Current opinion in pediatrics最新文献

Purpose of review: To summarize recent evidence from randomized clinical trials (RCT) and meta-analysis of patent ductus arteriosus (PDA) closure therapies versus conservative/expectant management on key outcomes such as bronchopulmonary dysplasia (BPD) or death in very preterm (<32 weeks' gestation) infants.

Recent findings: Of 10 completed RCTs in the past decade of medical therapies before 2 weeks of age to close a PDA, none demonstrated benefit in reducing moderate-severe BPD/death by 36 weeks postmenstrual age as compared to placebo treatment. When combined, the meta-analysis of the 10 RCTs showed an elevated risk of BPD/death [relative risk (RR): 1.10, 95% confidence interval (CI), 1.01-1.19) and higher risk of death by 36 weeks postmenstrual age or discharge (RR: 1.25; 95% CI, 1.01-1.56). A 2025 Cochrane meta-analysis also found a similar concerning trend of increased mortality following early medical treatment for PDA. Despite their recent popularity, there are no published trials demonstrating safety or efficacy of transcatheter PDA closure.

Summary: We now have ample evidence for all clinicians to finally acknowledge that conservative PDA management is the correct path forward. Clinical experimentation is no longer acceptable, and expectant PDA management must be adopted as the current standard if we are to adhere to our foundational principle, 'first, do no harm'.

Purpose of review: Recent advances in artificial intelligence (AI) coincide with decreases in confidence in vaccines. This review examines studies that analyze and mitigate vaccine skepticism by implementing artificial intelligence strategies in various ways.

Recent findings: Studies have explored public attitudes towards vaccines using AI to analyze language in social media postings and interactions, scrutinize AI responses to vaccine-related queries, and attempt to use AI to directly influence vaccine hesitancy. Findings show that AI can be effective in addressing vaccine hesitancy in various ways, including, but not limited to, directly interacting with vaccine-hesitant groups, identifying reasons for vaccine hesitancy, and predicting vaccine hesitancy among specific populations.

Summary: AI will undoubtedly continue to evolve and improve over the coming years. Continued advances and new applications can help mitigate unwarranted vaccine hesitancy in a variety of ways, such as educating people with messaging tailored to end users or using AI to identify the specific concerns of vaccine-hesitant individuals and groups. It will require an integrative approach to a complex issue - vaccine hesitancy is not a monolith; there is a range of degrees of vaccine hesitancy, and various factors go into a person's vaccine knowledge and beliefs.

Purpose of review: The clinical presentation of pediatric bacterial pneumonia often overlaps with that of other respiratory conditions, posing considerable diagnostic challenges. This review evaluates the potential of artificial intelligence to improve diagnostic accuracy and prognostic evaluation for this disease.

Recent findings: Artificial intelligence driven diagnostic tools for pediatric bacterial pneumonia have now been validated in several studies. Clinically, these systems can rapidly process chest imaging, synthesize heterogeneous patient data, and alert physicians to early signs of severe pneumonia. Beyond immediate diagnostics, they also show emerging utility in uncovering biomarkers relevant to disease prognosis and management.

Summary: In clinical practice, artificial intelligence driven decision support is emerging as a valuable tool for the early diagnosis of pediatric bacterial pneumonia. As high-quality, multicenter datasets continue to grow and model interpretability improves, artificial intelligence is expected to become increasingly important in managing pediatric bacterial pneumonia.

Purpose of review: Bronchopulmonary dysplasia (BPD) is a common complication among extremely low birth weight Infants. Evidence suggest that the incidence of BPD is increasing. This review examines current evidence-based strategies initiated early in life for prevention of BPD.

Recent findings: In this review of early life approaches for prevention of BPD, perinatal interventions, respiratory support strategies, surfactant therapy, pharmacological therapies, fluid management, patent ductus arteriosus management, nutrition, and dietary supplements are discussed.

Summary: There is no single effective strategy to prevent BPD in all at risk infants. Therefore, clinicians must use multifaceted evidence-based strategies, beginning during the perinatal period, to reduce the risk of developing BPD in preterm infants.

Purpose of review: This review examines the role of vascular health in children and adolescents with systemic hypertension. Like other areas of target organ damage (TOD), arterial dysfunction can have deleterious effects over time, leading to adverse cardiovascular events such as myocardial infarction or stroke as an adult.

Recent findings: Literature in the last few years has focused on TOD to the vascular tree in pediatric patients with hypertension. These data also included vascular dysfunction in ambulatory and masked hypertension, particularly in secondary causes of hypertension, which emphasize the importance of ambulatory BP monitoring in these patients. While subclinical TOD exists early on, longitudinal studies that follow diverse populations with hypertension from childhood into late adulthood are needed to determine if abnormal vasculature is independently associated with suboptimal cardiovascular outcomes. Consistent conduct of these tests would more formally incorporate them into pediatric clinical practice.

