Book Volume 2
Introduction of Challenges with Pediatric Diseases
Page: 1-29 (29)
Author: Noosha Samieefar, Delaram J. Ghadimi, Sara Zibadi, Fateme Heydari, Elham Pourbakhtyaran and Nima Rezaei*
DOI: 10.2174/9789815124187123020005
PDF Price: $15
Abstract
Children and the knowledge of taking care of them, pediatrics, are faced
with growing challenges. With the advancement of medical sciences, pediatrics is
becoming a group of subspecialties. This could lead to improving the care and
management of pediatric disorders, however, transdisciplinary management should not
be ignored.
Although the health status of children has improved over the past years, still
preventable child deaths are occurring, especially in low-income countries. The
increased sexual abuse, discrimination, racism, increased intercountry adoption,
malnutrition, environmental hazards like arsenic contamination, pornography, and
surrogacy are among the most important current challenges to children’s health.
Worldwide vaccination coverage has declined from 86% in 2019 to 83% in 2020, and
the number of completely unvaccinated children increased by 3.4 million.
Approximately, 1 billion children are dealing with multidimensional poverty all around
the world among which at least 356 million of them live in extreme poverty, and 100
million more children plunged into poverty as a result of COVID-19.
In this chapter, we will review the most important challenges of children’s health and
pediatrics with a focus on social and mental health problems.
Positive and Negative Outcomes of Sexting
Page: 30-36 (7)
Author: Elizabeth Englander*, Cheryl E. Sanders and Katalin Parti
DOI: 10.2174/9789815124187123020006
PDF Price: $15
Abstract
Historically, the concept of “sexting” (the sending of nude pictures or videos
between teenage youth) has been associated with extremely negative outcomes,
including legal vulnerabilities, lost future opportunities, and depression and suicide.
These negative outcomes have been widely promoted in the news media and in
research on the phenomena. Yet despite diligent efforts by adults to warn youth of
these negative outcomes, sexting persists and may even be more common than was first
thought. Almost a decade ago, the first research began to emerge that suggested that
these risks may be less common than first thought. More recent research has filled out
our knowledge about sexting by outlining positive outcomes of sexting that may help
explain why underage youth persist in these behaviors despite draconian warnings.
This paper outlines some of these positive outcomes, such as improved feelings of self-confidence and attractiveness; strengthening of existing relationships; and the view that
sexting is a safe way to explore emerging sexuality. Given this mix of both potential
positive and negative feelings about sexting, I propose here that sexting education
should follow the best practices long established for sex education, namely, ensuring
that youth understand risks, consider relationships and feelings, and do not engage in
sexting because of pressure or coercion.
The Role of Integrated Services in the Care of Children and Young People with Neurodevelopmental Disorders and Co-Morbid Mental Health Difficulties: An International Perspective
Page: 37-72 (36)
Author: Hani F. Ayyash*, Cornelius Ani and Michael Ogundele
DOI: 10.2174/9789815124187123020007
PDF Price: $15
Abstract
Children and Young People (CYP) affected by Neurodevelopmental,
Emotional, Behavioural and Intellectual Disorders (NDEBIDs) such as Attention
Deficit and Hyperactive Disorder (ADHD) and Autism Spectrum Disorder (ASD) are
at increased risk of other Mental Health (MH) difficulties such as anxiety and
depression. Therefore, they require comprehensive and holistic services to meet their
complex needs. However, many countries still offer them disjointed services involving
different healthcare providers and professionals each looking at only one aspect of the
CYP’s needs. To address this problem, the framework of “Integrated Care” is
recommended as a template for providing comprehensive and joined-up care to meet
the complex needs of these CYP with NDEBIDs and MH difficulties. This chapter
aims to explore integrated care. It outlines the adverse impacts of disjointed care
including: unnecessary multiple referrals, inefficient multiple assessments, delays in
accessing required assessment and treatment, frustration and distress for affected CYP
and their families and conflicts among professionals. Identified barriers to integrated
care include problems with health planning, limited evidence-base, inter-professional
difficulties related to different training and professional cultures and mental health
stigma. The chapter highlights the benefits of integrated care including user
satisfaction, the shortened path to point of care, systemic efficiencies and improved
professional relationships. Finally, the chapter discusses the following desirable
characteristics of integrated care: joint care commissioning, adequate ring-fenced
funding, strategic leadership and planning, cross-training for professionals and good adherence to evidence-based protocols. Perspectives from Low and Middle-Income
Countries (LMICs) were also discussed to acknowledge the international nature of the
problem.
