Current Treatment Options in Pediatrics最新文献

{"title":"Perinatal Cytomegalovirus Infection.","authors":"Alejandra Sandoval Carmona,&nbsp;Fatima Kakkar,&nbsp;Soren Gantt","doi":"10.1007/s40746-022-00261-y","DOIUrl":"https://doi.org/10.1007/s40746-022-00261-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>There have been recent advances in the field of congenital CMV infection (cCMV) related to antiviral treatment of pregnant women and infants, the implementation of newborn CMV screening programs, and the frequency and diagnosis of complications among infected children. In addition, postnatal CMV infection (pCMV) is increasingly recognized as a potential cause of long-term sequelae in addition to acute complications among preterm infants, raising important questions related to treatment, and prevention.</p><p><strong>Recent findings: </strong>High-dose valacyclovir appears to be safe and effective for the prevention of cCMV among women with first-trimester primary CMV infection. New studies reveal high rates of vestibular dysfunction and neuropsychiatric manifestations among children with cCMV. Some studies report associations between pCMV and long-term consequences, including neurodevelopmental delay and bronchopulmonary dysplasia, among very low birth weight infants, in addition to high risk of sepsis and death acutely, which has motivated efforts to eliminate the virus from breast milk by different methods.</p><p><strong>Summary: </strong>More long-term complications of cCMV are increasingly recognized among children previously thought to be asymptomatic. Although a preventive CMV vaccine may be achievable, strategies to reduce the burden of cCMV disease include maternal education about risk-reduction behaviors, antiviral treatment of pregnant women with primary infection, and newborn screening to allow timely, appropriate care. Similarly, although it remains unclear if pCMV causes long-term problems, there is growing interest in identifying and preventing disease from CMV infections among preterm infants.</p>","PeriodicalId":37445,"journal":{"name":"Current Treatment Options in Pediatrics","volume":"8 4","pages":"395-411"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9684878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10719363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Technologic Innovation and COVID-19 Pandemic on Pediatric Cardiology Telehealth.","authors":"Sanket S Shah,&nbsp;Amulya Buddhavarapu,&nbsp;Majid Husain,&nbsp;Craig Sable,&nbsp;Gary Satou","doi":"10.1007/s40746-022-00258-7","DOIUrl":"https://doi.org/10.1007/s40746-022-00258-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>Established telehealth practices in pediatrics and pediatric cardiology are evolving rapidly. This review examines several concepts in contemporary telemedicine in our field: recent changes in direct-to-consumer (DTC) pediatric telehealth (TH) and practice based on lessons learned from the pandemic, scientific data from newer technological innovations in pediatric cardiology, and how TH is shaping global pediatric cardiology practice.</p><p><strong>Recent findings: </strong>In 2020, the global pandemic of COVID-19 led to significant changes in healthcare delivery. The lockdown and social distancing guidelines accelerated smart adaptations and pivots to ensure continued pediatric care albeit in a virtual manner. Remote cardiac monitoring technology is continuing to advance at a rapid pace secondary to advances in the areas of Internet access, portable hand-held devices, and artificial intelligence.</p><p><strong>Summary: </strong>TH should be approached programmatically by pediatric cardiac healthcare providers with careful selection of patients, technology platforms, infrastructure setup, documentation, and compliance. Payment parity with in-person visits should be advocated and legislated. Newer remote cardiac monitoring technology should be expanded for objective assessment and optimal outcomes. TH continues to be working beyond geographical boundaries in pediatric cardiology and should continue to expand and develop.</p>","PeriodicalId":37445,"journal":{"name":"Current Treatment Options in Pediatrics","volume":"8 4","pages":"309-324"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9510217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10321677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Access to Pediatric Cardiac Care in the Developing World: the South African Perspective.","authors":"Ebrahim G M Hoosen, Antoinette M Cilliers, Stephen Brown, Belinda Mitchell","doi":"10.1007/s40746-022-00247-w","DOIUrl":"10.1007/s40746-022-00247-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>The paper outlines the current status of health care and pediatric cardiac services in South Africa and the challenges faced in providing pediatric cardiac care in the country.</p><p><strong>Recent findings: </strong>As infant and child mortality rates in South Africa and most of Sub-Saharan Africa continue to decline, establishing and improving the infrastructure to manage congenital heart disease increases in importance.