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

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 - July 10, 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 - July 9, 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 - June 29, 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 - June 29, 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 - June 18, 2018 Category: Pediatrics Source Type: research

Abnormal Uterine Bleeding in Adolescent Women
AbstractPurpose of ReviewTo review the current state of terminology, evaluation, and management of abnormal uterine bleeding (AUB) in adolescents.Recent FindingsThe current terminology classifies the causes of AUB under the mnemonic “PALM-COEIN”:Polyps,Adenomyosis,Leiomyoma,Malignancy/hyperplasia;Coagulopathy,Ovulatory dysfunction,Endometrial,Iatrogenic,Not yet classified. Heavy menstrual bleeding (HMB) is one manifestation of AUB. Complete menstrual, gynecologic, medical, and family histories, together with a thorough physical exam, are critical to the determination of the underlying cause of AUB. Initial labo...
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research

Caring for Transgender and Gender-Nonconforming Youth
AbstractPurpose of ReviewWe reviewed recently published literature around the care of transgender and gender-nonconforming youth. In this nascent area of medicine, there are few randomized controlled trials, but there are treatment guidelines that include expert opinion and best practices for a more standardized approach to care.Recent FindingsThe most significant article published the past year is the updated standards of care —“Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline”—which establishes a care framework with special emphas...
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research

Bone Health Considerations for the Adolescent Female Athlete
AbstractPurpose of ReviewProvide an update on bone health considerations for adolescent female athletes.Recent FindingsThis review explores multiple topics related to bone health in adolescent female athletes, including bone development, facilitators of and risks to bone health, assessment of bone health, and implications for poor bone health in this population.SummaryBone health has important implications for sports performance and overall wellness among adolescent female athletes. Recent studies support the benefits of approaching bone health in this population with an experienced multidisciplinary care team including me...
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research

Integrative Palliative Care and Management of Refractory Epilepsy
This article reviews the various treatment options for patients with refractory epilepsy and highlights the importance of palliative care.SummaryA child neurologist should participate as an integral part of the palliative care team in patients with refractory epilepsy to help guide the discussion about etiology, prognosis, and actively manages seizures as they work with other members of pediatric palliative care team towards improving the quality of life for the patient, caregiver, and family members. (Source: Current Pediatrics Reports)
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research

Opioid Use Disorders in Adolescents —Updates in Assessment and Management
AbstractPurpose of ReviewTo review information specific to adolescents regarding trends in opioid use, risk factors for opioid misuse, medical co-morbidity, and treatment updates.Recent FindingsAlthough opioid misuse in adolescents is uncommon, it is associated with morbidity and mortality such as hepatitis C and overdose. Adolescents commonly start with prescription opioid misuse before transitioning to heroin use. The existing literature supports the use of buprenorphine/naloxone for the treatment of adolescent opioid use disorders. Safe medication storage and disposal is important to decrease adolescent prescription opi...
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research

Integrative Therapies to Support Pediatric Palliative Care: the Current Evidence
AbstractPurpose of ReviewThis review offers an evidence-based introduction to integrative therapies that can be used with children receiving palliative care and suggestions for how to incorporate these therapies into practice.Recent FindingsFor each integrative therapy discussed, recent research from both the pediatric and adult literature is summarized.SummaryIntegrative medicine offers a patient-centered approach to care that brings together conventional and complementary therapies. Evidence-based integrative therapies exist for many troublesome end-of-life symptoms, including pain, anxiety, nausea, and constipation, and...
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research

Pediatric Palliative Care and the Pediatric Intensive Care Unit
AbstractPurpose of ReviewThe role of palliative care in pediatric critical care medicine is described, with a focus on communication practices, complex chronic medical disease, end-of-life care, and moral resiliency.Recent FindingsPalliative care medicine has an increasing presence in pediatric critical care medicine. The model for delivering quality palliative care from a primary to consultative role is evolving, as increasing numbers of patients and families benefit from this additional layer of care and advocacy. Palliative care medicine is complementary care at all levels and focuses on collaborating with families and ...
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research

Charlie Gard: How Did Things Go Wrong?
AbstractPurpose of ReviewWe examine the discussions generated to date by the Charlie Gard case, as well as the events of the case itself, in order to examine lessons for providers dealing with similar situations in the future.Recent FindingsPublications regarding the Gard case are relatively few and focus primarily on the ethical and legal issues that arise when involving the court system in complex medical decision-making and potential limits to parental authority. Some publications have also addressed the subject of experimental therapies, especially from the perspective of potential harms, suffering, and cost.SummaryWe ...
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research

Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents
AbstractPurpose of ReviewAvoidant/restrictive food intake disorder (ARFID) was added to the psychiatric nomenclature in 2013. However, youth with ARFID often present first to medical —rather than psychiatric—settings, making its evaluation and treatment relevant to pediatricians.Recent FindingsARFID is defined by limited volume or variety of food intake motivated by sensory sensitivity, fear of aversive consequences, or lack of interest in food or eating; and associated with medical, nutritional, and/or psychosocial impairment. It appears to be as common as anorexia nervosa and bulimia nervosa and can occur in ...
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research

The Inaugural Section on Adolescent Medicine
(Source: Current Pediatrics Reports)
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research

Hot Topics in Pediatric Palliative Care: a Calm Island in Troubling Waters
AbstractIn our world today, we are faced with disasters and shortages on a daily basis. In this article, we highlight some of the ways that pediatric palliative care practitioners can ease the burden and meet the needs of families in crisis. (Source: Current Pediatrics Reports)
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research

Social Media and Adolescent Health
AbstractPurpose of ReviewSocial media is used nearly ubiquitously by youth. Over the past decade, research has investigated ways in which social media may affect adolescent health both positively and negatively.Recent FindingsWe highlight five areas of work with newly emerging evidence in adolescent health: eating disorders, suicide, sexual health, substance use, and prevention. We also highlight new tools to promote safe social media use.SummarySocial media is a set of digital tools that influences adolescent health. By understanding current evidence around challenges and opportunities, we can leverage these tools to impr...
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research

Impact of Natural Disasters on Children Receiving Palliative Care Lessons Learned from Hurricane Harvey
AbstractPurpose of ReviewTo discuss the implications of natural disasters for pediatric palliative care patients and suggest a series of best practices for pediatric palliative care patients, their families, and their healthcare providers.Recent FindingsData from the aftermath of Hurricane Katrina provide insight into the effects of natural disasters on children with chronic medical conditions. We supplement this with details from our recent experience caring for pediatric palliative care patients during Hurricane Harvey as well as new data about grief and bereavement in the context of natural disasters.SummaryPediatric pa...
Source: Current Pediatrics Reports - June 1, 2018 Category: Pediatrics Source Type: research