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Topic Review
Ethics of Vaccination in Childhood
Although vaccination is recognised as the top public health achievement of the twentieth century, unequivocal consensus about its beneficence does not exist among the general population. In countries with well-established immunisation programmes, vaccines are “victims of their own success”, because low incidences of diseases now prevented with vaccines diminished the experience of their historical burdens. Increasing number of vaccine-hesitant people in recent years threatens, or even effectively disables, herd immunity levels of the population and results in outbreaks of previously already controlled diseases. We aimed to apply a framework for ethical analysis of vaccination in childhood based on the four principles of biomedical ethics (respect for autonomy, nonmaleficence, beneficence and justice) to provide a comprehensive and applicable model on how to address the ethical aspects of vaccination at both individual and societal levels. We suggest finding an “ethical equilibrium”, which means that the degree of respect for parents’ autonomy is not constant, but variable; it shall depend on the level of established herd immunity and it is specific for every society. When the moral obligation of individuals to contribute to herd immunity is not fulfilled, mandatory vaccination policies are ethically justified, because states bear responsibility to protect herd immunity as a common good.
  • 642
  • 08 Jun 2021
Topic Review
Role of FA Metabolites and Inflammation during Pregnancy
Normal pregnancy relies on inflammation for implantation, placentation, and parturition, but uncontrolled inflammation can lead to poor maternal and infant outcomes. Maternal diet is one modifiable factor that can impact inflammation. Omega-3 and -6 fatty acids obtained through the diet are metabolized into bioactive compounds that effect inflammation. The downstream products of omega-3 and -6 fatty acids may influence physiology during pregnancy.
  • 640
  • 17 Jan 2023
Topic Review
Zinc Supplementation on Nutritional Status in CKD
Zinc is one of the most important and essential trace elements required by all living organisms for many physiologic functions, with three major biological roles catalytic, structural and regulatory ones. It is the second most abundant metal in mammalian tissues, after iron, with almost 90% of that found in muscle and bone. Likewise, the cellular Zn2+ concentrations are nearly as high as those of major metabolites like the ATP. Zinc is an essential cofactor that influences the expression and activity of numerous enzymes, transcription factors and regulatory proteins.
  • 638
  • 19 Jan 2023
Topic Review
Feeding and Infant Sleep
Inconsistent conclusions from infant sleep and feeding studies may influence parents feeding-related decisions. Exclusively breastfed infants (≤6 months-of-age) had a greater number of night wakings, but most studies reported no difference in night-time and 24 h sleep duration compared to formula-fed infants. However, after 6 months-of-age, most studies reported breastfed infants to sleep less in the night-time and over 24 h compared to formula-fed infants. Furthermore, studies reported no association between the timing of introduction to complementary foods and infant sleep duration (<12 months-of-age).
  • 637
  • 11 Jan 2022
Topic Review
Atypical Teratoid/Rhabdoid Tumor in Taiwan
Atypical teratoid/rhabdoid tumor (AT/RT) is a rare, highly aggressive embryonal brain tumor most commonly presenting in young children. Older age, supratentorial site, and treatment with radiotherapy, chemotherapy, or both were significantly associated with better survival of patients with AT/RT in Taiwan. 
  • 636
  • 08 Feb 2022
Topic Review
Non-Contact Video-Based Neonatal Respiratory Monitoring
Video-based monitoring is a potential non-contact system that could improve patient care. This iterative design study developed a novel algorithm that produced RR from footage analyzed from stable NICU patients in open cribs with corrected gestational ages ranging from 33 to 40 weeks. The final algorithm used a proprietary technique of micromotion and stationarity detection (MSD) to model background noise to be able to amplify and record respiratory motions. We found significant correlation—r equals 0.948 (p value of 0.001)—between MSD and the current hospital standard, electrocardiogram impedance pneumography. Our video-based system showed a bias of negative 1.3 breaths and root mean square error of 6.36 breaths per minute compared to standard continuous monitoring. Further work is needed to evaluate the ability of video-based monitors to observe clinical changes in a larger population of patients over extended periods of time.
  • 624
  • 26 Oct 2020
Topic Review
Lateralized and Segmental Overgrowth in Children
Lateralized overgrowth (LO), or segmental overgrowth, is defined as an increase in tissue growth of various origins (skeletal, muscular, fibrous, vascular, adipose, or any association of these) in any region of the body.
