Current opinion in pediatrics最新文献

{"title":"Advances in pharmacological treatment for congenital adrenal hyperplasia.","authors":"Lara E Graves, Henrik Falhammar","doi":"10.1097/MOP.0000000000001583","DOIUrl":"10.1097/MOP.0000000000001583","url":null,"abstract":"<p><strong>Purpose of review: </strong>Congenital adrenal hyperplasia (CAH), most commonly caused by 21-hydroxylase deficiency, remains associated with substantial morbidity despite life-saving glucocorticoid replacement. This review is timely because several novel therapies have recently emerged with the potential to improve disease control while reducing glucocorticoid burden.</p><p><strong>Recent findings: </strong>Recent advances in CAH management include modified-release hydrocortisone, which better mimics physiological cortisol secretion and may improve androgen control with lower glucocorticoid exposure. Steroid-reducing agents have advanced rapidly, particularly the corticotropin-releasing factor type 1 receptor antagonist crinecerfont and the melanocortin 2 receptor (MC2R) antagonist atumelnant, both of which show promise in lowering adrenocorticotropic hormone (ACTH)-driven androgen excess and facilitating glucocorticoid dose reduction. Additional emerging approaches include insurmountable MC2R antagonists and the anti-ACTH monoclonal antibody Lu AG13909. Gene therapy and genome editing strategies are also progressing, although important biological and technical barriers remain, particularly for durable adrenal targeting.</p><p><strong>Summary: </strong>The therapeutic landscape for CAH is evolving rapidly beyond conventional steroid replacement. These innovations may improve biochemical control and long-term outcomes, but challenges remain regarding adrenal crisis risk, long-term safety, durability, cost, and global equity of access.</p>","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"434-439"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-infectious bronchiolitis obliterans in children: pathogenesis, treatment strategies, and future directions.","authors":"Elad Ben-Meir, Alejandro Teper, Lisa Strug, Felix Ratjen, Eitan Kerem","doi":"10.1097/MOP.0000000000001585","DOIUrl":"10.1097/MOP.0000000000001585","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide a comprehensive and updated overview of post-infectious bronchiolitis obliterans (PIBO) in children, focusing on pathogenesis, diagnostic approaches, and current management strategies, while highlighting emerging mechanistic insights and future therapeutic directions.</p><p><strong>Recent findings: </strong>Recent studies emphasize neutrophilic inflammation, inflammasome activation (e.g., interleukin-18, caspase-1), and genetic susceptibility as key contributors to disease development and progression.</p><p><strong>Summary: </strong>PIBO is a heterogeneous and often underrecognized chronic lung disease requiring a structured diagnostic approach based on clinical, functional, and radiologic criteria. Management remains largely empirical and supportive, with limited evidence for disease-modifying therapies. Improved understanding of disease mechanisms may enable the development of targeted, phenotype-directed interventions in the future.</p>","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"454-460"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hormonal acne therapies in pediatrics.","authors":"Carla Torres-Zegarra, Sofia Guelfand Warnken","doi":"10.1097/MOP.0000000000001589","DOIUrl":"10.1097/MOP.0000000000001589","url":null,"abstract":"<p><strong>Background: </strong>Acne vulgaris is one of the most common inflammatory skin conditions in adolescents, affecting up to 85% of individuals aged 12-24 years. Beyond its physical manifestations, acne can significantly impact self-esteem, quality of life, and psychological well-being.</p><p><strong>Discussion: </strong>Acne has a multifactorial pathogenesis involving follicular hyperkeratinization, increased sebum production, Cutibacterium acnes colonization, and inflammation. Hormonal influences, particularly androgen-mediated sebaceous gland activity during adrenarche, play a central role in disease development. In some patients, hormonal factors may be more prominent, with clinical features including acne concentrated on the lower face and jawline and flares associated with the menstrual cycle.</p><p><strong>Conclusion: </strong>Recognition of acne as a chronic inflammatory condition has supported the increasing use of hormonal therapies as an important treatment option in selected adolescent patients.</p>","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"396-401"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in the treatment of pediatric hidradenitis suppurativa: emerging therapies and future directions.","authors":"Anastasia Chajecki, Colleen H Cotton","doi":"10.1097/MOP.0000000000001590","DOIUrl":"10.1097/MOP.0000000000001590","url":null,"abstract":"<p><strong>Purpose of review: </strong>Hidradenitis suppurativa is a chronic inflammatory skin disease causing recurrent abscesses, tunnels, and scarring. Despite significant disease burden in children and adolescents, treatment data for this population remains limited. This review summarizes the most recent developments in pediatric hidradenitis suppurativa management.</p><p><strong>Recent findings: </strong>The 2025 North American clinical practice guidelines for the medical management of hidradenitis suppurativa in special populations included key consensus-based treatment recommendations for pediatric hidradenitis suppurativa. Although antibiotics remain the mainstay of treatment for acute flares, adult data support the use of intravenous ertapenem as a rescue therapy for severe, recalcitrant hidradenitis suppurativa. Hormonal therapies, including spironolactone and combined oral contraceptives, should be considered in postmenarchal women. Metabolic therapies, particularly metformin and GLP-1 receptor agonists, are newer adjunctive options for patients with comorbid obesity and insulin resistance. Secukinumab was recently approved for moderate-to-severe hidradenitis suppurativa in adolescents at least 12 years, and clinical trials for multiple other biologic therapies for pediatric hidradenitis suppurativa are underway.