Pulmonale Hypertonie im Kindes- und Jugendalter

Background

Pediatric pulmonary hypertension (PH) is a significant cause of morbidity and mortality. Recommendations for the diagnosis and therapy of pediatric PH have been derived from guidelines for adults with PH. However, recent publications and international registry data demonstrate specific differences between PH in adulthood and in childhood.

Methods

Based on a selective literature research in PubMed with an emphasis on population-based studies, the most important aspects of pediatric PH are summarized. In addition, our own experiences from a national expert center for children with PH are considered.

Results

Idiopathic PAH (IPAH) and PAH associated with congenital heart disease (PAH-CHD) are the most frequent types of PAH in children. Follow-up studies have highlighted the importance of right ventricular function as a major determinant of the long-term prognosis of PAH-CHD patients and have led to the development of new combined interventional/surgical treatment strategies. The prognosis of children with PH has been improved by focusing on the right ventricular-pulmonary arterial unit and by recent developments of PAH-specific drugs. However, curative treatment of PAH is not within reach yet.

Conclusions

The specific pathophysiology of PAH-CHD, modified diagnostic algorithms, as well as new pathophysiologically orientated therapeutic strategies are different in pediatric PH compared with PH in adults. Nationwide registries and systematic treatment protocols are important in improving the care of these patients in the future.     

Komplizierte Pneumonie im Kindesalter

Background

The term “complicated pneumonia” describes an inflammation of the lung with systemic and/or local complications. The incidence of local complications appears to be increasing.

Diagnosis

In children with pneumonia suffering from persistent fever despite appropriate antibiotics, cough, ventilation inhomogeneity, respiratory distress, chest pain, and weight loss, local complications should be anticipated. The most important diagnostic techniques are chest ultrasound and sectional imaging methods.

Therapy

Empirical therapy is the administration of an antibiotic being effective against the most common causative pathogens (Streptococcus pneumoniae, Staphylococcus aureus). In pleural effusion, empyema, and lung abscess, interventional procedures (pleura drainage with urokinase, CT-guided drainage in lung abscess) may be considered. Surgical interventions should be discussed in cases of failed conservative treatment.

Prognosis

Under appropriate therapy, the prognosis of local complications of pneumonia in childhood is generally good.     

Transkulturelle Pädiatrie – Vielfalt und Kindergesundheit

In Germany, children of immigrant families represent almost one-quarter of the population under the age of 18 years. Due to differing life course determinants of health, there is large heterogeneity in the health status and health care needs among children/adolescents from immigrant families. Health care organizations need to take action to meet the diverse needs of patients. At the level of the individual child health professional, management of a diverse pediatric population requires the development of transcultural skills, and demonstration of behaviors and attitudes that are appropriate to care for pediatric patients with a wide range of sociocultural attributes. There is a special need for support for recently immigrated minors and children/adolescents with chronic diseases. Significant health care inequities persist among refugee minors whom face numerous barriers to accessing an appropriate level of health care, which has implications for both individual and public health.     

Ernährung des Frühgeborenen

Background

A targeted nutritional management plays a key role in the health and growth of the preterm infant.

Material and methods

This review article provides well-known and recent data on the topics of parenteral and enteral nutrition of very low birth weight preterm infants with a birth weight below 1500 g and late preterm infants. New concepts of individually adjusted enrichment of breast milk or human milk-based fortifiers are presented as well as recent data on probiotics and lactoferrin. In addition, relevant aspects of discharge management are discussed.

Results

In parenteral nutrition an early onset and “aggressive” continuation are important issues to avoid growth restriction. New generations of lipid emulsions administered i.v. are available providing optimized immunomodulatory properties due to the favorable fatty acid profile. Standardized enteral feeding regimens including breast milk as the primary feeding source contribute to the prevention of necrotizing enterocolitis (NEC) and improve feeding tolerance.

Conclusion

Adequate nutrition of preterm infants is of great importance because it helps to prevent morbidities, such as NEC and osteopenia of prematurity. There is convincing evidence that optimizing nutrition in the early postnatal life of a premature infant also has an impact on better long-term neurodevelopmental outcome later in life.