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Wallace CK, Vernazza CR, Emmet V, Singhal N, Sathyanarayana V, Tse Y, Taylor GD. Evaluation of UK paediatric nephrology teams' understanding, experience and perceptions of oral health outcomes and accessibility to dental care: a mixed-methods study. Pediatr Nephrol 2024; 39:2131-2138. [PMID: 38300268 PMCID: PMC11147922 DOI: 10.1007/s00467-024-06292-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Oral health conditions are common in children and young people (CYP) with kidney disorders. There is currently limited literature on how confident paediatric nephrology teams feel to identify and manage oral health concerns for their patients. METHOD An exploratory mixed-method survey was distributed across all 13 UK specialist paediatric nephrology centres with responses received from consultants, registrars, specialist nurses and special interest (SPIN) paediatricians. RESULTS Responses received from 109 multidisciplinary team members of 13/13 (100%) UK tertiary units. Ninety-two percent (n = 100) of respondents reported they had never received any training in oral health and 87% (n = 95) felt that further training would be beneficial to optimise care for patients and improve communication between medical and dental teams. Most respondents reported that they did not regularly examine, or enquire about, their patients' oral health. Only 16% (n = 17) reported that all their paediatric kidney transplant recipients underwent routine dental assessment prior to transplant listing. Severe adverse oral health outcomes were rarely reported and only 11% (n = 12) of respondents recalled having a patient who had a kidney transplant delayed or refused due to concerns about oral infection. Seventy-eight percent (n = 85) felt that joint working with a dental team would benefit patients at their unit; however, 17% (n = 18) felt that current infrastructure does not currently support effective joint working. CONCLUSIONS Across the UK, paediatric kidney health professionals report lack of confidence and training in oral health. Upskilling subspecialty teams and creating dental referral pathways are recommended to maximise oral health outcomes for CYP with kidney diseases.
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Affiliation(s)
| | | | - Victoria Emmet
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Nidhi Singhal
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | | | - Yincent Tse
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Greig D Taylor
- School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK
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2
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Landén I, Olander AE, Salmela E, Jahnukainen T, Ruokonen H, Alapulli H, Helenius-Hietala J. Oral findings in paediatric patients with severe heart, liver, and kidney failure prior to organ transplantation. Eur Arch Paediatr Dent 2024; 25:247-253. [PMID: 38483710 PMCID: PMC11058910 DOI: 10.1007/s40368-024-00879-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/31/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Organ transplantation is an effective treatment for children with severe heart, liver, and kidney diseases. These patient groups may have more oral and dental diseases than healthy controls. It is important to eliminate oral infection foci before transplantation and to maintain good oral health to avoid potential post-transplant complications. The aim of this study was to describe and compare oral health in Finnish paediatric heart, liver, and kidney transplant recipients prior to organ transplantation. METHODS Eighty-six children who received a heart (n = 21), liver (n = 19), or kidney (n = 46) transplant in Finland during the years 2014-2018 were included in this study. The inclusion criterion was a pre-transplantation oral examination. Oral hygiene, enamel anomalies, and the number of decayed, missing, and filled teeth (dmft/DMFT) were analyzed retrospectively from medical and dental records and compared between the three patient groups. RESULTS Children with liver (p = 0.043) or heart (p = 0.047) disease had higher combined primary and permanent dentition dmft/DMFT scores compared to children with kidney disease. A higher combined dmft/DMFT score was associated with poor oral hygiene (p = 0.005). No significant differences in oral hygiene between the patient groups were found. Furthermore, all patient groups had a high prevalence of developmental dental defects. CONCLUSION Children with liver or heart disease seem to have a higher combined dmft/DMFT score, indicating a higher prevalence of caries compared to children with kidney disease. Prevention of dental caries, along with promoting a good oral hygiene routine and regular check-ups, is suggested in these patient groups.
