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Current Opinion in Pediatrics

Itai Kloog
PURPOSE OF REVIEW: Preterm birth is the leading cause of global child mortality, and survivors are at increased risk of multiple morbidities that can continue into adulthood. Recent studies have suggested that maternal exposure to air pollution and high and low ambient temperatures may increase the risk of preterm birth, whereas proximity to green space may decrease it. This review summarizes these findings and suggests avenues for further research. RECENT FINDINGS: Particulate matter may be associated with an increased risk of preterm birth, but the magnitude of the effect remains unclear...
January 11, 2019: Current Opinion in Pediatrics
Itai Kloog
PURPOSE OF REVIEW: Low, high, extreme, and variable temperatures have been linked to multiple adverse health outcomes, particularly among the elderly and children. Recent models incorporating satellite remote sensing data have mitigated several limitations of previous studies, improving exposure assessment. This review focuses on these new temperature exposure models and their application in epidemiological studies. RECENT FINDINGS: Satellite observations of land surface temperature have been used to model air temperature across large spatial areas at high spatiotemporal resolutions...
January 11, 2019: Current Opinion in Pediatrics
Lisa G Pell, Miranda G Loutet, Daniel E Roth, Philip M Sherman
PURPOSE OF REVIEW: Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality among premature neonates. Although randomized trials have shown that probiotics may be efficacious in the prevention of NEC, their use has not been universally adopted in the neonatal intensive care unit (NICU). Caveats regarding routine probiotic supplementation for the prevention of NEC are summarized in this review. RECENT FINDINGS: Accumulating evidence indicates that prophylactic probiotic supplementation in preterm infants can reduce the incidence of NEC...
January 9, 2019: Current Opinion in Pediatrics
Bonnie H Arzuaga, Christy L Cummings
PURPOSE OF REVIEW: Medical decision making and practices surrounding extremely premature birth remains challenging for parents and care providers alike. Recently, concerns have been raised regarding wide practice variation, selection bias, and the limitations of outcomes data in this population. The purpose of this review is to summarize the recent literature relevant to deliveries at extreme prematurity with a focus on outcomes, approaches, and institutional variation. RECENT FINDINGS: Newer data suggest that evidence-based clinical guidelines and protocols for both pregnant women and infants at extreme prematurity are emerging and may improve care and outcomes at lower gestational ages...
January 2, 2019: Current Opinion in Pediatrics
Erin Kim
PURPOSE OF REVIEW: Electrolyte abnormalities posttransplant are common occurrences that can have significant short-term and long-term effects on graft outcome and patient quality of life. Understanding the pathophysiology of these electrolyte derangements can help guide management to optimize bone health and minimize cardiovascular disease. This review explores the pathogenesis of the most common postrenal transplant electrolytes abnormalities as well as current treatment options. RECENT FINDINGS: Clarifications of the role of FGF-23 has improved our understanding of posttransplant bone disease in addition to the known roles of hyperparathyroidism and vitamin D...
December 21, 2018: Current Opinion in Pediatrics
Raja Dandamudi, Jodi Smith, Vikas R Dharnidharka
PURPOSE OF REVIEW: Infections represent a significant source of morbidity and mortality after kidney transplantation in children. We review recent advances in epidemiology, assessment, prevention and treatment for several different infections. RECENT FINDINGS: Infections, such as bacterial urinary tract infection or opportunistic viral infection remain common, may be increasing and represent a large proportion of hospitalization. Extended antiviral agent use reduces the incidence of cytomegalovirus disease but its efficacy to reduce Epstein-Barr virus disease remains controversial...
December 17, 2018: Current Opinion in Pediatrics
Nicola Brodie, Jennifer L Keim, Elizabeth A Silberholz, Nancy D Spector, Amy E Pattishall
PURPOSE OF REVIEW: Resilience is an important factor in withstanding the health consequences of childhood adversity. This article discusses recent literature related to promoting resilience in opioid-exposed children and siblings of children with special healthcare needs. It also addresses ways that school systems can foster childhood resilience. RECENT FINDINGS: Rising rates of opioid-exposed newborns have necessitated the development of multiple strategies to address the medical and social needs of this vulnerable pediatric population...
