Advances in Pediatrics


        Associate Editors v
        Contributors vii
        Introduction: Life Goes On: Health Care Systems, Complex Medical Conditions, and Newer Trends in Health Care: Post Pandemic xix
        Carol D. Berkowitz

        Health Systems Science

        Katherine M. Bartoletta and Stephanie R. Starr
         Health professions education requires a new approach 1
        Gaps in United States health and the health care system 1
        Existing and emerging pediatric health problems 2
        Third science is needed to close current and future gaps in child health 3
         Health systems science as the third science 3
        Definition and framework 3
        Systems citizenship 5
         Systems thinking 5
         Health care structures and processes 6
        Pediatric medical home 8
        Schools 8
        Application in clinical practice 8
         Population, public, and social determinants of health 9
        Social determinants of health as part of structural competency 9
         Clinical informatics and health technology: telehealth 10
         Health care policy and economics 11
        Health policy and health insurance that enable health 12
        Payment system reform for children 12
         Change agency, management, and advocacy 13
        Advocacy 13
         Summary 15
         Clinics care points (evidence-based pearls and pitfalls for point of care) 15
        Disclosure 16

        When Less is More: The Role of Overdiagnosis and Overtreatment in Patient Safety

        Audrey D. Kamzan and Elayna Ng
         Introduction 22
         Background 22
         Definitions of overuse, overdiagnosis, and overtreatment 24
         The scope of harm 26
         Case study in overuse: neuroblastoma screening 26
         Why do providers do more when less is best? 27
        Culture of medicine 27
        Clinician attitudes and beliefs 27
        Practice environment 28
        Patient factors and experiences 28
        Culture of health care consumption 29
        Publication bias 29
        Culture of medical education 29
        Industry influence 29
         What can be done? 29
        The Choosing Wisely campaign 29
        Changes in institutional priorities 30
        Patient-provider communication 31
        Medical student and trainee education 31
         Summary 32
         Disclosure 32

        Antibiotic Stewardship in Pediatrics

        Kurlen S.E. Payton and Marissa A. Brunetti
         Introduction 37
         Consequences of antibiotic overuse 38
        Microbiome 38
        Link to later disease 38
        Antibiotic resistance and economic impact 38
         Antibiotic stewardship strategies and antibiotic stewardship programs 39
         Neonates 39
        Unique challenges in the newborn nursery 39
        Full-term and late preterm infants in the neonatal intensive care unit 41
        Challenges managing preterm infants in the neonatal intensive care unit 42
        Adverse effects of antibiotics in preterm infants 42
        Culture-negative sepsis 42
        Antibiotic stewardship strategies in the nursery and neonatal intensive care unit 43
        Sepsis calculator 43
        Serial physical and clinical examinations 43
        Biomarkers for evaluating sepsis in the nursery and neonatal intensive care unit 43
        Guidelines and stewardship implementation for early onset sepsis in preterm infants 44
         Pediatric intensive care unit 45
        Tenets of antibiotic stewardship in the pediatric intensive care unit 45
        Biomarkers for antibiotic stewardship in the pediatric intensive care unit 46
         Outpatient antibiotic use 47
        Emergency department 47
        Factors contributing to antibiotic overuse in outpatient settings 47
        Outpatient antibiotic stewardship interventions 48
         Summary 49
         Clinics care points 49

        Balancing Autonomy and Protection in Pediatric Treatment and Research

        Tiffany Chenneville, Kemesha Gabbidon, Stefanie Hornschuh, and Janan Dietrich
         Introduction 56
         Child protection versus child autonomy 56
         Legal and ethical considerations 57
        Informed consent 57
        Privacy and confidentiality 59
         Developmental considerations 60
         Family considerations 61
         Cultural considerations 61
         Health equity and access considerations 62
         Relevant ethical models 63
        Goodness-of-fit ethical framework 63
        The protectionâ autonomy model 63
         Recommendations for balancing autonomy and protection in pediatric treatment and research 64
        Best practices for informed consent and assent 64
        Best practices for protecting confidentiality and disclosures 65
         Summary 66
         Clinics care points 67
         Disclosure 67

