Italian Journal of Pediatrics最新文献

Background: This study investigated the factors influencing the prognosis of children with steroid-resistant nephrotic syndrome (SRNS) in patients from the Guangxi region.

Methods: We retrospectively analyzed clinical and pathological data of 279 patients with SRNS from six tertiary hospitals in Guangxi. Clinical data were compared between initial (I-SRNS) and secondary (S-SRNS) steroid resistance subgroups and Cox regression analysis was used to determine risk factors for chronic kidney disease (CKD) and CKD stage 5 (CKD5) in patients with SRNS.

Results: The median age of onset was 54 months. Thirty-three patients had extra-kidney manifestations. Fifty-two, 24, 57, 33, and 41 patients had hypertension, acute kidney injury, vitamin D deficiency, high intraocular pressure, and dwarfism, respectively. One hundred eighty-two and 92 patients had I-SRNS and S-SRNS, respectively. There were significant differences in sex, ethnicity, family history, incidence of hematuria, clinical classification, efficacy of immune agents, and prognosis between groups (P < 0.05). Among the 279 cases of SRNS, 239 had normal kidney function, 37 developed CKD, and 16 had CKD5. An increase in serum creatinine level (HR = 1.003) was significantly associated with CKD in children with SRNS, and effective immunosuppressant therapy decreased the CKD risk (HR = 0.168). Patients with increased serum creatinine levels (HR = 1.003) and acute kidney injury (HR = 4.829) were more likely to progress to CKD5.

Conclusions: Children with S-SRNS showed a higher response to immunosuppressants than those with I-SRNS. Effective immunosuppressant therapy was found to protect against CKD, whereas increased acute kidney injury was an independent risk factor for CKD5.

Oral immunotherapy is proposed as the only active intervention to modify allergies and decrease the risk of severe reactions. However, it is crucial to note that oral immunotherapy still presents a notable failure rate and potential for severe, life-threatening outcomes. Notably, patients who discontinue oral immunotherapy may face an increased risk of fatal reactions. Omalizumab could be a viable option for patients with failed oral immunotherapy.

Tele-support in breastfeeding can be defined as any support provided by a service that connects health workers and/or lactation consultants with breastfeeding parents through video visits, although a telephone contact with the breastfeeding mother remains the first method of remote breastfeeding support. The tele-support in breastfeeding has increased significantly during the SARS-CoV2 pandemic worldwide and, given its effectiveness, may be maintained also after the pandemic. The Italian Society of Neonatology on the basis of: 1) two focus group studies on the tele-support in breastfeeding conducted in Italy with 11 Neonatal Intensive Care Unit nurses and 10 neonatologists, respectively, 2) a national survey on tele-support in breastfeeding addressing the Italian Neonatal Intensive Care Units, and 3) a review of the available experiences and literature, has provided a Position Statement, limitedly to the individual tele-support in breastfeeding. The Italian Society of Neonatology states that: 1) the tele-support in breastfeeding can be used when a consultation in person is not shortly available and may allow to select those situations that require an in-person visit; 2) the organization of a tele-support in breastfeeding session requires the use of a competent, dedicated healthcare staff (specifically trained and/or with adequate experience) and an appropriate methodology while preparing, running and concluding the support session. According to Italian Society of Neonatology the tele-support in breastfeeding may be an effective intervention to promote breastfeeding as a complementary method to the in-person assistance and should be possibly provided in an integrated manner by the Community Health Services and the Maternity Hospital.

Background: the independent association between parental obesity, sleep and lifestyle habits with cardiometabolic risk factors in children and adolescents has been widely explored in the literature. Our study represents a novel approach to comprehensively investigate a complex model encompassing various aspects associated with cardiometabolic risk in youth. Thus, the aim of the present study was to verify the relationship between parental obesity and cardiometabolic risk in children and adolescents, considering the mediator role of health indicators according to sleep time.

Methods: This cross-sectional study was conducted on 3,973 children and adolescents aged 6 to 17 years attending public and private schools in a city located in Southern Brazil. Sleep duration, lifestyle, physical activity, natural food consumption, and parental obesity were evaluated through self-reported questionnaires. Physical fitness was evaluated according to the protocols of Projeto Esporte Brasil. The body fat percentage was evaluated through the measures of tricipital and subscapular folds, and the body mass index was calculated. The clustered metabolic risk score (cMetS) considered the summing z-scores of waist circumference, systolic blood pressure, triglycerides, total cholesterol/high-density lipoprotein cholesterol ratio, and fasting glucose, divided by five. A structural equation model was applied for statistical analysis.

