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Persistent pulmonary hypertension of the newborn
IF 0.6 Q4 PEDIATRICS Pub Date : 2024-12-05 DOI: 10.1016/j.ppedcard.2024.101777
Jordan P. Priya Cooper , Ahzam Budhwani , Leah S. Kunneth , Isha A. Patel , Allison Omohundro , Olumayowa B. Sholola , Induja Gajendran , Michael Zayek , Diksha Shrestha

Background

Persistent pulmonary hypertension in the newborn is associated with increased risk of cardiorespiratory failure, neurodevelopmental delay, and death.

Aim of review

The purpose of this article is to review normal and abnormal perinatal pulmonary vasculature adaptation and persistent pulmonary hypertension of the newborn, including etiology, pathophysiology, clinical manifestations, diagnostic methods, and treatment.

Key scientific concepts of review

Persistent pulmonary hypertension of the newborn is characterized by failure of the pulmonary vasculature in the newborn to adapt after birth, resulting in sustained high pulmonary vascular resistance, abnormal extrapulmonary right-to-left shunting of deoxygenated blood, and refractory hypoxemia. The etiology and pathophysiology of persistent pulmonary hypertension of the newborn may be classified into four broad categories, including maladaptation of a structurally normal cardiopulmonary system, underdevelopment of the lungs, maldevelopment of pulmonary vasculature in the absence of pulmonary parenchymal disease, and intravascular obstructions associated with increased blood viscosity from polycythemia. Infants with persistent pulmonary hypertension of the newborn may present with labile hypoxemia, with or without respiratory distress. Evaluation may include simultaneous pre- and post-ductal oxygen saturation measurements, chest radiography, echocardiography, and arterial blood gas analysis. The hyperoxia test may be useful when echocardiography is unavailable. The main goal in treating persistent pulmonary hypertension of the newborn is to reverse pulmonary vasoconstriction, optimize cardiac function, and improve systemic oxygen delivery. Treatment may include supportive measures such as sedation, correction of metabolic disturbances, management of polycythemia, oxygen therapy, and mechanical ventilation. Targeted therapy, depending on the underlying cause of disease, may include surfactant therapy, pulmonary vasodilator therapy, and optimization of hemodynamic status. Infants with refractory PPHN may require extracorporeal membrane oxygenation. Survivors of moderate to severe disease should be monitored for neurologic abnormalities, hearing loss, and cognitive delay.
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引用次数: 0
Consequences and complications of un-intervened congenital heart defects in children: A retrospective cross-sectional study
IF 0.6 Q4 PEDIATRICS Pub Date : 2024-12-04 DOI: 10.1016/j.ppedcard.2024.101776
Tesfaye Taye Gelaw, Belaynew Zemed Alebachew

Background

Children with unrepaired congenital heart defects (CHDs) are at risk of developing complications related to the scarcity of interventions, delayed diagnosis, financial constraints, and difficulty reaching facilities in low-and middle-income countries.

Objective

Describe the frequency of complications by age and CHD type in children with un-intervened CHDs seen at Bahir Dar University Tibebe-Ghion Specialized Teaching Hospital.

Method

We conducted a retrospective cross-sectional study on children with un-intervened CHDs seen from September 01, 2021, to August 31, 2024. Data were collected from September 20 to 30, 2024, retrospectively. Categorical variables were analyzed in the form of proportions. Discrete variables were summarized as means (SD). Binary logistic regression was performed with 95 % confidence interval. P-value <0.05 was considered significant. Data were analyzed using SPSS version 27.

Result

Of the 310 children with un-intervened CHDs, 47 % were female. The mean (SD) age was 28 months (42). Wasting (46 %) is the most common complication in children with CHD, followed by congestive heart failure (41 %), and recurrent respiratory tract infection (30 %). Seventy percent of children with un-intervened CHDs have at least one complication (68 % of acyanotic and 77 % of cyanotic CHDs). After adjusting for covariates, one month increase in age of children with un-intervened CHD increases the proportion of complications by 2 % {AOR = 1.019, 95 % CI = (1.007, 1.031)}.

