Provide the reader with an understanding of the causes, diagnostic approach and management of neonatal blood loss, as well as recommendations for acute neonatal transfusion practices. Recognition of neonatal blood loss has improved with increased awareness and advances in diagnostic tools, including rapid diagnostic tools that identify fetal blood in suspected bleeding from vasa previa - as well as rapid hemoglobin and acid/base measurements with bedside blood-gas/ABG analyzers. However, clinical guidelines and recommendations for the management of neonatal blood loss remain scarce, largely due to limited high-quality randomized controlled trials in neonates. In addition, standardized protocols for massive transfusion in neonates are largely lacking, highlighting an important gap in current neonatal care. Neonatal blood loss can result from a wide range of perinatal, obstetric and internal bleeding causes. Early recognition is essential to prevent morbidity and mortality. This review gives an overview of current knowledge regarding evaluation and management of neonatal blood loss while highlighting recent developments in diagnostic strategies and transfusion practices.
Transitional urology is an emerging field focused on guiding adolescents with congenital genitourinary conditions into adult-oriented care. Despite increasing recognition of its importance, successful transition remains challenging. This review aims to identify and synthesize key barriers to healthcare transition across patient, provider, and system levels, and to examine how these barriers impact clinical outcomes. Recent literature demonstrates that barriers to transitional care are multifactorial and interrelated. Patient-level challenges include variability in transition readiness, psychosocial factors, and competing life priorities during young adulthood. Provider-level barriers include limited adult expertise in congenital urologic conditions, inconsistent preparation by pediatric providers, and communication gaps between care teams. At the system level, lack of formalized transition infrastructure, poor care coordination, and inadequate information transfer further contribute to discontinuity of care. These barriers are associated with measurable consequences, including loss to follow-up, accumulation of untreated urologic conditions, and increased reliance on acute healthcare services Barriers to transitional urologic care significantly impact long-term health and quality of life outcomes for patients with lifelong urologic conditions. Structured, multidisciplinary transition models, early and individualized transition planning, and improved provider training represent key strategies to address these challenges. Future research should focus on developing standardized transition pathways, validating disease-specific readiness tools, and evaluating long-term outcomes to optimize care delivery for this growing patient population.
Vesicoureteral reflux (VUR) is a common pediatric condition associated with recurrent febrile urinary tract infections (UTIs), renal scarring, and potential long-term kidney dysfunction. VUR is typically diagnosed by voiding cystourethrogram and graded I-V, with higher grades generally associated with lower rates of spontaneous resolution and greater risk of renal injury. Clinical course is influenced by reflux grade, age, infection history, laterality, and bladder and bowel dysfunction (BBD). This review synthesizes contemporary evidence and management principles regarding the natural history, risk stratification, medical and surgical treatment, surveillance, and primary care management of pediatric VUR, with emphasis on individualized decision-making and the role of general pediatricians. Management of VUR requires balancing the risks of recurrent infection and renal injury against the likelihood of spontaneous resolution. Continuous antibiotic prophylaxis (CAP) reduces recurrent UTIs, particularly in children with higher-risk features, but is associated with antimicrobial resistance, adherence challenges, and treatment burden. Contemporary practice therefore favors selective, risk-based use of CAP rather than universal prophylaxis. Surveillance increasingly emphasizes renal and bladder ultrasonography while limiting repeat cystography and dimercaptosuccinic acid scans to selected indications. Predictive models and nomograms may further refine estimates of spontaneous resolution and infection risk and support individualized management. Surgical intervention is highly effective in correcting reflux and is generally reserved for children with breakthrough febrile UTIs, persistent high-grade reflux, renal abnormalities, or other high-risk features, although its impact on long-term renal outcomes remains uncertain. Management of pediatric VUR is evolving toward individualized, risk-adapted care that integrates clinical risk factors, likelihood of spontaneous resolution, treatment burden, family preferences, and emerging predictive tools. General pediatricians play a central role in recognizing recurrent febrile UTIs, identifying and treating BBD, counseling families, ensuring appropriate imaging surveillance, and