Results: The relationship between parental obesity and cardiometabolic risk was observed in children and adolescents with adequate sleep, being significant (p < 0.05) mediated by physical activity, natural food, physical fitness, and lifestyle. This was also observed when parental education was included in the inadequate sleep cluster model.

Conclusion: Present findings underscore the importance of sufficient sleep duration as a critical factor in understanding the complex interplay between parental obesity and cardiometabolic risk in children and adolescents.

This meta-analysis aimed at investigating the therapeutic effects of probiotics against the symptoms of depression in children and adolescents as well as to identify the potential confounders. Following PRISMA guidelines, major databases were searched for randomized controlled trials focusing on effects of probiotics against the symptoms of depression in children and adolescents to analyze the effect size (ES) for primary outcomes (i.e., improvement in depressive symptoms) expressed as standardized mean difference (SMD) and odds ratios (ORs) for continuous and categorical variables, respectively, with 95% confidence interval (CI). Meta-analysis of five studies (692 participants, mean age = 7.33 years, treatment duration 8-104 weeks) demonstrated no significant improvement in depressive symptoms in subjects receiving probiotics (SMD = 0.04, 95% CI: -0.33 to 0.41, p = 0.84, five studies, 692 participants). Subgroup analysis also showed no significant improvement associated with probiotic use relative to controls in the subgroup of studies focusing on individuals diagnosed with neurodevelopmental disorders (SMD = -0.11, 95% CI: -0.73 to 0.51, p = 0.72, three studies, 452 participants) and that recruiting the general population (SMD = 0.24, 95% CI: -0.43 to 0.91, p = 0.48, two studies, 240 participants). However, high levels of heterogeneity were found in both our primary results (I2 = 77%, p = 0.001) and subgroup analyses for those with neurodevelopmental disorders (I2 = 84%, p = 0.002) and the general population (I2 = 79%, p = 0.03). The results did not support the use of probiotics for relieving depressive symptoms compared with controls in children and adolescents diagnosed with neurodevelopmental disorders or in the general population. Nevertheless, given the high level of heterogeneity across the included trials and a lack of studies focusing on those with diagnoses of anxiety or depression in the current meta-analysis, further large-scale clinical investigations are required to elucidate the therapeutic potential of probiotics against depressive symptoms in these populations, especially in those diagnosed with neurodevelopmental disorders or depression.

Background: In pediatric palliative care, the main caregiver is primarily responsible for managing pharmaceutical therapies. Few data are available regarding the influence of this burden on quality of life in terms of time, concerns as well as a considerable risk of administration errors and adverse effects. This study aims to investigate how caregivers prepared and administrated medication, including errors and associated expectations, to identify improvement interventions.

Methods: Between October 2022 and March 2023, a descriptive single-center survey study was carried out in the tertiary care pediatric palliative center of the Padova University Hospital. Participants were the caregivers of the patients followed by our center up to 23 years old, receiving at least one drug daily and who cannot self-administer their therapy. The questionnaire consisted of 18 multiple-choice and semi-closed questions, grouped into 4 main topics: therapy preparation, therapy administration, administration errors and therapy assessment.

Results: A total of 100 caregivers responded to the survey. Mothers represented the main caregiver (91%). The prevalence of polypharmacy was 67% across the patients. 52% of caregivers handled prescriptions at least three times per day and for 32% it took to prepare them more than 5 min each time. Only 59% reported to have been trained for preparing and administrating drugs. 14% reported having made at least a drug administration error due to the tiredness or the complexity of therapeutic regimens in the preceding three months. Nearly one caregiver out of three felt their child was using too many drugs. 73% positively welcomed the possibility of having clinical pharmacist-led counseling.

Conclusions: Many caregivers of pediatric palliative care patients frequently have trouble planning, preparing and delivering pharmacological therapy to their children. Attempting to simplify medication regimens, choosing formulations that are simpler to administer and measure, investing in improved caregiver training, talking about therapies with carers, and involving clinical pharmacists to clarify their doubts could be all potential strategies to improve this condition and reduce their burden.

