Current opinion in pediatrics最新文献_第6页

Use of delirium screening tools in the pediatric ICU: unnecessarily burdensome. 在儿科ICU使用谵妄筛查工具：不必要的负担。

IF 2.8 3区医学

Current opinion in pediatrics Pub Date : 2026-06-01 Epub Date: 2026-02-18 DOI: 10.1097/MOP.0000000000001553

Ariane Willems, Oliver Karam

{"title":"Use of delirium screening tools in the pediatric ICU: unnecessarily burdensome.","authors":"Ariane Willems, Oliver Karam","doi":"10.1097/MOP.0000000000001553","DOIUrl":"10.1097/MOP.0000000000001553","url":null,"abstract":"Purpose of review: Delirium screening is widely recommended in pediatric ICUs, despite persistent uncertainty about what delirium represents biologically, how accurately it can be measured, and whether its detection improves outcomes. Screening tools are increasingly embedded into routine care, even as concerns grow about overdiagnosis, workflow burden, and the absence of effective, evidence-based treatments.Recent findings: Delirium in critically ill children reflects heterogeneous acute brain dysfunction rather than a single disease entity. Validated screening tools show variable reliability and specificity, particularly in infants, children with neurodevelopmental delay, and those speaking a different language than the evaluator. Real-world implementation is limited by subjectivity and substantial nursing cognitive burden. Although delirium is associated with worse outcomes, evidence that screening or pharmacologic treatment alters these outcomes is weak. Pediatric drug trials are scarce, largely retrospective, and show inconsistent benefits with measurable risks.Summary: Current evidence does not support routine delirium screening as a strategy that improves outcomes in critically ill children. Given limited diagnostic precision and lack of effective therapies, clinical and research efforts should prioritize universal prevention strategies that target modifiable drivers of acute brain dysfunction, rather than widespread screening for a poorly defined and variably measured syndrome.","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"234-239"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590634","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}

引用次数: 0

Pediatric tracheostomy-associated respiratory infections: an evolving paradigm. 儿童气管切开术相关的呼吸道感染：一个不断发展的范例。

IF 2.8 3区医学

Current opinion in pediatrics Pub Date : 2026-06-01 Epub Date: 2026-04-02 DOI: 10.1097/MOP.0000000000001559

John M Morrison, Rebecca Steuart, Christopher J Russell

{"title":"Pediatric tracheostomy-associated respiratory infections: an evolving paradigm.","authors":"John M Morrison, Rebecca Steuart, Christopher J Russell","doi":"10.1097/MOP.0000000000001559","DOIUrl":"10.1097/MOP.0000000000001559","url":null,"abstract":"Purpose of review: Children with tracheostomy frequently experience tracheostomy-associated infections (TRAINs) such as pneumonia and tracheitis. This review will summarize current evidence regarding the diagnosis, treatment, and prevention of TRAINs.Recent findings: Recent evidence highlights limitations of respiratory culture testing in the face of a diverse, dynamic bacterial community within the airways of children with tracheostomy, challenging the notion that a positive bacterial culture is sufficient for diagnosing bacterial TRAIN. For this reason, recent consensus guidelines recommend against the routine obtainment of respiratory cultures for TRAIN diagnosis in the absence of specific clinical symptoms. Additional evidence for microbiome shifts and host inflammation as diagnostic tools may help identify those who will benefit from antibiotic treatment. Recent findings support selective anaerobic coverage when aspiration is suspected and suggest shorter antibiotic courses may be effective. Cycled inhaled tobramycin shows potential for reducing TRAIN frequency and related hospitalizations.Summary: With recent advances in TRAIN pathobiology, diagnosis, treatment, and prevention of TRAINs is undergoing a paradigm shift. Future translational research will define the airway microbiome during TRAINs and during wellness and its impact on host inflammation. Antibiotic clinical trials are needed to optimize treatment and prevention of TRAINs.","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"308-316"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627398","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}

