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Impact of antimicrobial resistance on infections in children in Africa.
IF 2.2 3区 医学 Q2 PEDIATRICS Pub Date : 2025-04-01 Epub Date: 2025-01-22 DOI: 10.1097/MOP.0000000000001440
Joycelyn Assimeng Dame, Yemah Mariama Bockarie, Anthony Kwame Enimil

Purpose of review: Antimicrobial resistance is an escalating public health threat in Africa, and an awareness of the devastating impact on children is growing. This review highlights the prevalence and patterns of antimicrobial resistance among children in Africa, focusing on pathogens responsible for bloodstream infections, community-acquired pneumonia, bacterial meningitis, neonatal infections, diarrhea and malaria. Current strategies to tackle antimicrobial resistance in pediatric populations are discussed.

Recent findings: Bloodstream infections significantly contribute to child mortality, with high resistance observed in pathogens like Salmonella spp., Klebsiella spp., Escherichia coli , and Staphylococcus aureus . Additionally, rising resistance in pathogens causing community-acquired pneumonia, meningitis and bacterial diarrhea challenges the effectiveness of WHO-recommended therapies. Antibiotics used to treat neonatal infections, such as ampicillin, gentamicin and cefotaxime, are threatened by high resistance in Escherichia coli and Klebsiella spp , contributing to adverse neonatal outcomes. PfKelch 13 mutations linked to artemisinin resistance in parts of Africa raise public health concerns, as malaria remains a major cause of illness and death.

Summary: Stronger collaborative efforts are needed to enhance surveillance, improve diagnostic capabilities and update treatment protocols based on local pathogen sensitivities. More research is required on pediatric antimicrobial resistance in Africa.

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引用次数: 0
The promise of cerebral organoids for neonatology. 脑器质性组织在新生儿学领域的前景。
IF 2.2 3区 医学 Q2 PEDIATRICS Pub Date : 2025-04-01 Epub Date: 2025-02-12 DOI: 10.1097/MOP.0000000000001446
Clare E Howard, Manju Cheenath, Elizabeth E Crouch

Purpose of review: Applying discoveries from basic research to patients in the neonatal intensive care unit (NICU) is challenging given the difficulty of modeling this population in animal models, lack of translational relevance from animal models to humans, and scarcity of primary human tissue. Human cell-derived cerebral organoid models are an appealing way to address some of these gaps. In this review, we will touch on previous work to model neonatal conditions in cerebral organoids, some limitations of this approach, and recent strategies that have attempted to address these limitations.

Recent findings: While modeling of neurodevelopmental disorders has been an application of cerebral organoids since their initial description, recent studies have dramatically expanded the types of brain regions and disease models available. Additionally, work to increase the complexity of organoid models by including immune and vascular cells, as well as modeling human heterogeneity with mixed donor organoids will provide new opportunities to model neonatal pathologies.

Summary: Organoids are an attractive model to study human neurodevelopmental pathologies relevant to patients in the neonatal ICU. New technologies will broaden the applicability of these models to neonatal research and their usefulness as a drug screening platform.

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引用次数: 0
The impact of environmental changes on infectious diseases among children in North America.
IF 2.2 3区 医学 Q2 PEDIATRICS Pub Date : 2025-04-01 Epub Date: 2025-02-07 DOI: 10.1097/MOP.0000000000001436
Kristen A Bastug, Elizabeth L Schwartz, Nadia A Sam-Agudu

Purpose of review: Climate change is no longer a distant threat but a present and accelerating force reshaping the epidemiology of infectious diseases in North America and elsewhere. Rising temperatures, shifting precipitation patterns, and extreme weather events are impacting the geographic distribution of pathogens and their vectors. Understanding these environmental influences on infectious diseases in children is essential for equipping healthcare providers to deliver competent care in the era of climate change.

Recent findings: The northward spread of vector-borne diseases, warming waters and soils, and disease outbreaks following extreme weather events highlight the complex and multifactorial ways through which the environment influences the spread of infectious diseases.

