Current Opinion in Pediatrics (Curr Opin Pediatr)

Publications in this journal

• Article: recent advances in autism spectrum disorders

  spence sj, tasker rc, pomeroy sl
  Current Opinion in Pediatrics 11/2011; 23(6):607.
• Article: Evaluation and management of hyperlipidemia in children and adolescents.

  Iughetti L, Bruzzi P, Predieri B
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  ABSTRACT: PURPOSE OF REVIEW: To review the recent findings on evaluation and management of dyslipidemia in childhood and adolescence, giving a critical view on new therapeutic approaches. RECENT FINDINGS: In 2008, the American Academy of Pediatrics released an updated policy statement recommending more frequent screening to detect dyslipidemia in childhood and the first-line use of statins in children with dyslipidemia who did not respond to lifestyle intervention and who were more than 8 years of age. These recommendations have caused a lot of controversy within the medical community and media. This debate is also sharpened by the fact that only few trials have investigated the long-term efficacy of statins on prevention of adult cardiovascular disease, their application in dyslipidemias other than familial hypercholesterolemia and the use of new pharmacological tools. SUMMARY: The purpose of our paper could not be achieved clearly without a review of the physiology of cholesterol metabolism together with an analysis of causes of primary and secondary dyslipidemia affecting children. Moreover, recent knowledge on lipid-lowering therapy is reviewed.
  Current Opinion in Pediatrics 08/2010; 22(4):485-93.
• Article: Little League Shoulder: Diagnosis and Management

  Daryl Osbhar MD, Han Jo Kim MD, Peter Dugas MD
  Current Opinion in Pediatrics 11/2009;
• Article: Pediatric Osteosarcoma: Management update

  Han Jo Kim MD, Peter Chalmers BS, Carol Morris MD
  Current Opinion in Pediatrics 11/2009;
• Article: Editorial comments

  Allen W Root
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  ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
  Current Opinion in Pediatrics 07/2009; 21(4):511-514.
• Article: A vision for an International Society for Fetal and Perinatal Cardiovascular Disease

  Jeffrey Phillip Jacobs, Jack Rychik, Gerald Tulzer, Jean-Claude Fouron, Dev Maulik, Wayne Tworetzky, Bohdan Maruszewski, Ganesh Acharya, James C Huhta
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  ABSTRACT: Purpose of review: The purpose of this review is to explain why it is now time to create an International Society for Fetal and Perinatal Cardiovascular Disease. Recent findings: Rapid advances in four domains that involve the professionals caring for patients with congenital cardiac disease all point to the fact that it is now time to create an International Society for Fetal and Perinatal Cardiovascular Disease: fetal diagnosis - the improved ability to diagnose prenatal cardiovascular disease due to education and improved ultrasound technology; subspecialization - the development of perinatal cardiology as a true subspecialty of the professions of pediatric cardiology and perinatology; analysis of outcomes - the multidisciplinary international efforts in the areas of nomenclature and databases for the analysis of outcomes of treatments for patients with congenitally malformed hearts, efforts that span traditional geographic and subspecialty boundaries; globalization - the rapidly evolving global organization of professionals caring for patients with congenital heart disease. Summary: Healthcare professionals caring for the pregnant woman and fetus with congenital cardiac disease would be enthusiastic about the creation of an International Society for Fetal and Perinatal Cardiovascular Disease in order to achieve multiple objectives: to discuss the management of prenatal and perinatal cardiovascular disease (not exclusively cardiac malformations); to benefit from educational programs covering prenatal and perinatal physiology and pathophysiology, clinical and technical topics, as well as genetic, ethical, and psychosocial aspects of this relatively new discipline; and finally to share our basic science, translational, and clinical research interests.
  Current Opinion in Pediatrics 09/2008; 20(5):532-537.
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  Article: Evaluation of hematuria and proteinuria: how should a pediatrician proceed?

