Pediatric Annals最新文献

Hepatitis-associated aplastic anemia (HAAA) is a rare but life-threatening disorder that requires early recognition and intervention. Pediatricians play a critical role in identifying cases where acute hepatitis transitions to severe bone marrow failure. This review presents the diagnostic and therapeutic complexities associated with HAAA, emphasizing the importance of a multidisciplinary approach. Key topics include the pathophysiology of immune-mediated marrow suppression, diagnostic strategies (eg, immunophenotyping, bone marrow biopsy), and management approaches (eg, immunosuppressive therapy, hematopoietic stem cell transplantation). The review also highlights emerging evidence on viral triggers, such as severe acute respiratory syndrome coronavirus 2, and underscores the need for heightened clinical awareness and standardized treatment strategies.

Human milk (HM) is the gold standard for infant nutrition, providing optimal components essential for growth, development, and immune protection. Many infants receive formula either partially or exclusively due to a range of medical, personal, or logistical reasons. This review outlines the nutritional composition of HM and discusses how infant formulas are designed to approximate its properties. Standard cow's milk formulas remain the most commonly used, but numerous specialized formulas, such as hydrolyzed, amino acid-based, and plant-based, offer tailored options for infants with specific medical or nutritional needs. Emerging preferences for European formulas and alternatives are also discussed, along with guidance on appropriate use and preparation. Ultimately, infants who are formula fed can achieve normal growth when provided with appropriately selected and prepared formulas under professional guidance. Understanding the composition, indications, and limitations of each formula type enables clinicians to support diverse feeding choices while promoting optimal infant growth and development.

The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) and gluten-free diets are increasingly used as both therapeutic and diagnostic interventions for pediatric patients with gastrointestinal disorders. The low FODMAP diet is primarily indicated for children with irritable bowel syndrome or disorders of brain-gut interaction when symptoms persist. Implemented in 3 phases (elimination, reintroduction, and personalization), the diet helps identify individual triggers and improve symptoms, such as bloating and abdominal pain. In contrast, the gluten-free diet is the cornerstone treatment for celiac disease. Accurate diagnosis and monitoring are important, as both diets carry nutritional and psychosocial risks. Primary care clinicians are responsible for identifying appropriate patients, coordinating evaluations, and monitoring adherence, growth, and well-being to ensure safe and effective use of these dietary interventions. Multidisciplinary collaboration with registered dietitians is important for growth monitoring, nutritional optimization, and both physician and patient support.

Pediatric asthma is a chronic inflammatory respiratory condition characterized by recurrent wheezing, chest tightness, breathlessness, and coughing, which can significantly impact quality of life and lead to hospitalization or long-term lung impairment. The prevalence of asthma has increased globally, with higher rates in urban areas and developing countries. Current management strategies emphasize inhaled corticosteroids (ICS) as the cornerstone of treatment, with long-acting beta 2-agonists (LABAs) introduced for patients requiring additional symptom control. ICS-LABA combinations have demonstrated efficacy in reducing exacerbations, improving lung function, and lowering health care utilization. However, concerns persist regarding adherence, potential masking of airway inflammation, and optimal dosing. The emerging maintenance and reliever therapy (MART) approach integrates ICS and formoterol into a single inhaler for both maintenance and symptom relief, aiming to enhance adherence and optimize treatment outcomes. This review examines the current evidence supporting ICS-LABA therapy and introduces MART as a potential alternative for pediatric asthma management.

Drowning is a leading source of mortality and morbidity in children. However, the vast majority of drowning deaths are preventable, and there are important actions that children, parents, and health care providers can take to reduce the risk of drowning in children.

Research has shown high rates of co-occurring neurodivergent traits and behaviors among youth who are transgender and gender diverse (TGD). Youth who are neurodivergent, TGD, or both present with unique medical and psychosocial care needs. This review outlines clinical considerations for pediatricians who care for youth who are neurodivergent and TGD and includes recommendations for screening, assessment, psychosocial care, and medical care (if indicated). Whenever possible, care for neurodivergent and TGD populations should employ interdisciplinary care teams comprised of experts in neurodivergence and gender diversity. However, absence of such teams should not preclude care, given the existing barriers faced by individuals who are both TGD and neurodivergent, as well as unique burdens associated with the intersectionality of both. Providers working with this population should seek collaboration and consultation with experts to best support the needs of this unique population based on existing guidelines. Care should be individualized, evidence-based, and flexible to accommodate each individual's distinct developmental, psychosocial, and health care needs.

Youth who are transgender and gender diverse (TGD) experience metabolic conditions with differing rates than their peers who are cisgender. Mental health, minority stress, and related behaviors likely play a significant role in these differences. At the same time, the sex hormones (ie, estrogen and testosterone) play an integral role in metabolic health with sexual dimorphic patterns. Emerging research is evaluating the positive, negative, or neutral metabolic changes seen with gender-affirming hormonal therapy (GAHT) in adolescents and young adults. In this review, we summarize these findings, specifically evaluating five domains: (1) cardiovascular health, (2) lipid metabolism, (3) insulin resistance, (4) body composition, and (5) liver function. Using the available evidence, we highlight the baseline characteristics prior to GAHT, describe the expected changes with therapy, and review the current guideline-based screening recommendations while on GAHT for metabolic conditions.