Current opinion in pediatrics最新文献

Purpose of review: Pediatric interventional pulmonology (PIP) is an evolving subspecialty aiming at respiratory diseases in children through procedural interventions. This review discusses recent developments and challenges in global adoption of these advancements.

Recent findings: Innovations such as ultra-thin cryoprobes and bronchoscopes allow for diagnostic and interventional procedures in pediatric airways. Cryotherapy demonstrates advantages in obtaining biopsies, treating airway stenosis, and extracting foreign bodies. Endobronchial ultrasound has improved the accuracy of diagnosing lymphadenopathy and pulmonary lesions, but its large size and high cost limit its use in resource-poor areas. Other newer techniques, such as tracheoesophageal fistula repair and endobronchial valves for air leaks, are promising but lack strong evidence for widespread adoption. Geographical and economic disparities impede progress, with high-income countries pioneering innovation, and low- and middle-income areas facing access and training challenges.

Summary: While PIP does have the potential to be transformational, global disparities in its adoption are significant. International collaborations, standardized training, and resources are paramount. This can be achieved through virtual training platforms and global conferences that will help narrow the gaps, ensuring equitable PIP growth to benefit pediatric respiratory care globally.

Purpose of review: Precision medicine is based on the idea that treatment can be individualized for each patient in a given clinical environment. This review summarizes factors that should be considered when clinicians are creating individualized plans for intubation, specifically focusing on physiologically difficult airways. Recent literature identifying physiologic risk factors is summarized, and individual and system-level interventions that can potentially mitigate risk are reviewed.

Recent findings: Physiologic derangements, most notably hypoxia and hypotension, have been associated with increased incidence of severe adverse events during intubation attempts. Individualized peri-procedural efforts to improve physiologic parameters through optimal oxygen delivery, fluid resuscitation, vasopressor administration, and thoughtful choice in rapid sequence intubation (RSI) medications may improve patient outcomes. Systems of care are being built around airway bundles, cognitive aids, and collaborations with airway teams to optimize outcomes.

Summary: Providers should develop individualized care plans for their patients to optimize physiologic and anatomic parameters peri-intubation. The physiologically difficult airway affects the rate of first pass success and adverse events, therefore patients should be optimized prior to undergoing the procedure based on their clinical presentation and data.

Purpose of review: This review outlines the prevalence and complications of apneas and intermittent hypoxemic events in preterm infants, examines current monitoring limitations in neonatal ICUs (NICUs), and explores emerging technologies addressing these challenges.

Recent findings: New evidence from the Prematurity-Related Ventilatory Control (Pre-Vent) study, which analyzed cardiorespiratory data from 717 extremely preterm infants, exposes the varying frequency, duration, and severity of apneas, intermittent hypoxemia, bradycardias, and periodic breathing during hospitalization, and highlights the negative impact of intermittent hypoxemia on pulmonary outcomes at discharge. Although traditional monitoring methods cannot differentiate between apnea types and quantify their burden, recent advancements in sensor technologies and data integration hold promise for improving real-time detection and evaluation of apneas in the NICU. Notably, small wearable mechano-acoustic sensors could improve apnea monitoring through continuous detection of airflow and respiratory efforts. Additionally, integrating bedside physiological data with modalities such as near-infrared spectroscopy, diaphragmatic activity, and electrical impedance tomography could help predict adverse outcomes by monitoring regional oxygen saturation and lung function in relation to apneas.

Summary: Enhancing our understanding of neonatal apneas and overcoming the current limitations in apnea monitoring through advanced sensor technologies and data integration could lead to more personalized management and improved outcomes for preterm infants.

Purpose of review: Human papillomavirus (HPV) is the most common STI and accounts for roughly 37 000 HPV-associated cancers annually in the United States. Despite documented safety and effectiveness of the HPV vaccine, vaccination rates should be higher. We summarize literature surrounding vaccine hesitancy, a main reason for suboptimal vaccine coverage. We aim to describe the complex factors that lead to hesitancy in order to support improvement of vaccination rates in our communities.