Summary: Continuing medical education and training on the evolving epidemiology of climate-sensitive diseases is critical for clinicians to address emerging health threats effectively. We advocate for more equitable funding and resource allocation to support innovative pediatric research on climate change and infectious diseases in the United States and other countries in North America.

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引用次数: 0
Precision decisions in pediatric airway management: addressing physiologic difficulty.
IF 2.2 3区 医学 Q2 PEDIATRICS Pub Date : 2025-03-10 DOI: 10.1097/MOP.0000000000001450
Laura Wylie, Kelsey A Miller, Joshua Nagler

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.

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引用次数: 0
Environmental factors trigger pubertal development. 环境因素引发青春期发育。
IF 2.2 3区 医学 Q2 PEDIATRICS Pub Date : 2025-02-28 DOI: 10.1097/MOP.0000000000001451
Sofia Malave-Ortiz, Cameron Grant, Natalie D Shaw

Purpose of review: We provide an overview of the secular trend of earlier pubertal development, why there is a growing concern that environmental factors may be to blame, and how these factors may influence the developing reproductive axis.

Recent findings: We highlight recent work suggesting that, in addition to activating sex steroid receptors, environmental compounds may influence neuropeptide receptors and/or epigenetic regulators. We describe recent studies linking air pollution, metals, endocrine disrupting compounds (EDCs), short sleep duration, early life adversity, and stress to pubertal timing.

Summary: Pubertal timing is tightly controlled by genetic, epigenetic, and environmental factors. While animal and epidemiological studies have pointed to several potential environmental factors, additional work is necessary to identify the critical levels and developmental windows of exposure as well as the mechanistic underpinnings.

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引用次数: 0
Update on neonatal and infantile onset epilepsies.
IF 2.2 3区 医学 Q2 PEDIATRICS Pub Date : 2025-02-11 DOI: 10.1097/MOP.0000000000001448
Evelina Carapancea, Tristan T Sands, Maria Roberta Cilio

Purpose of review: Neonatal and infantile epilepsies represent a diverse group of disorders with significant neurodevelopmental impact, necessitating early diagnosis, and tailored treatment. Recent advancements in genetic research, phenotyping, and therapeutic development have reshaped the understanding and management of these conditions, making this review both timely and relevant.

Recent findings: Next-generation sequencing has emerged as a cornerstone for diagnosing neonatal and infantile epilepsies, offering high diagnostic yields and enabling identification of etiology-specific phenotypes. Precision therapies, including sodium channel blockers, ganaxolone, and mammalian target of rapamycin (mTOR) inhibitors, target specific molecular mechanisms. Early initiation of treatment in conditions with a high risk of progressing to epilepsy, like vigabatrin in tuberous sclerosis complex, lower the incidence of infantile spasms and improve developmental outcomes. Drug repurposing has also provided effective options, such as fenfluramine in Dravet syndrome, with promising outcomes. Gene-based therapies, including antisense oligonucleotides and gene replacement, represent the new frontier for addressing the root causes of these disorders.

Summary: The integration of genetic and molecular advancements is transforming the management of neonatal and infantile epilepsies, fostering precision-driven care. Continued research and innovation are essential to refine these strategies, optimize patient outcomes, and establish new standards of care.

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引用次数: 0
Current progress in international pediatric emergency medicine: Erratum. 国际儿科急诊医学的最新进展:勘误。
IF 2.2 3区 医学 Q2 PEDIATRICS Pub Date : 2025-02-01 Epub Date: 2024-12-20 DOI: 10.1097/MOP.0000000000001433
{"title":"Current progress in international pediatric emergency medicine: Erratum.","authors":"","doi":"10.1097/MOP.0000000000001433","DOIUrl":"https://doi.org/10.1097/MOP.0000000000001433","url":null,"abstract":"","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":"37 1","pages":"112"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Should healthcare organizations be accountable for child community health indicators at the community level? 保健组织是否应对社区一级的儿童社区健康指标负责?
IF 2.2 3区 医学 Q2 PEDIATRICS Pub Date : 2025-02-01 Epub Date: 2024-12-02 DOI: 10.1097/MOP.0000000000001430
Kelly J Kelleher, Rose Hardy

Purpose of review: This paper reviews options for including community health accountability metrics for child healthcare systems, international and regional experience with such metrics, and some specific candidates for metric consideration.

