The addition of long-acting β2-agonists (LABAs) to inhaled corticosteroid for the treatment of asthma in children over 5 years of age is highly beneficial in the short term at improving lung function and day-to-day symptoms. Unfortunately, the effect wanes with time in some children. In addition, some children may still experience severe exacerbations while on LABAs. It is therefore important to ensure that these children are receiving adequate doses of inhaled corticosteroid before consideration be given to stopping LABA therapy. Further research is required in order to determine whether the rapid onset of action observed in formoterol therapy can be beneficially used in a combination single inhaler for both reliever and maintenance therapy.
{"title":"Is there a role for intermittent use of long-acting β2-agonists in childhood asthma?","authors":"L. Jindal, M. Shields","doi":"10.2217/PHE.10.30","DOIUrl":"https://doi.org/10.2217/PHE.10.30","url":null,"abstract":"The addition of long-acting β2-agonists (LABAs) to inhaled corticosteroid for the treatment of asthma in children over 5 years of age is highly beneficial in the short term at improving lung function and day-to-day symptoms. Unfortunately, the effect wanes with time in some children. In addition, some children may still experience severe exacerbations while on LABAs. It is therefore important to ensure that these children are receiving adequate doses of inhaled corticosteroid before consideration be given to stopping LABA therapy. Further research is required in order to determine whether the rapid onset of action observed in formoterol therapy can be beneficially used in a combination single inhaler for both reliever and maintenance therapy.","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"4 1","pages":"287-293"},"PeriodicalIF":0.0,"publicationDate":"2010-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.10.30","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68242678","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}
Wheezing in preschool children is mostly associated with viral upper respiratory tract infections, can recur frequently and is not usually associated with any underlying inflammation between episodes of wheeze. While spontaneous resolution of wheezing occurs in some of these children, in others wheeze persists, and these children are at risk of developing asthma. A number of birth cohort studies have improved our understanding of the natural history of preschool wheeze disorders but many gaps in our knowledge still remain. This article summarizes existing knowledge regarding preschool wheeze phenotypes including clinical relevance, natural history of preschool wheeze disorders, pathophysiology and treatment strategies. This article will focus on preschool children with recurrent wheeze with or without viral respiratory tract infections.
{"title":"Preschool wheeze: phenotypes and beyond","authors":"S. Sonnappa","doi":"10.2217/PHE.10.26","DOIUrl":"https://doi.org/10.2217/PHE.10.26","url":null,"abstract":"Wheezing in preschool children is mostly associated with viral upper respiratory tract infections, can recur frequently and is not usually associated with any underlying inflammation between episodes of wheeze. While spontaneous resolution of wheezing occurs in some of these children, in others wheeze persists, and these children are at risk of developing asthma. A number of birth cohort studies have improved our understanding of the natural history of preschool wheeze disorders but many gaps in our knowledge still remain. This article summarizes existing knowledge regarding preschool wheeze phenotypes including clinical relevance, natural history of preschool wheeze disorders, pathophysiology and treatment strategies. This article will focus on preschool children with recurrent wheeze with or without viral respiratory tract infections.","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"4 1","pages":"267-275"},"PeriodicalIF":0.0,"publicationDate":"2010-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.10.26","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68242222","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}
Term newborn infants with lung injury have varying degrees of pulmonary edema, increased airway resistance and uneven distribution of atelectasis contributing to decreased pulmonary compliance and functional residual capacity. Lung injury is often initiated by the inflammatory process associated with the primary etiology of respiratory failure and is further exacerbated by ventilator-induced lung injury. Volutrauma, atelectotrauma and, to a lesser extent, barotrauma and rheotrauma contribute to inducing biotrauma, which is lung injury that results from uncontrolled inflammation. Recognizing the mechanisms of lung injury and the pattern and limitations of measured changes in lung function and mechanics might also serve as indicators of lung injury and are important in the formulation of lung protective strategies. Maintaining adequate functional residual capacity (open lung strategy), assuring appropriate tidal volumes to avoid both atelectotrauma and volutrauma and avoiding excessive exposure to oxygen sh...
