Pediatric care has been on a path of progress since the 1960s, driven by advances in science and the catalytic power of innovation. Breakthrough therapies have emerged for conditions such as congenital heart disease and cystic fibrosis. In neonatal intensive care units, premature infants now benefit from enhanced interventions that have greatly reduced infant mortality. The advent of surfactant therapy has improved the prognosis for newborn respiratory distress syndrome, while combined regimens for acute lymphoblastic leukemia have boosted the five-year survival rate to an impressive 94%.  These remarkable achievements testify to the ongoing success of pediatric medicine in improving the health of infants and children.

Yet in an era where misinformation and disinformation threaten to erode public trust, the challenge is no longer only scientific—it is also communicative. Protecting children’s health extends beyond feats in medicine to include vigilance, seeing to it that factual and trustworthy information is within reach of families and clinicians as they make healthcare decisions.

Allowing wrong and deceptive information to thrive can lead to misplaced priorities and unrecognized urgencies. For example, the widespread claim that children today are less healthy because of a shift to ultra-processed foods and the pervasive culture of digital obsession overlooks the forest for the trees. Although this claim holds some sliver of truth, the full reality points to the larger picture—the leading causes of morbidity and mortality among young people today stem not from diet or inactivity but from gun violence and substance abuse. Widening our lens beyond lifestyle issues enables us to design interventions that address the full spectrum of risks facing children.

Falsities and half-truths compromise the delivery of optimal pediatric care—and it is children who ultimately bear the cost. They are placed in harm’s way through injury, death, and suboptimal treatment. Proposed strategies to counter misinformation and disinformation include proactive communication of medical advances, empowering primary care providers as authorities on health, and uplifting the quality of science education from an early age.  Pediatric medicine is on the right track, advancing health outcomes through research and discovery. Unfortunately, the widening gap between scientific reality and public perception has yet to be bridged. The future of pediatric care remains a battle between the real truth and the truth imagined. Bridging the gap between science and public perception is imperative—logically, and above all, morally.

Source:

Schleiss, M. R., Beers, L., Chamberlain, L. J., Hingorani, S., Lee, H. C., Lorch, S. A., ... & Pediatric Policy Council Keller David 9 10 11 Patel Mona 9 Ragavan Maya 9 Lorch Scott 10 Chamberlain Lisa 10 Cheng Tina 12 Geme Joseph St. 12 Mariani Thomas 11 Lakshmanan Ashwini 11. (2025). Misinformation and disinformation undermine progress in pediatric research: challenges and solutions. Pediatric Research, 1-6.

         Patent ductus arteriosus (PDA) is a common cardiovascular congenital condition among extremely pre-term neonates or those born before 28 weeks.  In utero, a shunt inside the fetus’s heart is normal, as it keeps the blood from entering the underdeveloped lungs; however, ex utero, open PDA becomes a danger. Initial problems include decreased pulmonary vascular resistance (PVR), increased left-to-right blood flow via the still open shunt, and interstitial pulmonary edema. When treatments are delayed and the PDAs are large, the risk for bronchopulmonary dysplasia (a chronic lung condition), left-sided heart failure, and poor systemic perfusion increases over time.

Perinatal acidosis, like PDA, often co-occurs with prematurity, underscoring how immaturity of organs (e.g., kidneys, hearts, and lungs) places the pre-term neonates at a disadvantage. When the blood pH and the base deficit fall below 7.20 and 10 mEq/L, respectively, metabolic acidosis occurs. When it does, the neonate may experience cognitive deficits, bronchopulmonary dysplasia (BPD), and even death in severe cases. The combination of PDA and metabolic acidosis does not bode well for the survival of the pre-term neonate. It is a serious combination that becomes more so when treatment for PDA is withheld or delayed.

         Clinicians delay or withhold PDA treatment because of how acidosis potentially complicates PDA management in preterm neonates. Faced with the risk of complications, clinical considerations and adjustments are continually made to ensure that the treatment is both appropriate and optimal. For instance, indomethacin, a conventional drug for PDA, has been reported to influence the body’s acid-base balance and interact with pre-existing acidosis. In other words, in a neonate with the twin condition of acidosis and PDA, Indomethacin may be ineffective and could worsen the acidotic state.  Other treatments for PDA (e.g., carbonic anhydrase inhibitors, potassium-sparing diuretics, and fluid restrictions) may contribute to acid buildup in the bloodstream. The interactions between acidosis and PDA treatments necessitate careful study for a more nuanced PDA management.

