Purpose of Review-To evaluate the impact of the 2017 American Academy of Pediatrics Clinical Practice Guideline (2017 AAP CPG) for Screening and Management of High Blood Pressure in Children and Adolescents. Recent Findings-The 2017 AAP CPG had several significant changes compared to the 2004 Fourth Report. This review will focus on the emerging evidence from the first studies to apply the 2017 AAP CPG and the simplified table it contains on the overall prevalence of HTN and on recognition among children and adolescents at a higher cardiovascular risk. Summary-Recent evidence suggests that use of the 2017 AAP CPG will result in an overall increase in prevalence of HTN, particularly in youth who are obese or who have other cardiovascular risk factors. The change in prevalence likely differs based on sex, age, and height. The ability for the 2017 AAP CPG to detect an association with hypertension and target organ damage requires further study. Continued study is required to assess long-term implications of the 2017 AAP CPG with the goal of a more meaningful HTN definition in the young.

Background Acute kidney injury (AKI) is common in pediatric patients undergoing liver transplantation (LT), with an incidence 17%–55%. Fluid, metabolic, and acid–base aberrancies are often pronounced pre‐operatively and further worsened by events during LT, making intra‐operative continuous renal replacement therapy (CRRT) an option for critically ill LT recipients. Methods All pediatric LT performed at our institution who underwent intra‐operative CRRT between January 2017 and August 2021 were included. Patient demographics and clinical data including graft outcomes, intra‐operative findings, and timing and indications for CRRT were collected from the electronic medical record. Results CRRT was used in nine of the 76 (12%) pediatric LT performed at our center during the study period. Ages at LT ranged from 39 to 17.7 years. Recipients requiring CRRT were more likely to have acute liver failure, status 1A, and higher calculated MELD/PELD scores. CRRT was initiated pre‐transplant in three recipients and continued post‐transplant in six recipients. Median duration of CRRT was two (range 0–14) days. Indications included hyperammonemia (3/9), acidosis (3/9), fluid overload (6/9), and hyperkalemia (2/9). The CRRT group had a significantly longer post‐transplant intensive care unit length of stay in comparison to those that did not require CRRT (median 6, range 3–40 days vs. median 3, range 0–121 days, p = .02], but there were no significant differences in reoperations, hospital length of stay, or recipient or graft survival. Conclusions We demonstrate that CRRT can be safely performed in pediatric LT recipients, including young infants through adolescents.

No abstract