referring children with high-grade reflux, renal abnormalities, recurrent or breakthrough infections, or other concerning features for subspecialty evaluation. Purpose of Review:Vesicoureteral reflux (VUR) is a common pediatric condition associated with recurrent febrile urinary tract infections (UTIs), renal scarring, and potential long-term kidney dysfunction. This review summarizes the natural history, risk stratification, monitoring, and contemporary management of VUR, with an emphasis on the role of general pediatricians in coordinating individualized care.Recent Findings:The clinical course of VUR varies substantially according to reflux grade, age, history of febrile UTI, renal abnormalities, and the presence of bladder and bowel dysfunction (BBD). Low-grade VUR frequently resolves spontaneously, whereas higher-grade reflux is less likely to resolve and carries a greater risk of recurrent infection and renal injury. Continuous antibiotic prophylaxis reduces recurrent UTIs, particularly among children with higher-risk features, but must be balanced against antimicrobial resistance, medication adherence, and treatment burden. Current practice therefore favors selective, risk-based prophylaxis rather than universal treatment. Follow-up strategies increasingly prioritize renal and bladder ultrasonography while reserving repeat cystography and dimercaptosuccinic acid renal scanning for selected indications. Predictive models and nomograms may further support individualized decisions regarding surveillance, prophylaxis, and intervention. Surgical treatment is highly effective in correcting reflux and is generally reserved for breakthrough febrile UTIs, persistent high-grade reflux, or other high-risk features, although its effect on long-term renal outcomes remains uncertain.Summary:Management of pediatric VUR is evolving toward individualized, risk-adapted care that balances the likelihood of spontaneous resolution against the risks of recurrent infection and renal injury. General pediatricians play a central role in recognizing recurrent febrile UTIs, counseling families, identifying and treating BBD, ensuring appropriate imaging follow-up, and referring children with high-grade reflux, renal abnormalities, recurrent or breakthrough infections, or other concerning features for subspecialty evaluation.
The purpose of this review is to highlight contemporary changes in the management of pediatric neurogenic bladder, using spina bifida as the reference population. Advances in early diagnosis, pharmacotherapy, and surveillance strategies have altered traditional treatment paradigms, with a growing emphasis on bladder preservation and prevention of upper urinary tract deterioration. Recent literature demonstrates an increased reliance on medical management as first-line therapy. Anticholinergic agents remain the cornerstone of treatment, with expanding use of beta-3 adrenergic agonists as adjuncts or alternatives. Intradetrusor onabotulinumtoxinA has emerged as an effective option for refractory detrusor overactivity, offering improved bladder compliance and continence outcomes. While these strategies may delay or reduce the need for surgical reconstruction, their long-term impact on rates and timing of lower urinary tract reconstruction remains unclear and warrants ongoing investigation. Multiple clinical guidelines now support structured, proactive management incorporating early clean intermittent catheterization, pharmacologic therapy and routine urinary tract surveillance. Imaging and urodynamics play a critical role in monitoring renal health and bladder dynamics. However, there remains uncertainty regarding the optimal protocol for longitudinal follow-up, including frequency and modality of evaluation. Future research should focus on standardizing surveillance strategies and determining how evolving medical therapies influence long-term surgical needs and patient outcomes.
Severe hypospadias, defined as proximal meatal ectopy with significant ventral curvature, represents a complex reconstructive challenge for pediatric urologists. This review synthesizes contemporary evidence on techniques and considerations for severe hypospadias management. This review covers high-yield topics including but not limited to: preoperative hormonal stimulation, intraoperative curvature assessment to minimize erroneous operative decisions, globally favored staged reconstruction approaches, a general framework outlining management strategies, and more. While mild phenotypes predominate prevalence, severe cases of hypospadias contribute disproportionately to surgical complexity, complication risk, and long-term morbidity. Numerous techniques have been used to address severe hypospadias, each with their own respective indications and limitations. Despite technical advances, long-term outcomes data remain limited by poor follow-up adherence, inconsistent phenotypic nomenclature, and underutilization of patient-reported outcome measures. Multi-center collaboration and standardized reporting frameworks are essential to advance evidence-based care and meaningfully counsel families on long-term functional and psychosocial outcomes.
