Pediatric Annals最新文献

Pediatric inflammatory bowel disease (IBD) is increasing in prevalence in the United States. While medical therapy options continue to expand, patients and their families often inquire about applications of complementary and alternative medicine (CAM). In this article, we review the existing literature for a wide variety of CAMs, including mind-body practices, modulation of the gut microbiome, and herbal supplements, which can be integrated into traditional medical treatments. Mind-body practices, particularly cognitive behavioral therapy, yoga, and acupuncture, have promising data for improved quality of life and potential for disease modification. Methods for gut microbiome modulation, such as probiotics and fecal microbiota transplant, have potential for modifying disease in IBD but need more studies evaluating safety and efficacy. Plant-based traditional remedies with anti-inflammatory properties, including curcumin and Indigo naturalis (Qing dai), have shown promising results in clinical trials demonstrating improvements in ulcerative colitis disease activity, although more pediatric trials are needed.

This article aims to describe the evolution of physician well-being. Ensuring professional fulfillment and mitigating the risk for burnout are priorities for all physicians. However, the threats and obstacles to preserving well-being are not universal. In both the inpatient and ambulatory settings, there are growing administrative burdens, increased clinical workload, and insufficient time per patient encounter. Among inpatient pediatric subspecialties, particularly high rates of burnout are reported within the field of pediatric critical care. The obstacles to career satisfaction and well-being in both areas are complex and myriad. The demands unique to women in medicine are different than those for men in medicine. Caregiving and gender-based inequities force women out of health care at rates higher than men. A career in medicine risks a woman's fertility and health. Despite increased prevalence of women-dominated subspecialties (eg, pediatrics), their presence in leadership roles continues to be relatively low. We have chosen to focus this article on issues facing inpatient physicians and the unique difficulties of being a woman provider in health care. [Pediatr Ann. 2025;54(7):e244-e248.].

Status epilepticus (SE) is a prolonged seizure episode. Prompt recognition and management of SE is essential in preventing morbidity and mortality associated with the condition. The longer SE persists the less responsive it becomes to first-line interventions. Additionally, a seizure episode that is longer than 30 minutes has increased risk of neuronal death and sequelae of SE. If the primary care clinician is confronted with a patient in SE, the evaluation and subsequent management should occur in a systematic, stepwise approach focusing on the patient's airway, breathing, circulation, and disability. Primary care clinicians and staff should be trained in supporting the pediatric airway, including the proper bag-valve-mask ventilation technique. Benzodiazepines are the first-line rescue medications for SE and should be promptly administered at the appropriate dose. [Pediatr Ann. 2025;54(7):e233-e237.].

Diabetic ketoacidosis (DKA) is often considered a critical care topic, but since many patients will initially present with new onset type 1 diabetes mellitus in DKA, it is essential that general pediatric providers are aware of the risk factors and variable symptoms. Many providers feel comfortable recognizing typical symptoms of diabetes mellitus but may not be aware of the different presentations of DKA, particularly in patients in whom the typical symptoms are difficult to discern from their history. In this article, we describe a patient with tachypnea as their initial symptom of DKA and type 1 diabetes mellitus. We discuss the background of DKA, presentation and differential diagnosis, and important management steps of which the general pediatrician should be aware. Our aim is to increase the general pediatrician's awareness of DKA and improve the time to diagnosis and critical treatment. [Pediatr Ann. 2025;54(7):e227-e232.].

Systemic juvenile idiopathic arthritis (sJIA) is an arthritis of unknown origin in children younger than age 16 years. While there is no definitive cure, the prognosis has improved with the development of biologic agents targeting interleukins (ILs). These drugs have shown positive outcomes but are associated with significant adverse effects, notably macrophage activation syndrome (MAS), which is a severe condition involving excessive immune activation. We sought to identify recent literature examining MAS as an adverse effect of sJIA treatment with biologics and to summarize the current understanding of the prevalence, pathophysiology, diagnosis, and management of MAS in the context of sJIA. Findings indicate that the incidence of MAS when using IL-1 and IL-6 inhibitors, particularly within the first 6 months of treatment, is relatively common; although, it is difficult to definitively identify biologic therapy as the cause. While biologics offer substantial benefits, they also require vigilant monitoring due to the increased risk of MAS. [Pediatr Ann. 2025;54(7):e249-e253.].

Firearm injury is a leading cause of morbidity and mortality in children and young adults in the United States. Inequities in this mechanism of injury related to race, gender, location, and economic status have increased during the coronavirus disease 2019 pandemic. Firearm injury is a public health crisis and requires a public health approach. By utilizing the Haddon matrix and injury equity framework, pediatric providers can systematically apply evidence-based medicine and strategies to combat this epidemic. It is imperative that acute care providers, including pediatric intensivists, pediatric hospitalists, and emergency medicine providers, unite with other subspecialists and primary care providers to reduce the burden of this preventable epidemic. [Pediatr Ann. 2025;54(7):e238-e243.].

This article provides guidance on the management of acne vulgaris (AV) and hidradenitis suppurativa (HS) in youth with skin of color (SOC) and youth who are transgender and gender diverse (TGD). Both diseases are associated with delayed diagnosis, treatment disparities, and heightened psychosocial burdens in underrepresented groups. For children with SOC and AV, it is crucial to minimize the risk of postinflammatory hyperpigmentation, with recommendations for starting lower concentrations of retinoids and cautious selection of oral therapies. In children who are TGD, masculinizing hormone therapy for transmasculine individuals may exacerbate acne, necessitating careful treatment planning. In HS, early and aggressive therapy is essential to prevent disease progression and scarring. While biologic agents (eg, adalimumab) demonstrate efficacy, they are underutilized in adolescents. Treatment adherence in both AV and HS can be influenced by systemic barriers to care, highlighting the need for culturally sensitive, multi-disciplinary approaches that address both the dermatologic and psychosocial aspects of care. [Pediatr Ann. 2025;54(6):e209-e216.].