Background: Botulism is a rare and life-threatening disease caused by the potent botulinum neurotoxin (BoNT), which can be produced by Clostridium botulinum (C. botulinum) and related bacteria. Clinical manifestations, which include a symmetrical, descending muscular paralysis, generalized hypotonia, and potentially respiratory failure, are non-specific and diagnosis is challenging, especially when anamnesis does not reveal any typical risk factor, like honey consumption.

Case presentation: We present what is, to the best of our knowledge, the first documented case of infant botulism (IB) in Sicily and discuss its peculiarities and the challenges faced in the diagnostic-therapeutic process. The infant was exclusively breastfed and no history of consumption of possibly contaminated foods, like honey, was found. The signs observed at presentation included poor suction, hypotonia, and hyporeactivity. A detailed anamnesis motivated the suspicion of botulism, due to the occurrence of constipation and exposure to dust from home renovation works during the days before the onset of symptoms. The botulinum antitoxin was administered and the diagnosis was confirmed through fecal examination, detecting toxin-producing C. botulinum.

Conclusion: IB should be considered in every infant with rapidly progressing hypotonia and a history of constipation. However rarely, transmission could occur through inhalation of dust particles containing the toxin, therefore it is important to explore all possible sources of exposure. In the case described, timely diagnosis and treatment determined the successful outcome, which highlights the importance of early intervention in managing IB.

Good hand-washing practice is the most important preventive measure to reduce the spread of communicable disease to under-five children. Prior studies on good handwashing practice at critical times among mothers of children under-five age in Ethiopia were extremely varied. Therefore, this meta-analysis aimed to assess the overall proportion of good handwashing practice at critical times and identify the associated factors in Ethiopia. A comprehensive search of relevant studies was performed using distinct databases. Data were extracted using Microsoft Excel spreadsheet, and exported to Stata-MPv-17 for analysis. A random-effect model was used to estimate the overall proportion of good hand-washing practice at critical times. A random or fixed effects model was used to compute the pooled AORs with their 95% Cis, which were presented on a forest plot. $I^2$ test statistics was used for assessing heterogeneity among the included studies. The funnel plot and Egger's test were used to assess the publication bias. Ten studies were included in this systematic review and meta-analysis. The overall pooled proportion of good hand-washing practice at critical times among mothers of children under-five age in Ethiopia was 43.18% (95% CI = 31.05, 55.31). Insufficient water (AOR = 0.33, 95% CI: 0.13, 0.52), good knowledge (AOR = 1.35, 95% CI = 1.09, 1.61), desirable attitude (AOR = 4.34, 95% CI = 1.84, 6.84) and higher educational level (AOR = 0.17, 95% CI = 0.08, 0.25) were significantly associated with good practice of hand-washing at critical times. The national level of good practice of hand-washing at critical times was low. Hence, to promote good practice of hand-washing, it is essential to increase the accessibility of water and provide hygiene health education and training programs to improve knowledge and desirable attitudes of mothers.

Sore throat represents one of the main causes of antibiotic overprescription in children. Its management is still a matter of debate, with countries considering streptococcal pharyngotonsillitis a benign and self-limiting condition and others advocating for its antibiotic treatment to prevent suppurative complications and acute rheumatic fever. Italian paediatricians frequently prescribe antibiotics on a clinical basis regardless of microbiological results. Moreover, broad-spectrum antibiotics are inappropriately prescribed for this condition. In this regard, an intersociety consensus conference was issued to promote the judicious use of antibiotic therapy in paediatric outpatient settings. A systematic review of the literature was performed, and updated recommendations were developed according to the GRADE methodology. Antibiotic treatment with amoxicillin (50 mg/kg/day) for 10 days is recommended in all children with proven streptococcal pharyngitis. Benzathine-penicillin could be prescribed in children with impaired intestinal absorption or inability to tolerate enteral intake and in those at high risk of suppurative complications with low compliance to oral therapy. In children with suspected amoxicillin allergy, third-generation cefalosporins for five days are recommended in low-risk patients, and macrolides are recommended in high-risk ones. Candidates for tonsillectomy due to recurrent pharyngitis could be treated with amoxicillin-clavulanic acid, clindamycin, or combined therapy with amoxicillin plus rifampicin for four days, in an attempt to avoid surgery.