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Pediatric In Review

Ryan Gise, Timothy Truong, David M Poulsen, Yssra Soliman, Afshin Parsikia, Joyce N Mbekeani
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of pediatric disability and mortality. Together with sight-threatening ocular injuries, TBIs may lead to devastating consequences in developing children and complicate rehabilitation. We sought to investigate this relationship in pediatric patients admitted with major trauma. METHODS: The records of pediatric patients admitted with ocular injury and concomitant TBI were reviewed retrospectively using the National Trauma Data Bank (2008-2014)...
October 17, 2018: Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Soichi Narumoto, Seisuke Sakamoto, Kengo Sasaki, Yoshihiro Hirata, Akinari Fukuda, Toru Uchiyama, Rie Irie, Takako Yoshioka, Mureo Kasahara
Desensitization with RTX has been broadly introduced in adult LT across the ABO blood type barrier. For pediatric LT, the prophylactic use of RTX has not been standardized, especially for children under 2 years of age. A 20-month-old girl with BA underwent living donor LT from her ABO-I mother. On POD 6, she developed combined T cell-mediated and AMRs. Steroid bolus injection was immediately introduced, followed by antibody-depleting therapy with PE and IVIG. Based on a peripheral blood lymphocyte analysis by fluorescence-activated cell sorting, ATG and RTX were introduced for refractory rejection...
October 19, 2018: Pediatric Transplantation
Nadia Panera, Barbara Barbaro, Claudia Della Corte, Antonella Mosca, Valerio Nobili, Anna Alisi
Nonalcoholic fatty liver disease (NAFLD) is a multifaceted disorder that ranges from simple fatty liver to nonalcoholic steatohepatitis (NASH) with or without fibrosis, which may evolve toward cirrhosis and hepatocellular carcinoma. It is currently considered a "global" and "epidemic" disease, whose prevalence is progressively increasing even in pediatric age. The incidence of NAFLD is very high in overweight/obese children, and a greater risk of disease progression is associated with severe obesity, highlighting the role of nutrition...
October 2018: Nutrition Research
Emily L Niu, Frances A Tepolt, Donald S Bae, Drake G Lebrun, Mininder S Kocher
BACKGROUND: Osteochondritis dissecans (OCD) of the capitellum is a rare but potentially debilitating condition. We sought to determine the healing potential of stable capitellar OCD treated nonoperatively, as well as factors predictive of successful nonoperative management. METHODS: We performed a retrospective review of patients younger than 19 years who presented with stable OCD of the capitellum and were treated nonoperatively for a minimum of 2 months. The average clinical and radiographic follow-up period was 12...
November 2018: Journal of Shoulder and Elbow Surgery
Lauren E Kelly, Michele P Dyson, Nancy J Butcher, Robert Balshaw, Alex John London, Christine J Neilson, Anne Junker, Salaheddin M Mahmud, S Michelle Driedger, Xikui Wang
BACKGROUND: Although children have historically been excluded from clinical trials (CTs), many require medicines tested and approved in CTs, forcing health care providers to treat their pediatric patients based on extrapolated data. Unfortunately, traditional randomized CTs can be slow and resource-intensive, and they often require multi-center collaboration. However, an adaptive design (AD) framework for CTs could be used to increase the efficiency of pediatric CTs by incorporating prospectively planned modifications to CT methods without undermining the integrity or validity of the study...
October 19, 2018: Trials
Cavan P Bailey, Mary Figueroa, Sana Mohiuddin, Wafik Zaky, Joya Chandra
Pediatric high-grade glioma (pHGG) and brainstem gliomas are some of the most challenging cancers to treat in children, with no effective therapies and 5-year survival at ~2% for diffuse intrinsic pontine glioma (DIPG) patients. The standard of care for pHGG as a whole remains surgery and radiation combined with chemotherapy, while radiation alone is standard treatment for DIPG. Unfortunately, these therapies lack specificity for malignant glioma cells and have few to no reliable biomarkers of efficacy. Recent discoveries have revealed that epigenetic disruption by highly conserved mutations in DNA-packaging histone proteins in pHGG, especially DIPG, contribute to the aggressive nature of these cancers...
October 18, 2018: Bioengineering
Xiaohang Li, Jiuzhi Li, Wei Zhu, Xiaolu Duan, Zhijian Zhao, Tuo Deng, Haifeng Duan, Guohua Zeng
OBJECTIVE: To compare the efficacy and safety of micropercutaneous nephrolithotomy (Microperc) and retrograde intrarenal surgery (RIRS) in treating renal stones using published literature. METHODS: A systematic literature review was performed on August 21, 2017, using PubMed, Embase, and Cochrane Library databases in accordance with the PRISMA guidelines. Summarized mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the differences in outcomes between Microperc and RIRS...