  Raymond Quigley
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  ABSTRACT: Finding blood or protein in the urine of a patient can be the source of immense anxiety. The list of diseases that result in these findings is quite long. Thus, many pediatricians believe that an exhaustive investigation is necessary to be certain of the cause. The review will discuss the major causes of hematuria and proteinuria in the pediatric population, and discuss a rational approach to the evaluation of these conditions. A number of recent studies have examined the results of mass screenings of school-age children and the final outcome of examination of children with hematuria and/or proteinuria. Most children with either isolated hematuria or isolated proteinuria had benign disease processes. Children with combined hematuria and proteinuria had a higher prevalence of significant kidney disease. The urinalysis combined with the history and physical examination should indicate the cause of hematuria and proteinuria in most cases. Significant renal disease can be ruled out with a minimal amount of work-up in most patients. The presence of hematuria and proteinuria together significantly increases the likelihood of significant renal disease and should prompt a referral to a specialist.
  Current Opinion in Pediatrics 05/2008; 20(2):140-4.
• Article: Evaluation and management of steroid-unresponsive nephrotic syndrome.

  Marcela Del Rio, Frederick Kaskel
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  ABSTRACT: Idiopathic nephrotic syndrome in children is commonly associated with minimal change disease and response to steroid therapy. Steroid-unresponsive nephrotic syndrome is often characterized by persistent proteinuria and progression to chronic kidney disease. Focal segmental glomerulosclerosis is the leading cause of steroid-unresponsive nephrotic syndrome in childhood. There is no uniformed consensus as to the treatment of steroid-unresponsive nephrotic syndrome. Advances in the pathogenesis, genetics and biomarkers or surrogate markers may be useful for the diagnosis and identification of patients with steroid-unresponsive nephrotic syndrome, severity of disease, progression and response to therapy. This review is intended to describe some of the recent changes in the epidemiology of steroid-unresponsive nephrotic syndrome, in particular focal segmental glomerulosclerosis, its pathogenesis and alternative therapies. Recent studies in both children and adults have shown an increase in the incidence of focal segmental sclerosis as a cause of steroid-unresponsive nephrotic syndrome. Advances in the pathogenesis and noninvasive methods of diagnosis may allow for the identification of steroid-responsive patients.
  Current Opinion in Pediatrics 05/2008; 20(2):151-6.
• Article: Case report: consumptive hypothyroidism consequent to multiple infantile hepatic haemangiomas.

  Yoon Hi Cho, Craig Taplin, Albert Mansour, Robert Howman-Giles, Robert Hardwick, David Lord, Neville J Howard
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  ABSTRACT: A 10-month-old infant with multiple infantile hepatic hemangiomas and developmental delay is reported. He was found to be profoundly hypothyroid. Evaluation and management issues are discussed. This case emphasizes the importance of screening for hypothyroidism in patients with hemangiomas and the potential therapeutic benefit of prednisolone therapy in this condition.
  Current Opinion in Pediatrics 05/2008; 20(2):213-5.
• Article: Continuous positive airway pressure: scientific and clinical rationale.

  Colin J Morley, Peter G Davis
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  ABSTRACT: To present recent data on the role of noninvasive ventilation in the respiratory management of newborn infants. Noninvasive ventilation is growing in popularity but is applied using widely varying devices and settings. Although short-term physiological advantages were reported for bubble and variable-flow continuous positive airways pressure, neither has convincingly shown superior clinically important outcomes. Continuous positive airways pressure may be used as the initial mode of support for very preterm infants but increased rates of pneumothorax in infants not receiving surfactant are a concern. Methods of administering surfactant without endotracheal intubation deserve further study. Nasal intermittent positive-pressure ventilation shows promise as a primary treatment for respiratory distress syndrome. Optimal pressure settings for continuous positive airways pressure and nasal intermittent positive-pressure ventilation remain uncertain. Noninvasive ventilation has partially fulfilled its promise as a gentler alternative to ventilation via an endotracheal tube. Appropriately designed randomized clinical trials are required to determine the best nasal interfaces and pressure generators.
  Current Opinion in Pediatrics 05/2008; 20(2):119-24.
• Article: Therapeutics and toxicology.

