Journal of Pediatric Health Care最新文献

Pediatric firearm violence is the number one cause of death in all children and a threat that must be addressed. Applying a harm reduction framework to this growing crisis recognizes that firearms exist and incorporates evidence-based practice actionable strategies for pediatric-focused Advanced Practice Registered Nurses (APRNs) to follow to address this public health crisis. This harm reduction framework encompasses several strategies, including an understanding of the physical and mental health care impact that pediatric firearm violence has on survivors, as well as recognizing the inherent health inequities associated with it. This framework also includes strategies to implement firearm safety education at the community level, discusses key laws and policies that pediatric-focused APRNs can advocate for to effect change, and raises awareness of accessible resources and funding for pediatric-focused APRNs to utilize.

Our hypothetical case study depicts the experience of a newly arrived refugee child, a 10-year-old refugee from war-torn Kyiv, Ukraine. She presented with symptoms of anxiety-related physical complaints following displacement and relocation to the United States. This case study illustrates the care provided by a pediatric nurse practitioner. A multidisciplinary approach was used to address her psychosomatic symptoms, mental health, malnutrition, immunization status, and social integration challenges.

Pediatric cases of metabolic dysfunction-associated fatty liver disease (MASLD, formerly termed non-alcoholic fatty liver disease (NAFLD) are a troubling new outcome of the pediatric obesity epidemic. Advising patients and families with this condition is challenging considering the nutrition needed to sustain developmentally appropriate growth in youth. Describing risk factors, comorbidities, management, and referrals for MASLD could improve surveillance and outcomes for this condition. MASLD is commonly seen with other comorbidities such as dyslipidemia, obstructive sleep apnea, type 2 diabetes, hypothyroidism, anxiety, and depression. Considerations of epigenetics, diabetes, and adverse childhood experiences will be explored as additional underlying contributors to MASLD. Screening patients for this condition in conjunction with other comorbidities is essential to preventing the progression to non-alcoholic steatohepatitis (NASH) and cirrhosis, as well as lowering the risk for hepatocellular carcinoma. This fraternal twin case report describes pertinent diagnostics, recommendations for referrals, follow-up consultations, and red flags for more advanced liver disease.

Kawasaki disease (KD) is the most common vasculitis in children, and can result in the development of coronary artery aneurysms (CAAs) if not properly managed. While intravenous immunoglobulin (IVIG) and aspirin are standard first-line treatments, refractory KD may develop, increasing the risk of coronary complications. Herein, we report the case of a young girl with KD who initially responded to IVIG, but later developed a giant CAA, despite additional treatments. Infliximab stabilized her condition, and one year later, the CAA remained stable without thrombus formation. This case demonstrates that clinical appearance, particularly fever, may not fully reflect the patient's condition, as fever can subside immediately after treatment, but may relapse days later, underscoring the need for vigilant monitoring.

Introduction: Myeloid sarcoma (MS) is a tumor containing myeloid blasts, with or without maturation, involving any anatomical site other than the bone marrow. It can occur de novo or following a hematological malignancy.

Case: We report a 6-year-old female who presented with fever and a rapidly enlarging left thigh mass. The initial provisional diagnosis considered was tubercular hip arthritis with an abscess, but imaging investigations suggested neoplastic swelling. A biopsy of the mass showed a malignant small-round cell tumor. Bone marrow aspiration revealed the diagnosis of acute myeloid leukemia without the presence of blasts in the peripheral smear.

Conclusion: MS is a rare malignancy. The diagnosis is often delayed due to a lack of clinical suspicion and the absence of blasts in peripheral blood. This report aims to enhance the awareness of pediatric nurse practitioners that MS should also be considered as a differential for an extremity mass.

Childcare and early educational programs provide children with the opportunities to learn and develop social skills prior to being introduced into the academic system. Suspension and expulsion from childcare and early education programs occur in high numbers and can cause life-long detrimental effects for children. Federal and state legislation has made advances over the years, but further development and implementation of universal policies are needed in order to reduce the number of young children being suspended and expelled. Pediatric nurse practitioners have a unique role in screening, identifying, and intervening when children are at risk or have experienced exclusionary discipline tracts.

Introduction: The purpose of this quantitative study was to consider factors that may negatively impact glycemic levels in Black and White children 8-12 years old with a diagnosis of type 1 diabetes mellitus.

Method: Perceived stress, diabetes distress, morning and afternoon salivary cortisol, inflammatory biomarkers, and hemoglobin A1c (HbA1c) were measured in this quantitative, cross-sectional phase of a larger, mixed methods study. Thirty-four children and their parents completed self-report surveys, and children provided blood and salivary samples, to examine effect sizes of relationships among variables of interest.

Results: Most children did not meet ADA recommendations for HbA1c. HbA1c was higher in Black children. Medium-to-large effects were noted between perceived stress and HbA1c. Cortisol and IL-8 may mediate the relationship between perceived stress and HbA1c in children.

Discussion: Understanding causes of elevated glycemic levels in children, especially from low-income and underrepresented populations, may help tailor diabetes management interventions to improve health outcomes.

Background: Sexually transmitted infections (STIs) affect 20 million adolescents and young adults in the United States annually.

Local problem: In a pediatric outpatient sickle cell disease clinic in the southeastern United States, 16% (43/272) of patients aged 16-24 years had a documented sexual health history, and 12% (4/77) completed STI screenings. The clinic aimed to increase sexual health assessment, STI screenings, diagnosis, and treatment.

Methods: Using process redesign, a standardized sexual health and STI screening process at routine visits was implemented to increase the completion of sexual health histories and STI screening.

Results: Sexual health history collection rates increased from 16% (43/272) pre-intervention to 92% (107/116) pos-tintervention. The rate of STI testing offered increased from 12% (5/43) preintervention to 100% (116/116) postintervention. The STI testing rates increased 22.5% from 40% (2/5) pre-intervention to 49% (20/41) post-intervention.

Conclusions: Evidence-based standardized interventions can successfully be used to assist in sexual health documentation and STI screening.