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Affiliation(s)
- I Landén
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, P.O. Box 281, 00029 HUS, Helsinki, Finland.
| | - A E Olander
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, P.O. Box 281, 00029 HUS, Helsinki, Finland
| | - E Salmela
- Department of Oral and Maxillofacial Diseases, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - H Ruokonen
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, P.O. Box 281, 00029 HUS, Helsinki, Finland
| | - H Alapulli
- Department of Oral and Maxillofacial Diseases, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Helenius-Hietala
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, P.O. Box 281, 00029 HUS, Helsinki, Finland
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3
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Nikolovski J, Chapman EE, Widmer RP, Ayer JG. Investigating the scope and costs of dental treatment provided under general anaesthesia among children with congenital heart disease. J Paediatr Child Health 2023; 59:885-889. [PMID: 37067153 DOI: 10.1111/jpc.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/02/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
AIM To identify the types of dental treatment provided under general anaesthesia for children diagnosed with congenital heart disease (CHD), quantify the costs within a publicly funded tertiary paediatric hospital setting and identify factors which affect the cost. METHODS A retrospective analysis of dental records (July 2015 to June 2019) was conducted for children with CHD who had undergone a dental general anaesthetic procedure at The Children's Hospital at Westmead, Australia. Patient and treatment-related information were collected, and a costing analysis was performed on 89 dental general anaesthetic procedures. RESULTS Mean age at the time of the general anaesthetic was 8.15 years. About 27% of children with CHD had a history of dental infection. Dental extractions and restorations comprised the majority of treatments provided, with extractions performed in 86% of procedures. The mean number of days in hospital was 1.43 and the mean cost was $4395.14. The cost was significantly greater when children presented with a facial swelling compared to any other reason. CONCLUSIONS Dental extractions are performed in the majority of general anaesthetics. Not only is there an economic burden to the public health system in providing dental treatment under general anaesthesia for children with CHD, the health impacts also appear to be substantial. A considerable proportion required overnight hospitalisation and days in hospital was strongly related to the cost of the dental general anaesthetic. Systematic referral pathways for accessing dental care are an important consideration for children with CHD.
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Affiliation(s)
- Jana Nikolovski
- Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Westmead Centre for Oral Health, Sydney, New South Wales, Australia
| | - Emily E Chapman
- The Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Richard P Widmer
- Paediatric Dental Department, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Julian G Ayer
- The Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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Saraç F, Derelioğlu SŞ, Şengül F, Laloğlu F, Ceviz N. The Evaluation of Oral Health Condition and Oral and Dental Care in Children with Congenital Heart Disease. J Clin Med 2023; 12:3674. [PMID: 37297868 PMCID: PMC10253266 DOI: 10.3390/jcm12113674] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/11/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Objective: Congenital heart disease (CHD) plays a key role in oral and dental health regarding its own impacts on teeth (i.e., enamel hypoplasia), infective endocarditis and choice of dental treatment. The purpose of this study's comparing the oral and dental health status in children with or without CHD is to contribute to the literature by determining the effects of CHD on oral and dental health. Material and Methods: The present study was conducted using a descriptive and correlational design and consisted of 581 children aged between 6 months and 18 years who were healthy (n = 364) or experienced CHD (n = 217). CHD-impacted children were classified according to their shunt and stenosis and then their saturation values were noted. In the intraoral examination, caries data (dmft/DMFT, PUFA/pufa), oral hygiene (OHI-S) and enamel defect (DDE) indices were recorded. Statistical analyses were performed using SPSS 26.0 at a significance level of 0.05. Results: In our study, caries index scores of children with or without CHD in primary or permanent dentition were found to be similar. The mean OHI-S index (p < 0.001) and gingivitis findings (p = 0.047) of children with CHD had a higher prevalence than the healthy ones. The incidence of enamel defects was determined as 16.5% in CHD-affected children whereas an incidence rate of 4.7% was observed in healthy children. The mean saturation value of the participants with enamel defects (89 ± 8.9) was observed to be significantly lower (p = 0.03) than the patients with no enamel defects (95 ± 4.2). Conclusions: Whereas the caries index scores of CHD-affected children with a history of hypoxia in primary and permanent dentition were found to be similar to the healthy ones, children with CHD were observed to be more prone to enamel defects and periodontal diseases. Furthermore, considering the risk of infective endocarditis resulting from existing carious lesions and periodontal problems, it is highly important for pediatric cardiologists, pediatricians and pediatric dentists to collaborate in a multidisciplinary manner.