Lower urinary tract symptoms (LUTS) affect an estimated 5-15
Neonatal sepsis (NS) is a leading cause of morbidity and mortality, and its definition has undergone recent changes. Neonatal septic shock (NSS), its most severe evolution, presents a clinical challenge due to its subtle and nonspecific early presentation, which often overlaps with normal neonatal adaptation and non-infectious conditions. Several diagnostic and therapeutic strategies have been developed to address NS and NSS, and these approaches are extensively discussed in this review. Biomarkers such as C-reactive protein, procalcitonin, interleukin-6, presepsin, and neutrophil CD64 may support diagnosis and management, but all have limitations. Targeted neonatal echocardiography and point-of-care ultrasound can improve shock phenotyping and guide individualized resuscitation, while near-infrared spectroscopy offers complementary information on regional tissue oxygenation. Machine learning models show promising diagnostic performance, but external validation and implementation studies remain limited. Antimicrobial stewardship, smaller fluid boluses, and physiology-guided vasoactive support are increasingly emphasized. Adjunctive therapies remain largely investigational and prevention continues to be the most effective strategy. The management of NS and NSS is evolving from protocol-driven care to individualized, multimodal assessment. Integrating clinical evaluation with biomarkers, imaging, microbiological testing, and risk stratification may improve early recognition and treatment. Future progress will depend on rigorous validation of precision tools, broader access to bedside technologies, and context-adapted implementation strategies.
Neonatal home phototherapy is novel approach to de-institutionalize and demystify newborn healthcare through early and careful identification of newborns who are at risk for severe hyperbilirubinemia but are at low risk for acute bilirubin encephalopathy (kernicterus) such that bilirubin reducing intervention may be administered in a safe, remotely medical-supervised setting such as the family home. Advent of affordable light-emitting-diode (LED) lamps configured to a specific narrow blue-green wavelength with the clinical capacity to provide remotely but intensely supervised medical care in a low-risk setting as well as the ability to track bilirubin values with point-of-care settings has allowed several global communities to structure curricula and standard-operating-procedures to practice neonatal home phototherapy. Thus far, the literature review has demonstrated no adverse outcomes for kernicterus, exchange transfusion, any complications attributed to phototherapy or rising bilirubin levels. These practices have been implemented in diverse cultural and geographic communities. More extensive and evidence-based experiences would enhance both clinical and societal roles of this intervention. However, this approach is not an alternative for those needing in-hospital treatment, such as preterm neonates, those with proven hemolytic disorders, sepsis or other neonatal illnesses that require intensive cardio-pulmonary care. Most importantly, active parent-partnership, education, support and collaboration is the primary key to success. Neonatal home phototherapy is feasible; it is safe, and it is a valid alternative to in-hospital phototherapy if candidate neonates are selected carefully to exclude unexpected experiences. Clinicians need to selectively identify the most suitable candidates (babies and their families), provide thorough and understandable parent education, and carefully guide equipment use and maintenance as well as vigilantly track serial TSB levels of infants> Neonates treated at home should have similar care as during in-patient practice. Costs of home phototherapy appear to be considerably less than those for rehospitalization. Advantages of breast-feeding at home are beneficial such that both clinician and family satisfaction is incurred while minimizing any adverse consequences.
