Pediatric Annals最新文献

Gun violence is a rapidly growing concern for youth. As rates of death by firearm rise, so does exposure to firearm violence and high levels of accompanying morbidity. Although gun violence cannot be attributed to any one cause, it is important pediatric health care providers understand the prevalence of this issue. Additionally, the long-term health effects are profound with many victims of, and witnesses to, gun violence experiencing new symptoms of general anxiety disorder. There are numerous initiatives taking place at the individual, local, and national levels to address this public health crisis. An overview of such interventions is also presented. With better screening and treatment of upstream and downstream symptoms of youth gun violence, pediatricians can decrease the morbidity and mortality that results from firearm use. [Pediatr Ann. 2024;53(6):e197-e199.].

The growing evidence detailing the harmful effects of exposure to antibiotics has driven an urgency to evaluate recommendations in common pediatric infections regarding antibiotic course duration and route of administration. The past decade has produced strong evidence in support of many patients with uncomplicated common pediatric infections receiving shortened antibiotic durations and early conversion from intravenous to oral antibiotics. In this review, we offer guidance to providers in selection of duration and route of administration in a subset of common pediatric infections, including community-acquired pneumonia, osteomyelitis, and infections of the head and neck. [Pediatr Ann. 2024;53(6):e229-e233.].

Neonatal hyperbilirubinemia is one of the most common conditions managed by pediatricians. Although many infants are affected, most will experience complete resolution without complication. Acute bilirubin encephalopathy and kernicterus are rare yet debilitating sequelae of severe hyperbilirubinemia that can be avoided through careful monitoring and treatment with phototherapy. Appropriate management of neonatal hyperbilirubinemia must balance the risks of these severe conditions with the effects of overtreatment. Released in 2022, the American Academy of Pediatrics revised the clinical practice guideline for the management of hyperbilirubinemia, which aims to provide that balance through updates to the previous guideline. This article will provide the reader with (1) an evidence-based harm and benefit analysis of the guideline, (2) an overview of key changes and clarifications made in the new guideline, and (3) a practical summary of guideline updates. [Pediatr Ann. 2024;53(6):e208-e216.].

Bronchiolitis is a viral lower respiratory tract infection primarily affecting children younger than 2 years; a common cause of health care encounters, including hospitalization; and a considerable economic burden for health care systems in the United States and worldwide. The American Academy of Pediatrics (AAP) most recently updated its bronchiolitis guideline in 2014 and reaffirmed supportive care as the mainstay of treatment. Despite these recommendations, there is still significant variability in care provided for these children, especially in bronchodilator usage, radiography, and high-flow nasal cannula. Since the 2014 AAP guideline, many pediatric hospitalists have undertaken quality initiatives to improve the adherence to published guidelines, yet a large gap remains between what is recommended and what is practiced. This article presents research on the efficacy of common interventions as well as an introduction to diagnostics and treatments potentially on the horizon. [Pediatr Ann. 2024;53(6):e223-e228.].

Many children in immigrant families may qualify for legal protection-for themselves if unaccompanied, or as a derivative on parents' claims-on humanitarian grounds related to persecution or forced migration. Pediatric providers can offer a spectrum of multidirectional medical-legal supports to increase access to medical-legal services and support children who are undocumented or in mixed-status families. These activities can include providing trusted information, incorporating screening for health-related social needs, establishing networks for multidirectional referrals, and providing letters of support for legal protection. To expand workforce capacity for medical-legal services related to immigration, pediatric providers can also receive training to conduct specialized, trauma-informed forensic evaluations and can advocate at individual, local, state, federal, and global levels to address factors leading to persecution and forced migration while supporting individuals who may be eligible for legal protection. [Pediatr Ann. 2024;53(5):e183-e188.].

In the United States, there are millions of globally displaced children who travel with family to seek immigration relief, many of whom have experienced family separation or live under the constant threat of separation. Family separation constitutes a significant trauma with lifelong impacts on a child's mental health, physical health, and development. This review provides a summary of the various contexts within which family separation occurs as well as the current literature on long-term health sequelae. These include mental illness, externalizing behaviors, developmental challenges, family stability, economic impacts, and educational attainment. Given the number of newcomer children in the US, it is paramount that pediatric clinicians develop a holistic understanding of their needs and the effects of separation to provide evidence-based care and to advocate for the prevention of this trauma for all future migrant families. [Pediatr Ann. 2024;53(5):e167-e170.].