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Affiliation(s)
- Fatma Saraç
- Department of Pedodontics, Faculty of Dentistry, Atatürk University, 25240 Erzurum, Türkiye; (S.Ş.D.); (F.Ş.)
| | - Sera Şimşek Derelioğlu
- Department of Pedodontics, Faculty of Dentistry, Atatürk University, 25240 Erzurum, Türkiye; (S.Ş.D.); (F.Ş.)
| | - Fatih Şengül
- Department of Pedodontics, Faculty of Dentistry, Atatürk University, 25240 Erzurum, Türkiye; (S.Ş.D.); (F.Ş.)
| | - Fuat Laloğlu
- Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine, Atatürk University, 25240 Erzurum, Türkiye; (F.L.); (N.C.)
| | - Naci Ceviz
- Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine, Atatürk University, 25240 Erzurum, Türkiye; (F.L.); (N.C.)
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Koerdt S, Hartz J, Hollatz S, Heiland M, Neckel N, Ewert P, Oberhoffer R, Deppe H. Prevalence of dental caries in children with congenital heart disease. BMC Pediatr 2022; 22:711. [PMID: 36510161 PMCID: PMC9743505 DOI: 10.1186/s12887-022-03769-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Congenital heart defects (CHD) affect about 8 out of 1000 births worldwide. Most of the patients reach adulthood and are exposed to an increased risk of endocarditis. Since bacteria already enter the bloodstream during everyday activities, oral hygiene is given special importance in the prevention of endocarditis. METHODS In this study 81 boys (55.1%) and 66 (44.9%) girls with CHD received a dental exam and additionally an assessment using the DIAGNOdent® pen. This study group consisting of patients with CHD was matched with a healthy epidemiological control group in Germany. RESULTS Eighty-one boys (55.1%) and 66 (44.9%) girls were examined. The mean age was 11 ± 4 years. 38.8% showed at least one untreated carious lesions. 37.4% had a dmft/DMFT ≥2 and thus represented a group with an increased caries risk. The dmft value was 2.12 ± 1.25 in the age group 3-6 year olds. In the group of the 7-12 year old patients the DMFT/dmft was 2.06 ± 2.27, whereas DMFT in 13-17 year olds was at 2.12 ± 1.58. However, children and adolescents with CHD had a higher DMF index than healthy children in the same age group. CONCLUSIONS The present study reveals that more than one third of those examined have a dental condition in need of rehabilitation. In future, close interdisciplinary cooperation between pediatric cardiologists and dentists should ensure regular dental check-ups.
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Affiliation(s)
- Steffen Koerdt
- grid.7468.d0000 0001 2248 7639Department of Oral and Maxillofacial Surgery, Corporate Member of Freie Universität Berlin, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Julia Hartz
- grid.6936.a0000000123222966Department of Oral and Maxillofacial Surgery, Technical University of Munich (TUM), Ismaninger Str. 22, D-81675 Munich, Germany
| | - Stefan Hollatz
- grid.6936.a0000000123222966Department of Sport and Health Sciences, Chair of preventive pediatrics, Technical University of Munich (TUM), Georg-Brauchle-Ring 60/62, D-80992 Munich, Germany
| | - Max Heiland
- grid.7468.d0000 0001 2248 7639Department of Oral and Maxillofacial Surgery, Corporate Member of Freie Universität Berlin, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Norbert Neckel
- grid.7468.d0000 0001 2248 7639Department of Oral and Maxillofacial Surgery, Corporate Member of Freie Universität Berlin, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Peter Ewert
- grid.6936.a0000000123222966Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center, Technical University of Munich (TUM), Lazarettstraße 36, D-80636 Munich, Germany
| | - Renate Oberhoffer
- grid.6936.a0000000123222966Department of Sport and Health Sciences, Chair of preventive pediatrics, Technical University of Munich (TUM), Georg-Brauchle-Ring 60/62, D-80992 Munich, Germany
| | - Herbert Deppe
- grid.6936.a0000000123222966Department of Oral and Maxillofacial Surgery, Technical University of Munich (TUM), Ismaninger Str. 22, D-81675 Munich, Germany
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Rughwani RR, Cholan PK, Victor DJ. Congenital Heart Diseases and Periodontal Diseases-Is There a Link? Front Cardiovasc Med 2022; 9:937480. [PMID: 35845078 PMCID: PMC9279652 DOI: 10.3389/fcvm.2022.937480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/30/2022] [Indexed: 11/14/2022] Open
Abstract
An understanding in the field of periodontal medicine explains the fact that the oral cavity serves as a niche for numerous pathogenic microorganisms. When these microorganisms or their by-products disseminate to the various parts of the body, they are capable of triggering diseases characterized by an altered host immune-inflammatory response in the anatomically distinct organ. This mechanism is reported in the propagation of cardiovascular diseases with respect to periodontal medicine. Abundant amount of literature suggests an association between atherosclerotic cardiovascular disease and periodontal diseases. However, there is very less data available to highlight the association between periodontal disease and non-atherosclerotic cardiovascular disease, such as congenital anomalies of the heart. This review outlines the relationship between periodontal diseases and congenital heart diseases and also helps us understand whether the presence of periodontal disease can worsen the preexisting congenital cardiac disease.