This review aims to synthesize current evidence on the epidemiology, virology, diagnosis, prevention, and management of hepatitis B virus (HBV) infection in children. It highlights global efforts toward HBV elimination, with a focus on the unique clinical challenges andtherapeutic strategies relevant to pediatric populations. Global HBV vaccination initiatives have significantly reduced pediatric HBV prevalence;however, the disease remains endemic in many low-resource settings, largely due to gaps in timely birth-dose coverage and healthcare infrastructure. Recent guidelines emphasize risk-based screening, early antiviral intervention, and the use of non-invasive tools to assess liver fibrosis in children. Promising therapeutic advances include the use of pegylated interferon and nucleos(t)ide analogues, with emerging interest inimmunotherapeutic approaches and functional cure strategies. Novel cellular targets,such as CCR5⁺CD8⁺ T cells, and mRNA-based vaccines are under investigation. Hepatitis B continues to pose a serious health burden for children globally, particularly in regions with limited access to immunization and treatment. Effective elimination will require a multifaceted approach, including improving vaccination coverage, optimizing screening practices, and expanding access to pediatric-appropriate antiviral therapies. Continued research into age-specific immune responses and innovative therapeutic targets may accelerate progress toward functional cure and long-term disease control in the pediatric population.
This review explores the role of neurostimulation in the treatment of disorders of gut-brain interaction, gastroparesis, and chronic constipation. Specific neurostimulation methods including gastric electrical stimulation, percutaneous electrical nerve field stimulation, direct sacral nerve stimulation, posterior tibial nerve stimulation, and transcutaneous parasacral nerve stimulation will be highlighted and discussed. This article also evaluates the safety and efficacy of neurostimulation techniques as well as limitations of existing studies in the literature. Growing evidence suggests that neurostimulation is effective in improving a wide of gastrointestinal symptoms including nausea, abdominal pain, constipation, and fecal incontinence. Despite these encouraging results, important questions remain regarding the optimal frequency, duration, and long-term use of these therapies. Neurostimulation is emerging as a promising technology in the management of pediatric gastrointestinal disorders. Current research indicates that the major forms of neurostimulation are generally effective and safe, with noninvasive transcutaneous methods offering particularly strong safety profiles. These therapies provide the added advantage of targeted treatment while minimizing the systemic side effects commonly associated with pharmacologic interventions. As safety profiles improve, physicians are increasingly utilizing neurostimulation in the management of gastrointestinal disorders especially in patients with refractory disorders of gut-brain interaction.
Pediatric cardiac intensive care units manage high risk, rapidly evolving physiology in children with congenital heart disease within a data dense environment shaped by continuous monitoring, device-based therapies, and time constrained decisions. This review summarizes how artificial intelligence (AI) is being applied to clinically meaningful pediatric cardiac intensive care unit (PCICU) problems and outlines the implementation barriers and future directions required for safe bedside translation. AI enabled decision support in PCICU has expanded across short horizon early warning systems, including cardiac arrest and hemodynamic decompensation syndromes such as low cardiac output syndrome, dynamic extubation readiness assessment, and prediction of postoperative complications such as cardiac surgery associated acute kidney injury. These advances are increasingly supported by high fidelity physiologic data infrastructures and interpretability tools that can link risk outputs to recognizable physiologic patterns and therapy intensity. In parallel, digital twin approaches in congenital heart disease, spanning electrophysiology focused and anatomy centered models, are emerging as a pathway toward simulation enabled personalization. Despite this momentum, most studies remain retrospective, with limited external validation, infrequent calibration reporting, and persistent gaps in prospective impact evaluation and workflow integration. Key barriers include pediatric data scarcity, center specific bias, alarm ecology and usability constraints, governance and lifecycle monitoring requirements, and regulatory and financial bottlenecks for pediatric specific AI. AI is poised to mature from isolated prediction models into trustworthy clinical infrastructure for PCICU, but clinical impact will depend on implementation discipline as much as model performance. High priority needs include multicenter collaboration, including privacy preserving scaling strategies such as federated learning, harmonized definitions and time synchronization standards for high fidelity streams, human centered and human in the loop design to reduce alert burden, routine subgroup auditing to mitigate inequities, and protocol linked actionability that maps risk states to predefined responses. With robust governance, transparency, and clinician education, AI can enhance intensive care unit to home continuity and personalized care while preserving safety, accountability, and patient clinician trust.
