http://pediatrics.aappublications.org:80 This feed contains articles for Pediatrics Subject Collection "Ophthalmology" Pediatrics http://pediatrics.aappublications.org:80 http://pediatrics.aappublications.org:80/cgi/content/short/30/11/e81?rss=1 Objectives Objectives Definition Epidemiology Causes and Pathogenesis Diagnosis and Evaluation Associated Neurologic and... Neuroimaging Visual Evoked Potentials (VEP) Visual Improvement Beyond the Striate Cortex Prognosis Rehabilitation and Management References After completing this article, readers should be able to: Recognize cortical visual impairment (CVI) as an important cause of pediatric visual loss. Identify the most frequent causes of pediatric CVI and, more specifically, understand the role of hypoxia as a cause of central visual damage. Describe the different pat ... Ospina, L. H. 2009-11-01 doi:10.1542/pir.30-11-e81 Cortical Visual Impairment American Academy of Pediatrics 11 30 90 81 2009-11-01 INTERNET-ONLY ARTICLE http://pediatrics.aappublications.org:80/cgi/content/short/10/11/e550?rss=1 Retinopathy of prematurity (ROP) is a clinically multifactorial process characterized by the aberrant vascularization of the retina that has potentially devastating effects on vision in preterm infants. Despite an appreciation for the postnatal risk factors that contribute to the development of ROP, this condition continues to be a major cause of childhood blindness. Studies using the mouse model of oxygen-induced retinopathy (OIR) have identified new therapeutic targets that may be used to guide treatment and determine which babies are at highest risk for ROP development. Such factors include the hypoxia-driven proteins vascular endothelial growth factor (VEGF) and erythropoietin (EPO) as well as the maternally derived factors insulin-like growth factor-1 (IGF-1) and omega-3 polyunsaturated fatty acids (PUFAs). Each has been demonstrated to have phase-specific effects on the pathogenesis of ROP. Through an understanding of the contribution of the IGF-1 pathway to the development of ROP in particular, a new algorithm has been developed (WINROPTM) that uses postnatal weight gain to identify infants at highest risk for ROP in an attempt to target therapy and resources more effectively. Heidary, G. Lofqvist, C. Mantagos, I. S. Vanderveen, D. K. Hellstrom, A. Smith, L. E. 2009-11-01 doi:10.1542/neo.10-11-e550 Retinopathy of Prematurity: Clinical Insights from Molecular Studies American Academy of Pediatrics 11 10 557 550 2009-11-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/30/7/243?rss=1 Objectives Objectives Introduction Classification Structure and Developmental... Chlamydia trachomatis Infection Chlamydophila pneumoniae... Chlamydophila psittaci Infection Areas for Additional Research Summary References Suggested Reading After completing this article, readers should be able to: Describe the varied clinical manifestations of Chlamydia trachomatis infection in neonates, children, and adolescents. Know the clinical manifestations of Chlamydophila pneumoniae infection. List the various diagnostic criteria and methods for C trachomatis and C pneumoniae infections. Discuss the ... Chandran, L. Boykan, R. 2009-07-01 doi:10.1542/pir.30-7-243 Chlamydial Infections in Children and Adolescents American Academy of Pediatrics 7 30 250 243 2009-07-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/123/4/e638?rss=1 BACKGROUND. The risk for sight-threatening retinopathy of prematurity is predicted by using gestational age and/or weight at birth. All infants below a threshold undergo serial ophthalmologic examinations for identification of those who would benefit from treatment ([~]10%). We hypothesized that factoring in postnatal weight gain could identify children at risk for sight-threatening retinopathy of prematurity more specifically and earlier. METHODS. Weekly weights from birth to postmenstrual week 36 were retrospectively entered into a surveillance system that gave an alarm when the rate of weight gain decreased to a certain level. For all children (N = 354) screened and/or treated for retinopathy of prematurity at Sahlgrenska University Hospital in 2004-2007, weekly weights were recorded. One child was excluded because of known nonphysiologic weight gain (hydrocephalus). RESULTS. For 127 (36%) of 353 children, no alarm was given; for 40%, alarm at low risk was given after postmenstrual week 32. None of those children developed retinopathy of prematurity requiring treatment. Of the remaining 24% of children who received alarm at high or low risk before 32 postmenstrual weeks, 41% developed proliferative retinopathy of prematurity and 29% were treated because of sight-threatening disease. The median time from alarm to treatment was 9 weeks. CONCLUSIONS. The weight, insulin-like growth factor, neonatal retinopathy of prematurity algorithm detected early 100% of infants who developed retinopathy of prematurity requiring treatment and correctly predicted the majority who did not require treatment. With this simple postnatal evaluation, costly stressful eye examinations can be markedly reduced ([~]75% of infants). In addition, early identification of children at risk may lead to the initiation of interventions and possibly prevent sight-threatening retinopathy of prematurity. Hellstrom, A. Hard, A.