Prognosis of Epilepsies and Epileptic Syndromes in Children: A Narrative Review

Epilepsies and epileptic syndromes are among the most common chronic neurological disorders in neonates, infants, and children. Remission occurs in 70% of epileptic children, while other cases experience frequent seizures and become refractory to various treatment modalities. The present study aimed to provide a narrative review of the most important risk factors for the recurrence of epilepsies in children by two child neurologists.

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Advances in Diagnosis and Management of Hemodynamic instability in Neonatal Shock

Shock in newborn infants has unique etiopathologic origins that require careful assessment to direct specific interventions. The pathophysiology in shock in newborn infants is discussed, including the transitional changes at birth and unique features that contribute to the challenges in early identification. Special emphasis has been placed on bedside focused echocardiography/focused cardiac ultrasound, which can be used as an additional tool for early, neonatologist driven, ongoing evaluation and management. An approach to goal oriented management of shock has been described and how bed side functional echocardiography can help in making a logical choice of intervention (fluid therapy, inotropic therapy or vasopressor therapy) in infants with shock.

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Echocardiographic evaluation of Hemodynamics in Neonates and Children

Hemodynamic instability and inadequate cardiac performance are common in critically ill children. The clinical assessment of hemodynamic status is reliant upon physical examination supported by the clinical signs such as heart rate, blood pressure, capillary refill time, and measurement of the urine output and serum lactate. Unfortunately, all of these parameters are surrogate markers of cardiovascular well-being and they provide limited direct information regarding the adequacy of blood flow and tissue perfusion. A bedside point-of-care echocardiography can provide real-time hemodynamic information by assessing cardiac function, loading conditions (preload and afterload) and cardiac output.

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Moving Beyond the Stethoscope: Diagnostic Point-of-Care Ultrasound in Pediatric Practice

Diagnostic point-of-care ultrasound (POCUS) is a growing field across all disciplines of pediatric practice. Machine accessibility and portability will only continue to grow, thus increasing exposure to this technology for both providers and patients. Individuals seeking training in POCUS should first identify their scope of practice to determine appropriate applications within their clinical setting, a few of which are discussed within this article. Efforts to build standardized POCUS infrastructure within specialties and institutions are ongoing with the goal of improving patient care and outcomes.

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Expert consensus statement ‘Neonatologist-performed Echocardiography (NoPE)’ – training and accreditation in UK

NoPE, also referred to as targeted neonatal echocardiography, functional neonatal echocardiography and point of care ultrasound is widely practiced in the UK, but by clinicians with varying degrees of training and experience. A formalised programme of training and quality assurance has considerable scope to standardise practice, reduce risk of misdiagnosis and improve patient care. Recommendations for training and quality assurance are discussed.

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