Recent findings: The inclusion of community metrics in child health accountability systems requires expanded accountability frameworks and re-education of clinicians. Most of the experience with use of community metrics in accountability systems comes from international settings. Lessons learned in these settings include the importance of linking the metrics to various policy and practice implementation measures while balancing the incentives for such 'horizontal' or communitywide indicators with current incentives. The Accountable Communities for Health movement may be the best-known example of US community health indicators for accountability. Four new papers suggest specific child metrics for consideration as child metrics, but only infant mortality rates and high school graduation rates are sufficiently standardized and nationally reported to be useful for such efforts.

Summary: Healthcare accountability for child community health is an important next step, but the coordination with existing accountability systems, data collection systems, and financial incentives require more research to be effective in helping children. Infant mortality rates and high school graduation rates have the most potential as cross system accountability metrics.

综述目的:本文综述了将社区卫生问责制指标纳入儿童卫生保健系统的选择,此类指标的国际和地区经验,以及一些具体的候选指标考虑。最近的发现:将社区指标纳入儿童健康问责制需要扩大问责框架和对临床医生的再教育。在问责制中使用社区指标的大多数经验来自国际环境。在这些情况下吸取的经验教训包括将指标与各种政策和实践实施措施联系起来的重要性,同时平衡这种“横向”或社区范围指标的激励措施与当前的激励措施。卫生问责社区运动可能是美国社区卫生问责指标最著名的例子。四篇新论文提出了具体的儿童指标,作为儿童指标加以考虑,但只有婴儿死亡率和高中毕业率得到了充分的标准化,并在全国范围内报告,对此类努力有用。总结:儿童社区卫生保健问责制是下一步的重要工作,但与现有问责制、数据收集系统和财政激励机制的协调需要更多的研究才能有效地帮助儿童。婴儿死亡率和高中毕业率最有可能作为跨系统问责制指标。
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引用次数: 0
Advances in cellular therapies for children and young adults with solid tumors. 儿童和青少年实体瘤的细胞治疗进展。
IF 2.2 3区 医学 Q2 PEDIATRICS Pub Date : 2025-02-01 Epub Date: 2024-11-20 DOI: 10.1097/MOP.0000000000001423
Michelle Choe, Matthew Campbell, Catherine M Albert

Purpose of review: Adoptive immunotherapy brings hope to children and young adults diagnosed with high-risk solid tumors. Cellular (cell) therapies such as chimeric antigen receptor (CAR) T cell, CAR natural killer (NK) cell, and T cell receptor (TCR) T cell therapy are potential avenues of targeted therapy with limited long-term toxicities. However, development of cell therapies for solid tumors is in its nascent stages. Here, we will review the current clinical experience, barriers to efficacy, and strategies to improve clinical response and patient access.

Recent findings: Cell therapies are shown to be generally safe and well tolerated. Strategies to optimize antitumor activity have now moved into early-phase trials. The immunosuppressive tumor microenvironment remains a major barrier to efficacy, and efforts are underway to gain better understanding. This will inform future treatment strategies to enhance the antitumor activity of cell therapies.

Summary: Clinical experiences to date provide important insights on how to leverage cell therapies against solid tumors. Key factors in advancing the field include a better understanding of immune cell biology, tumor cell behavior, and the tumor microenvironment. Lastly, improving access to novel cell therapies remains an important consideration in the conduct of clinical trials and for future implementation into standard practice.