-L. Engstrom, E. Niklasson, A. Andersson, E. Smith, L. Lofqvist, C. 2009-04-01 doi:10.1542/peds.2008-2697 Early Weight Gain Predicts Retinopathy in Preterm Infants: New, Simple, Efficient Approach to Screening American Academy of Pediatrics 4 123 645 638 2009-04-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/peds.2008-2697v1?rss=1 BACKGROUND. The risk for sight-threatening retinopathy of prematurity is predicted by using gestational age and/or weight at birth. All infants below a threshold undergo serial ophthalmologic examinations for identification of those who would benefit from treatment ([~]10%). We hypothesized that factoring in postnatal weight gain could identify children at risk for sight-threatening retinopathy of prematurity more specifically and earlier. METHODS. Weekly weights from birth to postmenstrual week 36 were retrospectively entered into a surveillance system that gave an alarm when the rate of weight gain decreased to a certain level. For all children (N = 354) screened and/or treated for retinopathy of prematurity at Sahlgrenska University Hospital in 2004-2007, weekly weights were recorded. One child was excluded because of known nonphysiologic weight gain (hydrocephalus). RESULTS. For 127 (36%) of 353 children, no alarm was given; for 40%, alarm at low risk was given after postmenstrual week 32. None of those children developed retinopathy of prematurity requiring treatment. Of the remaining 24% of children who received alarm at high or low risk before 32 postmenstrual weeks, 41% developed proliferative retinopathy of prematurity and 29% were treated because of sight-threatening disease. The median time from alarm to treatment was 9 weeks. CONCLUSIONS. The weight, insulin-like growth factor, neonatal retinopathy of prematurity algorithm detected early 100% of infants who developed retinopathy of prematurity requiring treatment and correctly predicted the majority who did not require treatment. With this simple postnatal evaluation, costly stressful eye examinations can be markedly reduced ([~]75% of infants). In addition, early identification of children at risk may lead to the initiation of interventions and possibly prevent sight-threatening retinopathy of prematurity. Hellstrom, A. Hard, A.-L. Engstrom, E. Niklasson, A. Andersson, E. Smith, L. Lofqvist, C. 2009-03-16 doi:10.1542/peds.2008-2697 Early Weight Gain Predicts Retinopathy in Preterm Infants: New, Simple, Efficient Approach to Screening American Academy of Pediatrics 2009 0 645 200826971 2009-03-16 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/30/2/65?rss=1 Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion References Case 2 Discussion Footnotes Case 3 Discussion A 16-year-old girl presents to the ED with persistent fever and headache for 9 days. She was previously healthy except for a tooth extraction 3 weeks ago, for which she received penicillin. She denies shortness of breath, visual changes, vomiting, diarrhea, palpitations, joint pain, weight loss, cough, or urinary symptoms. She had been seen repeatedly in the ED and had normal examination findings and unremarkable CBC, CSF analysis, and urinalysis. She was given intramuscular ceftriaxone and sent home with a prescription for oral azithromycin. After returning t ... Collins, S. W. Piebenga, E. C. Shaw, E. Toth, H. Fish, R. Dueker, D. Sadiq, R. Wolff, Y. 2009-02-01 doi:10.1542/pir.30-2-65 Index of Suspicion American Academy of Pediatrics 2 30 70 65 2009-02-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/123/2/e360?rss=1 To the Editor.-- Advances in wide-field digital imaging (WFDI) allow clinicians to routinely image the infant eye. It is perplexing that Kemper et al1 undertook a systematic review at such an early stage of this technology's life cycle when self-evidently the evidence base will not constitute a body of knowledge sufficient to permit meaningful appraisal. A recent UK systematic review2,3 recognized this insufficiency but did not denounce WFDI use in retinopathy of prematurity (ROP), noting that for some it is the technique of choice for ROP evaluation (as co-chair of the guideline group, Dr Fielder sent the draft guideline for the screening and treatment of retinopathy of prematurity3 to D. K. Wallace and G. E. Quinn by e-mail on November 20, 2 ... Fielder, A. R. Hildebrand, P. L. Ells, A. Lorenz, B. Trese, M. T. Capone, A. Gordon, R. A. Wilson, C. Fleck, B. W. Chiang, M. F. 2009-02-01 doi:10.1542/peds.2008-3579 Systematic Review of Digital Imaging Screening Strategies for Retinopathy of Prematurity American Academy of Pediatrics 2 123 361 360 2009-02-01 LETTERS TO THE