December 10, 2018: Current Opinion in Pediatrics
Paul Spearman, Yvonne Bryson
PURPOSE OF REVIEW: The purpose of this review is to describe some current challenges facing the field of pediatric infectious diseases and discuss strategies for enhancing recognition of the value of infectious disease services and for recruiting new talent to the field. RECENT FINDINGS: Pediatric infectious disease programs are currently filling approximately half of their fellowship positions, and salaries are among the lowest in medical subspecialties. Research-intensive careers in pediatric infectious diseases are threatened by low the National Institutes of Health paylines for career development awards...
December 10, 2018: Current Opinion in Pediatrics
Jordan A Gruskay, Christopher M Brusalis, Madison R Heath, Peter D Fabricant
PURPOSE OF REVIEW: The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and treatment for lateral ankle instability in pediatric patients. RECENT FINDINGS: Chronic ankle instability is a common sequela of lateral ankle sprain in young athletes. Incidence is increasing, possibly due in part to inadequate treatment of first-time ankle sprains, as well as increased youth participation in organized and competitive sports. The anterior talofibular ligament (ATFL) is injured in every case, whereas the calcaneofibular ligament (CFL) and syndesmosis may be involved in severe cases...
December 10, 2018: Current Opinion in Pediatrics
Paige I Partain, Jacob White, Paul Hammerness
PURPOSE OF REVIEW: To provide an up-to-date clinical review of U.S. Food and Drug Administration (FDA)-approved stimulant medications for attention-deficit/hyperactivity disorder (ADHD), including a framework for individualized treatment by primary care pediatric providers. RECENT FINDINGS: Stimulant medications are first-line agents for pediatric ADHD. Since 2012, 11 novel stimulant medications have been approved by the FDA for the treatment of ADHD. Because of an expanded formulary of available methylphenidate-based and amphetamine-based stimulants, primary care providers may be unfamiliar with some novel medications outside a select formulary...
December 6, 2018: Current Opinion in Pediatrics
Jamil F Soni, Weverley R Valenza, Anna Carolina Pavelec
PURPOSE OF REVIEW: The chronic Monteggia may lead to pain, mobility limitation, progressive valgus deformity, lateral elbow instability, late ulnar nerve paralysis, and degenerative changes. In this review, we discuss the current procedures in the literature focused on correcting chronic Monteggia to avoid these complications. RECENT FINDINGS: Correction of the ulnar deformity with elongation and angulation of the ulna in the opposite direction of the dislocation of the radial head is the most important factor for the reduction and consequent preservation of the radial head...
December 6, 2018: Current Opinion in Pediatrics
Sujith Baliga, Torunn I Yock
PURPOSE OF REVIEW: The advent of proton beam therapy (PBT) has initiated a paradigm shift in the field of pediatric radiation oncology, with increasing promise to alleviate both short-term and long-term toxicities. Given the dramatic rise in proton therapy centers in the United States, a discussion of the quality of evidence supporting its use in pediatric cancers is warranted. RECENT FINDINGS: Proton radiotherapy appears to decrease the incidence and severity of late effects with the strongest evidence in pediatric brain tumor cohorts that shows benefits in neurocognitive, hearing, and endocrine outcomes...
December 6, 2018: Current Opinion in Pediatrics
Maria Tuca, Nazira Bernal, Eva Luderowski, Daniel W Green
PURPOSE OF REVIEW: The purpose of this review is to summarize and clarify the current framework for treating tibial spine avulsion fractures (TSAFs). We will discuss how these fractures are classified both on plain radiographs and MRI as well as report the incidence of concomitant soft tissue injury, an important consideration that guides treatment. We will also compare guidelines for nonsurgical versus surgical treatment and summarize frequently used surgical techniques. Finally, we will review outcomes following treatment, including common complications...