Pediatric shock remains a leading cause of preventable mortality in low-resource settings, where limited diagnostics, shortages of trained personnel, and constrained critical care infrastructure delay recognition and treatment. The purpose of this narrative is to review studies current evidence and frontline innovations to guide clinicians working in low-middle income countries (LMICs), with particular emphasis on LMIC-specific etiologies such as malaria, dengue, anemia, burns, heat and malnutrition. A comprehensive, non-systematic search of the literature from 1990 to 2025 was conducted regarding clinical practice guidelines and implementation studies related to emergency care delivery in LMICs. Searches were performed in PubMed, Google Scholar, and WHO IRIS and sources included the following: World Health Organization (WHO) guidelines, Surviving Sepsis Campaign pediatric recommendations, Global Burden of Disease (GBD) reports, relevant key trials, studies, and context-specific documents. Due to limited laboratory and invasive monitoring in low-resource settings, early detection of shock relies on clinical signs such as capillary refill time, pulse quality, and mental status. Recent studies focused on fluid resuscitation strategies, like those established in the African FEAST trial, revealed that early fluid resuscitation in children with shock may increase mortality when compared to children who did not receive fluid boluses. As a result, a cautious stepwise administration of crystalloids with frequent reassessment is the current, predominate fluid resuscitation strategy used in low-resource settings. When fluids alone fail, epinephrine or norepinephrine are preferred over dopamine as first-line vasoactive agents, with peripheral or intraosseous delivery and gravity-drip systems offering feasible alternatives to infusion pumps. Neonates require special consideration: Kangaroo Mother Care sharply reduces hypothermia, and routine glucose screening mitigates occult hypoglycemia. In the context of hemorrhagic shock, whole blood is used rather than its components due to chronic blood shortages, with tranexamic acid and improvised autotransfusion serving as adjuncts. Low-cost technologies, such as telemedicine, task-shifting protocols, solar-powered devices, and AI-assisted triage, demonstrate promising reductions in mortality when integrated into broader health system improvements. Together, these context-adapted approaches form a pragmatic roadmap for improving pediatric shock outcomes in resource-scarce settings. This review discusses the challenges of pediatric shock management in low-resource settings and outlines practical, evidence-based approaches to improve outcomes. We focus on (1) clinical recognition of shock without advanced diagnostics (2), acute resuscitation strategies, including fluid therapy, vasoactive support, and transfusion alternatives tailored to resource-limited environments, and (3) innovative interventions and research advances that hold promise for the future of pediatric emergency and critical care in LMICs. By synthesizing current evidence and expert recommendations, we aim to provide a framework for clinicians and health systems to strengthen the care of children with shock in settings where resources are constrained.
Echocardiography serves as the primary diagnostic and surveillance non-invasive imaging modality for pediatric and congenital heart disease in fetal, pediatric, and adult patients. Echocardiography for this patient population is often constrained by anatomical complexity and rarity of lesions, significant inter-operator variability, and a global shortage of specialized expertise. Artificial intelligence (AI), specifically through machine learning and deep learning, is revolutionizing all steps of the echocardiography “imaging pipeline.” The more recent application of AI into pediatric and fetal echocardiography has yielded a number of promising studies for improving the efficiency, reproducibility, and accuracy of all aspects of the imaging pipeline. These include opportunities to enhance image acquisition and quality, automate view classification, automate measurements, and structure segmentation, improve disease detection, diagnosis, and fetal screening, enhance risk stratification and precision medicine, and create clinical decision support systems. This review explores the integration of AI in image acquisition and optimization, automated view classification, structure segmentation, and diagnosis and clinical decision support systems. By synthesizing foundational principles from the medical literature from 2020 to 2025, we outline how AI is transitioning from a primarily research-based interest to a clinical instrument in the quest for precision pediatric cardiology.
