechanisms.Recent FindingsRecent evidence suggests that metabolic diseases such as obesity, T2D, hypertension, and coronary artery disease are related to developmental programming in fetal period and early childhood. Rapid postnatal catch-up growth is also an important factor that contributes to the development of these long-term metabolic complications. The underlying mechanisms include...
Source: Current Pediatrics Reports - April 3, 2020 Category: Pediatrics Source Type: research

The Changing Adolescent: a Biopsychosocial and Behavioral Perspective
(Source: Current Pediatrics Reports)
Source: Current Pediatrics Reports - March 31, 2020 Category: Pediatrics Source Type: research

Baby B and Baby Doe —Their Lasting Effect on Parents’ Scope for Medical Decision-Making for Their Children
AbstractPurpose of ReviewThere have been several widely publicized legal cases about the limits of parental decision-making for their children. We examine the two very similar cases dating back to the 1980s that still provide legal precedents and constrain parental decision-making for newborns: Baby Doe in the USA, and Baby B in England.Recent FindingsThe US and English legal systems significantly constrain parental decision-making, even to the extent of preventing decisions that some clinicians may feel to be in the child ’s best interests. This is true for decisions to either limit care or continue care.SummaryLega...
Source: Current Pediatrics Reports - March 13, 2020 Category: Pediatrics Source Type: research

Fetal Cardiac Intervention: a Review of the Current Literature
AbstractPurpose of ReviewCongenital heart disease (CHD), the most common of birth defects, can be serious enough to require a lifetime of medical care including multiple surgeries or other interventions.Recent FindingsAdvances in ultrasound technology and a better understanding of the progression of CHDs have made it possible to intervenein utero. This early-stage intervention allows the still plastic cardiovascular system to return to a more normal trajectory thus sparing the newborn from negative consequences to morbidity and mortality.SummaryFetal cardiac intervention (FCI) has been successful altering the course of rig...
Source: Current Pediatrics Reports - February 15, 2020 Category: Pediatrics Source Type: research

Correction to: Providing Compassionate End of Life Care in the Setting of Mechanical Circulatory Support
The original version did not include the correct affiliations as noted by the authors in their proofs which can be seen below. (Source: Current Pediatrics Reports)
Source: Current Pediatrics Reports - February 5, 2020 Category: Pediatrics Source Type: research

APRV vs Oscillation
AbstractPurpose of ReviewWe compare the effectiveness of a conventional mode of ventilation, airway pressure release ventilation with non-conventional high frequency ventilation in achieving safety, comfort and liberation in infants and children requiring mechanical ventilation.Recent FindingsMechanical ventilatory support is important to the care of infants and children with acute respiratory failure. A paucity of high-level evidence exists to support one single ventilator strategy. A better understanding of the nuances of conventional and non-conventional modes of ventilation is needed to provide safe and effective venti...
Source: Current Pediatrics Reports - January 25, 2020 Category: Pediatrics Source Type: research

Shiga-Toxin E. coli Hemolytic Uremic Syndrome: Review of Management and Long-term Outcome
AbstractPurpose of ReviewWe review the pathophysiology of Shiga-Toxin Enteropathogenic –Hemolytic Uremic Syndrome (STEC-HUS), strategies to ameliorate or prevent evolution of STEC-HUS, management and the improved recognition of long-term adverse outcomes.Recent FindingsFollowing on from the preclinical evidence of a role for the complement system in STEC-HUS, the use of complement blocking agents has been the major focus of most recent clinical research. Novel therapies to prevent or lessen HUS have yet to enter the clinical arena. The long-term outcomes of STEC-HUS, similarly to other causes of AKI, are not as benig...
Source: Current Pediatrics Reports - January 17, 2020 Category: Pediatrics Source Type: research

Approach to Classification and Management of Childhood-Onset Lupus Nephritis
AbstractPurpose of Review(1) To discuss the relevance of the 2018 International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification system for nephritis in childhood-onset systemic lupus erythematosus (SLE). (2) To highlight current practices not addressed in the 2013 Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus treatment plan (CTP) for pediatric lupus nephritis (LN).Recent FindingsIn addition to class of glomerular involvement, multiple features on kidney biopsy can be assessed for prognosis and therapeutic decision-making. There is pediatric evidence and expertise for optimi...
Source: Current Pediatrics Reports - January 13, 2020 Category: Pediatrics Source Type: research

