Minerva Pediatrics最新文献

Allergen immunotherapy (AIT) is the only treatment capable of modifying the natural history of allergic diseases by promoting immune tolerance. Initially developed for respiratory allergies, AIT has expanded to include food allergies, particularly through oral immunotherapy (OIT). This review explores the historical evolution, current applications, and future directions of AIT in pediatric patients. Subcutaneous and sublingual immunotherapy (SCIT and SLIT) remain well-established approaches for allergic rhinitis, asthma, and hymenoptera venom allergy, demonstrating long-term benefits. Additionally, OIT has gained attention for food allergies, aiming to increase the threshold for allergic reactions and reduce the risk of severe reactions upon accidental exposure. Despite promising results, challenges remain, including safety concerns, adherence, and the durability of induced tolerance. Research continues to refine treatment protocols, improve safety profiles, and identify biomarkers to predict patient response. Advancements in immunology and personalized medicine continue to influence the future of AIT, with novel administration routes, adjuvants, and biologic therapies being explored to enhance efficacy and reduce adverse effects. While AIT has transformed the management of allergic diseases, optimizing patient selection, standardizing protocols, and ensuring broader accessibility remain key priorities. A deeper understanding of immune mechanisms will further improve individualized treatment approaches, maximizing long-term benefits for pediatric patients.

Background: Adolescent-parent negative relationships may favour depressive symptoms only (DSonly) and more strongly those plus suicide ideation (DSSI) or attempt (DSSA) in early adolescents (10-16 years). We assessed their associations which remain poorly addressed.

Methods: This study included 1256 middle-school adolescents from north-eastern France (mean age 13.5±1.3). They completed a questionnaire gathering socioeconomic features, academic performance, substance (alcohol, tobacco, cannabis and other substances) use, relationships with father and mother, depressive symptoms, last-12-month suicide ideation, and lifetime suicide attempt. For depressive symptoms and suicide attempt, the time of the first occurrence during adolescent's life course was also gathered. Data were analyzed using multinomial logistic regression models and Kaplan-Meier survival estimates.

Results: Many adolescents suffered from DSonly (8.0%), DSSI (2.5%) and DSSA (3.9%) and from negative relationships with father only (NRfather, 11.2%), mother only (NRmother, 6.1%), and both parents (NRboth parents, 10.9%). DSSA was more strongly associated (P<0.001) with NRmother (sex-age-adjusted odds ratio saOR=14.34) and NRboth parents (saOR=12.15) than NRfather (saOR=4.57). Similar results were found for DSSI (saOR 12.90, 12.23 and 2.16, respectively) and DSonly (saOR 4.18, 4.84 and 3.18, respectively). These results remained strong when controlling for socioeconomic features, academic performance and substance use (contribution reaching 62%). The risk early began and then steadily increased over time.

Conclusions: Adolescent-parent negative relationships favor DSonly and more strongly DSSI and DSSA. Mother had a much higher role than father. The role and support of both parents should be considered for prevention and care to reduce adolescents' mental health difficulties.

Background: Psychiatry is arguably the most medical practice that is affected by culture. The pediatric literature is sparse with respect to the differences between child psychiatric units in different cultures and different countries. In this study, we aim to investigate the discordance between admission diagnosis and discharge diagnosis for child psychiatric disorders.

Methods: A retrospective analysis was conducted on 206 patients admitted to a university hospital inpatient child and adolescent psychiatry unit in Ontario, Canada. The data extracted from electronic charts were age, gender, DSM-IV-based diagnosis at admission, living arrangement before admission, length of stay (minimum one day), post-discharge diagnosis, and post-discharge outcomes.

Results: There was 75% agreement with the discharge diagnosis. We found strong negative and positive associations between conduct disorder at discharge and the prescription of antipsychotics (+), antidepressants (-), and stimulants (-), and there was a strong association between a conduct disorder (CD) diagnosis and medication-free status. The powerful effect size of stimulant medication was specific to the association between a primary diagnosis of ADHD (vs. not-ADHD) and stimulant medication (c²=127.5, df=1, phi=0.79, P<0.0001).

Conclusions: We have found a significant agreement between admission and discharge diagnosis. It is suggested that the inpatient stay helped to refine the formulation and to improve the child's well-being.

Background: The pathogenesis of bronchopulmonary dysplasia (BPD) is attributed to the arrested lung development in premature infants. Studies showed the negative impact of inflammatory markers on the developing lung with higher levels of IL1, 6 and 8. Platelets contribute to the acute phase response of inflammation and are a direct source of IL-1β.

Methods: We conducted a retrospective data review of all preterm babies with gestational age (GA) <32 weeks admitted to NICU to assess the relationship between platelet parameters in the first 2 weeks of life with the incidence and severity of BPD in very low birth weight (VLBW) neonates.

Results: Of 114 screened newborns, 92 were included after exclusion criteria. Of these, 62 (67.3%) developed BPD. Mean platelet count (PC) (P=0.008) and mean platelet mass index (PMI) (P=0.027) were significantly lower and mean platelet volume (MPV) (P=0.016) was significantly higher in the BPD group. The highest difference between groups was observed at 2^nd week of life for PC and PMI and at 1^st week for MPV. Using multivariate logistic analysis, only PC (P=0.017) showed statistical significance. MPV and PMI showed a positive interaction but did not achieve significance (P=0.066 for both).

