W. Tang, Ting-zhao Gao, Yun Cao, Wenhao Zhou, Dongli Song, Laishuan Wang
Objective: To review the current evidence for management strategies applied during perinatal period to improve the short- and long- term outcomes in extremely preterm infants (EPIs). Background: EPIs are defined as infants born before 28 completed weeks of gestation. Due to extreme prematurity, a large number of EPIs are at increased risk for both mortality and morbidity. Although significant advances have been made in neonatal and perinatal medicine, the management of EPIs remains a great challenge to families, physicians, and the entire health care system. Methods: Literature searches were conducted in PubMed, Cochrane Library, OVID, Embase, and Web of Science to identify studies regarding perinatal management of EPIs from 2000 to 2021. Observational studies, randomized controlled trials (RCTs), systematic reviews and meta-analyses were included. The title and abstract of each article were screened for the selection of relevant articles. Conclusions: Numerous proactive interventions need to be implemented during this critical perinatal period so that the mortality and impairment rates of these vulnerable infants can be minimized. The effectiveness and safety of some interventions have been widely studied in large meta-analyses or RCTs. Meanwhile, a lot of novel management strategies are under investigation and many already have promising early results. However, the long-term effects of some intervention efforts remain limited. The answers of some important questions in the care practice of EPIs remain unsatisfying. 21
目的:回顾目前的证据，围生期管理策略的应用，以改善极早产儿(EPIs)的短期和长期结局。背景:EPIs被定义为妊娠28周前出生的婴儿。由于极度早产，大量计划生育儿童的死亡率和发病率都有增加的风险。尽管在新生儿和围产期医学方面取得了重大进展，但EPIs的管理仍然是家庭、医生和整个卫生保健系统面临的巨大挑战。方法:在PubMed、Cochrane Library、OVID、Embase和Web of Science中检索2000 - 2021年EPIs围产期管理的相关文献。包括观察性研究、随机对照试验(rct)、系统评价和荟萃分析。筛选每篇文章的标题和摘要，选择相关文章。结论:在这个关键的围产期，需要实施许多积极的干预措施，以尽量减少这些易感婴儿的死亡率和损伤率。一些干预措施的有效性和安全性已在大型荟萃分析或随机对照试验中得到广泛研究。与此同时，许多新的管理策略正在研究中，其中许多已经取得了可喜的初步成果。然而，一些干预措施的长期效果仍然有限。在EPIs的护理实践中，一些重要问题的答案仍不令人满意。21
{"title":"Narrative review of perinatal management of extremely preterm infants: what’s the evidence?","authors":"W. Tang, Ting-zhao Gao, Yun Cao, Wenhao Zhou, Dongli Song, Laishuan Wang","doi":"10.21037/pm-21-51","DOIUrl":"https://doi.org/10.21037/pm-21-51","url":null,"abstract":"Objective: To review the current evidence for management strategies applied during perinatal period to improve the short- and long- term outcomes in extremely preterm infants (EPIs). Background: EPIs are defined as infants born before 28 completed weeks of gestation. Due to extreme prematurity, a large number of EPIs are at increased risk for both mortality and morbidity. Although significant advances have been made in neonatal and perinatal medicine, the management of EPIs remains a great challenge to families, physicians, and the entire health care system. Methods: Literature searches were conducted in PubMed, Cochrane Library, OVID, Embase, and Web of Science to identify studies regarding perinatal management of EPIs from 2000 to 2021. Observational studies, randomized controlled trials (RCTs), systematic reviews and meta-analyses were included. The title and abstract of each article were screened for the selection of relevant articles. Conclusions: Numerous proactive interventions need to be implemented during this critical perinatal period so that the mortality and impairment rates of these vulnerable infants can be minimized. The effectiveness and safety of some interventions have been widely studied in large meta-analyses or RCTs. Meanwhile, a lot of novel management strategies are under investigation and many already have promising early results. However, the long-term effects of some intervention efforts remain limited. The answers of some important questions in the care practice of EPIs remain unsatisfying. 