</p><p><strong>Summary: </strong>Patients with pediatric hidradenitis suppurativa require individualized management approaches that consider their unique comorbidities and stages of development. Clinicians should integrate the 2025 North American guidelines into clinical practice, recognize, and co-manage comorbidities when appropriate, and counsel patients on approved and emerging biologic options.</p>","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"389-395"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences of sex development: from gene discovery to clinically actionable genomics.","authors":"Idoia Martinez de Lapiscina, Chrysanthi Kouri, Christa E Flück","doi":"10.1097/MOP.0000000000001595","DOIUrl":"10.1097/MOP.0000000000001595","url":null,"abstract":"<p><strong>Purpose of review: </strong>Differences of sex development (DSD) arise from disruptions in chromosomal, gonadal, or anatomical sex. Over the past 2 years, advances in sequencing technologies, enhancer biology, mitochondrial steroidogenesis, and sex-chromosome dosage effects have reshaped diagnostic and mechanistic understanding. This review synthesizes key discoveries and highlights their implications for clinical practice, including diagnostic pathways, endocrine surveillance, fertility counseling, and tumor-risk stratification.</p><p><strong>Recent findings: </strong>Diagnostic yield in 46,XY DSD remains below 50% with gene panels, driving adoption of whole-exome, whole-genome, and long-read sequencing to detect regulatory, structural, and other complex genetic mechanisms. New insights include enhancer-driven sex reversal, topologically associating domains disruption, and oligogenicity in NR5A1 /SF1-related DSD. Mechanistic studies clarify roles for NR2F2 in Leydig lineage specification, mitochondrial genes in steroidogenesis, and X-chromosome dosage effects in germ cell maturation. Clinically, genomic findings increasingly improve our understanding for adrenal and gonadal function, fertility potential, and tumor risk, while supporting individualized gonadal management and shared decision-making.</p><p><strong>Summary: </strong>DSD genetics is transitioning from single-gene models to integrated, multilayered pathomechanisms. Early comprehensive genomic testing, functional interpretation of regulatory and structural variations, and assessment of epigenetic and mitochondrial mechanisms, will be essential for improving diagnostic yield and delivering precise, ethically grounded care in DSD.</p>","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood sleep disorders: practical management for the pediatrician.","authors":"Joseph Collins","doi":"10.1097/MOP.0000000000001591","DOIUrl":"https://doi.org/10.1097/MOP.0000000000001591","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sleep disorders significantly impact pediatric cognitive development and behavioral health. As pediatric obesity and neurodevelopmental diagnoses rise, primary care providers require updated frameworks to differentiate between anatomical, behavioral, and circadian-driven sleep disturbances to ensure timely intervention.</p><p><strong>Recent findings: </strong>Pediatric obstructive sleep apnea (OSA) is primarily linked to adenotonsillar hypertrophy, with the CHAT study highlighting that surgical intervention significantly improves quality of life and behavior. Behavioral insomnia remains prevalent, effectively managed through extinction-based techniques. Furthermore, adolescents increasingly face Delayed Sleep-Wake Phase Disorder, where management has shifted toward environmental light manipulation and strategic melatonin dosing to realign internal biological clocks with school schedules.</p><p><strong>Summary: </strong>Effective management requires integrating oropharyngeal exams and sleep hygiene counseling into routine well child visits. While adenotonsillectomy remains the gold standard for OSA, behavioral and circadian issues are best addressed through caregiver education and consistent routines. Early identification by pediatricians reduces long-term neurobehavioral morbidity and guides necessary specialist referrals.</p>","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest: lifesaving rescue.","authors":"Sonia Labarinas, Jon Meliones","doi":"10.1097/MOP.0000000000001574","DOIUrl":"10.1097/MOP.0000000000001574","url":null,"abstract":"<p><strong>Purpose of review: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced form of resuscitation where an extracorporeal circuit is used to temporarily support circulation in patients with refractory cardiac arrest. It represents a highly complex and resource-intensive therapy, with outcomes shaped by institutional experience, patient selection, arrest-related factors, and post ECPR care. This review aims to show the clinical advantages of such a complex therapy.</p><p><strong>Recent findings: </strong>More than 15 000 children undergo cardiopulmonary resuscitation annually for in-hospital cardiac arrest in the United States. ECPR utilization has been increasing over the last 20 years. There has been ongoing uncertainty throughout the years about its efficacy in the pediatric population, especially in the noncardiac population. Recent studies have shown an optimization in outcomes, also in the general pediatric population with increased survival rates and positive neurological outcomes.</p><p><strong>Summary: </strong>ECPR remains a valuable intervention for rescuing children after refractory cardiac arrest. Current resuscitation guidelines endorse ECPR for pediatric cardiac patients. Although outcomes are encouraging, ECPR remains a complex intervention associated with considerable morbidity, mortality, and resource requirements, including significant financial and personnel investment. Future research should focus on identifying patient-specific predictors of benefit, refining selection criteria, and optimizing peri-arrest and post-ECPR management strategies.