Conclusions: We concluded that platelet parameters in the first 2 weeks of life were associated with the incidence of BPD in VLBW neonates. PC may also predict the severity of BPD in these infants.

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.

Background: Congenital pulmonary airway malformation (CPAM) is the most common pulmonary malformation. It can be managed via thoracoscopic lobectomy, which is safe and advantageous over thoracotomy. Some authors advocate the need for early resection to get an advantage over lung growth. Our study aimed to evaluate and compare the pulmonary function in patients who underwent thoracoscopic lobectomy for CPAM before and after 5 months of age.

Methods: This retrospective study was conducted between 2007 and 2014. Patients younger than 5 months were assigned to group 1 and those over 5 months of age were assigned to group 2. Pulmonary function tests (PFT) were requested for all the included patients. For patients who could not undergo full PFT, the function residual capacity (FRC) was evaluated by the helium dilution technique. The parameters evaluated in full PFT were forced expiratory volume in one second (FEV1), forced vital capacity (FVC), total lung capacity (TLC), and FEV1 to FVC ratio (FEV1/FVC). The Mann Whitney U test was used to compare both groups of patients.

Results: Seventy patients underwent thoracoscopic lobectomy during this period, 40 of which had CPAM. Twenty-seven patients tolerated and underwent PFT (group 1: 12 patients; group 2: 15 patients). Among them, 16 patients underwent full PFT and 11 patients had FRC measurement. FRC was similar in both groups (91% vs. 88.2%). FEV1 (83.9% vs. 86.4%), FVC (86.8% vs. 92.6%) and TLC (86.5% vs. 87.8%) were also similar between both groups. FEV1/FVC was slightly higher in group 1 (97.9% vs. 89.4%) but the difference was not statistically significant.

Conclusions: PFT for patients who underwent thoracoscopic lobectomy for CPAM before or after 5 months of age is normal and comparable between both groups. Surgical resection of CPAM can be performed safely early in life without any consequences for pulmonary function or more complications when older children undergo surgery.

Background: Inadequate feeding is a frequent reason for hospital referring in infants with bronchiolitis and may leads to unnecessary prolonged hospitalization. Our objective was to identify the factors associated with the time to recover adequate feeding (TRAF) and the hospital length of stay (LOS) in infants hospitalized for bronchiolitis.

Methods: We conducted a single-center retrospective study including infants less than 12 months hospitalized for bronchiolitis at Le Havre Hospital (France) between September 2018 and February 2021. A multivariate logistic regression model was computed to investigate the factors associated with (1) TRAF, and (2) LOS.

Results: 268 infants were included to assess the TRAF and 478 infants to assess the LOS. The median age was 3.2 months (1.6-5.4) and the sex ratio M/F was 11/20. The use of accessory muscles, nutritional support, and RR ≥70/min or <30/min or apnea are associated (OR=1.5), from virtually no association (OR=1.0) to a significant positive association (OR=2.6) with the TRAF. Intense use of accessory muscles (OR=3.9; 95% CI 1.6-10.4) and "severe" clinical condition (OR=2.8; 95% CI 1.7-4.8) at admission, O2 supplementation (OR=2.0; 95% CI 1.3-3.1) were significantly related to prolonged LOS in the multivariate analysis.

Conclusions: The clinical severity on admission may be related to the TRAF, ranging from none to significant. Other known factors such as oxygen therapy and the new clinical severity scale proposed by the latest French guidelines appeared to be related to the LOS in this work. Further studies are needed to highlight these factors.

Background: Acute post-viral cough (APVC) is a disturbing complaint that may also affect the quality of life. As a result, APVC requires an adequate managing with antitussive medications. In this regard, levodropropizine is an effective and safe peripheral antitussive drug.

Methods: The present retrospective observational study collected data from children with APVC and treated with levodropropizine for up to seven days. Cough intensity and frequency, impact on children's and parents' sleep, school and games, treatment days, satisfaction, and adverse events were considered.

Results: Data from 92 children (mean age 5.5 years) were analyzed globally. Levodropropizine reduced cough intensity and frequency in most children and improved school and game activities and sleep quality in children and their parents. The treatment was safe. Most parents were highly satisfied with the results.

Conclusions: This experience showed that levodropropizine was an effective and safe remedy for children with acute post-viral cough.

Fever is a common symptom and sign in children and adolescents. Italian pediatric guidelines recommend pharmacologically treating fever if discomfort is present. In addition, guidelines state that ibuprofen among NSAIDs and acetaminophen are the first-choice medications for relieving fever in children; however, among NSAIDs, also ketoprofen lysine salt (KLS) is indicated in young patients 6 years of age and older and proved to exert antipyretic effects. The present multidisciplinary Delphi Consensus, promoted by the Italian Society of Allergy and Clinical Immunology (SIAIP), aimed at proposing practical statements about fever management and the possible use of KLS to relieve acute pediatric fever. A multidisciplinary panel of 33 qualified experts discussed and anonymously voted on the statements drafted by a steering committee. The results confirmed a large agreement about the para-physiological role of fever and underlined the concept of not indiscriminately reducing fever. In addition, there was agreement that KLS displays efficacy and safety overlapping with ibuprofen and acetaminophen in modulating fever. Some discordances concerned the advantages of quickly relieving fever and the safety profile. Therefore, the steering committee hopes for new methodologically robust comparative trials. In conclusion. KLS could be considered a reasonable option for managing children and adolescents with fever. However, further studies are required to provide more robust evidence.