21","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":"1 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41269045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The purpose of this narrative review is to introduce artificial intelligence (AI) and machine learning (ML) to pediatricians in the field of epilepsy. Background: There has been significant interest in AI and ML in the field of medicine. The number of AI research in the field of pediatrics is also increasing rapidly. AI research team often asks pediatricians to review and label the data for AI research and provide insights for planning the AI/ML algorithms. Ever-increasing medical data such as medical imaging data and digitalized physiologic monitoring data and advanced computing power enabled AI and ML research to increase rapidly. The chronic nature of epilepsy care is another reason AI/ML research is increasing using digitized big data such as magnetic resonance imaging (MRI) and electroencephalography (EEG). Methods: This review provides examples of AI/ML research in epilepsy, focusing on clinical implications. The purpose of AI/ML research in epilepsy encompasses increasing diagnostic accuracy and precision, detecting and predicting seizures, supporting treatment decisions, improving treatment outcomes, and predicting seizure and non-seizure outcomes. We will review various AI/ML research on automated EEG interpretation, seizure detection and forecasting. Conclusions: Understanding the strength and limitations of AI/ML research will help pediatricians understand and contribute to AI/ML research of their field of expertise. We must find useful clinical implications and suggestions that affect our medical knowledge and change our clinical practice from the research as clinicians participate in AI/ML research. rate is an essential measure of performance. In case of high false positive alarms, the patient will have to anticipate seizure unnecessarily, and lowering this false alarm rate is relevant. Many studies in seizure prediction and the sensitivity and specificity have increased remarkably for few decades (60-63). We developed deep convolutional neural network-based interictal/preictal EEG prediction and applied to 9 pediatric patients with surgically proven focal cortical dysplasia type II. The best accuracy was 5 minutes as preictal period, all intracranial channels for analysis, and 512 Hz sampling rate for EEG acquisition. When we change the preictal period from 2 hours before seizure to 1 minute, accuracy increased to 5 minutes and showed a small decline in 1 minute. These findings tell us that the best functioning was when we set the preictal period to 5 minutes before the seizure started. When we changed the analyzing electrode from whole intracranial to most relevant four electrodes, accuracy declined, but the amount was 2%. Increasing the sampling rate from 128 to 512 Hz, the increase of accuracy was trivial. We found that we could reduce the number of electrodes and sampling rate with a slight decline in performance. The decreasing number of electrodes helps reduce surgical risk, and sampling rate reduction is related to
{"title":"Application of artificial intelligence (AI) and machine learning (ML) in pediatric epilepsy: a narrative review","authors":"Hunmin Kim, H. Hwang","doi":"10.21037/pm-21-26","DOIUrl":"https://doi.org/10.21037/pm-21-26","url":null,"abstract":"Objective: The purpose of this narrative review is to introduce artificial intelligence (AI) and machine learning (ML) to pediatricians in the field of epilepsy. Background: There has been significant interest in AI and ML in the field of medicine. The number of AI research in the field of pediatrics is also increasing rapidly. AI research team often asks pediatricians to review and label the data for AI research and provide insights for planning the AI/ML algorithms. Ever-increasing medical data such as medical imaging data and digitalized physiologic monitoring data and advanced computing power enabled AI and ML research to increase rapidly. The chronic nature of epilepsy care is another reason AI/ML research is increasing using digitized big data such as magnetic resonance imaging (MRI) and electroencephalography (EEG). Methods: This review provides