Minerva Pediatrics最新文献

Previous reports provided recommendations for familial renal glucosuria diagnosis without complex view on differential diagnosis of glucosuria. The aim of this review was to provide an overview of the causes of glucosuria and to create an evidence-based diagnostic approach for children with glucosuria. We searched the current literature with a focus to identify the possible etiology of glucosuria, gaining insight into the pathophysiology of glucosuria. Urinary glucose is completely reabsorbed in the proximal tubule of kidneys. It only appears in the urine if the plasma glucose concentration exceeds the renal threshold for glucose or in the case of insufficient renal glucose reabsorption. The proteins that provide glucose reabsorption are SGLT2 and SGLT1 - sodium-dependent co-transporters that transport glucose from the lumen into epithelial cells - and GLUT2 - a passive transporter providing facilitative glucose transport from epithelial cells to plasma. Renal glucose reabsorption is affected in case of acquired or inherited complex dysfunction of proximal tubule called Fanconi Syndrome or due to pathogenic variants of genes encoding glucose transporters. Prior to diagnosing any of these, diabetes mellitus must be excluded together with other conditions leading to hyperglycemia. In conclusion, glucosuria is always an abnormal finding. The review provides a simple evidence-based diagnostic approach to navigate the differential diagnosis of glucosuria.

Background: The Severe Acute Respiratory Syndrome virus (SARS-CoV-2) had a great impact in the worldwide population. Because of personal protective equipment (PPE), children have not been exposed to the commonly circulating respiratory viruses, with an effect on pneumonia disease spreading. The aim of our study was to evaluate the different distribution of invasive procedures for complicated pneumonia in pre, intra and post pandemic period.

Methods: We conducted a retrospective analysis in children who underwent invasive procedures for complicated pneumonia, focusing on the winter season. Three periods were identified: pre-SARS-CoV-2 (14 months), pandemic (11 months) and post-SARS-CoV-2 (5 months). The invasive procedures considered were thoracentesis, chest tube placement, and video-assisted thoracoscopic surgery (VATS).

Results: A total of 67 children were admitted to our Institution for complicated pneumonia between November 2017 and March 2023 with a mean of 2.6, 1 and 4.4 per months respectively, in pre-pandemic and post-SARS-CoV-2. A chest tube was placed in 24% of pre-pandemic patients, 9% of pandemic and 50% of post-pandemic (P=0.002). Fifty percent of post-pandemic patients required VATS (P=0.014). Chest CT scans demonstrated necrotizing pneumonia with higher frequency in post-SARS-CoV-2 period (P=0.031).

Conclusions: PPE preserved from SARS-CoV-2 but influenced the spread of other pathogens. We reported an increasing number of complicated pneumonias requiring surgery and of necrotizing pneumonia in the post-pandemic period.

Background: Infants undergoing magnetic resonance imaging (MRI) often require pharmacological sedation. Dexmedetomidine is an alpha-2 receptor agonist that is frequently used to sedate children and infants, because the neonatologist can easily adjust sedation depth, the patient maintains spontaneous breathing, and awakens rapidly afterwards. The present study evaluates whether dexmedetomidine could safely be used as the sole sedative for preterm and term-born infants less than 80 weeks' postmenstrual age undergoing diagnostic procedures.

Methods: We performed a retrospective monocentric analysis of 50 preterm and term-born infants (<80 weeks' postmenstrual age) who were sedated with dexmedetomidine for a brain MRI from October 2019 to March 2024.

Results: Successful imaging was achieved in all cases. The median dexmedetomidine loading dose was 2.75 μg/kg (2-4 μg/kg). Bradycardia was observed in four out of 50 patients (8%) and none of them required atropine.

Conclusions: These results suggest that dexmedetomidine can be safely used for procedural sedation in the high-risk cohort of preterm and term-born infants less than 80 weeks' postmenstrual age.

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: 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.