Free Pediatrics CME

Activity Description / Statement of Need:
In this online, self-learning activity:

Acute lymphoblastic leukemia (ALL) is one of a group of malignancies marked by unregulated growth of immature lymphoid cells. Each year, over 6,500 new cases are diagnosed, and ALL claims an estimated 1,390 lives in the same timeframe. The incidence of ALL peaks at 1 to 4 years of age, and it accounts for three quarters of cases of acute leukemia in children. The signs and symptoms of ALL are nonspecific and can include fatigue, malaise, or palpitations associated with anemia; fever with or without infection due to leukopenia or leukocytosis; petechiae; and bleeding or bruising of the oral mucosa or skin. Although the precise etiology of ALL remains unknown, some cases have been associated with exposure to ionizing, toxic chemicals, and herbicides; genetic conditions such as Down syndrome, Fanconi syndrome, neurofibromatosis; and viruses like human T-lymphotropic viruses 1 and 2 and Epstein-Barr virus.

Target Audience:
HCPs including: pediatric hematology-oncology, hematology, oncology, pathology, and those who otherwise commonly care for or clinically encounter patients with ALL.

Activity Description / Statement of Need:
In this online, self-learning activity:

Respiratory syncytial virus (RSV) is a highly contagious pathogen belonging to the Pneumoviridae family that circulates seasonally with other respiratory viruses. The majority of the population is exposed to RSV, but children under the age of two years and older adults are at the greatest risk of significant morbidity and mortality. RSV infections are responsible for approximately 60-80% of pediatric bronchiolitis and 40% of pediatric pneumonia cases and are a major cause of global hospitalization and mortality. Almost 70% of children are exposed to RSV during their first year of life, and 90% are exposed within their first two years, resulting in an estimated 427,000 emergency department visits and 1.6 million pediatrician visits annually.

Target Audience:
HCPs including: Obstetricians, pediatricians, and family medicine physicians; physician assistants, nurse practitioners, pharmacists specializing in pediatrics; and any other HCPs involved or interested in the management of RSV in infants and high-risk children.

Activity Description / Statement of Need:

In this online, self-learning activity:

Hemophilia is a genetic disease caused by mutation of one of the genes for coagulation proteins leading to dangerous, uncontrolled bleeding. In hemophilia B, a mutation in the gene for factor IX (FIX) leads to an endogenous deficiency in the clotting factor. The incidence of hemophilia B is the same in all geographic regions, populations, and ethnic groups, affecting approximately 1 out of every 30,000 male births. The condition is diagnosed by measuring FIX activity, and patients with severe hemophilia have levels of 1% or less. Patients with severe hemophilia B are at risk for spontaneous, life-threatening bleeding episodes. Untreated, the life expectancy is approximately 20 years, and painful or even life-threatening morbidities include: intracranial hemorrhage, severe bleeding in other organ systems, musculoskeletal injury, and joint injury. In contrast, in people with moderate or mild hemophilia, abnormal bleeding usually occurs after minor trauma or surgery. Unfortunately, the literature shows that not only do clinicians struggle with the classification of hemophilia severity and that there are gaps in knowledge present that contribute to delayed diagnosis and treatment, with an attendant increase in morbidity and mortality. Challenges in diagnosis and classification are only the first of several gaps in care that patients with hemophilia face.

Target Audience:

The following HCPs: hematologists and pediatricians; physician assistants, nurse practitioners, and pharmacists who practice in hematology, and other HCPs who practice in hemophilia treatment center; and any other clinicians with an interest in or who clinically encounter patients with hemophilia B.

Activity Description / Statement of Need:

In this online, self-learning activity:

Pompe disease (PD) is a progressive, often fatal, autosomal recessive, neuromuscular disorder caused by mutations of the α-glucosidase gene on chromosome 17. PD is characterized by glycogen accumulation in skeletal, cardiac and smooth muscles due to a deficiency in α-glucosidase (GAA), an important lysosomal enzyme responsible for glycogen catabolism. PD is categorized into three groups based on symptoms and age of onset. The classic infantile form presents in the first year of life, usually in the first two months, with hypertrophic cardiomyopathy. The non-classic infantile form presents later in the first year of life, without or with less severe cardiomyopathy. The late onset form of PD presents any time after one year of life, usually without cardiac complications.

