Current opinion in pediatrics最新文献

Purpose of review: Existing research on eating disorders has predominantly centered on affluent, young White cisgender women, limiting providers' understanding of how sociocultural context influences the identification, assessment, and treatment of eating disorders among racial and ethnic minorities. Latino boys and young men remain a particularly understudied group in eating disorder studies, despite growing recognition of the prevalence of eating disorders within Latino populations. This review integrates a synthesis of current literature, epidemiological data, and multidisciplinary perspectives on sex and culture to outline how sociocultural factors, including cultural beliefs such as machismo, acculturation, and family dynamics, impact the development and expression of eating disorders in Latinos.

Recent findings: Findings underscore that Latino boys and young men often present with atypical eating disorder symptoms, such as extreme dietary restrictions and excessive exercise aimed at achieving muscularity. Sociocultural factors (i.e., machismo, acculturative stress, and familial pressures) influence the manifestation and progression of these disorders. These influences are compounded by systemic barriers, such as limited access to culturally responsive care and a lack of awareness among providers regarding diverse eating disorder presentations.

Summary: This review highlights the urgent need for culturally informed diagnostic frameworks and interventions to address the eating disorder experiences of Latino boys and young men.

Purpose of review: Topical corticosteroids (TCS) have long been a mainstay in treating pediatric atopic dermatitis (AD). Topical steroid withdrawal syndrome (TSWS) has garnered increasing public attention, driven largely by social media discourse. This review aims to provide guidance for clinicians to effectively address concerns about pediatric TSWS in order to optimally manage AD in children.

Recent findings: An examination of the literature reveals several misconceptions surrounding TSWS. Research highlights the importance of standardized diagnostic criteria, caution with high- or inappropriate potency TCS, particularly in sensitive areas, and the need for provider-patient communication to improve therapeutic alliance.

Summary: TSWS is gaining recognition, and the lack of consensus on diagnostic standards and similarities with AD flares can result in misdiagnosis. This review highlights practical, evidence-based clinical approaches to discuss TSWS with patients/parents. Strategies to prevent adverse effects from TCS include appropriate potency selection and duration of treatment, utilizing gradual tapering protocols with proactive maintenance therapy, and addition of nonsteroidal anti-inflammatory therapies. Moreover, fostering an open, empathetic doctor-patient relationship can reduce unwarranted phobia around corticosteroids and ensure that TCS continue to be used optimally to treat AD and other inflammatory skin conditions. Thorough clinical guidance is essential to address patient/parent concerns about TSWS while working together toward an effective treatment plan for skin disease.

Purpose of review: The purpose of this review is to provide an update on screening, diagnosis, and treatment of lipid disorders in the pediatric patient.

Recent findings: Apart from the United States Preventive Services Task Force (USPSTF), the majority of medical societies recommend universal screening for lipid disorders in children and adolescents 21 years or younger. Recent population studies confirm lipid abnormalities are prevalent in children, affecting at least one in five children aged 6-19 years. A systematic review and network meta-analysis of lipid-lowering therapies in children and adolescents with familial hypercholesterolemia found that statins reduced LDL-C by 33.61% and adding ezetimibe reduced LDL-C by an additional 15.85%.

Summary: Nearly all major medical societies recommend universal lipid screening in children aged 9-11 and 17-21. Lipid abnormalities are common, and diagnosis is generally made by confirming abnormal lipid results with fasting lipid studies. Lifestyle modifications and statins are the mainstay for treatment of dyslipidemia. However, most research on lipid-lowering therapies is in familial hypercholesterolemia.

Purpose of review: To discuss updated guidelines for the provision of contraception to adolescents, review several contraceptive methods that have entered the market in recent years, and summarize insights from the literature that can assist clinicians in providing accurate, destigmatized contraceptive counseling to patients of all sizes.

Recent findings: The 2024 United States Selected Practice Recommendations (US SPR) and United States Medical Eligibility for Contraceptive Use (US MEC) guidelines include changes to recommendations for contraception use in persons with various health conditions, and new advice for management of implant-associated breakthrough bleeding, pain control for intrauterine device (IUD) insertions, and counseling for patients who take testosterone. Subcutaneous Depo-Provera usage increased during the COVID-19 pandemic, and multiple studies demonstrate favorable patient experiences with it. Annovera, Miudella, Opill, Phexxi, Slynd, and Twirla are newer contraceptives which have distinct features that may make them attractive options for some patients. Contraception-related weight changes continue to be an active area of research. With the Food and Drug Administration (FDA) recommending broader BMI inclusion criteria, providers can expect more information about safety and efficacy of new contraceptives in individuals across the weight spectrum.

Summary: Updated evidence-based guidelines and several new contraceptive options should empower providers to provide patient-centered contraception counseling to patients with a variety of health conditions and contraceptive preferences.

Purpose of review: Glucocorticoid-induced osteoporosis (GIO) poses a significant risk to pediatric patients undergoing chronic glucocorticoid therapy for inflammatory, autoimmune, and genetic conditions. This review highlights the pathophysiology of GIO in children and emerging insights into the role of bone vasculature in skeletal health during growth.

