Pediatric Disorders of Orthostatic Intolerance

@article{Stewart2018PediatricDO,
  title={Pediatric Disorders of Orthostatic Intolerance},
  author={Julian M. Stewart and Jeffrey R. Boris and Gisela Chelimsky and Phillip R. Fischer and John E. Fortunato and Blair P Grubb and G L Heyer and Imad T. Jarjour and Marvin S. Medow and Mohammed T. Numan and Paolo T Pianosi and Wolfgang Singer and Sally E. Tarbell and Thomas C. Chelimsky},
  journal={Pediatrics},
  year={2018},
  volume={141}
}
Pediatric OI is common, comprising physiological perturbations as well as diseases. We define, describe, and discuss forms of OI, their treatment, and prognosis. Orthostatic intolerance (OI), having difficulty tolerating an upright posture because of symptoms or signs that abate when returned to supine, is common in pediatrics. For example, ∼40% of people faint during their lives, half of whom faint during adolescence, and the peak age for first faint is 15 years. Because of this, we describe… Expand

Paper Mentions

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The overall effects of pharmacological therapy are modest and the most affected patients remain handicapped, so future efforts should focus on better understanding of POTS pathophysiology and designing randomized controlled trials for selection of more effective therapy. Expand
Postural Tachycardia Syndrome in Children and Adolescents: Pathophysiology and Clinical Management
TLDR
The present opinion is that POTS is a heterogeneous and multifactorial disorder that includes altered central blood volume, abnormal autonomic reflexes, “hyperadrenergic” status, damaged skeletal muscle pump activity, abnormal local vascular tension and vasoactive factor release, mast cell activation, iron insufficiency, and autoimmune dysfunction. Expand
Autonomic dysfunction in childhood hypersomnia disorders.
TLDR
In this retrospective sample, one third of children with hypersomnia disorders exhibited the symptom of OI at initial presentation, with female predominance, and had undergone autonomic reflex screen testing. Expand
Clinical Aspects of Paediatric PoTS
TLDR
Treatment for postural orthostatic tachycardia syndrome includes enhancing blood volume, daily aerobic exercise, ensuring adequate sleep, cognitive behavioral therapy, and, often, medications. Expand
Postural orthostatic tachycardia syndrome: A respiratory disorder?
TLDR
It is proposed that aberrant activation and response of the carotid body represents one potential common pathway in evolution, and the premise that POTS has a prominent respiratory component is expounded. Expand
Update of Individualized Treatment Strategies for Postural Orthostatic Tachycardia Syndrome in Children
TLDR
Individualized management strategies based on different subtypes of POTS would largely improve the curative effects of drugs for children with POTS, and further clinical investigation is still required to better understand the pathophysiology and treatment options. Expand
Screening for Orthostatic Intolerance in Symptomatic Children Presenting for Concussion Care
TLDR
Evaluating OI in youth presenting for clinical care for concussion and reporting symptoms frequently observed in OI suggested a link between concussion and OI, considerably higher than estimates in the general pediatric population. Expand
Children with Orthostatic Intolerance Exhibit Elevated Markers of Inflammation in the Dorsal Medulla.
TLDR
Proton (1H) magnetic resonance spectroscopy is used to quantify markers of neuronal and glial integrity in a pilot study of children with OI compared with asymptomatic controls to reflect the well-established impairment in regulation of the autonomic nervous system upon standing. Expand
Clinical Prognostic Factors in Pediatric Patients With Orthostatic Intolerance
TLDR
P predictive factors for OI by midodrine treatments are orthostatic symptoms and underweight in pediatric patients, and these findings are useful to develop further studies for Oi treatments. Expand
Non-pharmacologic management of orthostatic hypotension
TLDR
The non-pharmacological approach is aimed at optimizing blood volume, decreasing postural venous pooling, reducing heat and post-prandial induced vasodilation, emphasizing physical conditioning, and minimizing nocturnal diuresis. Expand
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TLDR
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TLDR
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