Providing Compassionate End of Life Care in the Setting of Mechanical Circulatory Support
AbstractPurpose of ReviewTo outline key elements in providing compassionate end-of-life care for pediatric patients with end-stage heart failure on mechanical circulatory support (MCS) such as extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs).Recent FindingsApproximately one in five pediatric patients with end-stage heart failure die on VAD support, with higher mortality associated with patients supported on ECMO. While it is considered ethically and legally permissible to withdraw MCS, pediatric-specific guidelines regarding indications and end-of-life management on MCS are lacking.SummaryA ...
Source: Current Pediatrics Reports - November 27, 2019 Category: Pediatrics Source Type: research

Ethics of Approaching Parents for Pediatric Donation After Circulatory Death
AbstractPurpose of ReviewDCD is expanding, and with this expansion, there are emerging ethical issues involved in approaching the parents of a child for DCD. This paper will address those issues.Recent FindingsThe ethical issue that has received the most focus recently regarding pediatric DCD is the duration of the waiting period, after death declaration but prior to organ recovery, to ensure lack of autoresuscitation. A growing body of literature exists investigating autoresuscitation, thus providing a little more insight into the process of death determination.SummaryPediatric DCD involves both the organ donor and the do...
Source: Current Pediatrics Reports - November 24, 2019 Category: Pediatrics Source Type: research

Consent for Conducting Evaluations to Determine Death by Neurologic Criteria: a Legally Permissible and Ethically Required Approach to Addressing Current Controversies
AbstractEthical and legal questions persist in the bioethics and clinical communities surrounding the determination of death by neurologic criteria (DNC). Among challenges to the determination of DNC are questions about the physician ’s role in the process. Once the exam is performed, if the patient meets criteria, the patient-physician relationship terminates. Whether informed consent is required to perform the exam, however, is a subject of ongoing controversy. Recent court cases also consider whether informed consent should occur prior to the determination of DNC. Those who argue against consent suggest that physi...
Source: Current Pediatrics Reports - November 23, 2019 Category: Pediatrics Source Type: research

Bedside Ultrasound in the Pediatric Intensive Care Unit: Newer Uses
AbstractPurpose of ReviewTo explore recent advancements in the use of point-of-care ultrasound in the pediatric intensive care unit or during the perioperative period.Recent FindingsUltrasound is useful for selecting an appropriate endotracheal tube size, predicting postextubation stridor, assessing vocal cord paralysis, performing ultrasound-guided lung recruitment, assessing circulatory volume status, performing transcranial Doppler for assessment of cerebral perfusion, assessing intracranial hypertension, assessing central venous catheter tip position, and performing arterial line cannulation.SummaryThere has been rapid...
Source: Current Pediatrics Reports - November 10, 2019 Category: Pediatrics Source Type: research

Focus on Chronic Variable Immunodeficiency for Primary Care Practitioners, the Gatekeepers to Optimal Health Outcomes for Primary Immunodeficiency Syndromes
AbstractPurpose of ReviewThis review sought to assess the extent and causes of suboptimal healthcare outcomes for chronic variable immunodeficiency (CVID).Recent FindingsSignificant improvements in diagnostic technology and treatment protocols over time were found, leading to reduced morbidity and mortality for those accessing therapies. Treatments continue to be largely non-curative with financing (mainly insurance coverage) an obstacle. Symptom recognition by primary care practitioners (PCP) remains a gating factor to treatment and a widespread and persistent barrier to optimal health outcomes.SummaryCVID is a subtype of...
Source: Current Pediatrics Reports - September 16, 2019 Category: Pediatrics Source Type: research

Communication in the PICU: Handoffs of Care
AbstractPurpose of ReviewLapses in communication can have significant consequences for the most vulnerable patients. Thus, we review various types of handoff occurring within pediatric intensive care units and between other care settings.Recent FindingsWe review the literature describing the impact of handoff between operating room to intensive care units, within the ICU, and among trainees. Specific constructs to facilitate transition of care have been studied with goal of minimizing error.SummarySuccessful standardized handoff tools stimulate a conversation centered around safety, create a shared mental model, and consid...
Source: Current Pediatrics Reports - September 16, 2019 Category: Pediatrics Source Type: research

Evolution of the Pediatric Intensivist Sedation Service
AbstractPurpose of ReviewDiscuss significant changes in provision of pediatric procedural sedation care in the last 2 decades.Recent FindingsOrganized pediatric sedation services have enabled statistically significant compilations of risk involved in providing sedation care to children. Sedation care outside of the operating room setting involves a wide variety of providers, novel medication administration techniques, and differentiation of scheduled and unscheduled sedation care.SummaryPediatric intensivists have been and are critical to providing procedural sedation for children particularly those with severe illness. (S...
Source: Current Pediatrics Reports - August 31, 2019 Category: Pediatrics Source Type: research