Epidemiological Evidence for Influences of Non-genetic Transgenerational Inheritance on Child and Adolescent Development
Page: 73-106 (34)
Author: Jean Golding* and Yasmin Iles-Caven
DOI: 10.2174/9789815124187123020008
PDF Price: $15
Abstract
Our use of the term ‘Non-genetic transgenerational inheritance’ concerns the
influence of environmental exposure to one generation on phenotypes in later
generations in the absence of changes in the structure of the DNA. Although animal
experiments have shown that the phenomenon exists in plants and animals, many
scientists have expressed doubt as to whether this type of inheritance is detectable in
humans. In this chapter, we describe the observational epidemiological data that has
been published and evaluate the evidence for this type of inheritance. We mainly
concentrate on the environmental exposures concerning famine, cigarette smoke and
radiation, and chart the associations between pre-conception and prenatal exposures.
We describe associations between these exposures and outcomes for the offspring and
grandchildren. In general, we demonstrate frequent evidence of sex-specific differences
in the likelihood of particular phenotypes, depending on whether it is the maternal or
paternal ancestor who is exposed. We also show that the timing of the exposure is often
important regarding specific outcomes, with particular emphasis on the 4-5 years
before puberty for preconception exposures and the trimester of pregnancy for prenatal
exposures. The evidence for non-genetic transgenerational inheritance is increasing.
Interestingly, the consequences of exposures that are harmful to one generation often
have a beneficial effect on a subsequent generation. It is important that future
epidemiological studies are planned to collect information concerning previous and/or
subsequent generations so that transgenerational consequences of exposures, such as
medications or pesticides, can be charted.
Clinical Approaches to Genetic Epilepsies in Children
Page: 107-129 (23)
Author: Mario Mastrangelo*
DOI: 10.2174/9789815124187123020009
PDF Price: $15
Abstract
A genetic etiology is determined in more than 30% of all diagnosed cases of
epilepsy with onset at the pediatric age. About 210 single disease-causing genes and
400 chromosomal imbalances are associated with epilepsy, and a presumed pathogenic
role has been suggested for about 7000 different genes.
Genetic epilepsies can be divided, according to the main correlated epileptogenic
mechanisms, into the following groups: a) channelopathies, b) transportopathies, c)
disorders of the intermediate metabolism, d) disorders of the neuronal cellular cycle
and signaling, e) disorders of synaptic vesicles trafficking and release, f) disorders
involving neuronal structural proteins, g) disorders of synaptic secreted proteins and h)
chromosomopathies and pathogenic copy number variants.
A careful diagnostic work-up should be focused on the exclusion of acquired causes of
seizures, the analysis of family history, the definition of seizure semiology and
epileptic syndromes, and the characterization of associated neurological and non-neurological manifestations.
Traditional genetic techniques (karyotype, array CGH, and Sanger sequencing) remain
useful for known epilepsy phenotypes (e.g. Dravet syndrome) and for various
syndromes including neurodevelopmental impairment.
Next-generation sequencing (NGS) includes different techniques (targeted gene panels
and whole genome sequencing) that allow a simultaneous sequencing of exons
belonging to a selected group of genes organized in panels or to the whole exome or
genome. Advantages of NGS include: a) the identification of new disease-causing genes
associated with epilepsy, b) an expansion of the known phenotypes associated with
previously discovered disease-causing genes, c) an improvement of genetic counseling,
d) a reduction of the times for the diagnosis, and e) a reduction of economic costs.
