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 7, 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 21, 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 develop...
Source: Current Pediatrics Reports - April 16, 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 16, 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 versus reduce...
Source: Current Pediatrics Reports - April 16, 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-based...
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 relapsing ne...
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