A Comprehensive, Multidisciplinary Approach to the Evaluation of the Neonatal Airway
AbstractPurpose of ReviewThis review identifies key distinctive features of the anatomy and physiology of the neonatal airway that contribute to pathology. Additionally, it highlights the importance of a multidisciplinary approach to the evaluation of the airway in certain neonates with respiratory distress in the neonatal intensive care unit.Recent FindingsAdvancements in airway imaging aid in the evaluation of the neonatal airway. However, a comprehensive airway evaluation is often indicated. This requires a team of subspecialists including neonatologists, radiologists, pediatric otolaryngologists, pulmonologists, and an...
Source: Current Pediatrics Reports - July 4, 2019 Category: Pediatrics Source Type: research

Mesenchymal Stem/Stromal Cell Therapy for Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit
AbstractPurpose of ReviewClinical trials of mesenchymal stem/stromal cell (MSC) therapy for bronchopulmonary dysplasia (BPD) are already underway. A thorough understanding of the preclinical work that underpins these trials is critical for neonatal practitioners to properly evaluate them.Recent FindingsThe more significant advances have been in investigating the mechanisms of action by which MSCs are thought to ameliorate BPD, and the recognition that this therapeutic effect is largely contained within the non-cellular exosome fraction of MSCs.SummaryIn rodent hyperoxia models of BPD, MSCs have a pro-angiogenic effect medi...
Source: Current Pediatrics Reports - June 14, 2019 Category: Pediatrics Source Type: research

Optimal Timing and Methodology of Umbilical Cord Clamping in Preterm Infants: a Review
AbstractPurpose of ReviewWe examine current recommendations for the timing of umbilical cord clamping in term and preterm infants and review available literature in support of these recommendations. Additionally, we explore potential barriers to practice change and identify opportunities for ongoing research.Recent FindingsAvailable literature supports the practice of delayed cord clamping (DCC) in neonates, with clear benefits over immediate cord clamping (ICC) when comparing both short- and longer-term outcomes. Additional studies suggest similar benefits may be conferred by the practice of umbilical cord milking (UCM). ...
Source: Current Pediatrics Reports - May 22, 2019 Category: Pediatrics Source Type: research

New Approaches to the Evaluation and Management of Well-Appearing Term and Late Preterm Neonates at Risk for Early-Onset Sepsis
AbstractPurpose of ReviewWe examine established guidelines for evaluating infants at risk for early-onset sepsis (EOS), as well as newer risk-based assessment strategies that may safely reduce unnecessary antibiotic exposure for well-appearing newborns.Recent FindingsWe highlight a new multivariate risk assessment tool (Neonatal Early-Onset Sepsis Calculator) that can reduce empirical antibiotic therapy, laboratory testing, maternal-infant separation, and healthcare costs, without increasing adverse events.SummaryIn the era of intrapartum antimicrobial prophylaxis for group BStreptococcus (GBS), the incidence of EOS among ...
Source: Current Pediatrics Reports - May 20, 2019 Category: Pediatrics Source Type: research

The Use of the Biomarker Procalcitonin in Pediatric Cardiovascular Disorders
AbstractPurpose of ReviewWe highlight the recent data investigating the use of the biomarker procalcitonin (PCT) in several clinical scenarios involving children with cardiovascular disorders. The diagnostic, therapeutic, and prognostic uses of PCT are discussed.Recent FindingsLimited pediatric-specific data, but substantial adult studies have described the use of PCT in 4 clinical scenarios: infection after cardiac surgery, heart failure and respiratory illness, infective endocarditis, and cardiac arrest.SummaryProcalcitonin is a biomarker with increasing utility in pediatric cardiovascular illness. Procalcitonin has succ...
Source: Current Pediatrics Reports - May 18, 2019 Category: Pediatrics Source Type: research

Neurodevelopmental Outcomes After Neonatal and Pediatric ECMO
AbstractPurpose of ReviewNeonatal and pediatric extracorporeal membrane oxygenation (ECMO) is an increasingly utilized, potentially life-saving therapy for critically ill patients. The immediate and long-term neurodevelopmental outcomes for patients who require ECMO is not fully understood or appreciated.Recent FindingsThere is a growing body of literature examining the neurodevelopmental outcomes of neonatal and pediatric survivors of ECMO. Estimates of ECMO patients ’ long-term neurological disabilities range from 10 to 60% (Glass et al. Pediatrics 83:72–78,1989; Boyle et al. Pediatr Crit Care Med 19:760 &nda...
Source: Current Pediatrics Reports - May 10, 2019 Category: Pediatrics Source Type: research