  Robert O Wright, Nigel Fields
  Current Opinion in Pediatrics 05/2008; 20(2):171.
• Article: Evaluation and management of steroid-sensitive nephrotic syndrome.

  Elisabeth M Hodson, Stephen I Alexander
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  ABSTRACT: This review examines new literature published in 2006 and 2007 on steroid-sensitive nephrotic syndrome. Steroid-sensitive nephrotic syndrome has long been thought to be due to lymphocyte-derived circulating factors leading to podocyte injury with subsequent proteinuria. New studies support this mechanism and implicate the T helper 2 cytokine IL-13. In addition a genetic mutation in familial nephrotic syndrome has been reported in a child, who responded to corticosteroid therapy. There are new clinical trial data supporting the efficacy of levamisole in steroid-sensitive nephrotic syndrome and preliminary trial data on mycophenolate mofetil supporting its efficacy as a steroid-sparing agent. Case reports support the use of the B cell-depleting antibody rituximab in steroid-sensitive nephrotic syndrome. Finally there is a meta-analysis of six studies suggesting an increase in the incidence of focal and segmental glomerulosclerosis in steroid-sensitive nephrotic syndrome over the last 20 years. Progress has been made towards elucidating the cause of steroid-sensitive nephrotic syndrome. Data from adequately powered randomized controlled trials are still required to evaluate therapies for frequently relapsing and steroid-dependent steroid-sensitive nephrotic syndrome.
  Current Opinion in Pediatrics 05/2008; 20(2):145-50.
• Article: Prenatal tobacco smoke and postnatal secondhand smoke exposure and child neurodevelopment.

  Melissa Herrmann, Katherine King, Michael Weitzman
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  ABSTRACT: To review the recent scientific literature examining the association of prenatal tobacco and postnatal secondhand smoke exposure and child neurodevelopment. Low birth weight and decreased in-utero brain growth are two of multiple potential etiologic pathways proposed as mediating the effects of prenatal tobacco smoke exposure on child neurodevelopment. These negative effects of prenatal exposure have been consistently demonstrated in animal models, and in humans have been found as early as the newborn period. The literature on both prenatal and postnatal exposure is remarkably consistent in showing associations with increased rates of behavior problems, including irritability, oppositional defiant behavior, conduct disorders and attention deficit hyperactivity disorder. A more rudimentary literature also suggests deficits in intelligence quotient. Recent studies have focused on elucidating the complex interaction among tobacco exposure, genetics and environmental factors. Questions still remain about the relative roles of prenatal vs. postnatal exposure and the potential role of genetic and social confounders, limiting the ability to infer a causal nature to these associations at this time. The consistency of findings across studies is, however, highly suggestive of a causal relationship between environmental tobacco exposure and adverse behavioral and cognitive outcomes in children. Prenatal tobacco and postnatal secondhand smoke exposure is consistently associated with problems in multiple domains of children's neurodevelopment and behavior.
  Current Opinion in Pediatrics 05/2008; 20(2):184-90.
• Article: Polychlorinated biphenyls, organochlorine pesticides and neurodevelopment.