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Affiliation(s)
- Roshan R. Rughwani
- Department of Periodontics and Oral Implantology, SRM Dental College, Chennai, India
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7
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Behaviour management problems in Finnish children with operated congenital heart disease: a practice-based study. Eur Arch Paediatr Dent 2022; 23:409-416. [PMID: 35249207 PMCID: PMC9167182 DOI: 10.1007/s40368-022-00696-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
Abstract
Purpose This retrospective, practice-based study investigates behaviour management problems (BMPs) in dental care among Finnish children with operated congenital heart disease (CHD). Methods All the heart-operated children born between the years 1997 and 1999 were identified in the national ProCardio database (n = 570). Primary dental care records were requested from this population and were eventually received from 211 patients. Information on gender, diagnosis, number of heart operations and perioperative care were collected from the ProCardio database, and the CHDs were categorised as shunting/stenotic/complex/other defects. Data on BMP/dental fear, oral conscious sedation, dental general anaesthesia (DGA) and past and present caries indices at 6, 12 and 15 years (d/D, dmft/DMFT) were assessed. Results Notes on behaviour management problems or dental fear were found in 19% of the study population. BMPs in dental care were more frequent among boys. Children with re-operations, longer post-operative intensive care stay and hospitalisation, and complications had not more BMP than others. Those children diagnosed with syndromes had more BMP often than the rest. Past and present caries experience were significantly associated with BMP, need of oral conscious sedation and DGA. Oral conscious sedation, nitrogen oxide sedation and dental general anaesthesia were used in 17/211, 2/221 and 24/211 CHD patients, respectively. Conclusion Dental caries remains a main factor associated with BMP in the CHD population. Need for oral conscious sedation and DGA were rather common. To maintain a good oral health and to avoid development of BMP, CHD children benefit from focus in health promotion and preventive care.
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Lyons-Coleman M, O'Sullivan E, Thompson W. The impact of COVID-19 on paediatric dental services and tips for patient management. Prim Dent J 2022; 10:88-94. [PMID: 35088634 DOI: 10.1177/20501684211066526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Managing paediatric patients in primary dental care while awaiting treatment by the specialist paediatric dental services can be tricky. COVID-19 has had a significant impact on dental services meaning wait times to be seen by a paediatric dental service may have been delayed. This article will discuss the management of paediatric patients in primary dental care and provide an update on some of the latest techniques in paediatric dentistry. It also covers tips that can be employed in the primary dental care setting such as the use of tooth mousse and silver diamine fluoride.