引用次数: 0

Pulmonary complications in pediatric hematopoietic stem cell transplantation: an overview for pediatricians. 儿科造血干细胞移植的肺部并发症：儿科医生综述。

IF 2.8 3区医学

Current opinion in pediatrics Pub Date : 2026-06-01 Epub Date: 2026-04-15 DOI: 10.1097/MOP.0000000000001571

Meera A Srikanthan, Pi Chun Cheng, Samuel B Goldfarb

{"title":"Pulmonary complications in pediatric hematopoietic stem cell transplantation: an overview for pediatricians.","authors":"Meera A Srikanthan, Pi Chun Cheng, Samuel B Goldfarb","doi":"10.1097/MOP.0000000000001571","DOIUrl":"10.1097/MOP.0000000000001571","url":null,"abstract":"Purpose of review: This review will describe pulmonary complications of hematopoietic stem cell transplantation (HCT) are a significant source of short- and long-term morbidity and mortality. In recent years the amount of HCT being performed in pediatric continues to increase with new disease included as a form of treatment. Complications which include infection, inflammation, immune mediated damage, and regimen associated toxicity is critically import for early recognition to avoid end organ damage.Recent findings: This review encompasses current literature related to pediatric pulmonary complications of HCT. Types of HCT and conditioning treatments have changed over the past 15-20 years with the goal of reducing complications of HCT such as graft versus host disease. Updated guidelines will be referenced that address post HCT follow up recommendations in pediatrics.Summary: Timely diagnosis of post HCT complications will improve overall care. Ongoing research in this field is needed to continue to improve outcomes and identify biomarkers of disease. Large cohort prospective studies are needed and underway to improve our knowledge with the goal of narrowing the knowledge gap in this field.","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"286-292"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688741","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}

引用次数: 0

Routine daily chest radiographs in pediatric critical care: necessary standard or unwarranted practice? 每日例行胸片检查在儿科重症监护中的应用：必要的标准还是不合理的做法？

IF 2.8 3区医学

Current opinion in pediatrics Pub Date : 2026-06-01 Epub Date: 2026-04-01 DOI: 10.1097/MOP.0000000000001565

Duane C Williams, Conrad Krawiec, Gregory Vorona

引用次数: 0

Use of near-infrared spectroscopy to guide care in the pediatric cardiac ICU: just another glorified gadget? 使用近红外光谱来指导小儿心脏ICU的护理：只是另一个美化的小工具吗？

IF 2.8 3区医学

Current opinion in pediatrics Pub Date : 2026-06-01 Epub Date: 2026-02-09 DOI: 10.1097/MOP.0000000000001554

Oliver Karam, Alia Marie Iqbal O'Meara

{"title":"Use of near-infrared spectroscopy to guide care in the pediatric cardiac ICU: just another glorified gadget?","authors":"Oliver Karam, Alia Marie Iqbal O'Meara","doi":"10.1097/MOP.0000000000001554","DOIUrl":"10.1097/MOP.0000000000001554","url":null,"abstract":"Purpose of review: Near-infrared spectroscopy (NIRS) is increasingly used in pediatric cardiac intensive care to monitor regional tissue oxygenation. Despite its widespread adoption, its clinical utility remains uncertain. This review examines the physiological rationale, accuracy, potential benefits, and limitations of NIRS as a monitoring tool in critically ill children, emphasizing whether it improves outcomes or meaningfully guides management.Recent findings: NIRS provides continuous, noninvasive regional oxygenation data, but measurements are affected by technical and physiological confounders and correlate only moderately with validated markers of systemic perfusion. Although low values may prompt interventions, no randomized trials have demonstrated improved mortality, neurological outcomes, or organ function with NIRS-guided care. Thresholds for intervention vary widely, and most centers lack standardized response protocols. NIRS use may increase unnecessary interventions, contribute to alarm fatigue, and impose substantial financial costs without demonstrated benefit.Summary: Current evidence suggests that NIRS should serve as an adjunct rather than a primary driver of clinical decision-making in pediatric cardiac intensive care. Established modalities such as venous oxygen saturation, lactate trends, echocardiography, and functional hemodynamic assessments provide more actionable information. Further trials are required to define whether NIRS improves outcomes.","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"248-253"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156430","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}

