Showing papers in "Current Opinion in Pediatrics in 2003"
TL;DR: The new STD treatment guidelines for gonorrhea, chlamydia, bacterial vaginosis, trichomonas, vulvovaginal candidiasis, pelvic inflammatory disease, genital warts, herpes simplex virus infection, syphilis, and scabies are reviewed.
Abstract: The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.
4,563Â citations
TL;DR: Recent studies suggest that the skin of patients with atopic dermatitis has increased avidity for binding to Staphylococcus aureus and is deficient in its ability to generate antimicrobial peptides needed to eradicate infectious agents.
Abstract: Purpose of reviewAtopic dermatitis is a chronic inflammatory skin disease commonly seen in children, but it also occurs in adults. This skin disease is often triggered by bacterial, fungal, or viral skin infections. The mechanisms resulting in this increased propensity for skin infections have been
185Â citations
TL;DR: Mutations in the homeobox gene, ARX, cause a diverse spectrum of disease that includes cognitive impairment, epilepsy, and in another group of patients severe cortical malformations.
Abstract: Purpose of reviewInfantile spasms, mental retardation, autism, and dystonia represent disabling diseases for which little etiologic information is available. Mutations in the Aristaless related homeobox gene (ARX) have been found in patients with these conditions. This discovery provides important g
135Â citations
TL;DR: Recognition of the biochemical defect in these syndromes has given insight into the role that cholesterol plays during normal development, into understanding the pathophysiological processes that underlie the clinical problems found in these disorders, and into developing therapeutic interventions.
Abstract: Purpose of reviewThis review covers a group of human malformation syndromes, which are caused by inborn errors of cholesterol synthesis. The Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive, multiple malformation, and mental retardation syndrome that is the prototypical example of this gr
124Â citations
TL;DR: In this article, the major genetic defect in neurodegeneration with brain iron accumulation (NBIA, formerly Hallervorden-Spatz syndrome) was identified by clinical, radiographic, and molecular features.
Abstract: Purpose of reviewAfter the recent discovery of the major genetic defect in neurodegeneration with brain iron accumulation (NBIA, formerly Hallervorden-Spatz syndrome), this heterogeneous group of disorders can now be differentiated by clinical, radiographic, and molecular features.Recent findingsDis
122Â citations
TL;DR: The anatomy, etiology, evaluation, classification, treatment, and expected outcome of osteochondritis dissecans lesions are discussed.
Abstract: Osteochondritis dissecans is a term used to describe the separation of an articular cartilage subchondral bone segment from the remaining articular surface. Juvenile osteochondritis dissecans describes an osteochondritis dissecans lesion found in skeletally immature children with a maximum incidence occurring between the ages of 10 and 20. It is found more frequently in children who are active athletically and involved in organized sports and is twice as common in males as in females. Although the etiology of these lesions is unclear, it is believed that repetitive microtrauma may interrupt the already tenuous epiphyseal blood supply in the growing child and contribute to the development of osteochondritis dissecans lesions. Treatment is dependent upon age at presentation, fragment size, fragment location, and fragment stability. Stable lesions in skeletally immature patients are generally amenable to conservative management. Failed conservative management or unstable lesions will more likely require surgical intervention. Lesions in skeletally mature patients have a more unpredictable course and may require surgery. This review article discusses the anatomy, etiology, evaluation, classification, treatment, and expected outcome of osteochondritis dissecans lesions.
119Â citations
TL;DR: Future models of child health supervision should address missed opportunities for anticipatory guidance and parents' desire for more information about what they can do to enhance their children's growth, development, and functioning.
Abstract: PURPOSE OF REVIEW: Anticipatory guidance is a key component of child health supervision. This review discusses the latest evidence on the effectiveness of anticipatory guidance and its impact on child and family functioning. RECENT FINDINGS: Anticipatory guidance on parent-infant interaction, sleep patterns, and injury prevention improve functional outcomes of children and their families. Recent findings also demonstrate that encouraging parents to share books with their children and free book distribution during well child care visits are associated with improved child language development and increased home literacy activities. Guidance promoting injury prevention and reading at home is supported by the best evidence. SUMMARY: Future models of child health supervision should address missed opportunities for anticipatory guidance and parents' desire for more information about what they can do to enhance their children's growth, development, and functioning.
