Preterm congenital heart disease and neurodevelopment: the importance of looking beyond the initial hospitalization.

Congenital heart disease (CHD) and prematurity are leading causes of infant mortality in the United States. Infants with CHD born prematurely are often described as facing "double jeopardy" with vulnerability from their underlying heart disease and from organ immaturity. They endure additional complications of developing in the extrauterine environment while healing from interventions for heart disease. While morbidity and mortality for neonates with CHD have declined over the past decade, preterm neonates with CHD remain at higher risk for adverse outcomes. Less is known about their neurodevelopmental and functional outcomes. In this perspective paper, we review the prevalence of preterm birth among infants with CHD, highlight the medical complexity of these infants, and emphasize the importance of exploring outcomes beyond survival. We focus on current knowledge regarding overlaps in the mechanisms of neurodevelopmental impairment associated with CHD and prematurity and discuss future directions for improving neurodevelopmental outcomes.

Utility of prenatal MRI in the evaluation and management of fetal ventriculomegaly.

OBJECTIVE: Fetal ventriculomegaly may occur in isolation or as part of a broader syndrome. We aimed to determine the added value of magnetic resonance imaging (MRI) for informing the pre-natal and postnatal care of pregnancies complicated by ventriculomegaly (VM). STUDY DESIGN: Retrospective analysis of all cases of prenatally diagnosed VM referred to the fetal center at Lucile Packard Children's Hospital Stanford 1/1/2009-6/1/2014 were reviewed. Ultrasound (US) and MRI findings were reviewed, and the added yield of MRI evaluated. RESULTS: A total of 91 cases of fetal VM were identified and 74 (81%) underwent MRI. In 62/74 (84%) cases, additional CNS or non-CNS findings, not seen on US, were discovered on MRI, of which 58 were CNS-related. Forty-six (62%) of the additional findings were considered clinically relevant, of which 45 were CNS-related. CONCLUSION: Fetal MRI identifies additional, clinically relevant CNS and non-CNS findings in a majority of cases of VM following initial US.

Update on adolescent immunizations: selected review of US recommendations and literature.

PURPOSE OF REVIEW: To provide a clinically relevant synopsis of recent research findings as well as updated recommendations from the American Academy of Pediatrics (AAP) and Advisory Committee on Immunization Practices (ACIP) regarding adolescent immunizations. RECENT FINDINGS: Coverage rates for the adolescent vaccinations continue to lag behind those of the childhood vaccinations, despite their importance. Recent research has focused on the reasons for suboptimal adolescent vaccination rates as well as strategies for improvement. By more fully understanding the barriers to immunization, efforts can be implemented to address these concerns and to ensure that all eligible adolescents receive their vaccinations. In addition, much work has focused on the duration of protection induced by childhood and adolescent vaccinations and the need for booster doses in older adolescents. Because immunity has been found to wane after vaccination, these booster doses can serve to more fully protect adolescents. This article reviews selected recent publications on human papillomavirus, meningococcal conjugate, and tetanus and diphtheria toxoids and acellular pertussis vaccines. SUMMARY: Adolescent vaccinations will continue to be studied and this research will serve to shape future recommendations. Through this work, we can learn the best methods to optimize the protection of all adolescents against these very serious diseases.

Update on child and adolescent immunizations: selected review of US recommendations and literature.

PURPOSE OF REVIEW: To provide a clinically relevant synopsis of recent research findings as well as updated guidelines from the American Academy of Pediatrics and Advisory Committee on Immunization Practices regarding child and adolescent immunizations. RECENT FINDINGS: Childhood vaccinations have served to dramatically reduce pediatric morbidity and mortality in the USA. Much of the recent research has focused on the improvement of current vaccines as well as on the development of new vaccines. By improving the safety, efficacy and immunogenicity of vaccinations, children can be more fully protected. Additionally, recommendations have broadened as vaccinations have been proven well tolerated and effective for a growing number of subpopulations. Although more groups of children are now included in vaccination recommendations, efforts must continue to ensure that all eligible children receive their vaccinations. This article reviews selected recent publications on influenza, human papillomavirus, the childhood and adolescent/adult formulations of diphtheria and tetanus toxoids and acellular pertussis, meningococcal conjugate and pneumococcal vaccines. The relationship between febrile seizures and childhood immunizations is explored. SUMMARY: The research on childhood and adolescent vaccinations is continuously growing and will serve to shape future recommendations. Through their findings, we can learn how to optimize the protection of all children and adolescents against these very serious diseases.