examples of AI/ML research in epilepsy, focusing on clinical implications. The purpose of AI/ML research in epilepsy encompasses increasing diagnostic accuracy and precision, detecting and predicting seizures, supporting treatment decisions, improving treatment outcomes, and predicting seizure and non-seizure outcomes. We will review various AI/ML research on automated EEG interpretation, seizure detection and forecasting. Conclusions: Understanding the strength and limitations of AI/ML research will help pediatricians understand and contribute to AI/ML research of their field of expertise. We must find useful clinical implications and suggestions that affect our medical knowledge and change our clinical practice from the research as clinicians participate in AI/ML research. rate is an essential measure of performance. In case of high false positive alarms, the patient will have to anticipate seizure unnecessarily, and lowering this false alarm rate is relevant. Many studies in seizure prediction and the sensitivity and specificity have increased remarkably for few decades (60-63). We developed deep convolutional neural network-based interictal/preictal EEG prediction and applied to 9 pediatric patients with surgically proven focal cortical dysplasia type II. The best accuracy was 5 minutes as preictal period, all intracranial channels for analysis, and 512 Hz sampling rate for EEG acquisition. When we change the preictal period from 2 hours before seizure to 1 minute, accuracy increased to 5 minutes and showed a small decline in 1 minute. These findings tell us that the best functioning was when we set the preictal period to 5 minutes before the seizure started. When we changed the analyzing electrode from whole intracranial to most relevant four electrodes, accuracy declined, but the amount was 2%. Increasing the sampling rate from 128 to 512 Hz, the increase of accuracy was trivial. We found that we could reduce the number of electrodes and sampling rate with a slight decline in performance. The decreasing number of electrodes helps reduce surgical risk, and sampling rate reduction is related to","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47653484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Prasad, A. Keir, M. Battin, J. Holberton, S. Chow, K. Lui
{"title":"The Australian and New Zealand Neonatal Network: past achievements and future directions","authors":"R. Prasad, A. Keir, M. Battin, J. Holberton, S. Chow, K. Lui","doi":"10.21037/pm-21-93","DOIUrl":"https://doi.org/10.21037/pm-21-93","url":null,"abstract":"","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45178883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Photobiomodulation and low level laser therapy have multiple clinical applications across medicine and dentistry and has been used, with varying degrees of success, in sleep medicine and dental sleep medicine. This case report describes the use of low level laser therapy with an Er:YAG laser for the immediate treatment of hypertrophic tonsils in a child with symptoms of a sleep airway disorder as recorded through pre-intervention screening with the pediatric sleep questionnaire and BEARS sleep screening tool. Immediate, 3-month post-intervention, and 1 year post-intervention clinical photos showed significant tonsil size reduction from the low level laser therapy with maintenance of tonsillar shrinkage over the following year. Post-intervention results on the pediatric sleep questionnaire and BEARS sleep screening tool showed a significant change in reported symptoms. No negative side effects were noted by the clinician or reported by the patient. The results of this case report indicate that low level laser therapy may be a potential treatment option for hypertrophic tonsils, with potential applications into the fields of sleep medicine and otolaryngology for both adults and children. Further research into the applications of low level laser therapy on hypertrophic tonsils should be conducted, with appropriate clinical protocols and patient selection criteria studied in detail.
