Aspects of Pediatric Hepatology and Access to Pediatric Health Care.

General pediatric care providers are exposed to clinical hepatology beginning with the care of newborns with indirect and direct hyperbilirubinemia. Indirect hyperbilirubinemia commonly involves “physiological” jaundice, breast-feeding and breast-milk jaundice, and jaundice secondary to hemolytic disease and resolves without potential lifelong or life-threatening disease. However, when practitioners see infants with direct hyperbilirubinemia, which indicates cholestasis, this requires immediate evaluation and the potential need for a pediatric gastroenterologist, geneticist, or metabolic specialist. The differential diagnosis is extensive and the shortand long-term prognoses depend on the etiology and management. In this issue of Pediatric Annals, Dr. Ruba K. Azzam, a pediatric gastroenterologist with special expertise in hepatology, and her team of authors present a series of stimulating and clinically relevant articles about cholestasis in infancy, the viral hepatitides, and the state of liver transplantation in children and adolescents. Infants, children, and adolescents with liver disease require ongoing follow-up care with their general pediatric providers as well as with subspecialists, family medicine physicians, medicine-pediatrics physicians, physician assistants, and advanced practice nurses. Although much progress has been made with the development of the medical home intended for all pediatric patients, insured or uninsured, documented or not, the circumstances and support for these programs may be changing with the results of the recent general election for US president. Several recently published messages from the American Academy of Pediatrics1-3 and from the New England Journal of Medicine4,5 stress the need for all pediatric providers to work together at every level to continue to provide access to optimal medical care for all children in this country, regardless of ethnicity, religion, or orientation. Please let us work to stick together to do the best we can for our patients and their families.