Summary: Hypertension is a chronic medical condition that needs a multipronged treatment approach. The vasculature is an important yet understudied area of TOD. Longitudinal studies in this realm could link subclinical disease in youth to adult adverse events and develop more precise management to mitigate these events and to enable a better quality of life.

Purpose of review: Children with congenital or acquired cardiac disease are at increased risk for both ischemic and hemorrhagic stroke. This review covers the epidemiology, presentation, acute management, and outcomes of stroke in children with heart disease.

Recent findings: The major advances in endovascular thrombectomy for adults with large vessel occlusions (LVOs) have had significant ramifications for children with cardioembolic stroke, who often present with LVO. Several large registry studies have shown that thrombectomy likely improves outcomes for children with LVO, including those with acquired or congenital heart disease. Improving both primary and secondary stroke prevention remains both vital and challenging; as more children with congenital heart disease survive into adulthood, studies show that they remain at increased risk for stroke and may be susceptible to earlier frailty and cognitive impairment.

Summary: Children with cardiac disease have a lifelong increased risk of stroke. While new interventions such as thrombectomy may improve outcomes, more research is needed to improve long term neurologic outcomes in this population.

Purpose of review: The mandated accessibility of the electronic health record (EHR), including direct patient access through a portal, has created a unique and important opportunity for clinicians to examine their communication. This development underscores the importance of understanding how language - both written and verbal - may inadvertently reinforce biases, perpetuate existing disparities, and potentially distance patients from care. Indeed, the language clinicians use - whether written or verbal - is not merely descriptive; it is a powerful intervention that can either build trust or perpetuate harm. While often unintentional, the misuse of language in a clinical context is a significant and modifiable driver of health disparities. We will examine the mechanisms by which biased words erode patient care and then propose concrete strategies to foster communication that are precise, respectful, and actively promotes health equity.

Recent findings: The connection between language in a clinical context and bias, whether spoken or written, is increasingly acknowledged in medical education and research literature. This evolving field is especially pertinent to pediatric care, where communication plays a critical role in health outcomes.

Summary: This review defines stigmatizing language and explores how linguistic patterns can influence the physician-patient relationship. We delve into the ways the use of stigmatizing language reinforces broader societal frameworks, shapes clinicians' attitudes, and healthcare disparities. We illustrate how shifting towards person-centered language can transform linguistic patterns. As our digital age continues to evolve, with increasing reliance on social media and artificial intelligence, we urge physicians to model language that fosters inclusivity by offering strategies, at both the individual and system levels, to integrate into their healthcare communication.

Purpose of review: The use of genetic testing within the pediatric population continues to expand as broad-based sequencing becoming more incorporated into routine practice. While these evaluations are also utilized within the military population, key points should be considered when providing these recommendations. This review aims to highlight the important differences between civilian and military genetics evaluations.

Recent findings: Review of the available literature and recent current events including an emphasis on military readiness and operational mission completion, reveals that the role of a military geneticist both within the pediatric and Active Duty population will only continue to expand.

Summary: Broad-based sequencing is increasingly offered as a first-line evaluation during routine genetic appointments for entities, such as unexplained symptoms, multiple congenital anomalies, or developmental delay. Within the military realm, considerations for potential impact to the Active Duty Service Member must be understood regarding future eligibility, current retainability, and possible effect on disability benefits. This is imperative as protection such as the Genetic Information Non Discrimination Act do not apply to the military population, but with proper and thorough pretest counseling, Soldiers will be able to make sound, informed decisions surrounding their own healthcare and their families as well.

Purpose of review: Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory state in adult and pediatric patients, with associated severe morbidity and mortality. Here, we provide an updated overview of HLH, associated triggers, diagnostic tools and criteria, as well as treatment considerations.

Recent findings: Hemophagocytosis lymphohistiocytosis, a state of severe inflammation and immune overactivation, can be life threatening with significant risk of morbidity and mortality. Diagnostic criteria initially used remain valid to this day, while newer laboratory measurements can be informative and helpful in identifying patients with this diagnosis, such as CXCL9, IL-18, and other serum cytokines. Initially thought to occur only in patients with inborn errors of immunity or malignancy, HLH is recognized as a spectrum of inflammation, occurring in healthy individuals in response to common infections. With this realization comes a pressing need for earlier consideration, identification, and treatment initiation to prevent severe or fatal outcomes.

Summary: Recent insights into the diagnosis of HLH have led to earlier identification, associated triggers and laboratory criteria, with the goal of decreasing delays in time to treatment and improved outcomes.