Pediatrics in review最新文献

Disorders of hypopigmentation are relatively common in children. Hypopigmentation refers to decreased pigmentation compared with surrounding skin, and depigmentation refers to a complete loss of pigmentation. The most common acquired causes include post-inflammatory hypopigmentation, pityriasis alba, vitiligo, tinea versicolor, and halo nevi. Commonly, congenital hypopigmented lesions may be attributed to pigmentary mosaicism, a term that refers to hypo- or hyperpigmentation resulting from somatic mosaicism. Pigmentary mosaicism most commonly occurs without syndromic association, such as in the case of nevus depigmentosus; however, rarely it can occur as part of a syndrome that may require further workup with genetic testing, such as with the hypomelanotic macules of tuberous sclerosis complex. Although most of the conditions causing hypopigmentation and depigmentation in children are benign, rare instances may be associated with syndromes or rare dermatoses that require further workup by a specialist. Given their common presentation to the general pediatrician, this article aims to cover the most common causes of hypo- and depigmentation in children, along with their differentiating features, natural history and prognosis, first-line treatment, and indications for further evaluation.

Central line-associated bloodstream infections (CLABSIs) are a common and significant health care-associated infection in hospitalized and nonhospitalized pediatric patients with central venous catheters. Interventions to prevent such infections have evolved over the last 2 decades, resulting in significant reductions in CLABSI rates through the development and implementation of evidence-based guidelines on prevention and management recommended by the Centers for Disease Control and Prevention and the National Healthcare Safety Network and pediatric infectious diseases and health care epidemiology professional societies. This review provides a detailed synopsis of CLABSIs in children, including the definition, pathogenesis, risk factors, prevention, and treatment principles.

Cannabis (also called marijuana) is naturally derived from the cannabis plant and can be consumed in many different product formulations that have varying concentrations of tetrahydrocannabinol (THC), the most prevalent psychoactive substance. Almost half of states in the United States have legalized recreational use for adults. Fortunately, longitudinal epidemiological studies indicate that less than 20% of youth report current cannabis use and that their lifetime use has actually decreased over the last few decades. Nevertheless, with the increasing availability of different formulations with higher concentrations of THC and notable increase in use among adults, pediatricians need to be more knowledgeable about cannabis and its health effects on children and adolescents. Clinical syndromes, both acute and chronic, evidenced-based screening tools, and treatment modalities are described. Pediatricians can play a unique role in both preventive counseling and engagement in reduction of its use among youth.

Rickets remains one of the most common nontransmissible pediatric diseases, especially in low- to middle-income countries. Rickets is characterized by impaired mineralization of growing bone resulting in bone frailty, deformities, impaired growth and development, and pain with standing or walking. Nutritional rickets is the most common cause of bone disease in the world. The most frequent etiology of rickets is vitamin D deficiency, with pathognomonic biochemical and radiologic characteristics. However, even in the context of appropriate vitamin D levels, other causes for rickets need to be considered, such as decreased calcium intake or absorption, metabolic bone disorders, abnormal phosphorus metabolism, and specific genetic forms that are not responsive to vitamin D therapy. Biochemical tests measuring serum and urine calcium and phosphorus, vitamin D, alkaline phosphatase, and parathyroid hormone allow differentiation between various forms of rickets. Treatment of rickets helps optimize growth and reduce disability. Nutritional rickets is treated with vitamin D repletion, most commonly with ergocalciferol. The treatment of hypophosphatemic rickets depends on the etiology of the condition and may include calcitriol, phosphorus, and, more recently, burosumab.