Current Pediatric Reviews

Necrotizing enterocolitis (NEC) has an incidence of 3-15%, varying among different geographical areas. Infants that suffer from NEC need surgical interventions in 30-40% of cases and have a mortality rate of 20-30% with a peak in 50% of cases [1- 3]. Diagnosis of NEC is carried out by Bell’s staging criteria, described in the 1970’s, that utilize clinical and radiological characteristics [4]. These criteria are less specific to differentiate NEC from another pathology with similar clinical and radiological presentations. For this reason, the estimate of the incidence of NEC is inaccurate because it is difficult to obtain a right diagnosis. NEC can cause bowel loss and persistent intestinal failure, furthermore, there is no standard of care defining the minimum length of residual bowel for which comfort care should be recommended [5]. Significant differences were observed in clinical decision-making between surgeons and neonatologists, where it is necessary to improve data showing long term outcomes in intestinal failure [5]. Nowadays, there are no new kinds of diagnostic criteria and therapies, so the major challenge in the future will be to discover test with high accuracy and specificity to carryout diagnosis of NEC and then, an early treatment. In this thematic issue for Current Pediatric Reviews, we focused on the new perspective on NEC in a comprehensive approach to physiopathology, diagnosis, classification, surgical timing, new nutritional and therapeutic strategies, long term outcome, follow up and the role of probiotics in the prevention of NEC. I am grateful to Professor Buonocore for his strong support to this thematic issue.

This special issue concerns several topics about the possible long-term consequences when a given life, during his fetal and neonatal periods, is compromised. I remember, when I was resident in neonatal intensive care (that was in the seventies, hence forty years ago), how fascinated I had been by the following sentence: “Time present and time past are both perhaps present in time future, and time future contained in time past” –Burnt Norton, Thomas Staerns Eliot. I sincerely couldn’t, at that time, realize the global meaning of these words Research in perinatal medicine has been induced by great pioneers such as among many examples: Sir Geoffrey Dawes in Oxford, Mary Ellen Avery in Boston and afterwards by many other around the world. It allowed to discover many aspects that will be described in The Introduction. It is my great pleasure to present to our readers the work about the following aspects from my collaborators and companions: Concerning the consequences of intra-uterine growth retardation: from the group of Olivier Baud [1]. Concerning renal and cardiovascular aspects: from the group of Umberto Simeoni [2]. Concerning the potential of stem cells in fragile premature, pulmonary aspects: from the group of Bernard Thebaud [3]. I wish to dedicate this manuscript to Wivinne Marion a marvellous mother and neonatologist who died unfortunately at 42 years.

It is my great pleasure to be Guest Editor of this special issue of Current Pediatric Reviews, focusing on the latest Advances in Food Allergy. Food allergy affects 6-8% of children and its prevalence has been on the increase. As a consequence, primary care physicians and pediatricians are likely to encounter children with food allergy frequently in their everyday practice and a practical knowledge of how to assess and manage this condition is essential. We open this issue with a review of food allergy diagnosis and management. There have been a lot of new advances in how we approach a food allergy diagnosis with significant emphasis on new diagnostic tools, such as specific IgE to allergen components and the basophil activation test. The advantages and disadvantages of different diagnostic techniques are fully debated by [1]. Helyeh et al. [2] detail new strategies in the active management of food allergies through risk management of accidental allergic reactions and also potential modification of the natural history of food allergies. The role of the gut microbiota in promoting tolerance in food allergy is examined at length, by Marrs et al, [3] who provide an interesting review of current studies on this intriguing topic. As we know, allergic disease can present with symptoms from various different body systems, including the respiratory and the skin. The association between food allergy and asthma is well documented, however, the exact interplay between the two atopic conditions is not fully understood yet. Foong et al. [4] investigate this link with the aim to offer a better understanding and recognition of these two conditions. A close relationship also exists between food allergy and atopic dermatitis, with a third of children with moderate to severe atopic dermatitis suffering from food allergy. Cartledge and Chan [5] explain the current understanding of this association and propose an easy-to-follow algorithm for primary care physicians and pediatricians who look after children with food allergy and atopic dermatitis. In the pediatric population, the commonest cause of anaphylaxis is food allergy [6]. We therefore conclude this special issue with a comprehensive review on anaphylaxis, a clinical emergency that all physicians should be prepared for. Finally, I would like to thank all the authors for their valuable contributions and hope that you will enjoy reading this special issue, while at the same time finding it educational and useful for your daily practice.

I am very thankful for the opportunity to act as a Guest Editor in this special issue of Current Pediatric Review. We hope to examine the advancement and opportunities that lie in the care of the acutely traumatized child. As the sole leading cause of death, the pursuit of knowledge in the care of traumatized children remains as important and as relevant as ever. Whether in the role of primary care providers or pediatricians, or as specialized emergency physicians, the acquisition of knowledge of the different facets of care will be of significant interest. As a profession, we should be proud that we have advanced far beyond treating these patients as “little adults”, and take pride that many advances in adult trauma care have led to the adoption of practices initiated and refined within pediatrics. We start this issue with a topic of great importance, traumatic brain injury. Through the understanding of the many different modalities of treatment options described by Belisle et al., [1] we can begin to strive for the very best outcome in these children. The role of various fluids and medications is also of great importance not only in traumatic brain injury, but in polytrauma. Discussion on different treatments and their application is presented expertly by Dr. Misir and Mehrotra [2]. Moving forward, various special circumstances demand discussion as their treatment options, and pitfalls to watch out and they are important to preserve the best outcomes for our patients. Mehrotra et al. [3]. tackle the two common situations of temperature disturbances, and thermal injuries. One of the largest changes in practice has been in our knowledge of the alleviation and treatment of pain in children, especially with the removal of codeine in the modern era. Poonai et al. [4]. provide an excellent insight into the current care standards and directions moving forward. Another example of something new in trauma care for children, we are delighted that Istasy et al., [5] were able to provide a 2017 review on point of care ultrasound and it’s various applications in children. Although trauma is the leading cause of death in children, it needn’t be. As health care advocates, the importance of injury prevention and advocacy for safety is clear. We thank Forward et al. [6] for providing us insight into the history and direction of injury prevention today. Last but certainly not the least, we thank Loubani et al. and Lynch et al. [7, 8] for providing excellent reviews on the management of orthopedic and abdominal trauma, respectively. Certainly, these two areas are extremely common, and also add to the significant morbidity and mortality of traumatic injuries in children. I would like to send my sincere thanks to all of the authors foe their assistance in these various areas, for their hard work and dedication. I hope that you will find this collection of topics useful and interesting.

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