What are the pediatric screening guidelines?

From the Guidelines

Pediatric screening tests should be performed according to the American Academy of Pediatrics' recommendations, which include screenings for dyslipidemia, hematocrit or hemoglobin, sexually transmitted infections, vision, cervical dysplasia, oral health, critical congenital heart disease, alcohol and drug use, and depression, as outlined in the 2016 update 1. The recommended screenings are as follows:

• Dyslipidemia screening in children 9 to 11 years old
• Hematocrit or hemoglobin screening at 12 months, and risk assessment at 15 and 30 months
• Sexually transmitted infection/HIV screening in adolescents 16 to 18 years old
• Vision screening at 4 and 5 years old, and instrument-based screening at other ages
• Cervical dysplasia screening starting at 21 years old
• Oral health screening with fluoride varnish application from 6 months to 5 years old
• Critical congenital heart disease screening with pulse oximetry in newborns before hospital discharge
• Alcohol and drug use assessment using the CRAFFT screening questionnaire
• Depression screening annually for children and adolescents 11 through 21 years old, as recommended by the American Academy of Pediatrics 1. These screenings are crucial for early detection and intervention, which can significantly improve outcomes for children with various health concerns, ultimately reducing morbidity, mortality, and improving quality of life.

From the Research

Pediatric Sickle Cell Disease

• Sickle cell disease (SCD) is an inherited disorder of hemoglobin, characterized by formation of long chains of hemoglobin when deoxygenated within capillary beds, resulting in sickle-shaped red blood cells, progressive multiorgan damage, and increased mortality 2
• An estimated 300 000 infants are born annually worldwide with SCD, with most individuals living in sub-Saharan Africa, India, the Mediterranean, and Middle East; approximately 100 000 individuals with SCD live in the US 2
• SCD is diagnosed through newborn screening programs, where available, or when patients present with unexplained severe atraumatic pain or normocytic anemia 2

Symptoms and Complications

• SCD is characterized by repeated episodes of severe acute pain and acute chest syndrome, and by other complications including stroke, chronic pain, nephropathy, retinopathy, avascular necrosis, priapism, and leg ulcers 2
• In the US, nearly all children with SCD survive to adulthood, but average life expectancy remains 20 years less than the general population, with higher mortality as individuals transition from pediatric to adult-focused health care systems 2

Treatment Options

• Hydroxyurea, which increases fetal hemoglobin and reduces red blood cell sickling, was the only disease-modifying therapy available for SCD until 2017, and remains first-line therapy for most individuals with SCD 2
• Three additional therapies, L-glutamine, crizanlizumab, and voxelotor, have been approved as adjunctive or second-line agents, with clinical trials showing reduced hospitalization rates, pain crises, and increased hemoglobin levels 2
• Hematopoietic stem cell transplant is the only curative therapy, but it is limited by donor availability, with best results seen in children with a matched sibling donor 2

Pain Management

• Pain is a hallmark of sickle cell disease (SCD) and its treatment remains challenging, with opioids being the major family of analgesics commonly used for treating severe pain 3
• However, opioids may have organ-specific pathological effects and exacerbate existent organ damage, highlighting the need to evaluate their role and contribution to complications in SCD 3
• Hospitalists managing pain in adults with SCD often have questions about defining a crisis, selecting and managing opioids, and distinguishing between opioid tolerance, physical dependence, and addiction or misuse 4