         In a 2025 cohort study,1 a counterclaim was made. According to it, perinatal acidosis is not a contraindication to PDA treatment, which means pre-term neonates with metabolic acidosis can undergo PDA standard treatments without worrying about negative outcomes. The study findings demonstrate that perinatal acidosis does not complicate PDA treatment outcomes as widely believed. Increased deaths or worsened acidosis were not observed. In fact, PDA treatment contributed to the survival of pre-term neonates despite their having acidosis.

While clinical fears and reservations about initiating or continuing PDA treatment in the presence of acidosis are not baseless, they should be balanced with a thoughtful and reasoned assessment that considers each case to be a unique blend of factors—clinical signs of hemodynamic instability, perfusion indices, and echocardiographic findings. In critical settings, risks are a mainstay; instead of risk avoidance, treatment initiation and choice should be a matter of benefits over risks. Life and survival—at least the expectation of it—come first before unwarranted trepidation and tentativeness.

Reference

Choi EK, Shin SH, Hwang SY, Kim H, Kim HR. Impact of patent ductus arteriosus treatment on neonatal outcomes in preterm infants with or without perinatal acidosis: a nationwide cohort study. BMC Pediatr. 2025;25:920. doi:10.1186/s12887-025-06200-8

Donning the heroic cape, mothers assume an active sacrificial role in the care of their children with congenital heart disease (CHD). Understood as inborn abnormalities in the heart's structure and function, CHD is considered the most common birth defect in children. In the Philippines, its prevalence is as high as in other nations, with CHD occurring in 5—10 children in every 1000 live births as of 2015.1

Despite the advancements in CHD, the Philippines, as a lower-middle-income country, still has limited capacity in translating these advancements into better cardiac outcomes—decreased CHD-related mortality, improved survival rates, and enhanced tools and resources for supportive care.

 Because of this, CHD remains a tremendous burden for mothers, who are often the child’s primary caregiver. A diagnosis of CHD can be devastating, particularly for mothers from low-income backgrounds. Not only does it drain their coffer, but it also takes a toll on their overall well-being. The journey of hospital visits, procedures, near-death episodes, and painstaking medication reflects their daily struggles with the demands of CHD.

Multiple studies2,3 show the negative psychosocial consequences—fear, depression, stress, hopelessness, helplessness, and feelings of uncertainty—that these women bravely contend with. As a pediatric cardiac nurse, I testify to these realities. I see mothers feeding their child without the benefit of sleep, praying as their child undergoes an operation, fighting back tears beside incubators, and holding on to hope when there is none. Through it all, they adapt because they understand—often painfully—that they are their child’s strength and lifeline.

Understanding how mothers cope is essential because of their supportive role in the management of CHD. To help them fulfill this function, we must provide them with the coping tools and resources as partners in their journey.

So far, what is known about the coping process of Filipino mothers is that they often resort to religion and spirituality, emotional regulation, and psychosocial support throughout their medical journey with their child.³ It is not uncommon for them to seek the help of traditional healers (aka ‘albularyo’ or ‘mananambal’), especially those who live in the more rural, isolated regions of the country. Others claim to gain strength through prayer and church visitation. Faith and spirituality aside, many mothers have found comfort in the encouragement and material assistance (e.g., financial, physical, and resource) from friends and family.

 Beyond external help, mothers express that acceptance of their child’s condition is the coping strategy that has led them to a peaceful mindset. Instead of unease or anger, there is resignation in their daily care, as they have convinced themselves that their journey ends with the purpose of personal growth and endurance.

The comprehensive approach to CHD does not exclude mothers from the management of the disease. It understands that mothers play a crucial role in the effective care and treatment of CHD in the home and hospital settings. Every step of the way, they are there for their children, from initial diagnosis to eventual transition to adult care. 

 However, in the Philippines, faced with the harsh reality of limited resources, we are left with no choice but to focus on the child, leaving the mothers behind. 

The neglect of mothers is unfortunate, but the future holds some promise as we hold on to the belief that a well-adapted mother means maximized care for a child with CHD.

 References:

Felipe-Dimog, E. B., Dacquigan, E. L. A., & Padilla, J. A. (2025). Coping Strategies of Filipino Mothers of Children with Congenital Heart Disease in a Tertiary Hospital in the Philippines. Acta Medica Philippina, 59(2), 41.

Chandran, T., Ethiraj, T., Rajendran, S. S., Kasinathan, K., Chinnadurai, J., Chakkaravarthi, B. I., & Posan, R. (2025). Psychological Challenges Faced by Mothers of Children with Congenital Heart Disease: A Mixed-Methods Study at a Tertiary Care Hospital. Journal of Pharmacy and Bioallied Sciences, 17(Suppl 1), S688-S690.