Abstract:
:CAD results from atherosclerosis, a chronic disease process that has its origin in childhood. Children and adolescents can be at higher risk for CAD by virtue of being from families with premature CAD or familial dyslipoproteinemias. The plasma lipid and lipoprotein levels result from a number of complex metabolic processes that are under the control of genetic and environmental (e.g., diet) influences. The normal ranges of plasma lipids and lipoproteins in children are known, and children and adolescents with dyslipoproteinemia are ordinarily defined as those having levels of plasma total, LDL, or triglyceride above the 95th percentile or with a low HDL cholesterol below the 5th percentile. Children of a parent with documented dyslipoproteinemia or with family history of premature CAD may be screened in the fasting state any time after 2 years of age. Following the exclusion of secondary causes of dyslipoproteinemia, the diagnosis of primary dyslipoproteinemia can be made. Lipoprotein patterns are not diagnostic for a given genotype. Efforts to determine further the biochemical defects responsible for a given phenotype have led to the investigation of gene coding for the apolipoproteins, the key enzymes in the lipoproteins pathways (LPL, HDL, and LCAT) and the receptors that process lipoproteins, such as the LDL receptor and the chylomicron remnant receptor. From a practical standpoint, the diagnosis of the kind of dyslipoproteinemia in a child will depend upon the nature and severity of the dyslipoproteinemia, both in the child (or adolescent) and in parents and siblings. Marked increases in plasma total and LDL cholesterol in the child and in at least one of the parents often reflect the presence of familial hypercholesterolemia, an inherited dominant condition due to a defect in the LDL receptor gene. The triglyceride levels are often normal. If the child has a different dyslipoproteinemia pattern from siblings and parents, then the diagnosis of familial combined hyperlipidemia or hyperapobetalipoproteinemia should be considered. Most children with mild or borderline elevations in total and LDL cholesterol will have polygenic hypercholesterolemia. Triglyceride problems in children and adolescents are relatively uncommon, particularly the more severe hypertriglyceridemia such as that found in lipoprotein lipase and apoC-II deficiency, dysbetalipoproteinemia, and type V hyperlipoproteinemia. High levels of Lp(a) lipoprotein, in isolation or in combination with other dyslipoproteinemia, accelerate risk for CAD. Low levels of HDL cholesterol in the absence of other abnormalities suggest the diagnosis of hypoalphalipoproteinemia.(ABSTRACT TRUNCATED AT 400 WORDS)
journal_name
Pediatr Clin North Amjournal_title
Pediatric clinics of North Americaauthors
Kwiterovich PO Jrdoi
10.1016/s0031-3955(16)37021-3subject
Has Abstractpub_date
1990-12-01 00:00:00pages
1489-523issue
6eissn
0031-3955issn
1557-8240pii
S0031-3955(16)37021-3journal_volume
37pub_type
杂志文章,评审abstract::Obstructive sleep apnea (OSA) is increasingly recognized in children. There is accumulating robust evidence to support early diagnosis and treatment of this condition. The purpose of this review is to provide an update on the epidemiology, clinical features, complications, and treatment of childhood OSA. The authors h...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2008.10.012
更新日期:2009-02-01 00:00:00
abstract::This article outlines a few of the hematologic problems that are particular to developing countries, particularly those of the tropics. Because of globalization and the increasing movement of populations, hematologists in wealthier countries must be aware of the general patterns of hematologic change in the important ...
journal_title:Pediatric clinics of North America
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doi:10.1016/s0031-3955(02)00087-1
更新日期:2002-12-01 00:00:00
abstract::The opportunity to mobilize linkages between quality improvement (QI) and research is at an early stage. This article describes some of the opportunities for and challenges of integrating QI and more traditional forms of clinical research to achieve broad improvements in medical care. The authors suggest that such int...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章
doi:10.1016/j.pcl.2009.05.008
更新日期:2009-08-01 00:00:00
abstract::Abnormalities of occlusal development manifest themselves clinically as a need for orthodontic treatment. There are many circumstances in which there is an interaction between traditional pediatric concerns and occlusal abnormalities. In some cases medical treatment impacts on the development of occlusion. In other ca...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0031-3955(16)38192-5
更新日期:1991-10-01 00:00:00
abstract::Healthy children may present acute mountain sickness (AMS) within a few hours after arrival at high altitudes. In few cases, serious complications may occur, including high-altitude pulmonary edema and rarely high-altitude cerebral edema. Those with preexisting conditions especially involving hypoxia and pulmonary hyp...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2020.09.015
更新日期:2021-02-01 00:00:00
abstract::Highly specialized pediatric critical care centers have matured significantly over the past two decades; however, access to this care is limited to tertiary care facilities and constrained by geography. With the advances of transport medicine, great distances can be spanned to bring critical care to the patient and pr...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0031-3955(16)38508-x
更新日期:1993-04-01 00:00:00
abstract::The management of chronic cough, a common complaint in children, is challenging for most health care professionals. Millions of dollars are spent every year on unnecessary testing and treatment. A rational approach based on a detailed interview and a thorough physical examination guides further intervention and manage...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2013.04.004
更新日期:2013-08-01 00:00:00
abstract::Beginning with a brief description of mature anatomic pathways and neurotransmitters in the "pain system," this article details their development in the human fetus, neonate, and child. Special emphasis is given to the basic mechanisms and physiologic effects of opioid analgesia. The clinical implications of these dat...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0031-3955(16)36722-0
更新日期:1989-08-01 00:00:00
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journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2017.03.011
更新日期:2017-08-01 00:00:00