  Susan A Korrick, Sharon K Sagiv
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  ABSTRACT: Although environmental levels of polychlorinated biphenyls and certain organochlorine pesticides--hexachlorobenzene, dichlorodiphenyl trichloroethane and its primary metabolite, dichlorodiphenyl dichloroethene--are generally on the decline, early-life exposures to these prevalent contaminants continue. The review will describe current understanding of the potential neurodevelopmental consequences of low-level exposures to these contaminants. Animal models suggest that early-life exposures to polychlorinated biphenyls, dichlorodiphenyl trichloroethane/dichlorodiphenyl dichloroethene or hexachlorobenzene are associated with decreased cognitive or behavioral function in later development. Despite almost 30 years of research, however, results of human studies are inconsistent regarding the nature of the observed effects and their persistence over time. Overall, epidemiologic studies support modest associations of primarily prenatal polychlorinated biphenyl exposures with differences in neuromotor development, decrements in cognition and behavioral deficits, particularly regarding attention and impulse control. There are limited published human data regarding potential neurodevelopmental toxicities of early-life exposures to dichlorodiphenyl trichloroethane/dichlorodiphenyl dichloroethene and hexachlorobenzene. Exposures to polychlorinated biphenyls, dichlorodiphenyl trichloroethane/dichlorodiphenyl dichloroethene and hexachlorobenzene are likely detrimental to neurodevelopment. Effective control of exposure is complicated by variable exposure sources and variable contaminant levels in food, particularly fish, for which it is important to balance the risk of contaminants with nutritional benefits.
  Current Opinion in Pediatrics 05/2008; 20(2):198-204.
• Article: IgA nephropathy and Henoch-Schönlein purpura nephritis.

  John T Sanders, Robert J Wyatt
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  ABSTRACT: IgA nephropathy and Henoch-Schönlein purpura nephritis are common glomerular disorders in pediatrics that can potentially progress to end-stage renal disease in some patients. This review summarizes our current understanding of the pathogenesis of these closely related conditions and discusses the rationale for development of diagnostic tests and prognostic markers. The review also presents the best data for long-term outcome, clinical markers of prognosis, and the results of randomized controlled trials. Our understanding of the defective galactosylation of O-linked glycans in the hinge region of human IgA1 and its role in the pathogenesis of IgA nephropathy and Henoch-Schönlein purpura nephritis has evolved over the past decade. This review discusses studies that suggest that demonstration of galactose-deficient IgA1 in the serum may become an important diagnostic tool for these conditions. Proteomic techniques for development of biomarkers for diagnosis and prognosis show promise. Although data from randomized controlled trials have failed to support the use of immunosuppressive agents in pediatric IgA nephropathy and Henoch-Schönlein purpura nephritis, recent data indicate that angiotensin converting enzyme inhibitor therapy is indicated for reduction of proteinuria. Childhood IgA nephropathy and Henoch-Schönlein purpura nephritis have the potential for serious morbidity, either during childhood or later in adulthood. In the future clinical tests will be used for noninvasive diagnosis and as markers for judging response to treatment, particularly in those individuals at highest risk for eventual progression to end-stage renal disease.
  Current Opinion in Pediatrics 05/2008; 20(2):163-70.
• Article: Update on child maltreatment.

  Alice W Newton, Andrea M Vandeven
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  ABSTRACT: The authors discuss the significance of studies published over the previous year regarding assessment and treatment and prevention of child maltreatment, including physical and sexual abuse, inflicted traumatic brain injury, and child neglect. The evidence base for many forms of child abuse is growing. As clinicians begin to understand the factors which may increase child vulnerability to abuse, more sophisticated and focused prevention efforts are being implemented. In response to a very public reprimand by the General Medical Council of two child abuse pediatricians, which was felt by many to be unwarranted, the UK government re-emphasized its commitment to the protection of children. In the US, this well-publicized set of events has renewed the medical community's commitment to the recognition of child abuse pediatrics as a formal subspecialty. Several authors detail the short-term and long-term outcome of varying forms of abuse for children as they grow into adults, reinforcing the importance of community efforts to prevent abuse and support families during times of heightened stress such as the current war in Iraq. The short-term and long-term impact of child maltreatment is significant not only for individuals, but for families and communities where abuse is taking place. General pediatricians have an important role to play with families and in the community as advocates for the protection of children.
  Current Opinion in Pediatrics 05/2008; 20(2):205-12.
• Article: Is the early and aggressive administration of protein to very low birth weight infants safe and efficacious?