2018: PloS One
Marco Farronato, Alberta Greco Lucchina, Carmen Mortellaro, Andrea Fama, Guido Galbiati, Giampietro Farronato, Cinzia Maspero
OBJECTIVES: The aim of this systematic review of the literature is to describe treatment options for bilateral coronoid process hyperplasia in pediatric patients, to describe etiologic and diagnostic correlations with the treatment, and to evaluate long-term follow-up treatment outcomes. METHODS: A systematic revision of the literature was performed in the Medline, PubMed, Cochrane library, and Embase database up to December 5, 2017. Predetermined Medical Subject Heading keywords were used: "bilateral" or "monolateral" and "coronoid" or "coronoid process" and "hyperplasia" and "temporomandibular joint" or "tmj" and "ankylosis" or "trismus" and "treatment"...
October 18, 2018: Journal of Craniofacial Surgery
Megan Culler Freeman, Carolyn B Coyne, Michael Green, John V Williams, Laurie A Silva
Recent years have brought a rise in newly emergent viral infections, primarily in the form of previously known arthropod-transmitted viruses that have increased significantly in both incidence and geographical range. Of particular note are DENV, CHIKV, and ZIKV, which are transmitted mostly by Aedes species of mosquitoes that exhibit a wide and increasing global distribution. Being important pathogens for the general population, these viruses have the potential to be devastating in the international transplant community, with graft rejection and death as possible outcomes of infection...
October 19, 2018: Pediatric Transplantation
Eric J Monroe, Arthie Jeyakumar, Christopher R Ingraham, Giri Shivaram, Kevin S H Koo, Evelyn K Hsu, Andre A S Dick
OBJECTIVE: To investigate Doppler US and catheter venogram correlates to improve detection of transplant HVOO and avoid unnecessary invasive imaging procedures. MATERIALS AND METHODS: A retrospective review was performed in all pediatric OLT patients undergoing catheter venography of the hepatic veins between 2007 and 2017 at a single large tertiary pediatric liver transplant institution. RESULTS: Forty-four transplant hepatic venograms in 32 OLT patients were included (mean 1...
October 19, 2018: Pediatric Transplantation
Sean Z Wu, Sophie Wang, Rubina Ratnaparkhi, Wilma F Bergfeld
BACKGROUND/OBJECTIVES: Data on treatment options in pediatric alopecia areata are limited. Topical anthralin has been demonstrated to be an effective treatment option in adults and has minimal systemic toxicity. Prior results on its efficacy in children with alopecia areata have been mixed. METHODS: Medical records of 37 patients with alopecia areata who were started on topical anthralin before age 17 were reviewed for efficacy and safety data. Scalp regrowth was quantified by serial photography if available or by medical record documentation if photographs were unavailable...
October 18, 2018: Pediatric Dermatology
Alison D Treister, Peter A Lio
BACKGROUND/OBJECTIVES: Clinical trials of dupilumab have shown efficacy in treating moderate-to-severe atopic dermatitis (AD) in adult patients. While a phase 2 trial of dupilumab has shown efficacy and safety in children, the medication awaits Food and Drug Administration (FDA) approval, and off-label use is limited by dosing currently available to adults. We present this case series to describe the efficacy and safety profile of off-label dupilumab use in six pediatric patients treated by one provider in a private practice...
October 18, 2018: Pediatric Dermatology
Sarah Bin Abdulqader, Ziyad Al-Ajlan, Abdulrahman Albakr, Wisam Issawi, Mohammed Al-Bar, Pablo F Recinos, Saad Alsaleh, Abdulrazag Ajlan
PURPOSE: Optic pathway gliomas (OPGs) are low-grade neoplasms that primarily affect children. The management of OPGs remains controversial. Reports on the use of the endoscopic endonasal approach (EEA) in OPGs are extremely limited, and no such reports exist on its utility for pediatric OPGs. Here, we report our results and experience with OPGs treated with the EEA. METHODS: We retrospectively reviewed the medical records of OPG patients who were treated surgically via the EEA at our institutions from 2015 to 2017...
October 18, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Girish Gulab Meshram, Neeraj Kaur, Kanwaljeet Singh Hura
BACKGROUND: Complete rectal prolapse is the circumferential descent of all the layers of the rectum through the anus. It often leads to bleeding, obstructed defecation, incarceration or fecal incontinence. CASE REPORT: We present a rare case of a 4-year-old child with complete rectal prolapse of 12 cm in length. The prolapsed rectum was manually repositioned after reducing the oedema. The precipitating factor was identified as excessive straining while passing stools...