{"title":"Pulmonary support strategies and options for improving lung function in term neonates: warning signs of damage","authors":"M. Attar, S. Donn","doi":"10.2217/PHE.10.21","DOIUrl":"https://doi.org/10.2217/PHE.10.21","url":null,"abstract":"Term newborn infants with lung injury have varying degrees of pulmonary edema, increased airway resistance and uneven distribution of atelectasis contributing to decreased pulmonary compliance and functional residual capacity. Lung injury is often initiated by the inflammatory process associated with the primary etiology of respiratory failure and is further exacerbated by ventilator-induced lung injury. Volutrauma, atelectotrauma and, to a lesser extent, barotrauma and rheotrauma contribute to inducing biotrauma, which is lung injury that results from uncontrolled inflammation. Recognizing the mechanisms of lung injury and the pattern and limitations of measured changes in lung function and mechanics might also serve as indicators of lung injury and are important in the formulation of lung protective strategies. Maintaining adequate functional residual capacity (open lung strategy), assuring appropriate tidal volumes to avoid both atelectotrauma and volutrauma and avoiding excessive exposure to oxygen sh...","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"4 1","pages":"277-286"},"PeriodicalIF":0.0,"publicationDate":"2010-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.10.21","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68242051","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}
Obesity increases the risk for future health problems, including cardiovascular disease, Type 2 diabetes, certain forms of cancer, orthopedic issues, nonalcoholic fatty liver disease, depression and psychosocial issues. Prevention and screening children should begin in infancy with parental education on the importance of healthy eating habits and daily physical activity. Early detection of at-risk behaviors, family risk factors and trends towards obesity should be assessed at every healthy-child visit by plotting height and weight in infants and toddlers and measuring BMI, starting at 2 years of age. Blood pressure monitoring should be a routine part of the physical examination in children over the age of 3 years. At-risk children with a BMI over the 85th percentile or with high-risk family histories should be screened for the potential health problems associated with childhood obesity. Early intervention and treatment using a staged approach with family involvement is important. Close monitoring with fre...
{"title":"Childhood obesity and future cardiac risk: what should physicians be looking for?","authors":"Frances R Zappalla","doi":"10.2217/PHE.10.23","DOIUrl":"https://doi.org/10.2217/PHE.10.23","url":null,"abstract":"Obesity increases the risk for future health problems, including cardiovascular disease, Type 2 diabetes, certain forms of cancer, orthopedic issues, nonalcoholic fatty liver disease, depression and psychosocial issues. Prevention and screening children should begin in infancy with parental education on the importance of healthy eating habits and daily physical activity. Early detection of at-risk behaviors, family risk factors and trends towards obesity should be assessed at every healthy-child visit by plotting height and weight in infants and toddlers and measuring BMI, starting at 2 years of age. Blood pressure monitoring should be a routine part of the physical examination in children over the age of 3 years. At-risk children with a BMI over the 85th percentile or with high-risk family histories should be screened for the potential health problems associated with childhood obesity. Early intervention and treatment using a staged approach with family involvement is important. Close monitoring with fre...","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"4 1","pages":"255-265"},"PeriodicalIF":0.0,"publicationDate":"2010-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.10.23","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68242128","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}
Pediatricians, neonatologists and pediatric endocrinologists are often challenged with determining the significance of atypical thyroid and adrenocortical function studies in preterm, low birth-weight (gestational age <37 weeks; birth-weight <2500 g), very low birth-weight (gestational age <30 weeks; birth-weight <1500 g) or extremely low birth-weight (gestational age <27 weeks; birth-weight <1000 g) neonates. The neonatal period is defined as the first 30 days after birth. Often, these neonates are critically ill and being treated with several medications that further confound their evaluation and therapeutic management. Physicians who care for these patients are regularly faced with the questions: What are normal values of thyroid hormones and cortisol in preterm neonates? What is the significance of hypothyroxinemia or hypocortisolemia in these subjects? When is hormone-replacement therapy warranted? In this review, the physiology of thyroid and adrenocortical hormone secretion in the fetus and neonate...