        Addressing Parental Adverse Childhood Experiences in the Pediatric Setting

        Rupal C. Gupta, Kimberly A. Randell, and M. Denise Dowd
         Introduction 71
         Parental adverse childhood experiences and child health outcomes 72
         Early experiences and the impact of parental adverse childhood experiences on parenting behaviors 73
         Intergenerational transmission of adverse childhood experiences 73
         Framework for addressing parental adverse childhood experiences in pediatric care settings 76
         Recognition of parental adverse childhood experiences in clinical settings 76
         The challenges of screening 77
         Implications for practice 79
         Universal interventions 79
         Targeted prevention strategies for high-risk families 82
         Resources 83
         Summary 84
        Acknowledgments 84
        Disclosure 84

        Caring for Medically Complex Children in the Outpatient Setting

        Michelle A. Blanco, Carol M. Lilly, Brooke C. Bavinger, Sara Garcia, and Michelle P. Hojnicki
         Introduction 89
         Identifying complex patients 90
        Scoring of complexity 91
        Benefits of identifying complex patients 92
         Complex care clinic models 92
        Medical home model 93
        Consultative model 93
        Episode-based model 94
         Challenges of delivering and managing complex care 94
        Finances 94
        Geographic access 95
        Infrastructure and care coordination 95
        Workforce readiness 96
         Patient and family support 96
        Home health care 96
        Medical day care 96
        Pediatric palliative care 97
        Peer-to-peer support groups 97
         Transitions in care 98
        Hospital discharge 98
        Transitions in development 99
        Transition to adult care 99
         Summary 100
         Clinics care points 100

        Postoperative Management of Pediatric Patients

        Melinda Murphy, Patricia O’Brien, and Matthew Gates
         Objectives 103
         Introduction 103
         Role of the pediatric hospitalist 104
        Disadvantages 105
         Communication 105
        Family-centered rounds 105
        Documentation 106
        Planning for discharge 106
         Routine postsurgical management considerations 107
        Respiratory 107
        Venous thromboembolism prophylaxis 109
        Postoperative pain control 110
         Complications 113
         Special populations 114
        Scoliosis and spinal fusion 114
         Summary 115
         Clinics care points 116
         Disclosure 116

        Inflammatory Bowel Disease in Children and Adolescents

        Nathan S. Rubalcava and Samir K. Gadepalli
         Introduction 121
        Epidemiology 121
        Pathogenesis 122
        Spectrum of disease 122
         Diagnosis 122
        Presentation 122
        Laboratory investigations 125
        Imaging 126
        Endoscopic findings 126
         Management 127
        Goals of management 127
        Medical management 128
        Surgical management (Crohn's disease) 129
        Surgical management (ulcerative colitis) 132
        Complications 134
         Outcomes 135
        Nutrition and growth 135
        Psychosocial 136
        Colon cancer 136
         Future Directions 136
        Exclusive enteral nutrition 136
        Collaborative care networks 136
        Transition from childhood to adulthood 137
        Fecal microbiota transplantation 137
         Summary 137
         Clinics care points 137
        Disclosure 138

        Updates in Juvenile Idiopathic Arthritis

        Deborah McCurdy and Miriam Parsa
         Introduction 143
         Classification 144
         Juvenile and prevalence 145
         Genetics 145
         Juvenile idiopathic arthritis: categories 145
        Oligoarticular juvenile idiopathic arthritis 145
        Polyarticular juvenile idiopathic arthritis 150
        Systemic juvenile idiopathic arthritis 154
        Juvenile psoriatic arthritis 157
        Enthesitis-related arthritis and juvenile ankylosing spondylitis 157
        Undifferentiated 158
         Biologic therapies 158
        Anti-tumor necrosis factor 158
         Diet, antibiotics, and autoimmunity 162
         Bone health in children with juvenile idiopathic arthritis 163
         Summary 165
         Clinics care points 165