{"title":"Photobiomodulation for pediatric hypertrophic tonsils: a clinical case report","authors":"Enoch T. Ng, M. Lagravère, A. David","doi":"10.21037/pm-21-18","DOIUrl":"https://doi.org/10.21037/pm-21-18","url":null,"abstract":": Photobiomodulation and low level laser therapy have multiple clinical applications across medicine and dentistry and has been used, with varying degrees of success, in sleep medicine and dental sleep medicine. This case report describes the use of low level laser therapy with an Er:YAG laser for the immediate treatment of hypertrophic tonsils in a child with symptoms of a sleep airway disorder as recorded through pre-intervention screening with the pediatric sleep questionnaire and BEARS sleep screening tool. Immediate, 3-month post-intervention, and 1 year post-intervention clinical photos showed significant tonsil size reduction from the low level laser therapy with maintenance of tonsillar shrinkage over the following year. Post-intervention results on the pediatric sleep questionnaire and BEARS sleep screening tool showed a significant change in reported symptoms. No negative side effects were noted by the clinician or reported by the patient. The results of this case report indicate that low level laser therapy may be a potential treatment option for hypertrophic tonsils, with potential applications into the fields of sleep medicine and otolaryngology for both adults and children. Further research into the applications of low level laser therapy on hypertrophic tonsils should be conducted, with appropriate clinical protocols and patient selection criteria studied in detail.","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45518524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sri Jayanti, J. Ghersi-Egea, N. Strazielle, C. Tiribelli, S. Gazzin
: The immature hepatic metabolism of bilirubin at birth is responsible for neonatal hyperbilirubinemia, present in more than 60% of otherwise healthy infants. Icterus (or jaundice), the most apparent features of the increased bilirubin level in the serum, testifies the entry of the pigment in the tissues and organs, brain included. The sensitivity of the central nervous system (CNS) to bilirubin toxicity is responsible for the potential neurologic damage, and even death. The symptoms in affected neonates suggest that selected brain areas are more specifically targeted by bilirubin, a hypothesis longer explained by the deposition of bilirubin in those areas, the “kern-icterus”. Most recently, a more complex picture and alternative explanations to the variability of the symptoms recapped by the terms bilirubin induced neurological dysfunction (BIND) or kernicterus spectrum disorder (KSD) are emerging, with pre-term neonates representing a new challenge. Here we will review what is known of the disease, from the dogma of the “kern-icterus” to the most recent findings bringing into play the stage of brain development at the time of bilirubin insult. Special emphasis will be given to the emerging population of pre-term neonates, especially sensitive to bilirubin toxicity. on the effect of free UCB on brain barriers integrity. A case report of a pre-term neonate with severe kernicterus indicates that signs of neurovascular network alteration was observed on autopsied brain tissue, possibly linked to an increase in vascular endothelial growth factor (VEGF) signaling (192). Given the comorbidities associated, whether UCB alone was responsible for these alterations remains to be understood. One study performed in Gunn rats, an animal model of jaundice characterized by a rapid postnatal increase in serum UCB evidenced a decrease in ABCC1 protein levels in CPs. This finding could be reproduced in vitro on choroidal epithelial cells chronically exposed to UCB, suggesting that ABCC1 downregulation results from a direct effect of UCB on the BCSFB
{"title":"Severe neonatal hyperbilirubinemia and the brain: the old but still evolving story","authors":"Sri Jayanti, J. Ghersi-Egea, N. Strazielle, C. Tiribelli, S. Gazzin","doi":"10.21037/PM-21-5","DOIUrl":"https://doi.org/10.21037/PM-21-5","url":null,"abstract":": The immature hepatic metabolism of bilirubin at birth is responsible for neonatal hyperbilirubinemia, present in more than 60% of otherwise healthy infants. Icterus (or jaundice), the most apparent features of the increased bilirubin level in the serum, testifies the entry of the pigment in the tissues and organs, brain included. The sensitivity of the central nervous system (CNS) to bilirubin toxicity is responsible for the potential neurologic damage, and even death. The symptoms in affected neonates suggest that selected brain areas are more specifically targeted by bilirubin, a