Conclusion

A higher proportion of children with CHD had at least one or more complications. A one month delay in intervention of children with un-intervened CHDs has a 2 % increase in the occurrence of complications.
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引用次数: 0
Conservative management of patent ductus arteriosus in preterm infants: A systematic review and meta-analysis of randomized controlled trials
IF 0.6 Q4 PEDIATRICS Pub Date : 2024-12-04 DOI: 10.1016/j.ppedcard.2024.101774
Rajanikant Kumar , Efeoghene Praise Epia , Mark W. Abdelnour , Joo Young Belen Kim Kim , Anne Boakyewaa Anokye-Kumatia , Rimmo Loyi Lego , Vrunda Kulkarni , Syed Ali Farhan Abbas Rizvi , Maryam Asif , Huzaifa Ahmad Cheema , Adeel Ahmad , Wajeeh Ur Rehman , Raheel Ahmed , Sourbha S. Dani

Background

In recent years, there has been a rise in the adoption of conservative approaches to managing patent ductus arteriosus (PDA) in preterm infants. Systematic appraisal of the clinical evidence supporting this approach is essential for guiding guideline recommendations.

Aim of review

This systematic review and meta-analysis aims to investigate a strategy of conservative management in comparison to active treatment in preterm infants with PDA.

Key scientific concepts of review

From inception to April 2024, we conducted a comprehensive search of MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov to identify relevant randomized controlled trials (RCTs) that evaluated conservative management versus active treatment of PDA in preterm infants. We used RevMan 5.4 to pool risk ratios (RRs).
Our review included 6 RCTs. There was no difference in the risk of mortality (RR 0.83; 95 % CI: 0.64–1.08) and BPD (RR 0.89; 95 % CI: 0.76–1.03) between the conservative management and active treatment groups. The rates of necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, sepsis, pulmonary hemorrhage, and the need for surgical ligation or transcatheter occlusion were similar between the two groups. In conclusion, our analysis showed no difference in the risk of all-cause mortality, BPD, or other clinical outcomes between a strategy of conservative management compared to active treatment. Further, large-scale RCTs focusing on targeted therapy for infants at the highest risk of complications from PDA are required.
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引用次数: 0
Pediatric Hypertension: definitions, evaluation, and treatment
IF 0.6 Q4 PEDIATRICS Pub Date : 2024-12-04 DOI: 10.1016/j.ppedcard.2024.101778
Shaira Bedi , Tania Raygoza , Josephine Jalkh , Jumoke Adelabu , Taryn Hartley , Rachel Lusk , Kevin Wong , Uzoma Obiaka , Dunya Mohammad

Background

Pediatric hypertension affects 3 % to 5 % of children and adolescents between ages 1 year to 18 years and may have long-term health consequences.

Aim of review

The purpose of this article is to review pediatric hypertension, including screening, methods of blood pressure measurement, etiology, evaluation, and treatment of patients with or without end-organ damage.

Key scientific concepts of review

In children, blood pressure levels are interpreted based on age, sex, and height to avoid misclassification. Blood pressure measurements at three separate visits are required to diagnose hypertension. Routine screening begins at age 3 years, but blood pressure is measured during each health visit in patients who have body mass index ≥95 %, take medications that increase blood pressure, or have health issues that may increase the risk of developing hypertension. The auscultatory method is preferred for blood pressure measurement in the right arm. A 24-h ambulatory blood pressure monitor is used to confirm hypertension and differentiate it from white-coat or masked hypertension. Primary (essential) hypertension is multifactorial and may be associated with overweight and obesity, genetic predisposition, premature birth, low birth weight, increased sodium intake, sedentary lifestyle, and obstructive sleep apnea. Secondary hypertension may be caused by specific diseases such as kidney disease, cardiovascular disease, endocrine abnormalities, adverse events from medication, and monogenic causes. Treatment for pediatric hypertension includes nonpharmacologic and pharmacologic therapies, including diet and lifestyle modification. Children with hypertension are more likely to have hypertension in adulthood and develop targeted end-organ injury of the brain, cardiovascular system, or kidneys. It is important to accurately diagnose and treat hypertension early in childhood to avoid long-term complications.
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引用次数: 0
Corrigendum to “A perinatal cardiology network review: The Nemours Children's health system approach in the state of Florida” [Progress in Pediatric Cardiology volume (2022) 101527]
IF 0.6 Q4 PEDIATRICS Pub Date : 2024-12-01 DOI: 10.1016/j.ppedcard.2024.101789
Katherine Braley , Thinh Nguyen , Kathryn Douglas , Gul Dadlani
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引用次数: 0
Corrigendum to “Evaluation of heart murmurs in children” [Prog. Pediatr. Cardiol. 65 (2022) 101493]
IF 0.6 Q4 PEDIATRICS Pub Date : 2024-12-01 DOI: 10.1016/j.ppedcard.2024.101790
Anevea Tinnery , Peace C. Madueme
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引用次数: 0
Corrigendum to “Vitamin D and morbidity in children with Multisystem inflammatory syndrome related to Covid-19” [Progress in Pediatric Cardiology 66 (2019) 101507]
IF 0.6 Q4 PEDIATRICS Pub Date : 2024-12-01 DOI: 10.1016/j.ppedcard.2024.101782
Diana Torpoco Rivera , Amrit Misra , Yamuna Sanil , Natalie Sabzghabaei , Raya Safa , Richard U. Garcia
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引用次数: 0
Cardiomyopathy in childhood cancer survivors: Etiology, pathophysiology, diagnosis, treatment, and screening 儿童癌症幸存者的心肌病:病因学、病理生理学、诊断、治疗和筛查
IF 0.6 Q4 PEDIATRICS Pub Date : 2024-12-01 DOI: 10.1016/j.ppedcard.2024.101766
Pedro Ricardo Cabrera , Isabella Dinelli , Noah Baker , Ashley Bates , Ashleigh Torrance , Induja Gajendran , Hamayun Imran

