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Current Opinion in Pediatrics

Atsuko Koyama, Lauren Middlebrooks, Adam Bullock
PURPOSE OF REVIEW: Adolescents and young adults continue to contribute to new HIV infections despite improved antiretroviral regimens and HIV preexposure and postexposure prophylaxis (PrEP and PEP). Knowledge about nonoccupational HIV PEP (nPEP) is relevant and important for all pediatricians as adolescents present under a variety of circumstances disclosing past sexual activity. RECENT FINDINGS: nPEP is effective in preventing HIV infection, and newer regimens have been shown to increase compliance amongst users, have less side effects, and lead to less HIV resistance...
April 9, 2019: Current Opinion in Pediatrics
Grace Z Mak, Jessica J Kandel
No abstract text is available yet for this article.
April 3, 2019: Current Opinion in Pediatrics
David N Cornfield
No abstract text is available yet for this article.
April 3, 2019: Current Opinion in Pediatrics
Jessica Lin, Nicholas Chadi, Lydia Shrier
PURPOSE OF REVIEW: Mindfulness, the practice of paying attention to the present moment, purposefully and nonjudgmentally, has been gaining popularity as adjunct treatment for adolescents with a range of physical and mental health problems. Research conducted in adults and emerging research conducted in adolescents has shown that mindfulness-based interventions can improve outcomes in several areas. The purpose of this review is to discuss recent research on the effects of mindfulness and suggest exercises that primary care clinicians can offer to their adolescent patients...
April 1, 2019: Current Opinion in Pediatrics
Kathleen Mealey, Laura M P Koenigs
PURPOSE OF REVIEW: Adolescent providers have a unique opportunity to interface with adolescents during a transformative time period. Optimizing vaccinations may protect teens against preventable but potentially deadly diseases. Healthcare providers must be aware of the evolving vaccination data and up-to-date recommendations for vaccinations. RECENT FINDINGS: In spite of the Center for Disease Control recommendations, there is a gap between the actual and desired vaccination rates of adolescents...
April 1, 2019: Current Opinion in Pediatrics
Dana Toy, Matthew S Braga, Matthew Greenhawt, Marcus Shaker
PURPOSE OF REVIEW: To provide an updated framework of management for allergic emergencies. RECENT FINDINGS: The most frequent causes of anaphylaxis include medications, foods, and stinging insects. Early and appropriate administration of epinephrine is critical to managing anaphylaxis. Although epinephrine is well tolerated and there is no absolute contraindication to using epinephrine in first-aid management of anaphylaxis, many patients at risk for anaphylaxis still fail to carry and use the medication prior to seeking emergency care...
April 1, 2019: Current Opinion in Pediatrics
Diana Chernikova, Irene Yuan, Marcus Shaker
PURPOSE OF REVIEW: Microbiota consist of symbiotic microscopic neighbors that interact on and within our bodies in diverse and incompletely understood ways throughout our lifetime. Though various associations with allergic disease have been described, clear effective therapeutic interventions to prevent allergy have been elusive. RECENT FINDINGS: The human microbiome is influenced by multiple factors, including: mode of infant delivery (vaginal vs. cesarean section), breastfeeding, diet, presence of siblings and pets, exposure to antibiotics and other medications (particularly antacids), lifestyle, and developmental context...
April 1, 2019: Current Opinion in Pediatrics
Samuel M Alaish, Alejandro V Garcia
PURPOSE OF REVIEW: Over the past 15 years, the Accreditation Council for Graduate Medical Education (ACGME) has significantly altered the regulatory framework governing fellowship training in pediatric surgery. The daily experiences of pediatric surgical trainees have been impacted by these changes, but training program directors and faculty have not developed a consistent approach to managing this shift. This review highlights the changes, which have occurred, analyzes the current state of fellowship training, and proposes potential strategies for management...
April 1, 2019: Current Opinion in Pediatrics
Calista M Harbaugh, Samir K Gadepalli
PURPOSE OF REVIEW: The purpose of this review is to explore the effects of the opioid crisis on pediatric patients in the postoperative setting and provide recommendations for well-tolerated opioid prescribing practices. RECENT FINDINGS: Opioid overdoses have increased among all age groups, predominantly related to overprescribing and accessibility of opioids in the home. Adverse risks of prescribed opioids include respiratory depression, gastrointestinal distress, accidental ingestion, intentional misuse, new chronic use, diversion to another user, and overdose...
April 1, 2019: Current Opinion in Pediatrics
Sarah Ullrich, Phyllis Kisa, Doruk Ozgediz
PURPOSE OF REVIEW: Two-thirds of the world's population lacks access to surgical care, many of them being children. This review provides an update on recent advances in global children's surgery. RECENT FINDINGS: Surgery is being increasingly recognized as an essential component of global and child health. There is a greater focus on sustainable collaborations between high-income countries (HICs) and low-and-middle-income countries (HICs and LMICs). Recent work provides greater insight into the global disease burden, perioperative outcomes and effective context-specific solutions...