Neonatal heart failure is a high risk, heterogeneous syndrome that emerges at the intersection of immature myocardial biology, rapid postnatal circulatory transition, and evolving systemic metabolic demand. Rather than a single diagnosis, it represents a shared physiologic endpoint arising from structural congenital heart disease, primary genetic and metabolic cardiomyopathies, and acquired myocardial injury related to inflammation, ischemia reperfusion, hypoxia, or sepsis. In this population, the brain, kidneys, liver, and gastrointestinal tract are uniquely vulnerable to impaired systemic oxygen delivery, making neonatal heart failure fundamentally a systemic disease with downstream multiorgan and neurodevelopmental consequences. This chapter reframes neonatal heart failure through an oximetric physiologic lens centered on the balance between oxygen delivery and oxygen consumption, emphasizing cardiac output and oxygen content over isolated pressure based endpoints. Pharmacologic therapies are organized according to their effects on preload, afterload, contractility, heart rate, energetic efficiency, and venous capacitance, with focused discussion of milrinone, levosimendan, ivabradine, and sacubitril valsartan alongside disease specific metabolic therapies such as carnitine supplementation. Escalation strategies including extracorporeal membrane oxygenation and durable ventricular assist devices are reviewed, as are evolving approaches to neonatal heart transplantation including ABO incompatible transplantation and contemporary size matching strategies. Emerging regenerative and enzymatic therapies for selected metabolic and lysosomal cardiomyopathies further highlight a shift toward disease modifying interventions. Neonatal heart failure is best understood as a disorder of inadequate systemic oxygen delivery with multiorgan consequences. An oximetric, physiology grounded framework that prioritizes cardiac output, oxygen content, and venous physiology enables more precise therapeutic targeting. Integration of advanced therapies with high fidelity physiologic monitoring, imaging, biomarkers, and molecular tools represents a path toward precision driven neonatal care.
Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced therapy for refractory pediatric cardiac arrest. This review outlines the clinical and organizational components necessary to implement and sustain a successful pediatric ECPR program. Registry analyses and updated resuscitation guidelines emphasize the importance of minimizing low-flow time, optimizing cardiopulmonary resuscitation (CPR) quality, and rapidly deploying ECPR in select patients. Shorter CPR duration and lower post-cannulation lactate are associated with improved outcomes, highlighting the need for formalized activation pathways and efficient team dynamics. Evidence supports the use of standardized protocols, predefined team roles, equipment bundling, and simulation-based training to reduce time to cannulation and improve reliability. Human factors and systems engineering frameworks, including the Systems Engineering Initiative for Patient Safety (SEIPS) model, provide structured approach to aligning personnel, tasks, technology, environment, and organizational processes across the continuum of ECPR care. ECPR is a complex, time-sensitive therapy that requires deliberate programmatic development to translate technical capability into meaningful survival and neurologic outcomes. Institutions seeking to offer ECPR should adopt structured activation criteria, simulation-based systems testing, and ongoing performance evaluation to ensure safe, timely, and effective delivery.
Pediatric procedural sedation (PPS) is a common and essential component of emergency department practice, enabling painful, prolonged, or anxiety-producing procedures to be performed in children who are otherwise uncooperative. Over the past two decades, PPS has evolved from a primarily analgesic intervention to a structured process guided by safety protocols, standardized monitoring, and pharmacologic strategies. However, sedation practices vary considerably across regions, particularly between high-resource and resource-limited settings. This review aims to examine current evidence on PPS in the emergency department, with a focus on global practice patterns, safety, pharmacologic management, and monitoring requirements across different resource environments. PPS is widely utilized across emergency departments, with common indications including fracture reduction, laceration repair, diagnostic imaging, and other invasive bedside procedures. Evidence from large registries and multicenter studies indicates a low incidence of serious adverse events when sedation is performed by trained personnel using standardized protocols. Ketamine remains the most commonly used sedative agent worldwide, particularly in resource-limited settings, due to its reliable dissociative properties and favorable airway safety profile. In contrast, propofol and combination regimens are more frequently used in high-resource environments and are associated with a higher incidence of respiratory complications, necessitating advanced monitoring. PPS in the emergency department is generally safe and effective when guided by evidence-based practices, appropriate patient selection, and adequate monitoring. Adaptable sedation strategies that account for local resources, while maintaining core safety principles, may help optimize outcomes across diverse healthcare settings.