PD is rare, with one study estimating the incidence in the U.S. to be 1 in 22,000 births. The biggest risk factor for the disease is genetics; at conception, each sibling of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being not a carrier. Nonspecific diagnostic findings for PD may include abnormal EMG, elevated serum creatine kinase, elevated transaminases and elevated lactate dehydrogenase. A definitive diagnosis for PD involves a dried blood spot test to determine GAA enzyme activity level; reduced GAA activity (less than 40% of normal) is indicative of a positive diagnosis. A gene mutation analysis, or another GAA enzyme test using a different area of tissue, is recommended to confirm the diagnosis. The disease is not uncommonly undiagnosed or is misdiagnosed, representing one practice gap that continued HCP education may address, particularly given that earlier treatment may minimize rapid and irreversible disease progression.

Target Audience:

The following HCPs: Neurologists, pediatricians, and primary care physicians; physician assistants and nurse practitioners in those areas of specialty; pharmacists who practice in specialty pharmacies that treat patients with rare diseases; and any other HCPs with an interest in or who may clinically encounter patients with PD.

Activity Description / Statement of Need:

In this online, self-learning activity:

Mucopolysaccharidoses (MPS) are a group of genetic diseases characterized by a deficiency of lysosomal enzymes responsible for the hydrolysis of glycosaminoglycans (GAGs), resulting in a variety of clinical manifestations in patients presenting with MPS. MPS has several subcategories, and MPS type I (MPS I) arises from the inheritance of an alteration in the IDUA gene, which encodes for alpha-L-iduronidase. Affecting an estimated one in 100,000 live births, MPS I is categorized as either attenuated MPS I (also known as Scheie or Hurler-Scheie syndromes) or severe MPS I with cognitive impairment (also known as Hurler syndrome).

Progressive in nature, MPS I is associated with multi-organ complications and sequelae. Patients exhibit a spectrum of clinical presentations, including facial deformities, organomegaly, cognitive impairments, upper airway obstructions, skeletal deformities, and cardiomyopathy. The burden of MPS I is considerable, with reports of caregivers contributing 51 hours per week on average to help patients perform daily activities of living. Quality of life for patients and their caregivers is significantly reduced with MPS I, affecting the social, emotional, and financial well-being of a family. It is reported that parents fear for their child’s delayed language acquisition, ability to fit in amongst peers and the society, fear of the expense for the necessary care, and fear for the death of a child from obstructive sleep apnea.

This learning activity has been designed to bring HCPs’ knowledge of the strategies for treatment and management of MPS I up to date and to improve their competence and performance in treating it.

Target Audience:

The following HCPs: Pediatricians, neurologists, endocrinologists, genetic disease specialists; physician assistants, nurse practitioners, and pharmacists in the aforementioned areas of specialty; and any other HCPs with an interest in or who may clinically encounter patients with MPS I.

Acne is one of the most common skin conditions treated by physicians, affecting 40 to 50 million people in the U.S. Although the disease can affect patients at any age, acne occurs most commonly during the adolescent years, with a prevalence as high as 85%. In 20% of cases, the acne is severe, resulting in permanent physical scarring as well as a mental health burden. That burden may include increased prevalence of mood disorders, psychiatric hospitalizations, school absenteeism, unemployment, and suicidality.

Acne is a multifactorial inflammatory disease affecting the hair follicles of the skin. While an understanding of acne pathogenesis is one that is continuously evolving, key pathogenic factors include follicular hyper-keratinization, microbial colonization, sebum production, and complex immune and inflammatory mechanisms. Other research suggests that neuroendocrine regulatory mechanisms, diet, and genetic and factors all may contribute to the multifactorial process of acne pathogenesis. Professional guidelines for the treatment of acne vulgaris in adolescents and adults highlight the roles of topical and systemic pharmacotherapies as well as non-pharmacologic treatment modalities, including lasers and photodynamic therapy. However, in the time since the guidelines were published, newer medications have been approved or entered late stage clinical investigation. Communicating related information to HCPs in a timely manner is a demonstrated need.

Primary immunodeficiency disorders (PIDD) comprise a group of 430 different known inborn errors of immunity. The heterogeneous etiology of PIDD leads to a vast array of clinical presentations, including infection, malignancy, autoimmunity, and inflammation. Once thought to be exceedingly rare, PIDD is increasingly being recognized as an underdiagnosed disease affecting between one in 1,000 to one in 5,000 births.