  • 624
  • 14 Dec 2021
Topic Review
VA ECMO use in Pediatric
In children with severe advanced heart failure where medical management has failed, mechanical circulatory support in the form of veno-arterial extracorporeal membrane oxygenation (VA ECMO) or ventricular assist device represents life-sustaining therapy.The two primary forms of mechanical circulatory support are veno-arterial extracorporeal membrane oxygenation (VA ECMO) and ventricular assist devices (VAD). The two technologies have unique advantages and disadvantages and could be considered as complementary devices and, at times, used in sequence as the clinical scenario dictates.
  • 616
  • 05 May 2021
Topic Review Peer Reviewed
Vibroacoustic Pollution in the Neonatal Ward
Excessive noise pollution is often a problem for neonatal nurseries. Noise pollution involves not only noise but also vibrations. The main difference between them is that noise can be heard, and vibrations are felt. The human ear cannot detect waves outside the range of 20 Hz–20 KHz. Waves from 0 Hz to 80–100 Hz should be considered vibrations. Both can be transmitted to the neonate through the incubator’s operational mechanisms and other noise sources. Neonatal units’ noise is well studied but very little is known about vibration. This entry focuses on the importance of vibrations reaching the inside of incubators in neonatal nurseries.
  • 615
  • 25 Dec 2023
Topic Review
Prenatal BPA Exposure on Metabolic Parameters
Metabolic syndrome (MS) is a multifactorial disease entity and is not fully understood. Growing evidence suggests that early exposure to bisphenol A (BPA) is a significant risk factor for the development of metabolic diseases. BPA is a monomer used in the manufacturing of polycarbonate plastics, thermal receipt paper, and epoxy resins. Owing to its widespread use, BPA has been detected in human fluids and tissues, including blood, placental and breast milk, and follicular fluid.
  • 605
  • 18 Jul 2022
Topic Review
Seizures and Newborn Infants
Seizures are common in newborn infants with hypoxic-ischemic encephalopathy and are highly associated with adverse neurodevelopmental outcomes. The impact of seizure activity on the developing brain and the most effective way to manage these seizures remain surprisingly poorly understood, particularly in the era of therapeutic hypothermia. Critically, the extent to which seizures exacerbate brain injury or merely reflect the underlying evolution of injury is unclear. Current anticonvulsants, such as phenobarbital and phenytoin have poor efficacy and preclinical studies suggest that most anticonvulsants are associated with adverse effects on the developing brain. Levetiracetam seems to have less potential neurotoxic effects than other anticonvulsants but may not be more effective. Given that therapeutic hypothermia itself has significant anticonvulsant effects, randomized controlled trials of anticonvulsants combined with therapeutic hypothermia, are required to properly determine the safety and efficacy of these drugs. Small clinical studies suggest that prophylactic phenobarbital administration may improve neurodevelopmental outcomes compared to delayed administration; however, larger high-quality studies are required to confirm this. In conclusion, there is a distinct lack of high-quality evidence for whether and to what extent neonatal seizures exacerbate brain damage after hypoxia-ischemia and how best to manage them in the era of therapeutic hypothermia. 
  • 603
  • 22 Jul 2021
Topic Review
Tics and Emotions
Tics can be associated with neurological disorders and are thought to be the result of dysfunctional basal ganglia pathways. In Tourette Syndrome (TS), excess dopamine in the striatum is thought to excite the thalamo-cortical circuits, producing tics. When external stressors activate the hypothalamic-pituitary-adrenal (HPA) axis, more dopamine is produced, furthering the excitation of tic-producing pathways. Emotional processing structures in the limbic are also activated during tics, providing further evidence of a possible emotional component in motor ticking behaviors.
  • 599
  • 17 Feb 2022
Topic Review
COVID-19 Newborn Infection
It is already known how SARS-CoV-2 passed from human-to-human with the  exeption of mother-to fetous transmission of infection.  The foetus, theoretically may become infected from the mother by a blood-borne route through the placenta, during birth, through contact with maternal secretions and after birth during close contact with the mother or others. Mother-to-fetus transmission of the virus is unlikely and its mechanism is poorly understood. In a number of published studies, researchers have not based the diagnosis of COVID-19 in the newborn on developed diagnostic criteria, which makes it even more difficult to determine the frequency and pathomechanism of congenital infection. Still not much is known about complications of SARS-CoV-2 infection in pregnancy for the fetus and neonate, there are many questions that we still cannot answer. despite this, it has been possible to determine how to limit airborne transmission of the virus. By analysing the mode of delivery it is known that SARS-CoV-2 infection is not an indication for caesarean section. There are no data that provide a basis for restricting breastfeeding. It has been established that breastfeeding should be done with hand disinfection and wearing a mask.