hypothesis longer explained by the deposition of bilirubin in those areas, the “kern-icterus”. Most recently, a more complex picture and alternative explanations to the variability of the symptoms recapped by the terms bilirubin induced neurological dysfunction (BIND) or kernicterus spectrum disorder (KSD) are emerging, with pre-term neonates representing a new challenge. Here we will review what is known of the disease, from the dogma of the “kern-icterus” to the most recent findings bringing into play the stage of brain development at the time of bilirubin insult. Special emphasis will be given to the emerging population of pre-term neonates, especially sensitive to bilirubin toxicity. on the effect of free UCB on brain barriers integrity. A case report of a pre-term neonate with severe kernicterus indicates that signs of neurovascular network alteration was observed on autopsied brain tissue, possibly linked to an increase in vascular endothelial growth factor (VEGF) signaling (192). Given the comorbidities associated, whether UCB alone was responsible for these alterations remains to be understood. One study performed in Gunn rats, an animal model of jaundice characterized by a rapid postnatal increase in serum UCB evidenced a decrease in ABCC1 protein levels in CPs. This finding could be reproduced in vitro on choroidal epithelial cells chronically exposed to UCB, suggesting that ABCC1 downregulation results from a direct effect of UCB on the BCSFB","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45490007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. X. Sotiropoulos, V. Kapadia, S. Ramachandran, J. Oei
Background and Objectives: The first 10 minutes of life is the most important for a newborn infant. For the 1% of infants that require extensive resuscitation measures, rapid evaluation of vital signs, including oxygen saturation and heart rate is vital. How a clinician achieves prompt and accurate assessment of the sick newborn infant within a few minutes remains one of the most important knowledge and practice gaps in modern newborn medicine. Over the last two decades, international newborn resuscitation practice has changed considerably. The most profound development is the focus on oxygenation within the first 10 minutes of life, with a global secular shift to using “lower oxygen strategies”. However, there is now emerging information of adverse consequences from low oxygenation during the first 5 minutes of life, especially in very preterm infants (<29 weeks’ gestation) who are already at highest risk of death. We aim to review delivery room practice aimed to provide best and most accurate assessment of the cardiorespiratory status of sick newborn infants. Methods: We performed a broad search of PubMed, MEDLINE, Google Scholar and scrutinized the reference lists of relevant English articles published before November 4th 2021, including systematic reviews, meta-analyses, randomized controlled trials, retrospective studies and previous narrative reviews. Key Content and Findings: This review outlines the clinical and biometric methods of assessing the newborn in the delivery room. We explore the strengths and weakness of each modality, and highlight that the resuscitation team must synthesize clinical and biometric information to guide their care. Conclusions: Clinicians must balance information gained from technology (e.g., pulse oximetry) with clinical judgement of the infant’s progress. Significantly more knowledge is needed to inform on the best assessment methods to guide resuscitation of the sick newborn infant. Failure to do so will prevent advances in research and stagnate efforts to improve outcomes for all sick newborn infants around the world. methods of assessing the infant’s response to resuscitation?
{"title":"Ten minutes to save a baby: a narrative review of newborn assessment during first minutes of life and relationship to outcomes","authors":"J. X. Sotiropoulos, V. Kapadia, S. Ramachandran, J. Oei","doi":"10.21037/pm-21-84","DOIUrl":"https://doi.org/10.21037/pm-21-84","url":null,"abstract":"Background and Objectives: The first 10 minutes of life is the most important for a newborn infant. For the 1% of infants that require extensive resuscitation measures, rapid evaluation of vital signs, including oxygen saturation and heart rate is vital. How a clinician achieves prompt and accurate assessment of the sick newborn infant within a few minutes remains one of the most important knowledge and practice gaps in modern newborn medicine. Over the last two decades, international newborn resuscitation practice has changed considerably. The most profound development is the focus on oxygenation within the first 10 minutes of