Background

There is an increase in childhood cancer survivors because of advancements in cancer treatment. Current overall survival of childhood cancer in developed nations is >80 %. Increased survival is associated with an increase in long-term therapy-related adverse events. Cardiotoxicity from exposure to chemo- and radiation therapy may cause major short- and long-term sequelae.

Aim of review

The purpose of this article is to review current concepts about cardiotoxicity associated with pediatric cancer therapy including etiology, pathophysiology, diagnosis, treatment, and screening.

Key scientific concepts of review

Anthracycline drugs produce reactive oxygen species that cause damage to myocytes. Radiation therapy causes collagen replacement and fibrosis in the pericardium and myocardium. Acute complications include arrhythmias, decreased left ventricle (LV) function, and heart failure. Chronic complications occurring >1 year after treatment initiation include coronary artery disease, valvular disease, and cardiomyopathy. These adverse events are observed mostly with high cumulative doses of anthracyclines (>250 mg/m2) or radiation therapy (>30 Gy). Additional risk factors such as preexisting cardiac illness, hypertension, dyslipidemia, and diabetes may contribute to adverse outcomes. Echocardiography is the most commonly used method of screening and diagnosis of cardiac dysfunction. In contrast, cardiac magnetic resonance imaging is more precise but also costly and requires sedation. Prevention of cardiotoxicity includes the use of dexrazoxane, enalapril, and methods to modify the dosage and delivery of chemo- and radiation therapy. Treatment of established cardiomyopathy may include interventions for LV preload and afterload reduction, implantable devices, and heart transplant. With emphasis on prevention, current guidelines recommend frequent screening echocardiography and individualized multimodal care for each patient. Further studies are justified to develop safe and effective alternatives to cardiotoxic cancer therapy regimens and improved treatments for established cardiomyopathy.
由于癌症治疗的进步,儿童癌症幸存者的数量有所增加。目前,发达国家儿童癌症的总体存活率为80%。生存期的增加与长期治疗相关不良事件的增加有关。暴露于化疗和放疗的心脏毒性可引起主要的短期和长期后遗症。本文的目的是综述目前关于儿童癌症治疗相关的心脏毒性的概念,包括病因、病理生理学、诊断、治疗和筛查。综述关键科学概念蒽环类药物产生活性氧,对肌细胞造成损伤。放射治疗引起心包和心肌的胶原替代和纤维化。急性并发症包括心律失常、左心室功能下降和心力衰竭。治疗开始1年后出现的慢性并发症包括冠状动脉疾病、瓣膜疾病和心肌病。这些不良事件大多发生在高累积剂量的蒽环类药物(250 mg/m2)或放射治疗(30 Gy)时。其他危险因素,如先前存在的心脏病、高血压、血脂异常和糖尿病可能导致不良后果。超声心动图是筛选和诊断心功能障碍最常用的方法。相比之下,心脏磁共振成像更精确,但也很昂贵,需要镇静。心脏毒性的预防包括使用右拉唑烷、依那普利,以及调整化疗和放疗的剂量和递送方法。已确定的心肌病的治疗可能包括左室前负荷和后负荷减少、植入式装置和心脏移植的干预措施。在强调预防的同时,目前的指南建议对每位患者进行频繁的超声心动图筛查和个性化的多模式护理。进一步的研究是合理的,以开发安全有效的替代心脏毒性癌症治疗方案和改进治疗已建立的心肌病。
{"title":"Cardiomyopathy in childhood cancer survivors: Etiology, pathophysiology, diagnosis, treatment, and screening","authors":"Pedro Ricardo Cabrera ,&nbsp;Isabella Dinelli ,&nbsp;Noah Baker ,&nbsp;Ashley Bates ,&nbsp;Ashleigh Torrance ,&nbsp;Induja Gajendran ,&nbsp;Hamayun Imran","doi":"10.1016/j.ppedcard.2024.101766","DOIUrl":"10.1016/j.ppedcard.2024.101766","url":null,"abstract":"<div><h3>Background</h3><div>There is an increase in childhood cancer survivors because of advancements in cancer treatment. Current overall survival of childhood cancer in developed nations is &gt;80 %. Increased survival is associated with an increase in long-term therapy-related adverse events. Cardiotoxicity from exposure to chemo- and radiation therapy may cause major short- and long-term sequelae.