  • 599
  • 24 Jul 2023
Topic Review
Granulicatella spp.
Granulicatella spp. are non-motile, non-sporulating, facultatively anaerobic Gram-positive cocci. These organisms have been referred to by several names, such as “nutritionally deficient streptococci”, “vitamin-B dependent streptococci” and “pyridoxal-dependent streptococci”, because of their fastidious nutritional requirements, which can often make culture isolation challenging. Known to be a member of the normal microbiota of the human oral cavity and urogenital and intestinal tracts, similar to other streptococci, Granulicatella spp. can cause bacteremia, sepsis and infective endocarditis. Considering the difficulty in growing this organism on culture medium, the fact that it is now included among the bacteria known to be responsible for culture-negative infective endocarditis suggests that its pathogenic role could be highly underestimated. Moreover, being considered such a rare causative agent, it is not a target of standard antibiotic empiric treatment. 
  • 596
  • 27 Dec 2022
Topic Review
Difficult Asthma in Children
Difficult asthma is asthma that is uncontrolled despite GINA step 4 and 5 (medium or high dose ICS with a second controller; maintenance of oral corticosteroids), or that requires such treatment to maintain good symptoms control and reduce the risk of exacerbations.
  • 595
  • 23 Feb 2021
Topic Review
Breastfeeding and Vitamin D in Preventing Childhood Infections
Human milk is the best food for infants. Breastfeeding has been associated with a reduced risk of viral and bacterial infections. Breast milk contains the perfect amount of nutrients needed to promote infant growth, except for vitamin D. Vitamin D is crucial for calcium metabolism and bone health, and it also has extra-skeletal actions, involving innate and adaptive immunity. As exclusive breastfeeding is a risk factor for vitamin D deficiency, infants should be supplemented with vitamin D at least during the first year. The promotion of breastfeeding and vitamin D supplementation represents an important objective of public health. 
  • 595
  • 09 Mar 2022
Topic Review
Pathophysiological Concepts of Pulmonary Manifestation of Pediatric IBD
Pulmonary manifestation (PM) of inflammatory bowel disease (IBD) in children is a rare condition. The exact pathogenesis is still unclear, but several explanatory concepts were postulated and several case reports in children were published. Different pathophysiological concepts were identified, including the shared embryological origin, “miss-homing” of intestinal based neutrophils and T lymphocytes, inflammatory triggering via certain molecules (tripeptide proline-glycine-proline, interleukin 25), genetic factors and alterations in the microbiome.
  • 588
  • 20 Jul 2022
Topic Review
Transition Care in Rheumatology
The transition from pediatric to adult health care is a challenging yet important process in rheumatology as most childhood-onset rheumatic diseases persist into adulthood. Numerous reports on unmet needs as well as evidence of negative impact from poor transition have led to increased efforts to improve transition care, including international guidelines and recommendations. In line with these recommendations, transition programs along with transition readiness assessment tools have been established. This entry focuses on how transition care in rheumatology has developed in recent years and highlights the gaps in current practices.
  • 587
  • 02 Mar 2021
Topic Review
Paediatric Type 1 Diabetes
Type 1 diabetes mellitus (T1DM) is one of the most common paediatric chronic illnesses, with a prevalence of 1 in every 400 youth and preceded only by asthma and epilepsy. Paediatric T1DM involves many life-challenges, as children and adolescents are forced to follow an inflexible regimen. Insulin injections, physical activity and healthy dieting to avoid episodes of extremely high or low levels of hemoglobin A1c (HbA1c), both of which can put their life at risk. The ongoing management of T1DM can also be extremely challenging for parents, as requiring family support for both the physical and psychological care of the children.
  • 582
  • 21 Jan 2021
Topic Review
Copper/Zinc Ratio in Childhood and Adolescence
Both copper (Cu) and zinc (Zn) are crucial micronutrients for human growth and development. Children and adolescents with acute and chronic conditions are at greater risk of developing elevated Cu/Zn ratios, related to altered nutritional, infectious, and inflammatory status.
  • 582
  • 18 Jan 2023
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