        Vitamin D Update in the Pediatric Population

        Lindsey A. Warner, Rachel L. Sewell, and Nina S. Ma
         Introduction 171
         Definition of hypovitaminosis D 173
         Pediatric at-risk groups 173
         Vitamin D assays 174
         Vitamin D and clinical outcomes 175
        Fractures 175
        Bone imaging 180
         Current supplementation guidelines 189
        Infants 189
        Children and adolescents 189
         Extraskeletal effects of vitamin D 190
         Summary 190
        Acknowledgments 190
        Disclosure 190

        Pediatric Breast Masses: An Overview of the Subtypes, Workup, Imaging, and Management

        Maria E. Knaus and Julia E. Grabowksi
         Introduction 195
         The spectrum of pediatric breast masses 196
        Cysts 196
        Neonatal lesions 196
        Male lesions 197
        Common benign lesions 197
        Rare benign lesions 198
        Malignant lesions 199
         Workup 201
        History and physical examination 201
        Imaging 202
         Management of a pediatric breast mass 203
         Summary 206
         Clinics care points 206
        Disclosure 206

        Pituitary Tumors in Children

        Craig A. Alter, Karuna V. Shekdar, and Laurie E. Cohen
         Introduction 211
         Pituitary imaging 212
        Normal MRI appearance of the pituitary gland 212
         Pituitary cysts 215
         Pituitary tumors 216
        Craniopharyngioma 216
        Pituitary adenoma 217
        Hypothalamic hamartoma 218
        Optic pathway glioma 219
        Pituitary stalk thickening 219
         Other structural nontumorous findings in the pituitary and hypothalamic region 220
        Ectopic posterior pituitary 220
        Optic nerve hypoplasia, hypopituitarism, and septo-optic dysplasia 220
        Empty sella syndrome 220
         Evaluation of the child with a pituitary mass 220
        Physical examination 220
        Testing 221
         Treatment 222
        Pituitary tumor and cyst treatment 222
        Hormone replacement 222
         Summary 223
         Clinics care points 224
         Disclosure 224

        Adrenal Tumors in Childhood

        John S. Fuqua
         Introduction 227
         Embryology and early development of the adrenal gland 228
         Adrenocortical tumors 228
        Presentation 228
        Molecular pathogenesis and association with malignancy syndromes 230
        Grading and staging of adrenocortical tumors 231
        Treatment 233
         Primary bilateral adrenal hyperplasias 233
        Primary pigmented nodular adrenal disease 234
        Isolated micronodular adrenocortical disease 234
        Primary bilateral macronodular adrenal hyperplasia 234
         Pheochromocytoma/paraganglioma 235
        Presentation 235
        Evaluation 235
        Molecular pathogenesis 239
        Treatment 239
        Outcomes 240
        Disclosure 241

        Advances in the Surgical Management of Esophageal Atresia

        Alexis N. Bowder and Dave R. Lal
         Introduction 245
        Incidence 245
        Cause/pathogenesis 246
        Prenatal and postnatal diagnosis 246
        Classification 248
        Preoperative work-up 250
        Preoperative management 250
        Emergent maneuvers in the preoperative period 251
         Surgical management 251
        Open repair 251
        Surgical approach in patients with a right-sided aortic arch 252
        Safety of thoracoscopic repair of esophageal atresia/tracheoesophageal fistula 252
        Surgical management of long-gap esophageal atresia 253
        Complications/outcomes 254
         Summary 256
         Clinics care points 256
        Disclosure 257

        Trends in Pediatric Recreational Drug Use and Ingestions

        Raymen R. Assaf and Kelly D. Young
         Introduction 261
         Clinical approach 263
        General history 263
        Workup 264
        Treatment 264
         Current toxidromes 264
        Nicotine-containing electronic cigarettes 264
        Marijuana: Weed, wax, and edibles 265
        Synthetic cannabinoids 267
        Opioids 268
        Prescription drug misuse 270
        Microdose psychedelics 271
        Inhalants 272
        Dextromethorphan 273
         Summary 274
         Clinics care points 274