life, with a global secular shift to using “lower oxygen strategies”. However, there is now emerging information of adverse consequences from low oxygenation during the first 5 minutes of life, especially in very preterm infants (<29 weeks’ gestation) who are already at highest risk of death. We aim to review delivery room practice aimed to provide best and most accurate assessment of the cardiorespiratory status of sick newborn infants. Methods: We performed a broad search of PubMed, MEDLINE, Google Scholar and scrutinized the reference lists of relevant English articles published before November 4th 2021, including systematic reviews, meta-analyses, randomized controlled trials, retrospective studies and previous narrative reviews. Key Content and Findings: This review outlines the clinical and biometric methods of assessing the newborn in the delivery room. We explore the strengths and weakness of each modality, and highlight that the resuscitation team must synthesize clinical and biometric information to guide their care. Conclusions: Clinicians must balance information gained from technology (e.g., pulse oximetry) with clinical judgement of the infant’s progress. Significantly more knowledge is needed to inform on the best assessment methods to guide resuscitation of the sick newborn infant. Failure to do so will prevent advances in research and stagnate efforts to improve outcomes for all sick newborn infants around the world. methods of assessing the infant’s response to resuscitation?","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46993003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neonatal jaundice holds significant morbidity including acute bilirubin encephalopathy and even death (1). Early identification of infants at risk for unconjugated hyperbilirubinemia has been the focus of much research. A 2006 study by Sgro et al., identified an overwhelming incidence of severe neonatal hyperbilirubinemia in Canada requiring admission for phototherapy (2). These findings resulted in several studies investigating methods and criteria for predicting infants at risk for longstanding consequences from delayed or missed treatment (1,3-14). Despite these efforts, failure to identify or monitor hyperbilirubinemia Original Article
{"title":"Factors associated to hospital re-admission of infants previously treated for hyperbilirubinemia","authors":"G. Bravo, Michael R. Miller, A. Zizzo","doi":"10.21037/pm-21-89","DOIUrl":"https://doi.org/10.21037/pm-21-89","url":null,"abstract":"Neonatal jaundice holds significant morbidity including acute bilirubin encephalopathy and even death (1). Early identification of infants at risk for unconjugated hyperbilirubinemia has been the focus of much research. A 2006 study by Sgro et al., identified an overwhelming incidence of severe neonatal hyperbilirubinemia in Canada requiring admission for phototherapy (2). These findings resulted in several studies investigating methods and criteria for predicting infants at risk for longstanding consequences from delayed or missed treatment (1,3-14). Despite these efforts, failure to identify or monitor hyperbilirubinemia Original Article","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43476098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Platt, K. Priddis, B. Lawton, Daniel E. Hall, D. Roland
: At the heart of every paediatric consultation is the clinician’s responsibility to determine ‘is this child sick?’ In paediatrics illustrative language communicates a clinical picture of the child before us. When we define ‘sick’ we are thinking about a child, from the neonate to the adolescent up to eighteen years old, who will continue to decompensate without medical intervention. We are not concerned about a minor cold or cough, instead we think about the ex-premature infant with bronchiolitis who has the potential to rapidly deteriorate or the child who is ‘irritable’ whom we have to assume has meningitis until we can call them ‘miserable but consolable’. As health care professionals we rely on experience, evidence-based knowledge and clinical gestalt to determine whether we should be worried about our patients, and how we should approach the management of our patients whilst maintaining a holistic overview. This paper draws upon the global experience of our not-for-profit openly accessible ‘Don’t Forget the Bubbles’ (DFTB) website (https:// dontforgetthebubbles.com) to present a ‘meta-blog’ synthesis of approaches to recognition of the sick child. We explore how knowledge translation can guide our clinical skills in recognising which children are most at risk and address neonatal, cardiac, respiratory, head injury, metabolic and abdominal pain presentations.