Genomic Sequencing for Infants and Children in Intensive Care Units
AbstractPurpose of ReviewWe highlight the evolving clinical application of genomic sequencing in caring for critically ill infants and children in the intensive care unit.Recent FindingsAs turnaround times for genetic sequencing continue to decrease, the application of this technology in caring for critically ill infants and children has correspondingly increased. Not only are clinicians now using genetic sequencing to make formal diagnoses in medically complex patients, but they are also using this information to inform recommendations regarding potential treatments and anticipate patient outcomes. Importantly, its applic...
Source: Current Pediatrics Reports - May 10, 2019 Category: Pediatrics Source Type: research

Bronchopulmonary Dysplasia: a Multidisciplinary Approach to Management
AbstractPurpose of ReviewWe aim to present the challenges in defining bronchopulmonary dysplasia (BPD) and summarize optimized management of established BPD in a multidisciplinary fashion.Recent FindingsIn the last few years, several meta-analyses assessing the treatment of BPD have been updated to assist in guiding clinical management. In addition, a new severity grading system was proposed at the National Institute of Child Health and Human Development (NICHD) BPD workshop with more objective criteria including commonly used modes of non-invasive respiratory support.SummaryAlthough survival of infants born prematurely ha...
Source: Current Pediatrics Reports - May 8, 2019 Category: Pediatrics Source Type: research

Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA): a Systematic Review and Historical Perspective
AbstractPurpose of the ReviewTo provide an updated literature review for the diagnosis, treatment, and outcomes of anomalous left coronary artery from the pulmonary artery (ALCAPA).Recent FindingsThe diagnosis of ALCAPA has shifted away from coronary angiography to noninvasive imaging modalities. Newer imaging techniques such as speckle tracking echocardiography to evaluate myocardial strain demonstrate subclinical myocardial dysfunction years after restoration of a dual coronary system.SummaryThe diagnosis of ALCAPA is primarily with echocardiography and computed tomography coronary angiography. Coronary reimplantation is...
Source: Current Pediatrics Reports - April 22, 2019 Category: Pediatrics Source Type: research

Neurodevelopmental Outcomes in Children with Complex Congenital Heart Disease
AbstractPurpose of ReviewThe purpose of this article is to better understand the challenges that children with congenital heart disease (CHD) face and the elements that put them at higher risk, and also to review existing interventions and discuss how they impact long-term neurodevelopment.Recent FindingsApproximately 1 –2% of all children are born each year with CHD, and survival into adulthood now surpasses 80%. It has thus become increasingly more important to recognize and manage the common complications seen in this population. There are a number of factors that contribute to increased risk for adverse neuro dev...
Source: Current Pediatrics Reports - April 17, 2019 Category: Pediatrics Source Type: research

Pulmonary Hypertension in Children with Sickle Cell Disease: a Review of the Current Literature
AbstractPurpose of ReviewPulmonary hypertension (PH) is a well-recognized complication of sickle cell disease (SCD) and is one of the strongest predictors of increased morbidity and mortality in adult patients. There is evidence that PH can develop in children with SCD and the clinical implications of this finding are an area of active research. We review the current literature examining the association of SCD and PH in childhood.Recent FindingsThe recent literature has focused on elucidating the multifactorial mechanisms for the development of PH in SCD with the goal of developing targeted therapies. In addition, there ha...
Source: Current Pediatrics Reports - April 17, 2019 Category: Pediatrics Source Type: research

Modern Day Care of Patients With Single Ventricle Heart Disease: Late Complications of Fontan Palliation
AbstractPurpose of ReviewThe majority of individuals who have undergone Fontan palliation are surviving into adulthood, yet complications are common. This review will focus on late complications —cardiac and extra-cardiac—which may present insidiously.Recent FindingsRecent meta-analysis of patients after Fontan operation suggests that over 80% will survive 20  years beyond surgery. This group is at risk for structural complications, arrhythmias, vascular complications, and heart failure. Not all forms of Fontan failure are the same, and categorization into separate entities such as failure with preserved v...
Source: Current Pediatrics Reports - April 17, 2019 Category: Pediatrics Source Type: research