Medical and Social Outcomes in the Management of Cardiac Diseases in Children
Page: 130-144 (15)
Author: Josephat M. Chinawa* and Fortune A. Ujunwa
DOI: 10.2174/9789815124187123020010
PDF Price: $15
Abstract
Children with cardiovascular diseases, especially congenital heart diseases
are exposed to socioeconomic burdens ranging from poverty, economic difficulties,
and emotional breakdown to parental schism.
There are various ways by which cardiac diseases affect children. These include the
effect of the disease on the child, the family and the nation as a whole. Management of
cardiovascular diseases in children comprises diagnosis, investigations, medical and
surgical rehabilitation/ergonomics and follow-up. All these steps in management have
both medical and social implications on the child.
The effects of cardiovascular diseases are not limited to health, but can seep into social
life, as well. Affected individuals tend to forgo a lot of things, including restrictions in
their life, depression and even family structure disintegration, decrease life expectancy
and family disharmony in some cultures.
The socio-economic burden of pediatric cardiovascular diseases is quite huge both for
the individual, household and society. The impact includes loss in financial resources,
productivity, increased disability-adjusted life years, decreased quality of life,
catastrophic expenditure and premature death. These burdens are more in the low and
middle-income countries. This chapter aims at eliciting the various social and
economic burdens that children with heart diseases encounter in the course of their
illness.
Meconium Stained Newborn
Page: 145-168 (24)
Author: Mohammad Moonis Akbar Faridi* and Sumaiya Shamsi
DOI: 10.2174/9789815124187123020011
PDF Price: $15
Abstract
Meconium Stained Amniotic Fluid (MSAF) and Meconium Aspiration
Syndrome (MAS) in newborn are commonly encountered by obstetricians and
neonatologists world over, and more so in developing countries. MAS is a serious
condition as it causes severe respiratory morbidity and complications like air leak,
pneumothorax, Persistent Pulmonary Hypertension (PPHN), surfactant inactivation and
death in many cases. There have been several changes in the management of pregnant
mothers and their neonates, as well as in the endotracheal suctioning guidelines for
babies born with MSAF ever since the pathogenesis of intra-uterine passage of
meconium and meconium aspiration syndrome, and evidence on intervention outcomes
became known. This chapter shall review the mechanism of meconium stained
amniotic fluid, the pathophysiology of meconium aspiration syndrome and
management of the newborn infant in the labor room, NICU and beyond, as per the
present consensus. Potential newer therapies and drugs shall also be briefly addressed.
Transient Tachypnea of the Newborn
Page: 169-181 (13)
Author: Fahri Ovali*
DOI: 10.2174/9789815124187123020012
PDF Price: $15
Abstract
Transient Tachypnea of the Newborn (TTN) is the most common respiratory
morbidity in term infants. In fetal life, the lungs are filled with fetal alveolar fluid,
which is secreted by the alveolar epithelium through chloride channels. In late gestation
and by the onset of labor, chloride-secreting channels switch to sodium-absorbing
channels, and alveolar fluid is cleared away, leaving space for air after birth. Disorders
that compromise the absorption of fetal lung fluid would end up in respiratory distress,
tachypnea and hypoxemia. Elective cesarean section is the major risk factor for TTN,
as well as other risk factors. Clinical features and chest radiograms are sufficient for the
diagnosis. The disease is usually benign and self-limiting, but in some cases,
respiratory support may be needed along with supportive treatment. The prognosis is
usually good but with an increased risk of asthma in childhood.
Fetal Tumors: Diagnosis and Management
Page: 182-209 (28)
Author: Forough Jabbari, Parnian Jabbari, Nazanin Taraghikhah, Behnaz Moradi and Nima Rezaei*
DOI: 10.2174/9789815124187123020013
PDF Price: $15
Abstract
Tumors can be formed in any organ throughout life. The fetal period is no
exception to this fact, and it is important to diagnose these tumors as soon as possible
to provide timely care to patients. If management is halted, tumors can cause
complications in delivery, child development and even death. In this chapter, we
discuss the diagnosis and management of several common fetal tumors. We also
overview possible future directions in the management of tumors found during the fetal
period.