105Â citations
TL;DR: The importance of appropriate developmental surveillance in early childhood, what is known about its effectiveness in current pediatric practice, and ways in which its delivery can be improved to optimize child outcomes are reviewed.
Abstract: Purpose of review This article reviews the importance of appropriate developmental surveillance in early childhood, what is known about its effectiveness in current pediatric practice, and ways in which its delivery can be improved to optimize child outcomes. Recent findings Many infants and young children with developmental delays or risk factors for poor developmental outcomes are not identified by pediatric practitioners in a timely manner. When they are identified, they are often not referred to appropriate early intervention services or early childhood development programs. They are therefore denied the opportunity to benefit from programs documented to have long-lasting benefits for children. Structuring developmental screening around the use of validated parent questionnaires improves the rates at which children with developmental needs are appropriately identified. At the same time, lowering thresholds for referral improves the rates at which children with identified needs receive appropriate services. Summary Pediatric practitioners are uniquely positioned to improve children's developmental outcomes through early identification and referral of children with developmental delays or risk factors for poor developmental outcomes. Unfortunately, inappropriate screening practices, high thresholds for referral, misplaced concerns about causing parental anxiety, and unfamiliarity with local resources all diminish the effectiveness with which many practitioners conduct developmental surveillance. Recent studies show that small changes in screening and referral practices have the potential to greatly improve the effectiveness of developmental surveillance. This, in turn, has the potential to improve lifelong outcomes for children.
101Â citations
TL;DR: Each of the seven rapid tests for influenza offers the promise of making rapid influenza diagnosis much more widely available than in the past, when rapid diagnosis could be made only by fluorescent antibody staining, a demanding technique available only in advanced laboratories.
Abstract: In recent years, seven rapid tests for influenza have become commercially available. These tests offer the promise of making rapid influenza diagnosis much more widely available than in the past, when rapid diagnosis could be made only by fluorescent antibody staining, a demanding technique available only in advanced laboratories. Two of the rapid tests have waived status under the Clinical Laboratory Improvements Amendments of 1988. This article describes each of the seven tests and reviews English-language publications that have evaluated the performance of these tests on specimens from children. A discussion of the implications of the tests for clinical decision-making is included.
100Â citations
TL;DR: This review will summarize the recent findings from the psychiatric literature in an attempt to provide the clinician with some initial diagnostic and treatment guidelines for ADHD and its comorbidities.
Abstract: Purpose of reviewAttention deficit hyperactivity disorder (ADHD) frequently occurs with a wide variety of comorbid psychiatric disorders such as conduct disorder, depression, mania, anxiety, and learning disabilities. Because the vast majority of children with ADHD are treated in primary care settin
91Â citations
TL;DR: Candida infections have become an increasingly frequent problem in neonatal intensive care units, particularly among extremely low birth weight infants, and the crude mortality rate among neonates with systemic candidiasis remains approximately 30%.
Abstract: Candida infections have become an increasingly frequent problem in neonatal intensive care units, particularly among extremely low birth weight infants. Transmission occurs both vertically and horizontally, with Candida albicans and C. parapsilosis as the predominant species. Multiple risk factors have been identified with prior antibiotic exposure, presence of a central line, endotracheal intubation, and prior fungal colonization reported most frequently. The primary site of infection can involve the bloodstream, meninges, or urinary tract, but disease is frequently disseminated to multiple organ systems. Amphotericin is the most commonly used antifungal agent, although fluconazole is being used more frequently. The potential role of antifungal prophylaxis is not yet clearly defined, but has been the topic of recent investigative efforts. The crude mortality rate among neonates with systemic candidiasis remains approximately 30%.
TL;DR: The frequency of gastrointestinal symptoms observed in population-based samples of autistic children indicate that gastrointestinal problems are not nearly as common in children with autism as reports from pediatric gastroenterology clinics suggest.
Abstract: We could identify no report that describes the prevalence of gastrointestinal disorders in a representative group of children with a diagnosis of autism compared with appropriate controls. Thus, we found no evidence upon which to base a confident conclusion as to whether gastrointestinal symptoms are more common in children with than without autism. However, the frequency of gastrointestinal symptoms observed in population-based samples of autistic children indicate that gastrointestinal problems are not nearly as common in children with autism as reports from pediatric gastroenterology clinics suggest.
