Current opinion in pediatrics最新文献

Purpose of review: This review summarizes and expands upon studies published since late 2023 regarding predisposing factors, diagnostic measures, and both pharmacologic and nonpharmacologic therapies in the management of pediatric disorder of gut-brain interactions (DGBIs). With up to 30% of children affected by DGBIs, recent advances in diagnostics, therapeutics, and psychosocial insights continue to improve their clinical outcomes.

Recent findings: Recent literature underscores multifactorial contributors to DGBIs, including in utero SSRI exposure and adverse childhood experiences, as well as the potential benefit of gastric motility studies such as dual-phase gastric emptying and water load testing. Furthermore, this article describes advancements in the treatment of pediatric patients with DGBIs including pharmacologic treatments like linaclotide for pediatric functional constipation and nonpharmacologic therapies like percutaneous nerve field stimulation, cognitive behavioral therapy, and parent-focused interventions for many DGBI conditions.

Summary: The most recent literature regarding pediatric DGBIs has newly identified in utero SSRI exposures in addition to psychosocial dynamics as risk factors for the conditions. Current literature supports the need for a multimodal approach to the treatment of pediatric DGBIs by integrating pharmacologic, behavioral, and neuromodulation. Further studies and expanded FDA approvals could further refine effective strategies for pediatric DGBIs.

Purpose of review: This review explores the modern training of pediatric cardiology fellows, starting from prefellowship residency preparation, highlighting new tools and strategies to support trainees during fellowship, and setting up successful transition to independent practice.

Recent findings: Pediatric cardiology fellows benefit from a variety of newer educational strategies. Most experience a boot camp at the start of fellowship to help exposure to the complex and technical elements of the field. The concept of competency based medical education has evolved to incorporate newer milestones for general practice domains as well as those specific to pediatric cardiology, and the incorporation of entrustable professional activities holds great promise. Fellows may benefit from close mentorship, use of newer technology and tools to augment their education, participation in national curricula, and close counseling by program directors about future careers and growth of the field.

Summary: The field of pediatric cardiology education is adapting to the modern healthcare needs to produce high-quality graduates who are trained in the foundational elements of pediatric cardiology. Felllowship graduates should take advantage of all the opportunities among a variety of learning domains to best prepare themselves for the next stage of their careers.

Purpose of review: Congenital heart disease (CHD) is a relatively common congenital anomaly with a wide range of complexity. Different types of CHD carry specific risks for bradyarrhythmias, tachyarrhythmias, or both. These risks and any symptoms guide testing and monitoring strategies. Novel techniques and devices allow for individualized care incorporating short- and long-term risks and benefits.

Recent findings: Changes to approaches in pacemaker lead placement have improved the treatment of cardiac dyssynchrony and the prevention of pacing-induced cardiomyopathy. Catheter ablation is increasingly a primary strategy for tachyarrhythmia management, due to high success rates and infrequent complications. For example, ablation of vulnerable isthmuses in patients with Tetralogy of Fallot prior to transcatheter pulmonary valve replacement is thought to decrease risk of ventricular tachycardia. New techniques and devices allow for more options for adolescent patients who require device implantation. This review will focus on arrhythmias that occur in adolescents with CHD and current strategies for their diagnosis and treatment.

Summary: Adolescents with CHD have unique needs during this time of transition toward healthcare independence. A structured program that addresses arrhythmia and other needs with consideration of long-term benefits and risks can improve quality of life for adolescence and beyond.

Purpose of review: To provide an update of recent advancements in pediatric hepatology, highlighting new diagnostic criteria, emerging therapeutic options, and molecular insights into liver diseases which are reshaping clinical practice and guiding future research.

Recent findings: Nonalcoholic fatty liver disease (NAFLD) has been redefned as metabolic dysfunction-associated steatotic liver disease (MASLD), reflecting an improved understanding of its underlying pathophysiology. Advances in immunophenotyping have identified activated T-cell hepatitis as a significant contributor to indeterminate pediatric acute liver failure. Additionally, the introduction of ileal bile acid transporter (IBAT) inhibitors marks a transformative shift in the management of pediatric cholestatic diseases including Alagille syndrome and progressive familial intrahepatic cholestasis (PFIC), offering improved growth, quality of life, and native liver survival.

Summary: Recent developments in pediatric hepatology are changing how liver diseases are approached in clinical practice. Evolving disease classifications, expanded use of genetic and immunologic profiling, and the introduction of novel therapies mark a shift toward more individualized care. Ongoing research is needed to evaluate long-term outcomes and ensure that these advances translate into durable improvements for children with liver disease.

Purpose of review: Median arcuate ligament syndrome (MALS) is understood to be a condition where compression of the celiac artery by the median arcuate ligament (MAL) may lead to symptoms of postprandial or exercise-induced abdominal pain, nausea, vomiting, diarrhea, oral aversion, and weight loss. This review summarizes recent literature on pediatric MALS while highlighting the challenges, comorbidities, and controversies encountered in this condition.

Recent findings: The pathophysiologic mechanism by which MALS leads to pain is currently unknown. Several overlapping conditions are described in MALS, including mental health comorbidities to autonomic disorders such as orthostatic intolerance, POTS, or Ehlers-Danlos syndrome. Comorbid gastrointestinal conditions may include gastroesophageal reflux disease (GERD), inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and gastroparesis. This overlap makes it difficult to distinguish the cause of broad symptoms patients may experience. MALS remains a complex and controversial topic with particular challenges in consensus diagnostic criteria, normative values in children, symptom definition or correlation, patient selection, predictive outcomes, or long-term follow-up data.

