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 12, 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 26, 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 23, 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 physician...
Source: Current Pediatrics Reports - November 22, 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 9, 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 15, 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 15, 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 30, 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 3, 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 13, 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 21, 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 19, 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 17, 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 –766,2018)...
Source: Current Pediatrics Reports - May 9, 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 9, 2019 Category: Pediatrics Source Type: research