EDITOR http://pediatrics.aappublications.org:80/cgi/content/short/123/2/e361?rss=1 Fielder et al take issue with our recent systematic review1 in which we concluded that the "evidence base is not sufficient to recommend that retinal imaging be routinely adopted by NICUs to identify infants who have serious retinopathy of prematurity [ROP]." Our report is timely because, as we described, many NICU directors are interested in investing in this technology. Although Fielder et al point to the helpful role of digital imaging in other domains (eg, nonaccidental trauma, serial imaging of certain eye diseases including ROP), our focus was solely on ROP screening and not on the use of digital imaging by an ophthalmologist as part of his or her routine diagnostic examination. The letter from Fielder et al identifies 2 main areas of disagreement: Absence of evidence is not evidence of absence. We agree and ... Kemper, A. R. Wallace, D. K. Quinn, G. E. 2009-02-01 doi:10.1542/peds.2008-3644 Systematic Review of Digital Imaging Screening Strategies for Retinopathy of Prematurity: In Reply American Academy of Pediatrics 2 123 362 361 2009-02-01 LETTERS TO THE EDITOR http://pediatrics.aappublications.org:80/cgi/content/short/123/2/714?rss=1 OBJECTIVE. We recently reported that 60% of children newly diagnosed with cystic fibrosis who had pancreatic insufficiency responded to treatment initiation and achieved catch-up weight gain to a level comparable with their birth weight z score within 2 years of diagnosis ("responders"), whereas the remaining 40% failed to do so ("nonresponders"). The present study examined the impact of this early weight recovery on subsequent growth pattern and pulmonary status at 6 years of age. PATIENTS AND METHODS. Sixty-three children with cystic fibrosis who had pancreatic insufficiency but no meconium ileus, and were enrolled in the Wisconsin Cystic Fibrosis Neonatal Screening Project, were studied. Responders were defined by a recovery of weight z score comparable with that at birth within 2 years of diagnosis. From ages 2 to 6, growth was measured by both height and BMI. Pulmonary status was evaluated by symptoms, spirometry, quantitative chest radiography, and respiratory microbiology. RESULTS. The majority (71%) of the responders maintained their early weight recovery through 6 years of age, whereas only 32% of the nonresponders achieved substantial growth improvement from 2 to 6 years of age. Proportionately fewer responders reported cough symptoms (10% daytime cough; 22% nighttime cough) compared with nonresponders (41% daytime cough; 45% nighttime cough) at age 6. The percentage of predicted forced expiratory volume in 1 second at age 6 was 11% higher in responders (99.5% {+/-} 13.9%) compared with nonresponders (88.3% {+/-} 18.5%). Responders had significantly better Brasfield (20.1 {+/-} 1.4) and Wisconsin chest radiograph (8.3 {+/-} 3.3) scores compared with nonresponders (Brasfield: 18.9 {+/-} 1.8; Wisconsin: 12.3 {+/-} 8.3). Respiratory microbiology results were not significantly different. Multiple regression analyses indicated that the positive association between responder and percent predicted forced expiratory volume in 1 second at 6 years of age remained statistically significant after controlling for infections with Pseudomonas aeruginosa and Staphylococcus aureus and chest radiograph scores. Growth patterns from 2 to 6 years of age were not associated with pulmonary measures at age 6. CONCLUSIONS. Patients with cystic fibrosis with pancreatic insufficiency who achieved early growth recovery within 2 years of diagnosis had fewer cough symptoms, higher lung function, and better chest radiograph scores at 6 years of age. Lai, H. J. Shoff, S. M. Farrell, P. M. with the Wisconsin Cystic Fibrosis Neonatal Screening Group, 2009-02-01 doi:10.1542/peds.2007-3089 Recovery of Birth Weight z Score Within 2 Years of Diagnosis Is Positively Associated With Pulmonary Status at 6 Years of Age in Children With Cystic Fibrosis American Academy of Pediatrics 2 123 722 714 2009-02-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/10/1/e20?rss=1 Retinopathy of prematurity (ROP) is a disorder of retinal vascular development in preterm infants. It remains a major cause of childhood blindness worldwide. This review addresses advances in knowledge during the past 8 years. The pathogenesis has become clearer with animal experimental work and from clinical observations. Large clinical trials have informed better management, and new retinal digital imaging is likely to change the role of the ophthalmologist. New treatment modalities, such as vascular endothelial growth factor (VEGF)-blocking antibodies, are being assessed. Finally, a number of evidence-based clinical guidelines for the management of ROP have been published. Fleck, B. W. McIntosh, N. 2009-01-01 doi:10.1542/neo.10-1-e20 Retinopathy of Prematurity: Recent Developments American Academy of Pediatrics 1 10 30 20 2009-01-01 ARTICLES