引用次数: 0

Delirium screening tools in the pediatric ICU: a useful tool. 谵妄筛查工具在儿科ICU：一个有用的工具。

IF 2.8 3区医学

Current opinion in pediatrics Pub Date : 2026-06-01 Epub Date: 2026-02-13 DOI: 10.1097/MOP.0000000000001552

Saba Javadi, Lauren Flagg, Sarah B Kandil

{"title":"Delirium screening tools in the pediatric ICU: a useful tool.","authors":"Saba Javadi, Lauren Flagg, Sarah B Kandil","doi":"10.1097/MOP.0000000000001552","DOIUrl":"10.1097/MOP.0000000000001552","url":null,"abstract":"Purpose of review: Pediatric delirium has emerged as a common and clinically meaningful complication of critical illness, with growing recognition of its association with adverse short-term and long-term outcomes. This review is timely given increasing guideline recommendations for routine delirium screening in pediatric critical care settings and the expanding use of validated bedside tools by multidisciplinary teams.Recent findings: Recent literature demonstrates that delirium affects a substantial proportion of critically ill children, particularly those in pediatric ICUs (PICUs) and pediatric cardiac ICUs (PCICUs). The development and validation of pediatric-specific delirium screening instruments have enabled reliable, real-time detection without exclusive reliance on psychiatric consultation. Studies highlight the clinical impact of delirium on morbidity, mortality, length of stay, discharge disposition, and post-intensive care sequelae. However, persistent challenges include variable implementation across units, limited data in certain subpopulations, and gaps in evidence linking screening to targeted interventions and improved outcomes.Summary: Routine delirium screening represents an important advance in pediatric critical care, positioning delirium as a modifiable adverse outcome. Future research should focus on optimizing implementation strategies, addressing special populations, and integrating screening into effective prevention and management pathways to improve patient-centered outcomes.","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"229-233"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146212603","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}

引用次数: 0

The value of disagreement in medicine. 医学中分歧的价值。

IF 2.5 3区医学

Current opinion in pediatrics Pub Date : 2026-06-01 Epub Date: 2026-04-29 DOI: 10.1097/MOP.0000000000001568

Oliver Karam, Jean E Klig

引用次数: 0

Leveraging Pediatric Healthcare Settings to Screen for Environmental Health Risks. 利用儿科医疗机构筛选环境健康风险。

IF 2.8 3区医学

Current opinion in pediatrics Pub Date : 2026-06-01 Epub Date: 2026-03-20 DOI: 10.1097/MOP.0000000000001560

Cesar Larancuent, Cian Jacob, Stephanie San Martin, Danielle Fisenne Katz, Joseph Burns

{"title":"Leveraging Pediatric Healthcare Settings to Screen for Environmental Health Risks.","authors":"Cesar Larancuent, Cian Jacob, Stephanie San Martin, Danielle Fisenne Katz, Joseph Burns","doi":"10.1097/MOP.0000000000001560","DOIUrl":"10.1097/MOP.0000000000001560","url":null,"abstract":"Purpose of review: This review aims to highlight key opportunities to implement available screening tools to identify environmental health risk factors across various pediatric care settings.Recent findings: Climate change is known to affect pediatric health outcomes. As its consequences become more evident, it is imperative to consider the environment as a social determinant of health. Common pediatric illnesses are exacerbated by climate change, such as asthma, respiratory infections, and cardiovascular disease. This review also reveals inequity in environmental health exposures in historically marginalized populations.Summary: It is the responsibility of pediatricians to leverage their clinical expertise, patient interactions, local partnerships, and legislative action to mitigate the effects of climate change on children. Fortunately, several screening tools are readily applicable in both ambulatory and inpatient settings. Further, it is essential to consider how marginalized populations are more susceptible to the impacts of climate change.","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"317-323"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590533","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}