December 3, 2018: Current Opinion in Pediatrics
Peter de Blank, Pratiti Bandopadhayay, Daphne Haas-Kogan, Maryam Fouladi, Jason Fangusaro
PURPOSE OF REVIEW: Pediatric low-grade gliomas (pLGGs) have been treated with similar therapies for the last 30 years. Recent biological insights have allowed a new generation of targeted therapies to be developed for these diverse tumors. At the same time, technological advances may redefine the late toxicities associated with radiation therapy. Understanding recent developments in pLGG therapy is essential to the management of these common pediatric tumors. RECENT FINDINGS: It is now well understood that aberrations of the mitogen-activated protein kinase pathway are key to oncogenesis in low-grade gliomas...
December 3, 2018: Current Opinion in Pediatrics
Rachel G Berger, Shevaun M Doyle
PURPOSE OF REVIEW: Provide a comprehensive overview of lumbar spondylolysis, a frequent cause of lower back pain in children and adolescents, from evaluation to management. RECENT FINDINGS: With the surge of structured sports participation in the pediatric population, spondylolysis is a common ailment that afflicts many young athletes due to rigorous competition that taxes the growing spine with repetitive extension and rotation. SUMMARY: Spondylolysis is a fracture through the pars interarticularis...
December 3, 2018: Current Opinion in Pediatrics
Jay Shah, Prithwijit Das, Nallammai Muthiah, Ruth Milanaik
PURPOSE OF REVIEW: In recent years, breakthroughs and advancements in new age technology have revolutionized the way children communicate and interact with the world around them. As social media platforms such as Facebook, Instagram, and Snapchat continue to grow in popularity, their usage has raised concerns about their role and impact on adolescent development and behavior. This review examines the psychosocial implications of social media usage on youth outcomes related to body image, socialization, and adolescent development...
November 30, 2018: Current Opinion in Pediatrics
James B Wood, Lauryn B Cravens, C Buddy Creech
PURPOSE OF REVIEW: Rising rates of multidrug-resistant organisms has necessitated the development of novel antimicrobials. In this review, we will highlight agents that have recently received licensure and those that are in clinical development. RECENT FINDINGS: In recent years, development of novel antimicrobial agents has accelerated. Although most studies have targeted the adult population, studies in pediatric patients are underway. Adequately powered clinical trials are needed to establish the safety and role of these new drugs...
November 30, 2018: Current Opinion in Pediatrics
Patrick Gavigan, Jonathan A McCullers
PURPOSE OF REVIEW: Influenza remains a major cause of morbidity and mortality. The 2017-2018 season was one of the most severe in the past decade. The exact factors determining the severity of a particular influenza season are complex and often poorly understood. RECENT FINDINGS: Factors impacting annual influenza severity include characteristics of the specific virus, influenza vaccination, and antiviral use. Although viral virulence factors are important in this context and our knowledge of these is growing, there is a complex interplay between expression of these factors and their impact on a particular patient population...
November 21, 2018: Current Opinion in Pediatrics
Suzanne MacFarland, Rochelle Bagatell
PURPOSE OF REVIEW: Our understanding of the biologic basis of neuroblastoma, the genetic heterogeneity of this malignancy and the role of host factors has expanded significantly in recent years. In this review, we highlight current and future risk-based treatment approaches and discuss the opportunities and challenges of selecting optimal therapies for specific patient subsets. RECENT FINDINGS: Significant progress has been made in understanding neuroblastoma predisposition and new approaches have been taken to treatment of this disease...
November 21, 2018: Current Opinion in Pediatrics
Amy M Firth, Ben A Marson, James B Hunter
PURPOSE OF REVIEW: The management of displaced medial humeral epicondyle fractures in children remains controversial. The indications for surgery, the ideal surgical strategy and the implications of a painful nonunion remain unclear. RECENT FINDINGS: This article describes the state of the evidence and the art in the management of medial humeral epicondyle fractures concentrating on recent research and current opinion. Treatment of paediatric medial epicondylar fractures of the elbow remains the domain of expert opinion and subject to great variance...
November 16, 2018: Current Opinion in Pediatrics
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