Autism Spectrum Disorder during Infancy: Implications for Diagnosis, Prognosis, and Therapeutic Approaches
Page: 210-230 (21)
Author: Kimia Kazemzadeh, Parnian Shobeiri, Serge Brand and Nima Rezaei*
DOI: 10.2174/9789815124187123020014
PDF Price: $15
Abstract
Autism spectrum disorder (ASD) is a complex psychiatric and
neurodevelopmental issue related to delays in the acquisition of behavioral and social
skills. The main symptoms of ASD are impairments in communication, limited interest
and skills in social interactions, and repetitive behavior. In the present chapter about
ASD during infancy, we reviewed the behavioral indicators of ASD, different ways of
diagnosis, and the significance of an early and correct diagnosis. While children with
ASD are usually diagnosed between ages 2-4, many pediatricians and psychiatrists are
interested in understanding the developmental course of ASD in early infancy and
infancy. Such an understanding would help both infants with ASD and their family
members to identify useful interventions to cope more favorably with difficulties
related to the infants’ symptoms of ASD. We highlighted that ASD traits unfavorably
impact a child’s and their family’s social, behavioral, and the family’s economic status
and conditions. Given this, an early diagnosis and timely and appropriate interventions
should mitigate ASD-related issues in everyday life. To this end, assessing a child’s
behavior is the gold standard for ASD diagnosis. Most of the symptoms appear in the
second year of life; often language acquisition is impaired. Considering the signs of
ASD in infancy, promising perspectives on ASD diagnosis will be introduced in the
future.
Medical Futility in Pediatrics: Challenges, Hopes, and New Perspectives
Page: 231-268 (38)
Author: Ardeshir Khorsand, Zahra Mohajer, Soroush Khojasteh-Kaffash, Zahra Hosseini Bajestani, Azar Ghasemi, Farbod Ghobadinezhad and Noosha Samieefar*
DOI: 10.2174/9789815124187123020015
PDF Price: $15
Abstract
The concept of medical futility is explored, particularly in relation to the
challenge of defining futile treatments, and the difficulties in identifying patient
subgroups that strictly match the criteria for treatment futility. The issue of categorizing
perinatal disorders as fatal is an important topic, with a focus on the moral and legal
repercussions of identifying lethal malformation. The identification of a lethal
malformation often has moral and legal repercussions, and the phrase “lethal” should
be avoided unless it is precisely defined, used consistently, and covered in transparency
in perinatal counseling following prenatal diagnosis.
We argue that a nuanced and carefully considered approach is required, one that takes
into account the complex medical and ethical issues involved, and that focuses on the
best interests of the patient and their family.
Overall, we highlight the importance of ethical considerations and effective
communication in the provision of perinatal palliative care for fetuses with genetic
disorders and congenital defects. Also, while there is much that remains uncertain and controversial in this field, continued research and discussions are necessary to ensure
that the best possible care is provided for all patients and their families.
Subject Index
Page: 269-274 (6)
Author: Nima Rezaei and Noosha Samieefar
DOI: 10.2174/9789815124187123020016
Introduction
Common Pediatric Diseases: Current Challenges provides an update on different diseases and problems that affect child and adolescent health. The book starts with a quick introduction to challenges in the field of pediatrics and child health. This is followed by chapters on the outcomes of sexting, the integrated care of children with neurodevelopmental disorders, the influence of non-genetic transgenerational inheritance on children and adolescents’ development and the approach to pediatric genetic epilepsy. Additional topics covered in the book include the medical and social outcomes of cardiac diseases along with a review on specific aspects of fetal and neonatal medicine (meconium-stained newborns, transient tachypnea of newborns and fetal tumors). The book also features a chapter on Autism Spectrum Disorder during infancy and its early symptoms. The concluding chapter covers medical futility controversies and end-of-life care.