Summary: Patients with MALS deserve a comprehensive multidisciplinary team to address their health. There is also a desperate need for collaborative research including randomized control trials in adults and a multicenter patient registry.

Purpose of review: Antenatal hydronephrosis is the most common prenatally detected fetal anomaly and represents a spectrum of diseases from benign and self-limiting to significant uropathies. This review aims to provide an updated overview of antenatal hydronephrosis, organized by etiology, outlining epidemiology, diagnostic approach, and clinical implications of common and uncommon causes of hydronephrosis. We also explore management strategies, long-term kidney outcomes, and emerging research areas.

Recent findings: Novel research has focused on machine learning models to interpret imaging and predict the natural history of hydronephrosis and urinary tract dilation. Further studies aim to individualize care, reduce the use of antibiotic prophylaxis, and minimize the use of invasive imaging studies.

Summary: Categorizing and risk-stratifying the underlying etiology of antenatal hydronephrosis is important to understand the need for further work-up, select appropriate treatment options, and predict outcomes for patients affected by this broad spectrum of disease.

Purpose of review: Pediatric chronic pancreatitis is an increasingly recognized condition with devastating impacts on a child's quality of life. This review explores recent developments in the diagnosis and treatment strategies of pediatric chronic pancreatitis, emphasizing the expanded awareness of risk factors, refined imaging techniques, and evolving therapeutic approaches, including pharmacologic, endoscopic, and surgical, interventions.

Recent findings: The rising incidence of pediatric chronic pancreatitis has been met with increased vigilance and study of how to approach and manage the disease paradigm. Greater understanding and advances in the role of genetics, efforts to standardize and optimize imaging techniques, and the expansion of access, applications, and outcomes of pediatric endoscopic therapy and surgery have all played an integral role in the improvement of care in children with chronic pancreatitis.

Summary: With increased recognition of pediatric chronic pancreatitis, efforts to diagnose and manage the disease have expanded in kind. Though additional needs exist, particularly in the diagnosis of early chronic pancreatitis and prevention of progression, pain management, and continued expansion of therapeutic outcomes and management, we continue to approach the goal of the comprehensive care of children with chronic pancreatitis.

Purpose of review: Routine diagnostic tests for childhood pneumonia lack the accuracy to identify bacterial pneumonia, leading to inappropriate antibiotic prescription. Novel tests are being developed. Optimizing diagnostic strategies using available diagnostic tools and exploring the role of new tests is essential to improve antimicrobial stewardship (AMS) in children. This review provides an overview of advances in diagnostic testing for pediatric pneumonia and discusses how strategies can be optimized in different settings in order to improve AMS.

Recent findings: All currently available tests for bacterial pneumonia are limited in their diagnostic accuracy. However, in settings with high baseline antibiotic prescription, routine diagnostics such as CRP or PCT-guided prescription can improve antibiotic use. Among the innovative tests, lung ultrasound with computer-aided detection and prediction models combining multiple tests holds most promise for low-resource settings. For high-resource settings, RNA signatures and next-generation sequencing are promising developments. The impact of innovative tests on AMS remains to be evaluated.

Summary: Robust diagnostic and contextual research is needed to develop new diagnostic tests and to optimize current strategies for bacterial pneumonia in children. In order to tailor diagnostic approaches to specific settings, broad impact studies and stratification of risk groups are crucial.

Purpose of review: The growing interest in complementary and alternative medicine (CAM) has sparked discussions about its role in modern pediatric healthcare. While some parents may turn to herbal supplements, essential oils, and other remedies for symptom management, questions remain regarding their safety, efficacy, and regulation for pediatric use. Pediatricians should understand the benefits and limitations of CAM to effectively inform families.

Recent findings: Recent studies suggest that certain CAM therapies may offer relief for pediatric conditions like anxiety and digestive disorders. However, a lack of research and standardized regulation raises concerns about their clinical value, appropriate dosing, and misinformation. While parental interest has led to integration of CAM into some mainstream settings, further studies are needed to establish better evidence-based guidelines for use in pediatric patients.

Summary: CAM continues to garner attention as families seek holistic alternatives to traditional healthcare. While CAM therapies may offer benefit when used alongside conventional medicine, they do not rival first-line treatments for pediatric disorders. Providers must be wary of unverified claims and risks. Incorporating evidence-based research and regulatory oversight can help maximize the well tolerated and effective use of CAM.

Purpose of review: Dextro-transposition of the great arteries (d-TGA) is a relatively common form of cyanotic congenital heart disease that is not typically associated with chromosomal abnormalities or extracardiac abnormalities. Most cases of d-TGA are prenatally diagnosed, but there are cases of postnatal diagnosis that may present with cyanosis, acidosis and circulatory collapse. It is important for the general practitioner to be familiar with this patient population, as they require continued monitoring for postsurgical complications following surgical repair.

Recent findings: The arterial switch operation was introduced in 1975 and is the current surgical treatment for d-TGA. As patients with arterial switch operation reach mid to late adulthood, we continue to explore the best ways to screen for, and treat, coronary insufficiency. Additionally, we are working to understand more about neurodevelopmental outcomes in this population.

Summary: Advancements in prenatal diagnosis and surgical management of d-TGA have led to excellent outcomes in pre and postoperative mortality. Patients should be screened after surgical repair for complications related to coronary insufficiency with routine cardiology follow up.