Current opinion in pediatrics最新文献

Purpose of review: Due to the infrequent nature of rare pediatric cancers, rigorously studied treatment algorithms are usually nonexistent, and experience with a given tumor may be limited at a single institution. Development of treatment plans for these populations often requires extensive literature review and outreach to experts at other institutions. National or international virtual tumor boards provide a streamlined, collaborative approach to discussing diagnosis and management of these patients through dissemination of collective experience and knowledge. This review highlights current virtual tumor boards for rare pediatric cancers and their benefit as a resource for patient care.

Recent findings: Over the last several years, national virtual tumor boards sponsored by government and academic institutions and cancer foundations have expanded access of pediatric oncologists to rare tumor expertise and guidance. Recommendations from these tumor boards often have an impact on medical decision making, and some serve as a resource for enduring educational reference materials.

Summary: National virtual tumor boards are a valuable resource to clinicians caring for patients with rare pediatric tumors. These conferences provide real-time management advice from peers and subject matter experts and provide essential educational content not easily accessible in other formats.

Purpose of review: Life on earth, as we know it, is changing. The likelihood of more frequent pandemics and disease outbreaks is something that current global healthcare infrastructure is ill equipped to navigate. Human activity is forcing our planet into a new geologic epoch, the Anthropocene, which is typified by increased uncertainty resulting from human disruption of earth's life-giving ecosystems. Plagues and pandemics have always been unfortunate partners to periods of disruption, as they will be again if the frequency and severity of climate and conflict-mediated disasters increase in coming years. If we continue to exceed and degrade the planetary boundaries that protect human health, our children and their children will reap the consequences.

Recent findings: Scientists have defined nine 'safe operating' planetary boundaries for life in all its glorious diversity to thrive on planet earth. Recent evidence suggests that six of these nine boundaries have already been transgressed, but the potential implications for these transgressions upon child health is not well articulated. We highlight how contravention of these boundaries will impact infectious disease risk and humans' ability to survive and thrive. We reflect specifically on how paediatricians are called upon to speak up for the most vulnerable members of our species, young children and as yet unborn future generations.

Summary: Post COVID-19 initiatives to improve pandemic preparedness and response are certainly warranted, but pandemic prevention should include committed efforts not to exceed safe planetary boundaries. Willingly exceeding these boundaries has deep moral consequences that are poorly articulated by current ethical frameworks. Paediatricians are best placed to develop and champion the neglected 'third dimension' of medical ethics, recognizing the moral imperative to protect the long-term best interests of children and future generations.

Purpose of review: This review aims to summarize how scientific advances in complement biology have not only improved the diagnosis and management of aHUS but also continue to offer insights into the pathophysiology of complement-mediated disease that may be leveraged for future therapeutic developments.

Recent findings: Updated information on the clinical and epidemiological features, pathophysiology, diagnosis, management, and potential for future therapeutic advancements in the treatment of aHUS are reviewed.

Summary: aHUS is a rare but potentially life-threatening disease that requires prompt diagnosis and treatment as well as long-term management via a multidisciplinary team providing coordination of primary and specialty care as well as outreach and education for children and families affected by this life-long disease.

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: 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.

Purpose of review: Early identification of cerebral palsy (CP), as in all neurologic conditions, has a profound impact on the ability to initiate interventions, support the education and empowerment of parents, ameliorate the effect of the conditions, and importantly identifies cohorts for neuroprotection or repair to address the primary injury. CP is a life span condition. Rapid initiation of services, support and anticipatory guidance is essential to maximize functional outcomes, prevent or manage complications and improve quality of life.

Recent findings: CP diagnosis should not be delayed. Early imaging as well as motor and neurologic evaluation can aid in early detection of CP before age 5 months. Early therapeutic intervention can influence function and assist in prevention of complications that can impact abilities. There is important ongoing research with efforts to prevent CP or alter the phenotype of the condition.

Summary: Literature review provides evidence to change in standard of care in diagnosing CP. There are published guidelines on how to pursue the diagnosis during early infancy. Early identification results in early intervention with the purpose of enhancing functional skill development, prevention of complications, and establishing parental support. Early identification provides an optimistic view and opportunity to intervene immediately in hopes to have an impact in the functional outcome and improving quality of life.

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 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: To provide an update on advancements in pediatric headache.

Recent findings: The symptomatology associated with primary headache disorders has been compared with ICHD-3 criteria. Primary stabbing headache pain lasts longer than 3 seconds in over half of patients. Persistent posttraumatic headache or new daily persistent headache have significant overlap in pain character and nonpain-related symptoms with migraine. In a large cohort with continuous headache at first follow-up, 47% reported resolution of their continuous headache and 19.4% had a 50% or greater reduction in frequency with improvements in fluid intake, sleep, not skipping meals, and exercise. There was no correlation with improved lifestyle habits and clinical outcomes despite the overall improvement. Studies noted significant improvement in headache scores with onabotulinum toxin A and incobotulinum toxin A injections with limited side effects. Intranasal sumatriptan without concurrent intravenous therapies found a clinically meaningful decrease in pain score prior to discharge with shorter lengths of stay and lower emergency department costs compared with the those who received intravenous therapies.

Summary: Newer studies have suggested changes to symptomatology and duration of pediatric headache syndromes. Onabotulinum toxin A and incobotulinum toxin A injections, and emergency department intranasal sumatriptan are well tolerated therapies in pediatric headache.

Purpose of review: This review aims to provide an overview of the current understanding of eosinophilic gastrointestinal disorders (EGIDs) and the role of the epithelium in influencing disease pathogenesis to inform and devise future therapeutic strategies.

Recent findings: Changes in epithelial cell structure, functions, and integrity are observed in EGIDs. In eosinophilic esophagitis (EoE), the esophageal epithelium has been shown to play key roles in perpetuating the inflammatory response in EoE through the expression of pro-inflammatory cytokines and immunological cell-surface proteins. Similar mechanisms appear to exist in the other EGIDs, including eosinophilic gastritis (EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). Because of the increasing rarity of each non-EoE EGID, research focusing on how the epithelium is modulating disease in each lower gastrointestinal compartment is still in its rudimentary stages.

Summary: While there has been significant progress in understanding the role of the epithelium in EoE, further research is needed to obtain a better understanding of the mechanisms mediating epithelial-immune crosstalk in non-EoE EGIDs. Using EoE-epithelial cell research to inform future EGID investigations could lead to the development of new therapeutic interventions, such as targeted therapies to restore epithelial barrier function and reduce inflammation, to improve rare disease-patient quality of life.