Recent findings: GIO arises from a dual mechanism of increased bone resorption and decreased bone formation, leading to rapid declines in bone mineral density. Recent studies emphasize the importance of angiogenic-osteogenic coupling, particularly in the growing skeleton. Endothelial cells are now recognized as active participants in bone health and regeneration. Advances in the understanding of signaling pathways regulating skeletal angiogenesis could predict skeletal side effects during drug development. Therapies enhancing endothelial cell function or promoting skeletal angiogenesis could mitigate glucocorticoid-induced damage. Key signaling pathways, such as platelet-derived growth factor type BB and nuclear factor (NF)-κB play critical roles in recruiting osteoprogenitors and establishing a vascular niche for skeletal angiogenesis.

Summary: GIO is uniquely concerning in children due to its impact on peak bone mass and lifelong fracture risk. Understanding how glucocorticoids impair bone vasculature and skeletal remodeling may reveal new therapeutic targets to preserve bone health and mitigate the osteotoxic effects of long-term glucocorticoid use in the growing skeleton.

Purpose of review: JAK inhibitors have emerged as a promising new therapy for inflammatory skin disease, including in pediatric populations. However, due to their boxed warnings and lack of long-term safety and efficacy data, their specific role in the treatment ladder for various conditions remains to be determined.

Recent findings: JAK inhibitors are currently approved for pediatric atopic dermatitis and alopecia areata with evidence of both efficacy and safety. They are currently being investigated for use in children with vitiligo, psoriasis, juvenile dermatomyositis, and hidradenitis suppurativa. So far, no significant safety concerns, especially regarding the FDA-mandated black box warnings, have been observed in pediatric patients being treated for inflammatory skin disease.

Summary: JAK inhibitors provide clinicians and patients with another tool to consider when faced with challenging inflammatory skin diseases. Place in therapy amid the current armamentarium of available treatments for select skin conditions is evolving, as efficacy and safety data accumulates in trials and clinicians develop more real-world experience. As of now, use of JAK inhibitors should be considered on a case-by-case basis after a comprehensive assessment of the benefits and potential risks.

Purpose of review: To provide pediatric providers with the most up to date information on evaluation, diagnosis, and treatment of orthostatic intolerance and postural orthostatic tachycardia syndrome (POTS).

Recent findings: In this review, new research is summarized on the importance of exercise, the role of anxiety and depressed mood in exacerbating symptoms, and medication utilization.

Summary: Orthostatic intolerance and POTS are increasingly common causes of significant infirmity during adolescence. Pediatricians are front line in implementing treatment, which is centered on patient education and nonpharmacologic strategies. Precise history taking identifies the conditions, and accurately explaining the pathophysiology to families encourages patient buy-in to follow a rigorous treatment program. While anxiety and depressed mood are not central causes of symptomatology, they do exacerbate a patient's presentation and thus must be treated aptly. Prognosis is excellent in patients who adhere to a treatment plan, and encouragement from providers as to this expectation is key to building a strong therapeutic alliance.

Purpose of review: Critically ill children admitted to the intensive care unit frequently need respiratory care to support the lung function. Mechanical ventilation is a complex field with multiples parameters to set. The development of precision medicine will allow clinicians to personalize respiratory care and improve patients' outcomes.

Recent findings: Lung and diaphragmatic ultrasound, electrical impedance tomography, neurally adjusted ventilatory assist ventilation, as well as the use of monitoring data in machine learning models are increasingly used to tailor care. Each modality offers insights into different aspects of the patient's respiratory system function and enables the adjustment of treatment to better support the patient's physiology. Precision medicine in respiratory care has been associated with decreased ventilation time, increased extubation and ventilation wean success and increased ability to identify phenotypes to guide treatment and predict outcomes. This review will focus on the use of precision medicine in the setting of pediatric acute respiratory distress syndrome, asthma, bronchiolitis, extubation readiness trials and ventilation weaning, ventilation acquired pneumonia and other respiratory tract infections.

Summary: Precision medicine is revolutionizing respiratory care and will decrease complications associated with ventilation. More research is needed to standardize its use and better evaluate its impact on patient outcomes.

Purpose of review: Intensive care unit (ICU) liberation bundles aim to reduce acquired morbidities in the growing population of pediatric ICU survivors. This review will explore emerging precision medicine strategies to personalize the implementation of the ICU liberation bundle.

Recent findings: The ICU liberation bundle, also known as the ABCDEF bundle, consists of six interrelated components: A: assess, prevent, and manage pain; B: spontaneous breathing trials; C: choice of analgesia and sedation; D: delirium assessment, prevention, and management; E: early mobility and exercise; F: family engagement and empowerment. Emerging research and technology are advancing personalized approaches to each component, enabling researchers and clinicians to optimize implementation based on patient-specific factors. Key innovations include automated screening and risk stratification using computational models, wearable technologies that detect bundle elements, and genetic assessments to evaluate disease risk and medication responses.

Summary: This review provides an overview of the ICU liberation bundle for critically ill children and highlights opportunities to personalize each bundle element to enhance survivorship. By integrating advancements in precision medicine, clinicians and researchers can improve the quality of care for the growing population of PICU survivors, ultimately leading to better long-term outcomes.