Patients with congenital heart disease (CHD) are living longer due to advances in procedural options and care. However, there is a growing burden of chronic conditions, including chronic kidney disease (CKD). The purpose of this review is to summarize the current literature on the epidemiology, outcomes, and potential therapeutics for CKD in children, young adults, and adults with CHD. Recent studies have highlighted the burden of CKD in children and adults with CHD. Follow-up of kidney health in these patients is poor, and abnormalities in kidney function are often unrecognized. Significant advances in therapeutics have been used in adults to delay the progression of CKD, none of which have been tested in children with CHD. Improving our understanding of CKD and its pathogenesis in CHD is likely to aid in identifying patients who should receive early nephrology referral and those most likely to benefit from targeted therapies.
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.