{"title":"Evaluation and management of hypothyroxinemia and hypocortisolemia in preterm neonates: current concepts and contentious issues","authors":"Pallavi Iyer, A. Root","doi":"10.2217/PHE.10.19","DOIUrl":"https://doi.org/10.2217/PHE.10.19","url":null,"abstract":"Pediatricians, neonatologists and pediatric endocrinologists are often challenged with determining the significance of atypical thyroid and adrenocortical function studies in preterm, low birth-weight (gestational age <37 weeks; birth-weight <2500 g), very low birth-weight (gestational age <30 weeks; birth-weight <1500 g) or extremely low birth-weight (gestational age <27 weeks; birth-weight <1000 g) neonates. The neonatal period is defined as the first 30 days after birth. Often, these neonates are critically ill and being treated with several medications that further confound their evaluation and therapeutic management. Physicians who care for these patients are regularly faced with the questions: What are normal values of thyroid hormones and cortisol in preterm neonates? What is the significance of hypothyroxinemia or hypocortisolemia in these subjects? When is hormone-replacement therapy warranted? In this review, the physiology of thyroid and adrenocortical hormone secretion in the fetus and neonate...","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"4 1","pages":"329-341"},"PeriodicalIF":0.0,"publicationDate":"2010-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.10.19","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68241986","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}
Evaluation of: Bundy DG, Strouse JJ, Casella JF, Miller MR: Burden of influenza-related hospitalizations among children with sickle cell disease. Pediatrics 125, 234–243 (2010). Children with sickle cell disease (SCD) are particularly vulnerable to invasive bacterial infections. Influenza virus infection multiplies the risk by destroying physical barriers to penetration by bacteria that inhabit the respiratory tract and by further impairing the function of polymorphonuclear leukocytes. Bundy et al. have quantitated the risk of hospitalization of children with SCD with discharge diagnoses including influenza. They accessed the Healthcare Cost and Utilization Project State Inpatient Databases for California, Florida, Maryland and New York, USA, to find the cases for the epidemic years 2003–2004 and 2004–2005 and calculated rates for children with SCD, cystic fibrosis or neither. They found that the rates for children with SCD were approximately two-times higher than for those with cystic fibrosis, and 56-ti...
对Bundy DG, Strouse JJ, Casella JF, Miller MR:镰状细胞病儿童流感相关住院负担的评估。儿科学125,234-243(2010)。患有镰状细胞病(SCD)的儿童特别容易受到侵袭性细菌感染。流感病毒感染破坏了呼吸道细菌渗透的物理屏障，并进一步损害了多形核白细胞的功能，从而增加了风险。Bundy等人量化了出院诊断包括流感的SCD患儿住院的风险。他们访问了美国加利福尼亚州、佛罗里达州、马里兰州和纽约州的医疗成本和利用项目州住院患者数据库，查找了2003-2004年和2004-2005年流行期的病例，并计算了患有SCD、囊性纤维化或两者都没有的儿童的发病率。他们发现患有SCD的儿童的发病率大约是患有囊性纤维化的儿童的两倍。
{"title":"Reducing risk of influenza for high-risk children","authors":"W. Glezen","doi":"10.2217/PHE.10.20","DOIUrl":"https://doi.org/10.2217/PHE.10.20","url":null,"abstract":"Evaluation of: Bundy DG, Strouse JJ, Casella JF, Miller MR: Burden of influenza-related hospitalizations among children with sickle cell disease. Pediatrics 125, 234–243 (2010). Children with sickle cell disease (SCD) are particularly vulnerable to invasive bacterial infections. Influenza virus infection multiplies the risk by destroying physical barriers to penetration by bacteria that inhabit the respiratory tract and by further impairing the function of polymorphonuclear leukocytes. Bundy et al. have quantitated the risk of hospitalization of children with SCD with discharge diagnoses including influenza. They accessed the Healthcare Cost and Utilization Project State Inpatient Databases for California, Florida, Maryland and New York, USA, to find the cases for the epidemic years 2003–2004 and 2004–2005 and calculated rates for children with SCD, cystic fibrosis or neither. They found that the rates for children with SCD were approximately two-times higher than for those with cystic fibrosis, and 56-ti...","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"4 1","pages":"251-253"},"PeriodicalIF":0.0,"publicationDate":"2010-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.10.20","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68242000","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}