This review examines barriers that prevent general outpatient pediatric providers from delabeling patients with low-risk penicillin allergy. It provides a summary of current progress and offers insight into potential solutions to improve clinical implementation. Unverified penicillin allergy, often labeled in early childhood, are associated with adverse health outcomes and increased healthcare costs over time. Consequently, the focus has shifted to the general pediatric setting for identifying and delabeling low-risk allergy. This review concentrates on key factors influencing implementation in outpatient pediatrics, including the need for standardized, validated pediatric-specific protocols; the perceptions and education of patients and medical staff; environmental and social determinants of health; and economic and logistical challenges. This review identifies the primary obstacles to effective outpatient delabeling as knowledge gaps among providers, patient and family apprehension, systemic healthcare challenges, and disparities in allergy care resources. Overcoming these barriers will require a multi-faceted approach that includes structured education, the adoption of validated low-risk penicillin allergy delabeling strategies for pediatric patients, and policy-driven changes to healthcare delivery. These efforts are essential for improving outcomes for pediatric patients labeled with a history of penicillin allergy. This review provides practical insights and solutions to barriers faced in the general outpatient pediatric implementation of low-risk penicillin allergy delabeling.
The aim of this review is to provide a comprehensive summary of current clinical evidence on the relationship between GLP-1 receptor agonists and pediatric obesity, to evaluate these findings from metabolic and therapeutic perspectives, and to offer potential directions for future research in the field. Obesity is a chronic disease that threatens health across all age groups, particularly children and adolescents. Lifestyle modification and nutrition-based approaches are regarded as the cornerstone strategies for treating pediatric obesity; however, they have important limitations in achieving sustainable long-term weight loss. This has increased interest in pharmacological treatment options. GLP-1 receptor agonists were originally developed for the treatment of type 2 diabetes mellitus, and they are now among the pharmacological agents with therapeutic indications not only in adults but also in pediatric and adolescent populations. As clinical evidence of their effects on body weight has accumulated, these agents have been incorporated into obesity treatment indications. In current clinical practice, the GLP-1 receptor agonists with approved indications for the treatment of pediatric obesity are liraglutide and semaglutide. Available evidence indicates that GLP-1 receptor agonists represent a promising pharmacotherapeutic option for the treatment of obesity in children and adolescents. Nevertheless, more comprehensive studies are needed regarding the long-term efficacy, safety profiles, and clinical positioning of these agents. Future research is expected to clarify the role of GLP-1 receptor agonists in the management of pediatric obesity.
To provide the reader with understanding of neonatal physiology relating to fluids and electrolytes, and how optimal enteral and parenteral fluid provision should be provided during the transition from intra- to extrauterine life and during management of the various disorders that may occur in the neonatal period. Traditional recommendations of parenteral fluid volumes for late preterm and term infants may overestimate their fluid needs, placing them at risk for overhydration reflected by inadequate postnatal weight loss and hyponatremia. Preterm infants require larger parenteral fluid volumes than those born at term, due to their greater insensible water loss and high urine output related to their inability to adequately concentrate urine. However, care must be taken not to provide excessive fluids as it increases their risk of morbidity, mortality and adverse developmental outcomes. When providing neonates with fluids and electrolytes the uniqueness of their physiology needs to be considered. Meticulous monitoring of serum sodium, body weight and fluid balance is needed to optimize fluid and electrolyte management, especially in extremely preterm and sick infants. The volume and composition of fluid given must be adequate to maintain body homeostasis, but excessive fluid administration increases the risk of adverse neonatal outcomes.
