Minerva Pediatrics最新文献

Background: Hospitalizations for children with neurological impairments (NI) are frequently caused by chronic lung aspiration (CLA). Gastroesophageal reflux disease (GERD) and posterior drooling are two of the causes of CLA. Combination of anti-reflux procedure, i.e. Nissen fundoplication (NF), and anti-drooling surgery, i.e. subtotal functional sialoadenectomy (SFS), could effectively address both components of CLA. This study presents outcomes of the combined surgical treatment, especially focusing on long-term results. The aim of this article is to present our experience using a combination of NF and SFS as treatments for CLA caused by refractory GERD and drooling in pediatric patients with NI.

Methods: Retrospective analysis of consecutive patients treated in our pediatric tertiary center (period: 2012-20). Inclusion criteria: NI patients with CLA, simultaneous refractory GERD and drooling, minimal follow-up ≥12 months.

Results: Seventeen patients included (12 males): all patients had dysphagia and fifteen (88%) had vomiting/regurgitation. Four patients (24%) had ≤1 aspiration pneumonia/year, while 13 (76%) had recurring episodes (≥2 per year). The median age at surgery was 8.2 years old (0.8-18.5). Three patients (18%) had early major complications (Clavien-Dindo ≥IIIa). After surgery, study population showed a significant decrease in vomiting/regurgitation (P=0.0004), posterior drooling (P=0.0039), and mean episodes of pneumonia/year (P=0.0009). One patient (6%) needed re-do fundoplication for GERD recurrence. One patient (6%) had tracheostomy. No surgery related mortality was recorded.

Conclusions: The combination of NF and SFS offers a chance to face up to chronic pulmonary aspiration, proving to effectively treating both GER and posterior drooling, with an acceptably low complication rate.

Introduction: Nocturnal enuresis is defined as involuntary urination during sleep in children, particularly those aged 5 years or older. Treatment approaches include both pharmacological and non-pharmacological methods, with choices depending on the type and severity of nocturnal enuresis, as well as family dynamics. This review evaluates current knowledge on nocturnal enuresis treatment in children.

Evidence acquisition: A systematic review of studies published from 2000 to 2024 was conducted, assessing both pharmacological and non-pharmacological interventions.

Evidence synthesis: Nocturnal enuresis in children has been treated with various pharmacological and non-pharmacological interventions. Non-pharmacological therapies for nocturnal enuresis offer effective, low-risk options for managing this common pediatric condition, particularly when used in combination. Enuresis alarm therapy, considered the first-line treatment, has demonstrated success rates between 50% and 70%. On the other hand, bladder training, pelvic floor retraining and dietary modification play a supportive role in nocturnal enuresis management. Pharmacological interventions mainly include desmopressin and anticholinergics. Combination therapies, particularly desmopressin and anticholinergics, have demonstrated superior efficacy and faster results compared to monotherapy.

Conclusions: A variety of pharmacological and non-pharmacological treatments have been developed to manage nocturnal enuresis and improve the quality of life for affected children. The primary goal for healthcare providers is to tailor a treatment plan to each child, taking into consideration the individual needs of the child and their family.

Introduction: Achieving appropriate levels of premedication and parental separation is needed for smooth induction of anesthesia and prevention of perioperative complications. Both melatonin and midazolam are used for the premedication in children, but we do not have consensus on which premedication is superior among them.

Evidence acquisition: A systematic review of randomized controlled trials comparing the efficacy and safety of use of midazolam and melatonin as premedication in children aged 1-15 years was conducted. Patients who received drugs other than melatonin or midazolam as premedication were excluded. PubMed, Embase, Scopus, Google Scholar were searched and the last search was done in December 2022.

Evidence synthesis: Full text of ten articles with a total of 774 participants (442 melatonin, 332 midazolam) were eligible. The data extracted were synthesized after quality assessment. The outcomes appraised included: sedation, anxiety in preoperative room and during induction. Among four studies examining sedation, there were no significant differences between melatonin and midazolam (SMD=0.03, 95% CI - 0.35 to 0.40, P=0.88, I²⁼81%). There were no significant differences between melatonin and midazolam among two studies examining anxiety in pre-operative room (SMD=-0.04, 95% CI -4.58,4.50, P=0.99, I²⁼0%) and anxiety during anesthesia induction as an outcome (SMD=-1.38, 95% CI -4.81 to 2.05, P=0.43, I²⁼0%).

Conclusions: The review showed that melatonin is comparable to midazolam in achieving sedation for facilitating inhalational induction in pediatric patients. The review showed no significant difference in reduction of anxiety in the preoperative room and during induction of anesthesia when either melatonin or midazolam is used as premedicants. Heterogeneity in premedication doses, parameters assessed, outcomes measured, and scales that quantify efficacy resulted in the inconsistencies in how the medications were compared and hence resulted in difficulties in data synthesis. Future studies comparing efficacy of premedication need to consider the proposed standardizations in methodology for achieving optimal results that are a fair comparison of the two medications.

Fetal alcohol spectrum disorder (FASD) refers to a range of conditions caused by prenatal exposure to alcohol. First described in the 1970s as fetal alcohol syndrome, continuing progress has been made in the understanding, recognition and treatment of what is now recognized to be a range of related neurodevelopmental disorders. FASD is common, especially in countries with higher levels of alcohol consumption such as those in Europe and North America, where the prevalence is estimated to be around 3%. A number of diagnostic systems are in operation in different countries, and work is ongoing to develop an internationally agreed set of diagnostic criteria. People with FASD often have other developmental, mental and somatic conditions, and there appears to be a high rate of traumatic and other adverse experiences in this population. People with FASD are at increased risk of being involved in the criminal justice system, but they may be ill-equipped to successfully navigate it and are likely to provide false confessions, leading to wrongful convictions. Some interventions and treatments have been shown to be effective in improving functioning in children and families affected by FASD, which tend to take the form of coaching, education, advocacy and support. People with FASD have many strengths, which are often overlooked in research. They have been described as skilled musicians, artists and sportspeople with wide vocabularies who are resilient, compassionate, hard-working, and kind. Increasing attention is being paid to FASD but this is not enough. More research, diagnostic capacity, recognition, understanding, infrastructure and support are needed across the world.

Introduction: Debate exists regarding the ideal timing for surgery in Hirschsprung disease (HSCR) in various groups of age. The aim of this paper was to suggest a possible strategy to determine the optimal timing for reconstructive surgery in patients affected by HSCR.

Evidence acquisition: A systematic literature search of papers published on PubMed and Embase during the last decade, addressing "Hirschsprung," "preoperative enterocolitis," "preoperative mortality," "complications," and "timing" in all possible combinations, was performed.

Evidence synthesis: A total of 10 out of 170 identified papers addressed this issue in detail and were subsequently assessed for in-depth analysis. Our review confirmed that the most important issue to guide surgical timing is represented by HSCR Associated Enterocolitis (HAEC). Most authors suggest performing pull-through at around 3 months of age after effective bowel decompression, which should not be continued indefinitely to avoid complications.

Conclusions: Based on this systematic review we suggest the following: 1) healthy neonates should undergo surgical reconstruction at 3 months of age; 2) urgent surgery (levelling enterostomy) might be required in critically unwell patients, those with Total Colonic HSCR, or those in whom nursing proved to be ineffective; 3) surgery can be safely postponed only in older patients with a lower likelihood of HAEC (i.e. without previous HAEC occurrences) always avoiding long-lasting rectal irrigations.