引用次数: 0

Beyond the scan: quick MRI's emergence in pediatric emergency care. 扫描之外：快速核磁共振成像在儿科急诊护理中的出现。

IF 2.8 3区医学

Current opinion in pediatrics Pub Date : 2026-06-01 Epub Date: 2026-04-08 DOI: 10.1097/MOP.0000000000001570

Brenda Varriano, Kristina Brumme, Wee-Jhong Chua

{"title":"Beyond the scan: quick MRI's emergence in pediatric emergency care.","authors":"Brenda Varriano, Kristina Brumme, Wee-Jhong Chua","doi":"10.1097/MOP.0000000000001570","DOIUrl":"10.1097/MOP.0000000000001570","url":null,"abstract":"Purpose of review: Computed tomography (CT) remains the dominant neuroimaging modality in the pediatric emergency department despite growing awareness of the risks associated with cumulative ionizing radiation exposure. Advances in rapid MRI have renewed interest in quick brain MRI (qbMRI) as a feasible, radiation-free alternative. This manuscript explores emerging strategies to reduce unnecessary CT utilization, expand MRI accessibility, and synthesize growing evidence supporting the use of qbMRI across a range of pediatric emergency indications.Recent findings: Recent literature demonstrates that qbMRI offers significant reductions in radiation exposure with comparable diagnostic performance to CT for the evaluation of hydrocephalus and cerebrospinal fluid shunt malfunction. Studies also highlight its value in selected traumatic brain injuries, abusive head trauma screening, and nontraumatic neurologic emergencies; notably for pediatric stroke, where diffusion-weighted qbMRI shows superior sensitivity to CT. Quality improvement data highlight the successful integration of qbMRI protocols that produce substantial decreases in CT utilization while sustaining diagnostic accuracy.Summary: QbMRI increasingly represents a safer neuroimaging strategy compared to CT. While CT remains essential for detecting acute intracranial hemorrhage and skull fractures, qbMRI can meaningfully reduce radiation exposure in appropriately selected patients. Ongoing technological advances, such as improved fracture detection; along with targeted implementation efforts, are likely to further expand its role in pediatric emergency neuroimaging.","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"275-279"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670771","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}

引用次数: 0

Routine daily chest radiographs in mechanically ventilated children: necessary surveillance. 机械通气儿童每日常规胸片检查：必要的监测。

IF 2.8 3区医学

Current opinion in pediatrics Pub Date : 2026-06-01 Epub Date: 2026-03-30 DOI: 10.1097/MOP.0000000000001566

Trupti V Ingle, Shah Ali Ahmed, John S Giuliano

{"title":"Routine daily chest radiographs in mechanically ventilated children: necessary surveillance.","authors":"Trupti V Ingle, Shah Ali Ahmed, John S Giuliano","doi":"10.1097/MOP.0000000000001566","DOIUrl":"10.1097/MOP.0000000000001566","url":null,"abstract":"Purpose of review: With the growing availability of bedside point-of-care technologies, an expanding body of evidence questions the necessity of routine daily chest radiographs in pediatric intensive care unit (PICU) patients. Nevertheless, this review illustrates that daily chest imaging continues to yield clinically meaningful information and should not be entirely discontinued.Recent findings: Routine daily chest radiographs in the PICU frequently reveal malpositioned devices including central venous catheters, chest tubes, nasogastric tubes, and endotracheal tubes. They may also uncover unanticipated cardiopulmonary abnormalities that warrant changes in management. Moreover, the potential risks of radiation exposure can be mitigated through the use of portable imaging and targeted scanning techniques that limit exposure to essential regions.Summary: Routine daily chest radiographs continue to be a valuable tool for pediatric intensivists and have the potential to identify unexpected complications that can significantly influence patient management. Future research should focus on risk stratifying pediatric patient populations which may benefit from routine chest radiography.","PeriodicalId":10985,"journal":{"name":"Current opinion in pediatrics","volume":" ","pages":"254-257"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590580","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}

引用次数: 0