The Role of Complement in the Pathogenesis of HUS and the TMA Spectrum Disorders
AbstractPurpose of ReviewThis review aims to examine the current definitions of primary and secondary hemolytic uremic syndromes. Specifically, it seeks to determine which external conditions can result in secondary Thrombotic microangiopathy (TMA), which can trigger cases of primary atypical uremic syndromes (aHUS), and the role of complement in the pathogenesis of TMA spectrum disorders.Recent FindingsBuilding on the growing insight about the pathogenic role of dysregulation of the alternative complement pathway in primary aHUS, the successful use of complement-blocking treatment in cases of thrombotic microangiopathy wi...
Source: Current Pediatrics Reports - February 13, 2019 Category: Pediatrics Source Type: research

Iatrogenic Withdrawal Syndrome: a Review of Pathophysiology, Prevention, and Treatment
AbstractPurpose of ReviewIatrogenic withdrawal syndrome (IWS) is the direct result of sedative agents utilized to facilitate pediatric intensive care. The purpose of this review is to overview how sedative agents result in IWS and overview the assessment tools, prevention strategies, and treatments for the condition.Recent FindingsSince the development of validated withdrawal assessment tools, there has been a focus on identifying IWS risk. The most significant IWS risk factors are duration of exposure to sedatives and total cumulative doses of these agents. Given these risk factors, there has been an effort to develop str...
Source: Current Pediatrics Reports - February 12, 2019 Category: Pediatrics Source Type: research

Urinary Tract Infection in Children
AbstractPurpose of ReviewUrinary tract infections (UTI) are common among children. In the past 20  years, a number of key trials have substantially changed practice, in addition to clarifying the natural history of children managed expectantly. It is now clear that among children with normal kidneys at presentation, chronic kidney disease and hypertension are rare. Improved antenatal ultrasound now detects most significant abnormalities of the kidney and urinary tract, particularly severe hypodysplasia, which is often associated with high-grade vesico-ureteric reflux (VUR). This review aims to summarize the evidence-b...
Source: Current Pediatrics Reports - November 10, 2018 Category: Pediatrics Source Type: research

An Update on Neonatal and Pediatric Acute Kidney Injury
ConclusionsThe incidence and adverse impact of AKI on outcomes across critically ill pediatric and neonatal populations have been clearly established The importance of fluid overload in children with severe AKI requiring renal replacement therapy is clear. Children with AKI are at increased risk of chronic kidney disease and require long-term outpatient follow-up. As the impact of AKI has become clear, efforts have shifted to prevention of nephrotoxic-induced AKI, early identification, risk stratification (renal angina), and the development of novel biomarkers. (Source: Current Pediatrics Reports)
Source: Current Pediatrics Reports - October 29, 2018 Category: Pediatrics Source Type: research

Recent Advances in Genetic Aspects and Treatments for Steroid-Sensitive Nephrotic Syndrome in Children
This article reviews recent advances in genetic aspects and treatments for steroid-sensitive nephrotic syndrome (SSNS) in children over the previous 5  years.Recent FindingsSix genes, which have roles in Rho-like small GTPase activity, have been identified as causes of partially steroid-treatable nephrotic syndrome, and the strongest susceptible gene of SSNS has been located in theHLA DR/DQ locus. For treatment, prolongation of prednisolone therapy beyond 2 to 3  months in the initial episode of SSNS does not reduce the risk of relapse. Rituximab has been established as a treatment for complicated frequently rela...
Source: Current Pediatrics Reports - October 15, 2018 Category: Pediatrics Source Type: research

Hypertension Diagnosis and Management in Children and Adolescents: Important Updates
AbstractPurpose of ReviewThis review aims to examine new literature and clinical practice guidelines on the diagnosis and management of hypertension in children along with the potential impact on clinical practice of the new recommendations.Recent FindingsHypertension is underrecognized and underdiagnosed in clinical practice. Tools for improving diagnosis may include prompts in electronic medical records, use of a blood pressure screening table, and standardized blood pressure thresholds for adolescents. The recent AAP clinical practice guideline on the management of hypertension in children developed new blood pressure t...
Source: Current Pediatrics Reports - October 13, 2018 Category: Pediatrics Source Type: research

Recent Advances in the Evaluation, Medical, and Surgical Management of Pediatric Nephrolithiasis
AbstractPurpose of ReviewWith the recent rise in the incidence of pediatric nephrolithiasis, much work has focused on understanding the epidemiology and burden of this disease. We reviewed the recent literature to understand current hypotheses for increased kidney stone risk in children, define current best practices for imaging evaluation, assess surgical advances and outcomes, and evaluate up to date strategies for risk modification.Recent FindingsThe interactions of multiple risk factors comprise the exposome that may define future risk of nephrolithiasis. Computed tomography appears to be over-utilized in the acute pre...
Source: Current Pediatrics Reports - September 1, 2018 Category: Pediatrics Source Type: research