</p><p><strong>Summary: </strong>South Africa has well-established pediatric cardiac units in most major centers in the country. These have been able to train sufficient numbers of pediatric cardiologists to double the number in the country in just over a decade as well as train fellows from surrounding countries. A significant proportion of funding for this training comes from non-government sources. The number of pediatric cardiologists is however still far less than required with services spread unevenly throughout the country. Pediatric cardiac surgical services remain severely constrained with an urgent need to train more pediatric cardiac surgeons. Further progress depends not only on focussing resources on cardiac disease but also improvements in the health care systems and socioeconomic conditions in general.</p>","PeriodicalId":37445,"journal":{"name":"Current Treatment Options in Pediatrics","volume":"8 3","pages":"141-150"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9137262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9913090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of the Pathophysiologic and Clinical Aspects of Hypokalemia in Children and Young Adults: an Update.","authors":"Oluwatoyin Fatai Bamgbola","doi":"10.1007/s40746-022-00240-3","DOIUrl":"10.1007/s40746-022-00240-3","url":null,"abstract":"<p><p>This article examines the regulatory function of the skeletal muscle, renal, and adrenergic systems in potassium homeostasis. The pathophysiologic bases of hypokalemia, systematic approach for an early diagnosis, and therapeutic strategy to avert life-threatening complications are highlighted. By promoting skeletal muscle uptake, intense physical exercise (post), severe trauma, and several toxins produce profound hypokalemia. Hypovolemia due to renal and extra-renal fluid losses and ineffective circulation activate secondary aldosteronism causing urinary potassium wasting. In addition to hypokalemic alkalosis, primary aldosteronism causes low-renin hypertension. Non-aldosterone mineralocorticoid activation leading to low-renin and low-aldosterone hypertension occurs in Liddle's syndrome and apparent mineralocorticoid excess. Although there is enzymatic inhibition of cortisol synthesis in congenital adrenal hyperplasia, precursors of aldosterone produce low-renin hypokalemic hypertension. In addition to the glucocorticoid effect, hypercortisolism activates mineralocorticoid receptors in Cushing's syndrome. Genetic mutations involving furosemide-sensitive Na⁺-K⁺-2Cl^- co-transporters and thiazide-sensitive Na⁺-Cl^- transporters result in (non-hypertensive) salt-wasting nephropathy. Proximal and distal renal tubular acidosis is associated with hypokalemia. Eating disorders causing hypokalemia include bulimia, laxative abuse, and diuretic misuse. Low urinary potassium (<15 mmol/day) and/or low urinary chloride (<20 mol/L) suggest a gastrointestinal pathology. Co-morbidity of hypokalemia with chronic pulmonary and cardiovascular diseases may increase the fatality rate.</p>","PeriodicalId":37445,"journal":{"name":"Current Treatment Options in Pediatrics","volume":"8 3","pages":"96-114"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9115742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9910533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Management of Urinary Tract Infections in Children.","authors":"Philip Olson, Anne G Dudley, Courtney K Rowe","doi":"10.1007/s40746-022-00242-1","DOIUrl":"10.1007/s40746-022-00242-1","url":null,"abstract":"<p><strong>Purpose of review: </strong>Urinary tract infection (UTI) in children is a major source of office visits and healthcare expenditure. Research into the diagnosis, treatment, and prophylaxis of UTI has evolved over the past 10 years. The development of new imaging techniques and UTI screening tools has improved our diagnostic accuracy tremendously. Identifying who to treat is imperative as the increase in multi-drug-resistant organisms has emphasized the need for antibiotic stewardship. This review covers the contemporary management of children with UTI and the data-driven paradigm shifts that have been implemented into clinical practice.</p><p><strong>Recent findings: </strong>With recent data illustrating the self-limiting nature and low prevalence of clinically significant vesicoureteral reflux (VUR), investigational imaging in children has become increasingly less frequent. Contrast-enhanced voiding urosonogram (CEVUS) has emerged as a useful diagnostic tool, as it can provide accurate detection of VUR without the need of radiation. The urinary and intestinal microbiomes are being investigated as potential therapeutic drug targets, as children with recurrent UTIs have significant alterations in bacterial proliferation. Use of adjunctive corticosteroids in children with pyelonephritis may decrease the risk of renal scarring and progressive renal insufficiency. The development of a vaccine against an antigen present on <i>Escherichia coli</i> may change the way we treat children with recurrent UTIs.