What have we learned about acute pancreatitis in children?

Pediatric pancreatitis has received much attention during the past few years. Numerous reports have identified an increasing trend in the diagnosis of acute pancreatitis in children and key differences in disease presentation and management between infants and older children. The present review provides a brief, evidence-based focus on the latest progress in the clinical field. It also poses important questions for emerging multicenter registries to answer about the natural history and management of affected children with pancreatitis.     

What have we learned from the Tucson Children's Respiratory Study?

The Tucson Children's Respiratory Study was the first longitudinal assessment of the natural history of asthma in which children were enrolled at birth. Over 1200 children were originally included and over 800 were still participating at age 13. The study has provided general indications about the most important risk factors for and the prognosis of different phenotypes associated with recurrent airway obstruction during childhood. The most important conclusion from the study is that asthma is a heterogeneous disease, with different predominant expressions at different ages. The form of the disease that is associated with atopy is not very frequent in early life, but becomes preponderant during the school years. However, this form is more persistent and is associated with significant deficits in lung function growth up to age 11. Up to two-thirds of infants who wheeze have a transient form of recurrent airway obstruction associated with low premorbid lung function. Many children who wheeze during the preschool years do so only during viral infections. These children usually have a history of wheezing due to respiratory syncytial virus during early life and low levels of lung function during the school years. Understanding the different asthma phenotypes of childhood will provide new clues for strategies for the primary prevention of the disease.     

Post-traumatic urethral strictures in children: What have we learned over the years?

BackgroundUrethral stricture presents an uncommon but difficult urological problem in the pediatric population. Treatment protocols are different from in adults due to anatomical considerations.Material and methodsA thorough manual and Medline search was conducted to review the existing literature on post-traumatic pediatric urethral strictures, with key words: stricture, children, post-traumatic, urethroplasty, pediatric.ResultsOpinion early on was that, due to the confined perineum, high incidence of supramembranous injury resulting in less predictable distraction defects of the posterior urethra and a high incidence of prostatic displacement, transperineal urethroplasty is technically more difficult than in adults and thus the transpubic approach is more feasible. Recent reports revealed that both approaches resulted in almost the same clinical outcomes for children with post-traumatic posterior urethral strictures.ConclusionThe ideal reconstruction for the treatment of post-traumatic posterior urethral strictures in children is bulboprostatic anastomosis. This procedure should be initially attempted through the perineum in every case. A transpubic procedure should be done only when tension-free anastomosis cannot be accomplished through the perineum.     

What have we learned from febrile seizures?

What have we learned from febrile seizures? We have learned that there is a natural history to different seizure types, what some have taken to calling "seizure syndromes." We have learned that understanding these "natural histories" may be helpful in making decisions about treatment. We have learned that seizures themselves, while unpleasant, may not be harmful and don't always have to be treated. We have learned that sometimes the treatment is worse than the disease and that the side effects of medication may have more consequences than the occurrence of another seizure. We have learned that the determination of the "risks" and consequences of the seizures should be made by the patient or the family, and that they may assess the risks and benefits quite differently than the physician. Similarly, the benefits and consequences of anticonvulsant medication may be assessed quite differently by different people. We have learned that all seizures do not need to be treated, and we have learned that those that are treated should be treated for the shortest time possible. I believe that these are important lessons that should affect our management of afebrile seizures as well.     

Ultrasonography in developmental dysplasia of the hip: what have we learned?

Developmental dysplasia of the hip (DDH) is an important but poorly defined entity, the natural history of which is incompletely understood. The term encompasses a disease spectrum ranging from a stable hip with a mildly dysplastic acetabulum to complete hip dislocation. Much controversy surrounds the diagnosis, imaging and management of this condition. We present a review of the history of US imaging of DDH from the radiologist’s perspective, summarising the most widely recognised US methods described to date. We discuss controversies in the approach to US examination, with particular emphasis on current opinions. The existing scientific evidence for and variations in the practice of US screening for DDH, including recommendations from the United States Preventive Services Task Force and the ESPR DDH Taskforce Group respectively, are discussed.     

Oxygen saturation target ranges and alarm settings in the NICU: What have we learnt from the neonatal oxygenation prospective meta-analysis (NeOProM)?

The Neonatal Oxygenation Prospective Meta-analysis combined the individual participant data of 4965 extremely preterm infants. They had been randomly assigned in 5 trials to arterial oxygen saturations of 85%–89% or 91%–95% using modified oximeters to mask the treatment allocation. The primary outcome of death or disability did not differ significantly between the groups. Assignment to the higher target range reduced the risks of death and severe necrotizing enterocolitis but increased the risk of treated retinopathy. Trade-offs between the benefits and risks of higher or lower saturation targets should be informed by the local patient risks and institutional rates for outcomes that may be affected by a policy change. Features of the oximeter masking algorithm introduced unanticipated artifacts into the saturation display that are not seen in routine care. NeOProM provides little guidance on where to set the oximeter alarms and how to respond to them.     

Iron in sickle‐cell disease: What have we learned over the years?

Over the last four decades, monumental advances have been made in the understanding, assessment, and management of transfusion-dependent patients, which have translated into significant improvements in patient morbidity and mortality. Important lessons have been learned from extensive clinical experience of iron management in the thalassemias, but greater knowledge of key differences in the sickle-cell disease (SCD) population may impact on our approach to patient assessment and management. The unique pathophysiology of SCD is reflected in a distinct pattern of iron loading with minimal organ-specific injury. An appreciation and understanding of these differences should allow us to develop tailored management approaches that optimize patient outcomes.     

Domestic humidifiers. What do we know about them?

Popular opinion assumes that environmental humidity relieves the clinical symptoms of respiratory tract diseases. Various types of home humidifiers are available on the market. Parents buy them in the belief that they will improve their children's well-being but are usually unaware of whether these devices provide a real benefit. Pediatricians should bear the main responsibility in the task of informing and guiding families in the use of home humidifiers but general lack of knowledge on the subject and the scarcity of published data make this task difficult. The aim of this review is to increase general knowledge of home humidifiers. We describe what they are, their main types, their basic functioning, advantages and disadvantages and the importance of suitable maintenance. We define what environmental humidity means, how it can change according to temperature and how it can influence human health. Finally, we suggest that optimal relative humidity is approximately 40-60 % and that it should be measured before using a home humidifier.