</p>","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"263-267"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence meets point-of-care ultrasound: implications for pediatric emergency and critical care.","authors":"Jeffrey T Neal, Robert M Hoffmann, Elaine L Chiang, Cynthia A Gravel","doi":"10.1097/MOP.0000000000001555","DOIUrl":"10.1097/MOP.0000000000001555","url":null,"abstract":"<p><strong>Purpose of review: </strong>Artificial intelligence has been integrated in nearly all aspects of clinical care to improve patient outcomes, augment human capabilities and improve efficiency. Particularly in the field of radiology and medical imaging, artificial intelligence could revolutionize how care is delivered. In this review, we review the recent literature and provide an assessment of the advantages (pros) and limitations (cons) of artificial intelligence in point-of-care ultrasonography (POCUS).</p><p><strong>Recent findings: </strong>Emerging literature suggests that artificial intelligence assisted diagnostic models offer a performance advantage over standard imaging modalities with regards to image acquisition and diagnostic accuracy particularly with less experienced users. In pediatric POCUS, artificial intelligence has been shown to improve image acquisition and augment education, which is remarkably helpful in areas where ultrasound experts are limited. Nevertheless, integration of artificial intelligence in the growing field of POCUS requires careful assessment of its drawbacks, biases and limitations. Models that are trained primarily on adult populations should be assessed and validated before utilization in the pediatric population to ensure generalizability. Furthermore, the use of artificial intelligence should integrate with and not replace existing educational models and credentialing processes to preserve ultrasound skills. Finally, at the institutional and global levels, hospitals and organizations will need to weigh in on policies, data governance and oversight in this vulnerable population.</p><p><strong>Summary: </strong>The use of artificial intelligence in POCUS in the fields of emergency medicine and critical care is promising but should be viewed with a lens of caution. It holds promise for improving accessibility, reducing variability in care and transforming care in resource-limited settings, but integration of this evolving technology should be thoughtful to address its potential limitations.</p>","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"280-285"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146212621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current opinion in pediatrics: pediatric lung transplantation in the 21 st century.","authors":"Spoorthi Davala, Xin Si","doi":"10.1097/MOP.0000000000001572","DOIUrl":"10.1097/MOP.0000000000001572","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides a summary of the evolving landscape of pediatric lung transplantation highlighting current trends, short and long-term outcomes, ongoing challenges in posttransplant survival, and unique considerations in pediatric populations.</p><p><strong>Recent findings: </strong>The annual volume of pediatric lung transplantation has declined over the past decade due to a decreased need among children with cystic fibrosis. Improvement in survival has paralleled advancements in bridge to transplant strategies, expanding what were once considered contraindications. Despite the ongoing shortage of donor organs, innovations in policy changes, surgical and immunologic strategies, and organ preservation technologies have expanded the donor lung pool. Chronic lung allograft dysfunction (CLAD) remains the primary limitation to long-term survival, with limited management strategies and emerging immunomodulatory therapies offering promise.</p><p><strong>Summary: </strong>As survival in pediatric lung transplantation improves, emphasis should shift to long-term outcomes including quality of life and equitable care, development of effective CLAD prevention strategies and pediatric-specific guidelines to optimize long-term survival.</p>","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"293-301"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal cardiopulmonary resuscitation for pediatric cardiac arrest: lifesaving rescue, but not for everyone.","authors":"Morgann Loaec, Hera Z Mahmood, Adam S Himebauch, Ryan W Morgan","doi":"10.1097/MOP.0000000000001557","DOIUrl":"10.1097/MOP.0000000000001557","url":null,"abstract":"<p><strong>Purpose of review: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used as a rescue therapy for pediatric cardiac arrest. Its use has expanded beyond its original application in select cardiac populations at highly specialized centers despite limited evidence regarding patient selection, intra-arrest management, and long-term outcomes. Current pediatric ECPR data are derived predominantly from observational studies and registries that are vulnerable to selection bias and incomplete reporting. Estimates of benefit may be overstated, and generalizability across heterogeneous cardiac arrest populations remains uncertain.</p><p><strong>Recent findings: </strong>We examine five key vulnerabilities in pediatric ECPR: limitations of supporting data; challenges in patient selection; compromise of other resuscitative priorities during deployment; impact on patients and families; and strain on healthcare systems and personnel. While ECPR can be lifesaving for carefully selected patients, its indiscriminate application risks unintended harm by undermining patient-centered outcomes and program sustainability.</p><p><strong>Summary: </strong>Responsible expansion of ECPR requires acknowledgement of existing knowledge gaps, investment in thorough collection of prospective data including neurologic and quality-of-life outcomes, and development of clearer institutional frameworks for candidacy. Aligning eagerness for this rescue modality with scientific objectivity is critical to ensure ECPR aligns with the best interests of children, families, and healthcare systems.</p>","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"268-274"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}