Pediatric Annals最新文献

Influenza remains a significant public health concern, particularly among children. This comprehensive review focuses on pathophysiology, epidemiology, clinical presentation, treatment, and vaccines for pediatric influenza. Key genetic and immune-related factors, as well as excessive neutrophil activation, contribute to severe disease and outcomes. Epidemiologically, influenza affects 8% to 10% of children in the United States annually, with higher hospitalization rates among children who are Black, Hispanic, Native American and Alaska Native, and Asian and Pacific Islander. Clinically, children exhibit more severe symptoms and higher rates of gastrointestinal manifestations compared with adults. Treatment primarily involves neuraminidase inhibitors, like oseltamivir; although, therapies, such as baloxavir marboxil, are also effective. Vaccination remains the cornerstone of prevention, yet declining rates of uptake and increasing vaccine hesitancy pose challenges for population immunity. Universal influenza vaccine research offers hope for broader protection. This review aims to inform evidence-based practices in managing pediatric influenza and highlights areas for future research. [Pediatr Ann. 2025;54(5):e174-e178.].

A full-term newborn is found to have clinically significant hyperbilirubinemia in the first 24 hours of life secondary to maternal anti-Rhesus (Rh) (E) immunization in this illustrative case. Rh(E) is a minor non-Rh(D) antigen that is less commonly implicated in hemolytic disease of the fetus and newborn (HDFN). The infant had both a severe and prolonged course of HDFN and hemolytic anemia requiring a combination of phototherapy, intravenous immunoglobulin (IVIG), and blood transfusions during the course of 2 weeks. By following the 2022 American Academy of Pediatrics' Clinical Practice Guidelines for hyperbilirubinemia, we demonstrate that rapid identification and adjuvant therapy with IVIG successfully avoids exchange transfusion in a case of severe immune-mediated HDFN. This case also specifically highlights the importance of minor antigens, such as Rh(E) in newborn hemolytic conditions. [Pediatr Ann. 2025;54(4):e125-e129.].

Duodenal atresia has a strong association with chromosomal anomalies, particularly trisomy 21. Duodenal atresia is identified prenatally in up to 60% of cases, and intestinal obstructions often present with signs, including difficulty feeding, emesis (particularly in the first 24 to 48 hours of life), abdominal distension, and inability to pass meconium in the immediate postnatal period. In this article, we present a simulated case of a neonate with trisomy 21 who presented at age 2 weeks for evaluation of poor weight gain and feeding intolerance and was diagnosed with duodenal atresia. Imaging is the mainstay of diagnosis and imaging modalities, such as abdominal radiographs or upper gastrointestinal studies, will reveal a "double bubble" sign. This sign indicates proximal dilation of the duodenum and stomach, suggesting duodenal atresia. Management often involves surgical correction to bypass the obstruction and parenteral nutrition, as enteral feeds are often introduced slowly postoperatively. Early diagnosis and a collaborative multidisciplinary approach are vital to successful treatment. [Pediatr Ann. 2025;54(4):e139-e143.].

Fungal infections are associated with high risk of morbidity and mortality in the neonatal population. Infants who are premature and extremely low birth weight (ELBW) are at increased risk for fungal infections due to their fragile skin barrier, immature immune systems, disruption of normal flora with antibiotic exposure, presence of central catheters, and corticosteroid use. In neonates, most invasive fungal infections are caused by the Candida species. Infections from other fungal species, such as Aspergillus, are rare. The case presented in this article describes an infant who is ELBW born at 23 weeks' gestation and their course with severe cutaneous A. fumigatus infection requiring multiple surgical debridement procedures. These fungal infections require a high index of suspicion for prompt identification and early treatment. Primary cutaneous aspergillosis should be suspected in high-risk infants with rapidly progressive ulcerative or necrotic skin lesions. [Pediatr Ann. 2025;54(4):e130-e134.].

Specific learning disorders (SLDs) account for the largest percentage of children receiving specialized instruction in schools. Despite the high prevalence, the diagnosis of SLDs is often delayed until it has had a detrimental impact on a child's academic performance and mental health, which has long-term consequences. The general pediatric provider is uniquely positioned for impactful intervention on SLDs when caring for children during critical windows of learning and development. In this article, we provide a review of the existing literature for the general pediatric provider and describe the role that providers ought to have in screening and referring for SLDs. We suggest current gaps and future opportunities for research and advocacy. [Pediatr Ann. 2025;54(4):e144-e149.].

Organized sports participation for youth has been growing across the nation. Much of this is fueled by the excitement surrounding collegiate, professional, and Olympic sports competitions, as women and athletes of color are specifically being recognized. There is also increased motivation due to the potential for financial success if elite skill levels can be achieved early on. Primary care clinicians play a major role in children and teenager participation in organized sports by carrying out the sports physical visit and by being a source of support in times of injury. With this responsibility, clinicians need to be aware of the risks for overuse injuries and burnout and the disparities that exist for youth athletes from racial and ethnic minority communities. Sports specialization, parental involvement, and inequi- ties in access are all factors affecting youth organized sports participation. Clinicians can educate and maintain awareness of these elements as a part of their preventative medicine practice. [Pediatr Ann. 2025;54(4):e119-e122.].

Congenital neck masses are a diverse group of anomalies present at birth and encompass a wide range of pathologies-from benign developmental defects to potentially life-threatening conditions. Among these, congenital goiter (a rare yet significant entity) stands out due to its implications for neonatal thyroid function and overall development. This article aims to provide a comprehensive overview of congenital neck masses, with a particular focus on congenital goiter, its pathophysiology, clinical presentation, diagnostic evaluation, and management strategies. Congenital neck masses are frequently identified during prenatal ultrasounds, with fetal magnetic resonance imaging serving as a critical tool for evaluating their size, location, and impact on surrounding anatomy. In cases of potential airway obstruction, multidisciplinary delivery planning, including the possibility of an ex-utero intrapartum treatment procedure, is essential. Management of congenital goiter centers on correcting the underlying etiology, achieving euthyroidism through hormone replacement or maternal medication adjustment, and, in rare cases, surgical intervention to address airway compromise. [Pediatr Ann. 2025;54(4):e135- e138.].