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Affiliation(s)
| | | | - Wendy Thompson
- NIHR Clinical Lecturer in Primary Dental Care, Division of Dentistry, University of Manchester, Manchester, UK
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Schulz-Weidner N, Weigel M, Turujlija F, Komma K, Mengel JP, Schlenz MA, Bulski JC, Krämer N, Hain T. Microbiome Analysis of Carious Lesions in Pre-School Children with Early Childhood Caries and Congenital Heart Disease. Microorganisms 2021; 9:1904. [PMID: 34576799 PMCID: PMC8469307 DOI: 10.3390/microorganisms9091904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/23/2021] [Accepted: 09/02/2021] [Indexed: 12/04/2022] Open
Abstract
Oral bacteria have been associated with several systemic diseases. Moreover, the abundance of bacteria associated with caries has been found to be higher in patients with congenital heart disease (CHD) than in healthy control groups (HCGs). Therefore, this study aimed to evaluate the dental microbiota in children with CHD compared to a HCG. The aim was to describe and compare the carious microbiome regarding the composition, diversity, and taxonomic patterns in these two groups. Twenty children with CHD and a HCG aged between two and six years participated. All of them were affected by early childhood caries. Microbiome profiling indicated that Fusobacterium, Prevotella, Capnocytophaga, and Oribacterium were more abundant in the CHD group, whereas Lactobacillus and Rothia were predominant in the HCG. Furthermore, microbiome analysis revealed three distinct clusters for the CHD and HCG samples. In the first cluster, we found mainly the genera Lactobacillus and Coriobacteriaceae. The second cluster showed a higher relative abundance of the genus Actinomyces and a more diverse composition consisting of more genera with a smaller relative lot. The third cluster was characterized by two genera, Streptococcus and Veillonella. These data can help us to understand the oral microbial community structures involved in caries and endodontic infections of pre-school children in relation to the general health of these high-risk patients.
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Affiliation(s)
- Nelly Schulz-Weidner
- Dental Clinic—Department of Pediatric Dentistry, Justus Liebig University, Schlangenzahl 14, 35392 Giessen, Germany; (N.S.-W.); (J.C.B.); (N.K.)
| | - Markus Weigel
- Institute of Medical Microbiology, Justus Liebig University, Schubertstrasse 81, 35392 Giessen, Germany; (M.W.); (F.T.); (K.K.); (J.P.M.)
| | - Filip Turujlija
- Institute of Medical Microbiology, Justus Liebig University, Schubertstrasse 81, 35392 Giessen, Germany; (M.W.); (F.T.); (K.K.); (J.P.M.)
| | - Kassandra Komma
- Institute of Medical Microbiology, Justus Liebig University, Schubertstrasse 81, 35392 Giessen, Germany; (M.W.); (F.T.); (K.K.); (J.P.M.)
| | - Jan Philipp Mengel
- Institute of Medical Microbiology, Justus Liebig University, Schubertstrasse 81, 35392 Giessen, Germany; (M.W.); (F.T.); (K.K.); (J.P.M.)
| | - Maximiliane Amelie Schlenz
- Dental Clinic—Department of Prosthodontics, Justus Liebig University, Schlangenzahl 14, 35392 Giessen, Germany;
| | - Julia Camilla Bulski
- Dental Clinic—Department of Pediatric Dentistry, Justus Liebig University, Schlangenzahl 14, 35392 Giessen, Germany; (N.S.-W.); (J.C.B.); (N.K.)
| | - Norbert Krämer
- Dental Clinic—Department of Pediatric Dentistry, Justus Liebig University, Schlangenzahl 14, 35392 Giessen, Germany; (N.S.-W.); (J.C.B.); (N.K.)
| | - Torsten Hain
- Institute of Medical Microbiology, Justus Liebig University, Schubertstrasse 81, 35392 Giessen, Germany; (M.W.); (F.T.); (K.K.); (J.P.M.)
- Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, Justus Liebig University, Schubertstrasse 81, 35392 Giessen, Germany
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Abstract
PURPOSE OF REVIEW The scope of this review is to discuss aspects of general pediatric care which significantly impact the outcome of children after heart transplant. The general practitioner (GP) often serves as the frontline for prevention and early detection of common problems after heart transplant. RECENT FINDINGS Multiple studies in the literature show the negative impact of preventable illness in immune compromised patients, including the appropriateness of vaccine administration. Except for live vaccines, pediatric heart transplant recipients generally follow standard childhood vaccine schedules. In addition, diagnosis of cardiac and noncardiac conditions by the practitioner can lead to earlier treatment by subspecialists. While rejection and infection are such conditions the practitioner may identify, psychological and neurocognitive conditions are common and impact both adherence to medications and quality of life. SUMMARY These issues are addressed in this review of the recent literature. Through knowledge, detection, and collaboration of care, the practitioner can greatly improve the well being of pediatric heart transplant recipients.
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