Minerva Pediatrics最新文献

Introduction: Perinatal stroke includes a heterogeneous group of early focal neurological injuries affecting subsequent brain development, often resulting in motor sequelae, symptomatic epilepsies, and cognitive, language and behavioral impairment. The incidence of perinatal stroke is about 1/3500 live birth.

Evidence acquisition: A PubMed and SCOPUS search strategy included the entries "neonatal ischemic stroke" OR "perinatal ischemic stroke" and the age of the filter under 18 years and January 2000-August 2022.

Evidence synthesis: The cumulative literature analysis highlighted 3880 published patients (from 98 articles) with stroke, mainly presenting with clinical or electro-graphical seizures (2083 patients). The mean age at presentation was 2,5±2,4 days (data available for 1182 patients). Stroke occurred in the first week of life in 1164 newborns. The mainly involved ischemic areas were within the territories of the middle cerebral artery (1403 patients). Predisposing risk factors included fetal/newborn factors (1908 patients), dystocial birth (759 patients), maternal (678 patients), and placental factors (63 patients). No thrombolysis and/or endovascular treatments were performed, while data about other pharmacological treatments were restricted to a single article. The death occurred in 29 newborns. Motor, neurocognitive and language impairment were cumulatively reported in 875 patients. Epileptic seizures during the follow-up were reported in 238 cases.

Conclusions: The literature analysis highlighted that every term newborn presenting with acute neurological signs and symptoms during the first week of life should always be considered for the identification of an ischemic stroke.

The management of pain in pediatrics is multimodal and includes non-pharmacologic and pharmacologic approaches. Opioids, and particularly morphine and hydromorphone, are frequently used to treat moderate-to-severe pain. The goals of this review are to describe the pharmacological characteristics of both drugs, to cover the latest evidence of their respective indications, and to promote their safe use in pediatrics. Morphine is the most studied opioid in children and is known to be safe and effective. Morphine and hydromorphone can be used to manage acute pain and are usually avoided when treating chronic non-cancer pain. Current evidence suggests that both opioids have a similar efficacy and adverse effect profile. Hydromorphone has not been studied in neonates but in some centers, it has been used instead of morphine for certain patients. In palliative care, the use of opioids is often indicated and their benefits extend beyond analgesia; indications include treatment of central neuropathic pain in children with severe neurologic impairment and treatment of respiratory distress in the imminently dying patients. The longstanding belief that the use of well-titrated opioids hastens death should be abandoned as robust evidence has shown the opposite. With the current opioid crisis, a responsible use of opioids should be promoted, including limiting the opioid prescription to the patient's anticipated needs, optimizing a multimodal analgesic plan including the use of non-pharmacological measures and non-opioid medications, and providing information on safe storage and disposal to patients and families. More data is needed to better guide the use of morphine and hydromorphone in children.

Background: The Coma Recovery Scale for Pediatrics (CRS-P) is a modified version of the Coma Recovery Scale-Revised (CRS-R). This CRS-P looks at behavioral responses and diagnoses Coma, Vegetative State, MCS and E-MCS in pediatric age. It is an ordinal scale consisting of 29 items divided into 6 subscales. The CRS-R is a gold standard for the assessment of adults with disorders of consciousness (DOC) and is also recommended for children, following the American Guidelines.

Methods: The CRS-P was translated and culturally adapted into Italian by two independent translators in order to test an adapted Italian version on Italian children.

Results: We found conceptual, semantic and content correspondence between the original version and the preliminary version of the CRS-P in Italian.

Conclusions: The Italian CRS-P version can be tested on Italian children and then validated.

Introduction: Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases of childhood and presents with various clinical phenotypes. A multifactorial and complex interaction of genetic and environmental factors are responsible for JIA, of which the proinflammatory cytokine genes are of particular research interest. This meta-analysis investigates the association between IL-1A and IL-1B gene polymorphisms and susceptibility to JIA.

Evidence acquisition: A total of eight studies, involving 1633 patients and 2309 controls were included, and a meta-analysis was performed on the association between IL1A -889 C/T, IL1B -511 C/T, and IL1B +3954 C/T, and susceptibility to JIA.

Evidence synthesis: There was no significant association between the presence of IL1A -889 C/T, IL1B -511 C/T, and IL1B +3954 C/T polymorphisms and JIA, under any genetic model or in any ethnicity subgroups.

Conclusions: Results of this study suggest that these three IL-1 variants do not increase the susceptibility to JIA. However, the limited number of studies and the considerable level of heterogeneity must be taken into account before interpretation.