TL;DR: Although the role of stem cell transplantation for thalassemia major is well defined, few transplants have been carried out in sickle cell disease, and, in light of recent advances, the roles should be revised.
Abstract: Hereditary anemias caused by beta-thalassemia and sickle cell disease are the most common genetic diseases worldwide. Supportive therapies such as chronic lifelong transfusions, iron chelation for thalassemia, and transfusions or hydroxyurea for sickle cell anemia have significantly ameliorated clinical manifestations of these diseases but cannot eliminate disease and treatment-related complications that result in end-organ damage. Allogeneic hematopoietic stem cell transplantation is the only cure for patients with hemoglobinopathies. Results of transplants have steadily improved over the last few decades due to effective control of transplant-related complications and development of new preparative regimens. Our understandings of mixed chimerism in patients with hemoglobinopathies provide a rationale for the use of less intensive conditioning regimens and gene therapy in these disorders. Although the role of stem cell transplantation for thalassemia major is well defined, few transplants have been carried out in sickle cell disease, and, in light of recent advances, the role of stem cell transplantation in this disease should be revised. This review summarizes the current status of stem cell transplantation for hemoglobinopathies.
TL;DR: The molecular mechanisms that promote diabetes in susceptible individuals, the best treatment plans, and methods of prevention of this disorder are not yet established.
Abstract: Type 2 diabetes mellitus in the pediatric population is now a public health problem. It represents 8 to 45% of all diabetes reported among children and adolescents. Concurrently, childhood obesity has become an epidemic in the United States. Epidemiologic risk factors and diagnostic criteria have largely been established: The incidence of type 2 diabetes increases with age and obesity. Children and adolescents diagnosed with type 2 diabetes usually have a first- or second-degree relative with the disorder. Familial clustering and twin studies have suggested a genetic component for type 2 diabetes. However, the molecular mechanisms that promote diabetes in susceptible individuals, the best treatment plans, and methods of prevention of this disorder are not yet established.
TL;DR: Recent studies have shown that etomidate is both safe and effective in this pediatric population; however, a significant rate of side effects, including hypoxia, apnea, and decreased blood pressure, may limit its use.
Abstract: Procedural sedation for pediatric patients having painful or anxiety-producing procedures is a necessary but often a daunting task for emergency medicine providers. This article focuses on the two agents that have most recently been described for use in this population-etomidate and propofol. Etomidate is a nonbarbiturate sedative hypnotic agent with no analgesic properties. Its rapid onset of action, short duration of action, and minimal hemodynamic effects make it an attractive agent for use in procedural sedation. Similar to previous adult studies, recent studies have shown that etomidate is both safe and effective in this pediatric population. Propofol is also a sedative hypnotic agent with rapid onset and short duration of action. Typically, it is administered as a bolus injection followed by an infusion. It has long been used for surgical procedures as well as in the intensive care unit setting, but little literature has supported its use in the pediatric emergency department. Recent studies appear to support propofol's use in this setting; however, a significant rate of side effects, including hypoxia, apnea, and decreased blood pressure, may limit its use.
TL;DR: Practical and clinically relevant classifications of neonatal thrombocytopenia have now been developed which aid the practicing neonatologist by highlighting the principal conditions precipitating severe thROMbocy Topenia (eg, sepsis, necrotizing enterocolitis, perinatal asphyxia, and the immune thromBocy topenias).
Abstract: Thrombocytopenia remains a common problem in sick newborns. A quarter of all neonates admitted to neonatal intensive care units develop thrombocytopenia, and in 20% of episodes the thrombocytopenia is severe (platelets <50 x 10(9)/L). Practical and clinically relevant classifications of neonatal thrombocytopenia have now been developed which, by highlighting the principal conditions precipitating severe thrombocytopenia (eg, sepsis, necrotizing enterocolitis, perinatal asphyxia, and the immune thrombocytopenias), aid the practicing neonatologist. Recent reviews demonstrate that many neonates with severe thrombocytopenia receive repeated platelet transfusions, although evidence of their clinical benefit is lacking, and there exists a significant variation in platelet transfusion practice between centers. These facts support the need for the development of evidence-based protocols for platelet transfusion in the newborn and stimulate continued interest in the potential of hemopoietic growth factors (, thrombopoietin and interleukin-11) to prevent or treat neonatal thrombocytopenia.