Early-onset scoliosis is a diagnosis when a child is presenting with scoliosis before the age of 5 years. This excludes other causes of scoliosis (e.g., congenital, neuromuscular or syndromic). Twin studies and observations of familial aggregation reveal significant genetic contributions to idiopathic scoliosis. Radiographic criteria help in distinguishing the progressive curves from those that will resolve spontaneously. One must do a complete clinical evaluation to exclude other organ involvement especially congenital heart disease, inguinal hernia and hip dysplasia. MRI scans of the neural axis are mandatory in curves greater than 20° at presentation to rule out any occult lesions in the CNS. Minor nonprogressive curves can be managed with observation until growth is completed. Some curves may be managed with casting and bracing. There is increased risk of morbidity and mortality due to respiratory failure in untreated children with early-onset scoliosis who have progressive curves. Therefore, progress...
{"title":"Current concepts in the management of early-onset idiopathic scoliosis","authors":"U. Debnath","doi":"10.2217/PHE.10.24","DOIUrl":"https://doi.org/10.2217/PHE.10.24","url":null,"abstract":"Early-onset scoliosis is a diagnosis when a child is presenting with scoliosis before the age of 5 years. This excludes other causes of scoliosis (e.g., congenital, neuromuscular or syndromic). Twin studies and observations of familial aggregation reveal significant genetic contributions to idiopathic scoliosis. Radiographic criteria help in distinguishing the progressive curves from those that will resolve spontaneously. One must do a complete clinical evaluation to exclude other organ involvement especially congenital heart disease, inguinal hernia and hip dysplasia. MRI scans of the neural axis are mandatory in curves greater than 20° at presentation to rule out any occult lesions in the CNS. Minor nonprogressive curves can be managed with observation until growth is completed. Some curves may be managed with casting and bracing. There is increased risk of morbidity and mortality due to respiratory failure in untreated children with early-onset scoliosis who have progressive curves. Therefore, progress...","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"82 1","pages":"343-354"},"PeriodicalIF":0.0,"publicationDate":"2010-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.10.24","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68242191","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}
Celiac disease (CD) is now recognized as one of the most common genetic diseases of humankind. Furthermore, and contrary to previous opinion that categorized CD as a primarily pediatric disorder, CD can occur at any age and can present with a wide range of clinical manifestations. Missed and delayed CD diagnoses are common for a number of reasons, one of which is a lack of CD awareness among primary healthcare clinicians. The purpose of this article is to increase clinicians’ knowledge and awareness of CD.
{"title":"Celiac disease and the gluten-free diet","authors":"Suzanne Martin","doi":"10.2217/PHE.10.22","DOIUrl":"https://doi.org/10.2217/PHE.10.22","url":null,"abstract":"Celiac disease (CD) is now recognized as one of the most common genetic diseases of humankind. Furthermore, and contrary to previous opinion that categorized CD as a primarily pediatric disorder, CD can occur at any age and can present with a wide range of clinical manifestations. Missed and delayed CD diagnoses are common for a number of reasons, one of which is a lack of CD awareness among primary healthcare clinicians. The purpose of this article is to increase clinicians’ knowledge and awareness of CD.","PeriodicalId":88627,"journal":{"name":"Pediatric health","volume":"4 1","pages":"321-328"},"PeriodicalIF":0.0,"publicationDate":"2010-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/PHE.10.22","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68242065","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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