</p><p><strong>Summary: </strong>The American Academy of Pediatrics defines a UTI as the presence of at least 50,000 CFU/mL of a single uropathogen obtained by bladder catheterization with a dipstick urinalysis positive for leukocyte esterase (LE) or WBC present on urine microscopy. UTIs are more common in females, with uncircumcised males having the highest risk in the first year of life. <i>E. coli</i> is the most frequently cultured organism in UTI diagnoses and multi-drug-resistant strains are becoming more common. Diagnosis should be confirmed with an uncontaminated urine specimen, obtained from mid-stream collection, bladder catheterization, or suprapubic aspiration. Patients meeting criteria for imaging should undergo a renal and bladder ultrasound, with further investigational imaging based on results of ultrasound or clinical history. Continuous antibiotic prophylaxis is controversial; however, evidence shows patients with high-grade VUR and bladder and bowel dysfunction retain the most benefit. Open surgical repair of reflux is the gold standard for patients who fail medical management with endoscopic approaches available for select populations.</p>","PeriodicalId":37445,"journal":{"name":"Current Treatment Options in Pediatrics","volume":"8 3","pages":"192-210"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9108690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9910308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Utility of Point-of-Care Ultrasound in the Pediatric Cardiac Intensive Care Unit.","authors":"Jessica N Persson,&nbsp;John S Kim,&nbsp;Ryan J Good","doi":"10.1007/s40746-022-00250-1","DOIUrl":"https://doi.org/10.1007/s40746-022-00250-1","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes the diverse uses of point-of-care ultrasound (POCUS) in critically ill children with congenital and acquired heart disease. Diagnostic utility and practicality of POCUS is reviewed. Importantly, the role of POCUS in the medical management of children in the cardiac intensive care unit is highlighted.</p><p><strong>Recent findings: </strong>The use of POCUS in critically ill pediatric patients has emerged as an essential diagnostic tool that enhances the physical examination and influences delivery of care. Assessment of a wide range of body systems and pathologies has been impacted by the use of POCUS. Recent studies have demonstrated the use of POCUS for evaluation of cardiac tamponade, pneumonia, vocal cord function, and loss of muscle mass in critically ill children (Hamilton et al. Pediatr Crit Care Med 22(10):e532-e539, 2021; Hoffmann et al. Pediatr Crit Care Med 22(10):889-897, 2021; Najgrodzka et al. Ultrasound Q 35(2):157 163, 2019; Alerhand et al. Pediatr Ann 50(10):e424-e431, 2021).</p><p><strong>Summary: </strong>POCUS is a non-invasive, low-risk, imaging modality that can be used to diagnose and help guide management of critically ill children in the cardiac intensive care unit. POCUS can be performed by an intensivist at the patient's bedside with real-time interpretation, leading to rapid clinical decision-making and the hope of improving patient outcomes.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s40746-022-00250-1.</p>","PeriodicalId":37445,"journal":{"name":"Current Treatment Options in Pediatrics","volume":" ","pages":"151-173"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9264295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40665775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extra-esophageal Manifestations of Pediatric Gastroesophageal Reflux Disease: Updated Review","authors":"Zeyad M. Abdulkader, F. Woodley, P. Lu","doi":"10.1007/s40746-021-00229-4","DOIUrl":"https://doi.org/10.1007/s40746-021-00229-4","url":null,"abstract":"","PeriodicalId":37445,"journal":{"name":"Current Treatment Options in Pediatrics","volume":"7 1","pages":"217 - 228"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42065767","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":"Management of Atrial Tachyarrhythmias in Adults With Single Ventricle Heart Disease","authors":"Megan M. SooHoo, M. Stone, J. V. von Alvensleben, Roni M. Jacobsen","doi":"10.1007/s40746-021-00231-w","DOIUrl":"https://doi.org/10.1007/s40746-021-00231-w","url":null,"abstract":"","PeriodicalId":37445,"journal":{"name":"Current Treatment Options in Pediatrics","volume":"7 1","pages":"187 - 202"},"PeriodicalIF":0.0,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44673790","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":"Management of Fetal Arrhythmias","authors":"M. R. Gropler, B. Cuneo","doi":"10.1007/s40746-021-00230-x","DOIUrl":"https://doi.org/10.1007/s40746-021-00230-x","url":null,"abstract":"","PeriodicalId":37445,"journal":{"name":"Current Treatment Options in Pediatrics","volume":"7 1","pages":"167 - 186"},"PeriodicalIF":0.0,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45373805","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":"Metabolic Syndrome in Children and Adolescents: Looking to New Markers","authors":"M. Fazeli, M. Mohammad-zadeh, Z. Meshkat, H. Ghazizadeh, E. Barati, G. Ferns, M. Ghayour-Mobarhan","doi":"10.1007/s40746-021-00226-7","DOIUrl":"https://doi.org/10.1007/s40746-021-00226-7","url":null,"abstract":"","PeriodicalId":37445,"journal":{"name":"Current Treatment Options in Pediatrics","volume":"7 1","pages":"152-166"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s40746-021-00226-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47585931","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}