Screening for and Management of Chronic Kidney Disease for Children with Congenital Abnormalities of the Kidney and Urinary Tract
AbstractPurpose of ReviewCongenital abnormalities of the kidney and urinary tract (CAKUT) are the most common cause of chronic kidney disease (CKD) in children. Our objective is to review the current diagnosis and management of CAKUT, with a focus on kidney function outcomes.Recent FindingsThe rate of detection of CAKUT has increased with routine prenatal ultrasonography. Despite earlier detection, children with CAKUT are still at risk for future CKD. Several tools offer prognostic information on renal function, including traditional urinary testing for proteinuria and more contemporary biomarkers. Blood pressure monitorin...
Source: Current Pediatrics Reports - September 1, 2018 Category: Pediatrics Source Type: research

Bladder-Bowel Dysfunction in Children: Consequences, Risk Factors and Recommendations for Primary Care Interventions
AbstractPurposeThe goals of this paper are to review potential risk factors and emerging insights into nature of bladder-bowel dysfunction (BBD) and highlight a patient-centered approach to management, which can begin in the primary care setting.Recent Findings(1) BBD is documented in about half of patients with vesicoureteral reflux and increases potential for renal scarring. (2) Neurodevelopmental and environmental factors are associated with BBD and greater understanding of a neurocentric basis for BBD is emerging. (3) A patient-centered approach to care is required. The way in which children and adolescents understand ...
Source: Current Pediatrics Reports - September 1, 2018 Category: Pediatrics Source Type: research

Antibiotic Prophylaxis in Children with Urinary Tract Infection
AbstractPurpose of ReviewAntibiotic prophylaxis is prescribed to prevent recurrent urinary tract infections (UTIs) in children, but this practice is being questioned with attention to efficacy and potential harm of long-term antibiotics.Recent FindingsProphylaxis for children with vesicoureteral reflux remains controversial and providers should consider factors that contribute to risk of recurrent UTI such as age, sex, circumcision status, reflux grade, and bladder and bowel dysfunction. Further complicating our understanding of the impact of prophylaxis is evidence that adherence is poor. Antibiotic resistance is a growin...
Source: Current Pediatrics Reports - September 1, 2018 Category: Pediatrics Source Type: research

Surgical, Patient, and Parental Considerations in the Management of Children with Differences of Sex Development
AbstractPurpose of ReviewThe goal of this review is to provide an overview of the controversies affecting care and outcomes of patients with disorders/differences of sex development (DSD). In recent years, there has been a significant paradigm shift in management of patients with DSD. Within this context, this review will then discuss key advances in DSD care.Recent FindingsImportant controversies to be cognizant of when caring for patients with DSD include DSD nomenclature, gender assignment, and timing of surgery. Within the last two decades, there have been dramatic advances in surgical techniques, understanding of pati...
Source: Current Pediatrics Reports - September 1, 2018 Category: Pediatrics Source Type: research

Management of Acute Liver Failure: A Pediatric Perspective
AbstractPurpose of ReviewPediatric acute liver failure is a rare, complex, rapidly progressing, and life-threatening illness. Majority of pediatric acute liver failures have unknown etiology. This review intends to discuss the current literature on the challenging aspects of management of acute liver failure.Recent FindingsCollaborative multidisciplinary approach for management of patients with pediatric acute liver failure with upfront involvement of transplant hepatologist and critical care specialists can improve outcomes of this fatal disease. Extensive but systematic diagnostic evaluation can help to identify etiology...
Source: Current Pediatrics Reports - September 1, 2018 Category: Pediatrics Source Type: research

Transitional Urology Care for Patients with Spina Bifida
AbstractPurpose of ReviewPatients with spina bifida require urologic care and follow-up throughout all phases of life. The transition from adolescence to adult care represents a high-risk time for these individuals and their families and can be challenging for providers. In this review, we seek to analyze the literature on spina bifida patients regarding issues pertinent to transition of their urologic care to adult clinics, providers, and hospitals, and to summarize the experience in the field to date.Recent FindingsExperience in transitioning spina bifida patients to adult care is increasing. Efforts to better define the...
Source: Current Pediatrics Reports - September 1, 2018 Category: Pediatrics Source Type: research