  Sudha Kashyap
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  ABSTRACT: Most conventionally managed very low birth weight infants experience postnatal growth restriction. There is some evidence that this postnatal growth restriction may have long-lasting effects, and contribute to short stature and poor neurodevelopmental outcomes. There is also evidence suggesting that early protein intake may improve growth in these very low birth weight infants. Therefore, to optimize protein intake early in the infant's neonatal course seems a logical goal. Randomized controlled trials provide evidence of short-term safety and efficacy for starting amino acid infusion as soon as possible after birth at 2.5-3.0 g/kg/day in very low birth weight infants; however, there are no long-term data to support the safety or efficacy of this practice. There is some evidence from recent studies of improved growth by providing 4.0 g/kg/day of amino acid early in the neonatal period while keeping the nitrogen to energy ratio above 1:100 and continuing with this protein intake during the infants stay in the hospital. At the present time long-term safety of this strategy is also not known. Appropriately designed large-scale randomized controlled trials are needed to determine the long-term safety and efficacy of early and aggressive administration of protein to very low birth weight infants.
  Current Opinion in Pediatrics 05/2008; 20(2):132-6.
• Article: Acute poststreptococcal glomerulonephritis: an update.

  Sun-Young Ahn, Elizabeth Ingulli
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  ABSTRACT: Acute poststreptococcal glomerulonephritis, the most common form of acute glomerulonephritis in children, continues to be a major concern worldwide. This review summarizes the recent advances in the pathogenesis, host susceptibility factors, diverse clinical presentations, and treatment of the condition. Several recent advances have been made in identifying streptococcal antigens that may play a pathogenic role in acute poststreptococcal glomerulonephritis. Nephritis-associated streptococcal plasmin receptor and streptococcal pyrogenic exotoxin B are currently considered major putative nephritogens. Host susceptibility factors including HLA-DRB1*03011 have been found at a higher frequency in acute poststreptococcal glomerulonephritis patients than in healthy controls. Reversible posterior leukoencephalopathy and autoimmune hemolytic anemia are newly reported clinical associations with the disease. Studies from developing countries question whether the outcome is always benign. Treatment remains mostly conservative; however, controversy exists over the use of aggressive therapy with poor prognostic factors. Severe group A streptococcal disease including acute poststreptococcal glomerulonephritis remains a cause of morbidity and mortality in developing countries and among impoverished populations. Various reports on the diverse clinical manifestations that can be associated with the condition will aid physicians in prompt diagnosis and intervention, while studies focusing on better understanding of immunopathogenesis may facilitate vaccine development and prevention.
  Current Opinion in Pediatrics 05/2008; 20(2):157-62.
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  Article: Pesticides and child neurodevelopment.

  Lisa G Rosas, Brenda Eskenazi
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  ABSTRACT: This review summarizes the recent research on pesticide exposure and child neurobehavioral development with a focus on in-utero exposure to organochlorine and organophosphate pesticides. Recent studies on in-utero exposure to the organochlorine pesticide dichlorodiphenyltrichloroethane and its breakdown product, dichlorodiphenyldichloroethene, indicate that exposure is associated with poorer infant (6 months and older) and child neurodevelopment. Yet, the studies differ on the domain of development that is affected. Research on organophosphate pesticide exposure and neurodevelopment is limited but suggests some negative association of exposure and neurodevelopment at certain ages. Two reports agree that increased levels of organophosphate exposure in utero result in greater numbers of abnormal reflexes in neonates and studies in older infants and young children also point to a negative association with development. In young children (2-3 years) two separate studies observed an increase in maternally reported pervasive developmental disorder with increased levels of organophosphate exposure. Given that the literature suggests a link between organochlorine and in-utero pesticide exposure and impaired child neurodevelopment, clinicians should educate parents about prevention of exposure, especially in populations living in agricultural areas or where household use is common.
  Current Opinion in Pediatrics 05/2008; 20(2):191-7.