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journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0031-3955(05)70402-8
更新日期:1996-02-01 00:00:00
abstract::Worldwide, cervical cancer is the fourth most common cancer among women. Human papillomavirus (HPV) vaccination, if broadly implemented, has the potential to significantly reduce global rates of morbidity and mortality associated with cervical and other HPV-related cancers. More than 100 countries around the world hav...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2015.08.004
更新日期:2016-02-01 00:00:00
abstract::Pediatricians and other medical providers caring for children need to be aware of the dynamics in the significant relationship between substance abuse and child maltreatment. A caregiver's use and abuse of alcohol, marijuana, heroin, cocaine, methamphetamine, and other drugs place the child at risk in multiple ways. M...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2009.01.006
更新日期:2009-04-01 00:00:00
abstract::In an otherwise healthy child with acute dehydration known to be due to diarrhea or vomiting, the amount of deficit can best be estimated by accurate weight. Total serum protein and hematocrit provide a rough estimate of reduction in circulating blood volume, but calculation from these data will usually underestimate ...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章
doi:10.1016/s0031-3955(16)32538-x
更新日期:1971-02-01 00:00:00
abstract::Fractures are common during childhood; however, they can also be the presenting symptom of primary or secondary causes of bone fragility. The challenge is to identify those children who warrant further investigation. In children who present with multiple fractures that are not commonly associated with mild to moderate...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2015.04.006
更新日期:2015-08-01 00:00:00
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journal_title:Pediatric clinics of North America
pub_type: 杂志文章
doi:10.1016/s0031-3955(16)33136-4
更新日期:1975-05-01 00:00:00
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journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2014.06.008
更新日期:2014-10-01 00:00:00
abstract::Intestinal failure (IF) is the ultimate malabsorption state, with multiple causes, requiring long-term therapy with enteral or intravenous fluids and nutrient supplements. The primary goal during management of children with potentially reversible IF is to promote intestinal autonomy while supporting normal growth, nut...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2009.07.005
更新日期:2009-10-01 00:00:00
abstract::This article reviews the necessary skills required for clinicians to make informed decisions about the use of medications in women who are breastfeeding. Even without specific data on certain medications, this review of kinetic principles, mechanisms of medication entry into breast milk, and important infant factors c...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2012.10.009
更新日期:2013-02-01 00:00:00
abstract::The adoptive process can produce unusual stresses on the child, and biologic and adoptive parents, from prenatal to postnatal life, and through the various phases of physical and pscyhological development. Because of the possibility of these children and their families falling into the "at risk" category with greater ...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章
doi:
更新日期:1975-08-01 00:00:00
abstract::This article describes the evolution of board certification for pediatricians and the current ongoing assessment process called Maintenance of Certification (MOC). To be called a board-certified pediatrician under the MOC framework requires a level of training, competence, and knowledge that can only be achieved by co...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章
doi:10.1016/j.pcl.2009.05.010
更新日期:2009-08-01 00:00:00
abstract::The development of feeding skills is an extremely complex process influenced by multiple anatomic, neurophysiologic, environmental, social, and cultural factors. Most children negotiate the necessary developmental sequence without significant difficulties. An understanding of the development of normal feeding abilitie...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0031-3955(16)38229-3
更新日期:1991-12-01 00:00:00
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journal_title:Pediatric clinics of North America
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更新日期:1986-12-01 00:00:00
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journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
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更新日期:1992-08-01 00:00:00
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journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2017.11.013
更新日期:2018-04-01 00:00:00
abstract::Recent advances in science and technology have led to the capability of early screening of newborn infants for congenital hypothyroidism. Preliminary screening programs in North America have been established in Quebec and in the Northwestern and Northeastern United States. To date these programs have screened approxim...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章
doi:10.1016/s0031-3955(16)33598-2
更新日期:1978-08-01 00:00:00
abstract::This article addresses the current and desired future state of interprofessional practice in pediatric hospital medicine. It focuses on identifying optimal team composition and work patterns, describing the value of parent involvement on both the patient's care team and on operational teams, describing the need for in...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2019.03.003
更新日期:2019-08-01 00:00:00
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journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.pcl.2010.01.004
更新日期:2010-02-01 00:00:00
abstract::Renal arteriography remains the only study to identify and define correctly both location and extent of renal artery stenosis. Because other studies do not adequately identify all children who have renal artery disease, it is reasonable to perform renal arteriography in those children with severe hypertension who do n...
journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
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更新日期:1993-02-01 00:00:00
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journal_title:Pediatric clinics of North America
pub_type: 杂志文章,评审
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更新日期:2005-10-01 00:00:00
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journal_title:Pediatric clinics of North America
pub_type: 历史文章,杂志文章,评审
doi:10.1016/j.pcl.2009.03.003
更新日期:2009-06-01 00:00:00