April 1, 2019: Current Opinion in Pediatrics
Erica M Carlisle, Erin E Rowell
PURPOSE OF REVIEW: Rapid advancement in the field of pediatric surgery has resulted in unprecedented opportunities to advance the care of children. However, assuring that the highest quality, most appropriate care is available to all pediatric patients remains challenging. Regionalization of care has been proposed as a means of obtaining this critical goal. In this review, we discuss the ethical challenges associated with regionalization of pediatric surgical care. RECENT FINDINGS: Regionalization of pediatric surgical care is associated with improved patient outcomes...
April 1, 2019: Current Opinion in Pediatrics
Benjamin A Raby
PURPOSE OF REVIEW: This article reviews the progress in the search for the genetic determinants of severe asthma. RECENT FINDINGS: Twin studies estimate that approximately 25% of the phenotypic variability in asthma severity is determined by genetic factors, with the remainder determined by nongenetic factors including environmental and psychosocial factors, behavioral traits, and comorbidities. Most genetic association studies of asthma severity performed to date are underpowered and not designed to clearly distinguish asthma severity variants from asthma susceptibility variants...
March 20, 2019: Current Opinion in Pediatrics
Christopher D Baker
PURPOSE OF REVIEW: Modern medical advances have resulted in an increased survival after extremely preterm birth. However, some infants will develop severe bronchopulmonary dysplasia (BPD) and fail to wean from invasive or noninvasive positive pressure support. It remains unclear which infants will benefit from tracheostomy placement for chronic ventilation. Once the decision to pursue chronic ventilation has been made, questions remain with respect to the timing of tracheotomy surgery, optimal strategies for mechanical ventilation, and multidisciplinary care in both the inpatient and outpatient settings...
March 18, 2019: Current Opinion in Pediatrics
Mihir R Atreya, Hector R Wong
PURPOSE OF REVIEW: Pediatric sepsis is a heterogeneous state associated with significant morbidity and mortality, but treatment strategies are limited. Clinical trials of immunomodulators in sepsis have shown no benefit, despite having a strong biological rationale. There is considerable interest in application of a precision medicine approach to pediatric sepsis to identify patients who are more likely to benefit from targeted therapeutic interventions. RECENT FINDINGS: Precision medicine requires a clear understanding of the molecular basis of disease...
March 18, 2019: Current Opinion in Pediatrics
Saquib A Lakhani, Richard Pierce
PURPOSE OF REVIEW: The purpose of this review is to highlight the significant advances in the testing, interpretation, and diagnosis of genetic abnormalities in critically ill children and to emphasize that pediatric intensivists are uniquely positioned to search for genetic diagnoses in these patients. RECENT FINDINGS: Ten years following the first clinical diagnosis made through whole exome sequencing, we remain in the dark about the function of roughly 75% of our genes...
March 18, 2019: Current Opinion in Pediatrics
Carole Wehbe Chidiac
PURPOSE OF REVIEW: The diagnosis of anorexia nervosa is associated with the highest mortality rate of any psychiatric disorder, mainly caused by medical complications.The purpose of this article is to review the common medical consequences of anorexia nervosa focusing on the special considerations related to children and adolescents and recent updates on the pathophysiology of these complications and their prognosis significance. RECENT FINDINGS: The main findings were related to the diagnostic and prognostic value of hypokalaemia, QTc prolongation, hypoglycaemia and orthostatic changes...
March 14, 2019: Current Opinion in Pediatrics
Shaina M Willen, Mark Rodeghier, Michael R DeBaun
PURPOSE OF REVIEW: Asthma is common in children with sickle cell disease (SCD) and appears to be associated with increased morbidity. Providers caring for children with SCD have struggled with the question of whether asthma exists as a true comorbidity or whether certain aspects of the chronic inflammatory disease gives children with SCD an asthma-like phenotype. RECENT FINDINGS: Clinical signs and symptoms seen in children with asthma in the general population, such as wheezing, airway hyperresponsiveness, atopy, elevated leukotrienes, and abnormal lung function are seen in children with SCD both with and without a diagnosis of asthma...
March 14, 2019: Current Opinion in Pediatrics
Lawrence M Nogee
PURPOSE OF REVIEW: Mutations in genes encoding proteins critical for the production and function of pulmonary surfactant cause diffuse lung disease. Timely recognition and diagnosis of affected individuals is important for proper counseling concerning prognosis and recurrence risk. RECENT FINDINGS: Involved genes include those encoding for surfactant proteins A, B, and C, member A3 of the ATP-binding cassette family, and for thyroid transcription factor 1. Clinical presentations overlap and range from severe and rapidly fatal neonatal lung disease to development of pulmonary fibrosis well into adult life...
March 6, 2019: Current Opinion in Pediatrics
Yih-Chieh Chen, Jean Klig
PURPOSE OF REVIEW: To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population. RECENT FINDINGS: There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use...
March 6, 2019: Current Opinion in Pediatrics
Ben Lawton, Henry Goldstein, Tessa Davis, Andrew Tagg
PURPOSE OF REVIEW: Concern regarding appendicitis is a common reason for presentation to the paediatric emergency department. We review recent progress in the use of biomarkers, imaging and clinical scoring systems in improving diagnostic accuracy in suspected appendicitis in children. RECENT FINDINGS: Use of ultrasound, often performed at the bedside, is becoming more widespread with a parallel reduction in computed tomography (CT) use. Protocols for image acquisition and interpretation have been shown to improve diagnostic accuracy...
February 14, 2019: Current Opinion in Pediatrics
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