{"title":"Identification of sick children in acute care settings","authors":"R. Platt, K. Priddis, B. Lawton, Daniel E. Hall, D. Roland","doi":"10.21037/pm-21-54","DOIUrl":"https://doi.org/10.21037/pm-21-54","url":null,"abstract":": At the heart of every paediatric consultation is the clinician’s responsibility to determine ‘is this child sick?’ In paediatrics illustrative language communicates a clinical picture of the child before us. When we define ‘sick’ we are thinking about a child, from the neonate to the adolescent up to eighteen years old, who will continue to decompensate without medical intervention. We are not concerned about a minor cold or cough, instead we think about the ex-premature infant with bronchiolitis who has the potential to rapidly deteriorate or the child who is ‘irritable’ whom we have to assume has meningitis until we can call them ‘miserable but consolable’. As health care professionals we rely on experience, evidence-based knowledge and clinical gestalt to determine whether we should be worried about our patients, and how we should approach the management of our patients whilst maintaining a holistic overview. This paper draws upon the global experience of our not-for-profit openly accessible ‘Don’t Forget the Bubbles’ (DFTB) website (https:// dontforgetthebubbles.com) to present a ‘meta-blog’ synthesis of approaches to recognition of the sick child. We explore how knowledge translation can guide our clinical skills in recognising which children are most at risk and address neonatal, cardiac, respiratory, head injury, metabolic and abdominal pain presentations.","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42585570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anxiety disorders are the most common class of mental disorder among children and adolescents and cause significant impairment and distress. A decision science model of anxiety is presented that explains two hallmark characteristics of anxiety disorders, worry and avoidance. In a Rational Choice Theory (RCT) paradigm, anxious worry results from extreme beliefs about either the probability of certain outcomes materializing, or the subjective utility associated with those outcomes. These correspond to fatalistic and catastrophizing presentations of anxiety. In a Fear Learning paradigm, anxious avoidance is the result of a lowered conditioning threshold or a heightened tendency to generalize conditioned behavior. This presents as avoidance of the conditioned stimulus. The current suite of treatment options for anxiety disorders already reflects this model to a considerable extent. For mild-to-moderate presentations, the first line treatment is Cognitive Behavioral Therapy (CBT), in particular, the exposure-based variations of CBT that have been developed for anxiety disorders. For severe presentations, or when psychotherapy alone fails to achieve the desired result, CBT should be supplemented with pharmacotherapy. SSRIs are the primary class of drugs that should be considered. Evidence does not support the use of anxiolytics for pediatric anxiety. Treatment planning should account for both symptom severity and the degree of impairment caused by the symptoms. The decision science model highlights negative, self-perpetuating cycles of anxious beliefs and behavior, and suggests multiple ways to improve current treatments by focusing on the processes of learning and belief
{"title":"Understanding adolescent anxiety disorders through the lens of decision science: towards a mathematical psychiatry","authors":"L. Amsel, J. Kortenhorst","doi":"10.21037/pm-21-38","DOIUrl":"https://doi.org/10.21037/pm-21-38","url":null,"abstract":"Anxiety disorders are the most common class of mental disorder among children and adolescents and cause significant impairment and distress. A decision science model of anxiety is presented that explains two hallmark characteristics of anxiety disorders, worry and avoidance. In a Rational Choice Theory (RCT) paradigm, anxious worry results from extreme beliefs about either the probability of certain outcomes materializing, or the subjective utility associated with those outcomes. These correspond to fatalistic and catastrophizing presentations of anxiety. In a Fear Learning paradigm, anxious avoidance is the result of a lowered conditioning threshold or a heightened tendency to generalize conditioned behavior. This presents as avoidance of the conditioned stimulus. The current suite of treatment options for anxiety disorders already reflects this model to a considerable extent. For mild-to-moderate presentations, the first line treatment is Cognitive Behavioral Therapy (CBT), in particular, the exposure-based variations of CBT that have been developed for anxiety disorders. For severe presentations, or when psychotherapy alone fails to achieve the desired result, CBT should be supplemented with pharmacotherapy. SSRIs are the primary class of drugs that should be considered. Evidence does not support the use of anxiolytics for pediatric anxiety. Treatment planning should account for both symptom severity and the degree of impairment caused by the symptoms. The decision science model highlights negative, self-perpetuating cycles of anxious beliefs and behavior, and suggests multiple ways to improve current treatments by focusing on the processes of learning and belief","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43944059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Transgender in pediatrics: a narrative review","authors":"A. Díaz, Veronica M Figueredo","doi":"10.21037/pm-21-66","DOIUrl":"https://doi.org/10.21037/pm-21-66","url":null,"abstract":"","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45346074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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