Because a significant percentage of people with PIDD are undiagnosed, improving the recognition of PIDD signs and symptoms necessarily forms the foundation of PIDD-focused medical education efforts. Early treatment improves outcomes and health-related quality of life in children and adults with PIDD, yet time from symptom onset to diagnosis can exceed 4 years. Diagnostic lag has serious consequences for many patients with PIDD due to recurrent infections, which may take a toll on pulmonary function. In a large-scale analysis of patients with common variable immunodeficiency, a common form of PIDD, risk of death increased by 1.7% each year of diagnostic delay.  The most up-to-date guidance around the classification of PIDD and how to determine related genetic tests has been published relatively recently. Communicating related information to HCPs in a timely manner is a demonstrated need.

Activity Description / Statement of Need:

In this online, self-learning activity:

The term human papillomavirus encompasses a family of DNA viruses that are sexually transmittable and may cause either benign or malignant lesions. They are the leading cause of cervical cancer (CC), with approximately 90% of CC cases attributable to HPV, as well as a major contributor to anogenital and head and neck cancers, although many patients infected with HPV will never develop any related symptoms or disease. The prevalence of HPV in the U.S. is 42.5 million people, and direct medical costs attributed to it are $775 million. HPV 16 accounts for a majority or plurality of HPV-related cancers of both genital tract and head and neck.

The CDC’s Advisory Committee on Immunization Practices (ACIP) recommends HPV vaccination beginning as early as age nine for both sexes, with the schedule and number of doses dependent on age of first dose.

Target Audience:

The following HCPs: Primary care physicians and pediatricians; physician assistants, nurse practitioners, and pharmacists who practice in the aforementioned areas of specialty; and any other HCPs with an interest in or who clinically encounter patients who would benefit from HPV vaccination.

Activity Description / Statement of Need:

In this online, self-learning activity:

Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic connective tissue disorder characterized by dysregulated chondrogenesis, with heterotopic ossification (HO) being the most typical feature. The global prevalence of FOP is estimated at 1.43 per million individuals, with a U.S. prevalence of 0.88 per million. FOP develops due to a mutation in the ACVR1 gene encoding the active receptor-like kinase (ALK2), with unique presenting symptoms including great toe malformations and the development of swelling in several areas of the body within the first decade of life.

Target Audience:

HCPs including: pediatricians, pediatric orthopedic surgeons, endocrinologists, and medical geneticists; nurse practitioners, physician assistants, and pharmacists who practice in orthopedics, orthopedic surgery, and rheumatology; and any other healthcare professionals with an interest in or who clinically encounter patients with FOP.

Activity Description / Statement of Need:

In this online, self-learning activity:

Neonatal respiratory distress syndrome (RDS) occurs in an estimated five to seven percent of term births and up to 90% of preterm births. The risk for neonatal RDS decreases with increasing gestational age,  such that at a gestational age of 37 weeks, the risk has fallen to just three times that of a full-term infant. In addition to premature birth, risk factors for neonatal RDS include maternal gestational diabetes, male sex, multiparity, abnormal fetoplacental circulation, fetal distress, Cesarean delivery, and low birth weight. The ability for the clinician to recognize neonatal RDS is a documented practice gap, and failure to do so is associated with mortality and complications that may include respiratory failure in the short-term and chronic lung disease in the long-term.

Target Audience:

The following healthcare professionals: neonatologists; physician assistants, nurse practitioners, nurses, and pharmacists who practice in neonatology; and any other healthcare professionals with an interest in or who clinically encounter patients with neonatal RDS.  

In this online, self-learning activity:

Neonatal respiratory distress syndrome (RDS) occurs in an estimated five to seven percent of term births and up to 90% of preterm births. The risk for neonatal RDS decreases with increasing gestational age,  such that at a gestational age of 37 weeks, the risk has fallen to just three times that of a full-term infant. In addition to premature birth, risk factors for neonatal RDS include maternal gestational diabetes, male sex, multiparity, abnormal fetoplacental circulation, fetal distress, Cesarean delivery, and low birth weight. The ability for the clinician to recognize neonatal RDS is a documented practice gap, and failure to do so is associated with mortality and complications that may include respiratory failure in the short-term and chronic lung disease in the long-term.

Target Audience:

The following healthcare professionals: neonatologists; physician assistants, nurse practitioners, nurses, and pharmacists who practice in neonatology; and any other healthcare professionals with an interest in or who clinically encounter patients with neonatal RDS.