TL;DR: The understanding of the molecular biology of Toll-like receptors, focusing on the LPS response, is highlighted, with a summary of ongoing evaluation and potential therapeutic strategies for treating sepsis through blockade of TLR signaling.
Abstract: Despite extensive research, bacterial sepsis and its associated systemic inflammation remain a major cause of morbidity and mortality in the pediatric intensive care unit Advances in molecular biology, however, have improved our understanding of this disease process and have opened up new avenues o
TL;DR: Bariatric surgery should be part of a multidisciplinary approach to the management of adolescents with clinically severe obesity and should be performed by specialists dedicated to pediatric care, in institutions capable of meeting the guidelines for surgical treatment outlined by the American Society of Bariatric Surgery.
Abstract: An epidemic increase in adolescent obesity in the United States has resulted in significant obesity-related comorbidities, previously seen only in adults. Although bariatric surgery is an acceptable alternative for weight loss in severely obese adults, no conclusions have been made about the appropriateness of bariatric surgery for individuals younger than 18 years old. Nonetheless, bariatric surgery is increasingly being performed on adolescents with clinically severe obesity and experience suggests that it is effective and safe. Application of the principles of adolescent growth, development, and compliance is essential to avoid adverse physical, cognitive, and psychosocial outcomes following bariatric surgery. Bariatric surgery should be part of a multidisciplinary approach to the management of adolescents with clinically severe obesity and should be performed by specialists dedicated to pediatric care, in institutions capable of meeting the guidelines for surgical treatment outlined by the American Society of Bariatric Surgery.
TL;DR: Preliminary studies showed unique fingerprints in urinary protein patterns in children with primary VUR, providing the basis for developing novel noninvasive molecular diagnostic tests of vesicoureteral reflux by proteomics methodology.
Abstract: The incidence of primary vesicoureteral reflux is about 1% to 2% of the general population and is as high as 50% in siblings as well as offspring of affected patients, suggesting autosomal dominant inheritance. The current diagnosis of vesicoureteral reflux involves voiding cystourethrograms, which are invasive and costly. Consequently, vesicoureteral reflux screening in siblings and offspring is not routinely practiced, because of the known high risk. Early detection of vesicoureteral reflux will be valuable for prevention of reflux nephropathy, because the incidence of reflux nephropathy can be reduced effectively by antibiotic prophylaxis. Furthermore, the presence of reflux nephropathy can only be accurately assessed currently by dimercapto-succinic acid nuclear scans, which are costly, time and labor intensive, and often require conscious sedation by a pediatric anesthesiology team. As a result, the clinical assessment of reflux nephropathy is also not routinely practiced. There is a pressing need to develop less invasive and less costly tests for the early diagnosis of primary vesicoureteric reflux and reflux nephropathy. Recent molecular and genetic studies have greatly increased our understanding of vesicoureteral reflux and provide a promise of novel non-invasive tests. Targeted disruption of angiotensin type II receptor and uroplakin III genes result in the phenotype of primary vesicoureteral reflux. There are characteristic patterns of message and protein changes in the knockout animals, providing the basis for detection of genetic mutations leading to vesicoureteral reflux in humans by studying differential gene expression by functional genomics methodology. The urothelium is also known to secrete proteins into the urine. Preliminary studies showed unique fingerprints in urinary protein patterns in children with primary VUR, providing the basis for developing novel noninvasive molecular diagnostic tests of vesicoureteral reflux by proteomics methodology.
TL;DR: Genotype–phenotype correlation between patients with SoS harboring either intragenic mutations or microdeletions is discussed as well as their implication for possible revision of the diagnostic criteria of SoS.
Abstract: Purpose of reviewSotos syndrome (SoS) (OMIM #117550) is a childhood overgrowth syndrome characterized by excessive growth, distinctive craniofacial features, developmental delay, and advanced bone age. Recently, haploinsufficiency of the NSD1 gene has been identified as the major cause of SoS, with
TL;DR: A better understanding of the distinct phenotypes under Jarcho-Levin syndrome will help clinicians to understand the pathological factors of the disease, establish mode of inheritance, and provide adequate genetic counseling, prognosis, molecular diagnosis, and clinical management recommendations.