Recent findings: Studies document sustained immunogenicity and effectiveness 10 years post HPV vaccination. Vaccine coverage was rising until 2022, when initiation declined. Primary reasons for hesitancy are: perceived lack of provider recommendation, a lack of parental knowledge and necessity especially if an adolescent is not sexually active, and safety concerns. The COVID-19 pandemic challenged access to care and exacerbated vaccine-related discourse. Studies of hesitant adopters reveal that social processes, including conversations with community members, have a substantial impact on decisions to vaccinate.

Summary: We highlight recent literature behind parental hesitancy toward the HPV vaccine, focusing on concerns about its necessity and safety, exacerbated by medical mistrust and misinformation. We summarize findings of successful educational outreach and community-based interventions to improve vaccination rates in the postpandemic social media era.

Purpose of review: The use of body composition to assess the quality of infant growth may add valuable information to pediatric clinical care. Preterm infants have differences in their fat and muscle mass development compared with infants born at term, which may be related to their early nutritional exposures. This review focuses on recent studies examining early nutrition in preterm infants and related body composition outcomes in the newborn period and beyond.

Recent findings: Overall, the evidence shows that early nutrient delivery in parenteral nutrition and through formula supplementation or human milk fortification is associated with increased fat-free mass or lean mass in early life. However, future research is needed to fully understand the link between these body composition changes and longitudinal outcomes in preterm infants.

Summary: Inclusion of body composition assessments in preterm infant nutrition research is critical to understand the factors associated with differences in adiposity and lean mass development in preterm infants. Medical fragility in preterm infants limits the routine use of body composition assessment tools which are currently validated, and additional studies are needed to thoroughly assess other methods which may be more feasible to integrate into bedside routine.

Purpose of review: This review examines the implications of the 2022 Dobbs v. Jackson Women's Health Organization decision on neonatal care and explores how legal restrictions on abortion are influencing medical practices for neonates and the broader healthcare landscape for neonates.

Recent findings: The Dobbs decision has led to increased uncertainty and challenges in both maternal and neonatal healthcare. Restrictive abortion laws are associated with higher infant mortality rates, increased health disparity, and increased care provider ethical dilemmas and moral distress due to legal uncertainty surrounding the care of infants. However, current changes in federal and state law regarding abortion do not change the previously established standard of care for neonates. Other federal legal statutes potentially addressing the care of neonates have existed for over 20 years and have had minimal effect on the practice of neonatology, because there is no record of federal enforcement actions or federal case law to clarify how the law should be interpreted.

Summary: While restrictive abortion laws primarily affect women and pregnant people's health care, indirect effects on neonatal care are becoming more common. There are other laws and policies with greater potential to regulate care for infants at the federal and state level. Professional medical standards remain the guiding framework in neonatal care. Clinicians can mitigate legal concerns through knowledge and advocacy.

Purpose of review: The densely populated Asia Pacific region is home to 600 million children, and suffers from a significant burden of morbidity and mortality due to infections associated with antimicrobial resistance (AMR). We aimed to identify the drivers, challenges and potential opportunities to alter the burden of AMR within the region.

Recent findings: Despite the high AMR burden borne by the Asia Pacific region, there are limited (and geographically imbalanced) published data to delineate the contemporary epidemiology of serious multidrug-resistant bacterial infections in children. Furthermore, the region is impacted by overcrowded and poorly resourced healthcare facilities, insufficient microbiological resources, and widespread community and environmental antibiotic use leading to limited efficacy for frequently prescribed antibiotics. Vaccine coverage is also inadequate and inequitable, further driving the burden of infectious disease (and antibiotic overuse) in children.

Summary of implications: There are many challenges in implementing antimicrobial stewardship and infection prevention and control programs to reduce the excessive AMR disease burden in children across the Asia Pacific region, yet locally-driven strategies have successfully reduced antibiotic overuse in some settings, and should be replicated. Reducing the AMR disease burden will require improved healthcare resourcing, including better access to microbiological diagnosis, and multidisciplinary approaches to enhance infection prevention and antibiotic prescribing.