综述目的:过继免疫治疗为诊断为高危实体瘤的儿童和青少年带来希望。细胞疗法,如嵌合抗原受体(CAR) T细胞,CAR自然杀伤(NK)细胞和T细胞受体(TCR) T细胞治疗是靶向治疗的潜在途径,具有有限的长期毒性。然而,针对实体瘤的细胞疗法尚处于起步阶段。在这里,我们将回顾目前的临床经验,影响疗效的障碍,以及改善临床反应和患者获得的策略。最近的研究发现:细胞疗法通常是安全且耐受性良好的。优化抗肿瘤活性的策略现已进入早期试验阶段。免疫抑制肿瘤微环境仍然是影响疗效的主要障碍,人们正在努力获得更好的理解。这将为未来的治疗策略提供信息,以增强细胞疗法的抗肿瘤活性。总结:迄今为止的临床经验为如何利用细胞疗法对抗实体瘤提供了重要的见解。推进该领域的关键因素包括对免疫细胞生物学、肿瘤细胞行为和肿瘤微环境的更好理解。最后,改善获得新型细胞疗法的途径仍然是进行临床试验和未来实施标准实践的重要考虑因素。
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引用次数: 0
Pediatrics leading the way: co-enrollment as the next step in health-related social needs screening and referral. 儿科引领潮流:共同登记作为健康相关社会需求筛查和转诊的下一步。
IF 2.2 3区 医学 Q2 PEDIATRICS Pub Date : 2025-02-01 Epub Date: 2024-11-12 DOI: 10.1097/MOP.0000000000001416
Stephanie Ettinger de Cuba, Carley Ruemmele, Ana Poblacion

Purpose of review: To contextualize how pediatrics led the field in developing and implementing tools to screen for social determinants of health in clinical care as well as in creating innovative interventions to mitigate them, and to summarize where the evidence points as the next frontier.

Recent findings: The evidence showed that health-related social needs (HRSN), like food insecurity, energy insecurity, and housing instability, continue to drive poor health outcomes across the lifespan; patients and healthcare providers are open to discussing HRSN in clinical settings, though some providers feel ill-equipped to do so; to mitigate HRSN, healthcare plays a unique role in ensuring patients' HRSN are understood, referring to effective resources through building strong, lasting relationships with community partners, embedding services in the healthcare setting across all departments, and empowering patient families to participate in programs and services; and administrative burden hinders families from getting all the benefits to which they are entitled, which streamlined co-enrollment processes can address.

Summary: Pediatric providers can add a unique and credible voice to seeking changes to the safety-net, including co-enrollment, that could reduce administrative burden, address patients' HRSN, and improve health starting in the prenatal period through later adulthood.

综述的目的:概述儿科如何在开发和实施工具以筛查临床护理中的健康社会决定因素以及创建创新干预措施以减轻这些决定因素方面引领该领域,并总结证据指向的下一个前沿领域。最近的发现:有证据表明,与健康相关的社会需求(HRSN),如粮食不安全、能源不安全和住房不稳定,在整个生命周期中继续导致健康状况不佳;患者和医疗服务提供者对在临床环境中讨论HRSN持开放态度,尽管一些医疗服务提供者觉得自己没有能力这样做;为了减轻HRSN,医疗保健在确保了解患者的HRSN方面发挥着独特的作用,通过与社区合作伙伴建立牢固、持久的关系,在所有部门的医疗保健环境中嵌入服务,以及授权患者家属参与项目和服务,来参考有效的资源;行政负担阻碍了家庭获得他们应得的所有福利,简化共同登记程序可以解决这个问题。总结:儿科医疗服务提供者可以在寻求改变医疗保障体系方面发出独特而可信的声音,包括共同登记,这可以减轻行政负担,解决患者的HRSN问题,并改善从产前到成年后期的健康状况。
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引用次数: 0
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Current opinion in pediatrics
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