Abstract: Purpose of the reviewJarcho-Levin syndrome is an eponym that has been used to describe a variety of clinical phenotypes consisting of short-trunk dwarfism associated with rib and vertebral anomalies. This admixture of phenotypes under Jarcho-Levin syndrome has allowed some confusion in terms of phen
TL;DR: The most recent epidemiologic data on inhalant abuse is reviewed, the types of substances used and their mechanism of actions are summarized, and clinical toxicity and medical management are discussed.
Abstract: Inhalants remain one of the most commonly abused substances by adolescents in the United States today. Recent epidemiologic studies have demonstrated a decrease in the prevalence of inhalant abuse, but overall rates remain high. Inhalants have the potential to result in serious organ system dysfunct
TL;DR: This article focuses on early identification and aggressive treatment of the low cardiac output syndrome peculiar to patients with congenital heart defects and the recent advances in the treatment of pulmonary hypertension, mechanical support, and neurologic surveillance after cardiac surgery.
Abstract: The field of cardiac intensive care is rapidly evolving with nearly simultaneous advances in surgical techniques and adjunctive therapies, respiratory care, intensive care technology and monitoring, pharmacologic research and development, and computing and electronics. The focus of care has now shifted toward reducing morbidity and improving "quality of life" while the survival of infants and children with congenital heart defects, including those with univentricular hearts has dramatically improved during the last three decades. Despite these advances, there remains a predictable fall in cardiac output after cardiopulmonary bypass. This article focuses on early identification and aggressive treatment of the low cardiac output syndrome peculiar to these patients. The authors also briefly review the recent advances in the treatment of pulmonary hypertension, mechanical support, and neurologic surveillance after cardiac surgery.
TL;DR: The clinical presentation of patients with primary FSGS is proteinuria, usually severe, resulting in the nephrotic syndrome, and the presenting clinical features of hematuria and hypertension have not been shown to be predictive of outcome.
Abstract: Focal segmental glomerulosclerosis (FSGS) is defined by the histologic finding of sclerosis, which affects a segment of the glomerular tuft of only some (focal) glomeruli, predominantly those in the juxtamedullary region [1]. A renal biopsy is necessary to make the diagnosis of FSGS, because no clinical finding is specific for the underlying histology [2]. The clinical presentation of patients with primary FSGS is proteinuria, usually severe, resulting in the nephrotic syndrome. However, FSGS can also be asymptomatic, with proteinuria detected only on routine analysis (proteinuria <3.0 g/24 hours, normal albumin). Focal segmental glomerulosclerosis is distinguished clinically from minimal change disease by hematuria, hypertension, renal insufficiency at presentation, steroid resistance, and progressive renal insufficiency [3]. Although children present more often with nephrotic syndrome compared to adults (75% vs 50%, respectively), the occurrence of hypertension, hematuria and renal insufficiency do not differ in both groups [4]. The presenting clinical features of hematuria and hypertension have not been shown to be predictive of outcome.
TL;DR: Commercial surfactant preparations currently available are not optimal, given the variability of surfactants protein content and their susceptibility to inhibition, and further progress in the treatment of neonatal respiratory disorders may include the development of "designer" surfACTant preparations.
Abstract: Surfactant therapy has revolutionized neonatal care and is used routinely for preterm infants with respiratory distress syndrome. Recent investigation has further elucidated the function of surfactant-associated proteins and their contribution toward surfactant and lung immune defense functions. As the field of neonatology moves away from intubation and mechanical ventilation of preterm infants at birth toward more aggressive use of nasal continuous positive airway pressure, the optimal timing of exogenous surfactant therapy remains unclear. Evidence suggests that preterm neonates with bronchopulmonary dysplasia and prolonged mechanical ventilation also experience surfactant dysfunction; however, exogenous surfactant therapy beyond the first week of life has not been well studied. Surfactant replacement therapy has been studied for use in other respiratory disorders, including meconium aspiration syndrome and pneumonia. Commercial surfactant preparations currently available are not optimal, given the variability of surfactant protein content and their susceptibility to inhibition. Further progress in the treatment of neonatal respiratory disorders may include the development of "designer" surfactant preparations.