</div></div><div><h3>Aim of review</h3><div>The purpose of this article is to review current concepts about cardiotoxicity associated with pediatric cancer therapy including etiology, pathophysiology, diagnosis, treatment, and screening.</div></div><div><h3>Key scientific concepts of review</h3><div>Anthracycline drugs produce reactive oxygen species that cause damage to myocytes. Radiation therapy causes collagen replacement and fibrosis in the pericardium and myocardium. Acute complications include arrhythmias, decreased left ventricle (LV) function, and heart failure. Chronic complications occurring &gt;1 year after treatment initiation include coronary artery disease, valvular disease, and cardiomyopathy. These adverse events are observed mostly with high cumulative doses of anthracyclines (&gt;250 mg/m<sup>2</sup>) or radiation therapy (&gt;30 Gy). Additional risk factors such as preexisting cardiac illness, hypertension, dyslipidemia, and diabetes may contribute to adverse outcomes. Echocardiography is the most commonly used method of screening and diagnosis of cardiac dysfunction. In contrast, cardiac magnetic resonance imaging is more precise but also costly and requires sedation. Prevention of cardiotoxicity includes the use of dexrazoxane, enalapril, and methods to modify the dosage and delivery of chemo- and radiation therapy. Treatment of established cardiomyopathy may include interventions for LV preload and afterload reduction, implantable devices, and heart transplant. With emphasis on prevention, current guidelines recommend frequent screening echocardiography and individualized multimodal care for each patient. Further studies are justified to develop safe and effective alternatives to cardiotoxic cancer therapy regimens and improved treatments for established cardiomyopathy.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"75 ","pages":"Article 101766"},"PeriodicalIF":0.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Corrigendum to “Analysis of buccal mucosa as a prognostic tool in children with arrhythmogenic cardiomyopathy” [Progress in Pediatric Cardiology 64 (2022) 101458]
IF 0.6 Q4 PEDIATRICS Pub Date : 2024-12-01 DOI: 10.1016/j.ppedcard.2024.101783
Carlos Bueno-Beti , Ella Field , Adalena Tsatsopoulou , Gregory Perry , Mary N. Sheppard , Elijah R. Behr , Jeffrey E. Saffitz , Juan Pablo Kaski , Angeliki Asimaki
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引用次数: 0
Corrigendum to “Feasibility of electrocardiogram screening in the USA prior to high school sport participation” [Prog Pediatr Cardiol 65 (2022) 101522]
IF 0.6 Q4 PEDIATRICS Pub Date : 2024-12-01 DOI: 10.1016/j.ppedcard.2024.101793
Gabriel S. Krivenko , Emily R. Ribeiro , Scott Walker , Coralis Mercado-Gonzalez , Shawn Sima , Evan Ernst , Svjetlana Tisma-Dupanovic , Gul H. Dadlani
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引用次数: 0
期刊
PROGRESS IN PEDIATRIC CARDIOLOGY
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