September 25, 2018: Open Access Macedonian Journal of Medical Sciences
Alexandra B Yonts, Matthew P Kronman, Rana F Hamdy
Antibiotics are one of the most commonly prescribed classes of medication for children and adolescents. While they are arguably the most powerful tool we possess against bacterial infections, they are frequently given to children whose illnesses are due to viruses or other non-infectious etiologies. When antibiotics are not used judiciously, the consequences can be serious and accumulate over time. This review article quantifies the burden of antimicrobial use in the pediatric outpatient setting in the United States, reviews recommended first line antibiotic regimens for common outpatient pediatric and adolescent conditions, investigates the reasons for inappropriate prescribing of antibiotics in outpatient healthcare settings, and explores the range of consequences of overuse and inappropriate use of antibiotics, from adverse drug reactions to impact on the microbiome to rising rates of antimicrobial resistance in common ambulatory conditions...
October 15, 2018: Current Problems in Pediatric and Adolescent Health Care
Meredith N Will, Kristn Currans, Jennifer Smith, Stephanie Weber, Amie Duncan, Jenny Burton, Kimberly Kroeger-Geoppinger, Valerie Miller, Megan Stone, Lindsay Mays, Ashley Luebrecht, Anna Heeman, Craig Erickson, Julia Anixt
This paper reviews evidenced-based interventions for children with autism spectrum disorders (ASD) across the disciplines of psychology, speech-language pathology, occupational therapy, and developmental pediatrics. BACKGROUND: rates of ASD diagnoses have been steadily rising over the past 2 decades. There are a wide range of therapies and interventions, of varying levels of evidence, across disciplines that are now available to treat children with ASD. The field has moved toward a greater emphasis on the identification and utilization of evidenced-based treatments...
October 15, 2018: Current Problems in Pediatric and Adolescent Health Care
Oliver M Barry, Kimberlee Gauvreau, Jonathan Rhodes, Jeffrey R Reichman, Laura Bourette, Tracy Curran, Julieann O'Neill, Jennifer L Pymm, Mark E Alexander
OBJECTIVES: This study quantified the incidence of arrhythmias during pediatric exercise stress tests (ESTs) and evaluated criteria to identify patients at risk of clinically important arrhythmias. BACKGROUND: The incidence of clinically important arrhythmias during pediatric ESTs and criteria for identifying high-risk patients are poorly characterized. METHODS: A retrospective review of ESTs performed from 2013 to 2015 was studied. Arrhythmias were categorized into 4 classes based on need for test termination and intervention...
October 2018: JACC. Clinical Electrophysiology
Cananzi Mara, Vajro Pietro, Rela Mohamed, Dhawan Anil
BACKGROUND: NAFLD has now become a common cause of chronic liver disease in children, however unlike adults liver transplantation is rarely required as treatment. It is important that in children presenting with NAFLD, secondary causes of fatty liver particularly inherited metabolic defects should be excluded. METHODS: A pediatric working group comprised of 3 hepatologists and a liver transplant surgeon was tasked with a set of questions to address the current state of evidence and knowledge about NAFLD in children with particular focus on liver transplantation...
October 16, 2018: Transplantation
Lindsey L Perea, Joshua P Hazelton, Nicole Fox, John P Gaughan, John Porter, Anna Goldenberg
OBJECTIVES: Vascular injury in pediatric trauma patients is uncommon but associated with a reported mortality greater than 19% in some series. The purpose of this study was to characterize pediatric major vascular injuries (MVIs) and analyze mortality at a high-volume combined adult and pediatric trauma center. METHODS: A retrospective review (January 2000 to May 2016) was conducted of all pediatric (<18 years old) trauma patients who presented with a vascular injury...
October 17, 2018: Pediatric Emergency Care
Kaynan Doctor, Kristen Breslin, James M Chamberlain, Deena Berkowitz
OBJECTIVES: Rising costs in healthcare have focused attention on interventions to optimize efficiency of patient care, including decreasing unnecessary diagnostic testing. The primary objective of this study was to determine the variability of laboratory and radiology testing among licensed independent providers (LIPs) with different training backgrounds treating low-acuity patients in a pediatric emergency department (PED). METHODS: We performed a retrospective review of the electronic health records of all encounters with patients 21 years or younger, triaged as low-acuity, visiting 2 urban, academic PEDs from January 2012 to December 2013...
October 17, 2018: Pediatric Emergency Care
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