TL;DR: In this review are discussed the current guiding principles and the controversies in the diagnosis of brain death in children.
Abstract: In 1981, the Report of the Medical Consultants on the Diagnosis of Death established guidelines for the diagnosis of brain death and, in 1995, the American Academy of Neurology published practice parameters to standardize determination of brain death. In 1987, the American Academy of Pediatrics established guidelines for determining brain death in children. Despite the establishment of these guidelines, the declaration of "death" based on the cessation of brain function remains complex and controversial. In this review are discussed the current guiding principles and the controversies in the diagnosis of brain death in children.
TL;DR: Surgical robots are enabling devices for minimally invasive (laparoscopic) surgery (MIS) that use a computer to enhance a surgeon's skills as hand movements are transmitted to robotic arms that make suturing and knot tying far more accurate and efficient.
Abstract: Surgical robots are enabling devices for minimally invasive (laparoscopic) surgery (MIS). They use a computer to enhance a surgeon's skills as hand movements are transmitted to robotic arms. The computer filters tremor, which becomes important at high magnifications of 10 to 15 times available in MIS. It also provides motion scaling so that large hand movements are converted to very small movements of the robotic arm. The robotic arms also have wrists that make suturing and knot tying far more accurate and efficient. Surgical robots are currently used clinically for procedures such as MIS Nissen fundoplication, cholecystectomy, and splenectomy. Laboratory experience indicates that they may provide advantages for newborn procedures such as portoenterostomy for biliary atresia and repair of esophageal atresia and tracheoesophageal fistula. They have a potential for making possible MIS procedures, which can only be done open now, and for introducing entirely new procedures as well as for the performance of procedures by operators distant from the patient.
TL;DR: The magnitude, impact, and suggested screening interventions for maternal depression are reviewed, including the identification and referral of parents for emotional health problems that adversely affect children and family well-being.
Abstract: PURPOSE OF REVIEW Maternal depression is an old problem that has received heightened public attention in recent years. Although the prevalence of maternal depression remains considerable, healthcare providers continue to underrecognize and undertreat women with this condition. Currently there is increasing political as well as international support for further study to understand depression and its impact on those directly and indirectly involved. This article will review the magnitude, impact, and suggested screening interventions for maternal depression. RECENT FINDINGS Various studies and reviews have documented the prevalence of maternal depression as well as the underrecognition and undertreatment of the problem. The barriers that contribute to this can be related to the individual, the provider, as well as the healthcare delivery system. Depression and even depressive symptoms have been well documented to have deleterious impacts in several domains. These include maternal-child relationships, parenting practices, family functioning, and even children's general development and well-being. SUMMARY The care of the mother has not been in the conventional scope of practice for pediatricians. However, child healthcare practitioners play a crucial rule in delivering family-oriented care, including the identification and referral of parents for emotional health problems that adversely affect children and family well-being.
TL;DR: The history, diagnosis, evaluation, treatment, and management of common types of benign tumors of bone commonly seen in children and adolescents are reviewed in the light of current literature.
Abstract: When children present for evaluation of bone tumor, great anxiety often occurs among the family. Usually the diagnosis of a benign bone tumor can be made easily with plain radiographs without biopsy. Most have a good outcome. However, occasionally, serious complications can develop. Moreover, the physician must be aware of the possibility of the malignant tumors. To avoid errors in the evaluation and treatment of this heterogeneous group of tumors, the clinician should have a good knowledge base of common bone neoplasms and correlate the clinical, radiographic, and pathologic findings. In this article, history, diagnosis, evaluation, treatment, and management of common types of benign tumors of bone commonly seen in children and adolescents are reviewed in the light of current literature.
TL;DR: The serotonin selective reuptake inhibitors are considered a first-line pharmacological treatment for anxiety disorders in children and adolescents, along with minimal side effects and good tolerability.
Abstract: Purpose of reviewAnxiety disorders constitute a significant problem among children and adolescents, with estimated prevalence of 6 to 10%. Left untreated, anxiety disorders can have major effect on academic, social, and family function, as well as impact on developmental progress. Effective treatmen