Rivista di formazione e aggiornamento di pediatri e medici operanti sul territorio e in ospedale. Fondata nel 1982, in collaborazione con l'Associazione Culturale Pediatri

Gli articoli più visti nel mese di Febbraio 2023

1) Il graffio - Gennaio 2023

a cura di Alessandro Ventura

La colazione dei bambini

disponibile pdf 548 kB

2) La Pediatria sulla Grande Stampa - Supplemento 2022

La Pediatria sulla Grande Stampa 2022

Alessandro Ventura

C’è una novità, di forma e di contenuto, in questo “speciale” 2022: ogni argomento sarà introdotto (attualizzato alla realtà pratica di tutti i giorni) da una breve intervista (tre, quattro domande) a un esperto. Un modo per fare il punto della situazione, per avere dei riferimenti precisi che ci aiutino a interpretare nella maniera più corretta gli spunti di riflessione e le novità proposte dalla letteratura oltre che naturalmente a mantenere la giusta rotta nella pratica di ogni giorno.
L’intermezzo è sempre dato dai casi clinici. La cui lettura, rimango convinto, rimane il modo più utile per imparare e fissare nella memoria ciò che serve: perché è immergendosi in una storia, soffermandosi su un’immagine che più si è spinti a riflettere e a confrontarsi concretamente con le proprie esperienze.
Mi auguro come sempre che oltre all’utile chi si inoltrerà in questa lettura trovi anche il dilettevole. Perché, sia ben chiaro, se non c’è (anche) divertimento non potrà esserci stabile apprendimento.
Buona lettura quindi. E Buon Anno: un po’ in ritardo, come sempre, dalle pagine dello “speciale”.

Alessandro Ventura

Consulta la versione sfogliabile.

non disponibile pdf 16 MB

3) L'aria che tira - Gennaio 2023

La recrudescenza delle infezioni (anche) da streptococco beta-emolitico di gruppo A?

Marchetti F.
Since the beginning of December 2022, unusually high number of Group A Streptococcus (GAS) infections among children have been reported across at least five Member States in the European Region (France, Ireland, Sweden, Holland and the United Kingdom). At the moment in Italy there has not yet been a report of an increase in cases of GAS infections, which could be either real or due to the lack of adequate monitoring. It is essential to implement adequate population monitoring systems also for GAS infections and pay particular attention to the clinical pictures that GAS can determine, both slight and dangerously invasive infections (iGAS). The increase in the cases of iGAS, as well as those from viral respiratory infections, is clearly related to the restrictions that have been adopted during the Covid-19 pandemic and only the return to the normal circulation of microbial agents will be able to avoid further infectious endemic clusters by restoring the “immune debt” phenomenon that has occurred.

disponibile pdf 376 kB

4) Neonatologia - Gennaio 2023

La Neonatologia… caso per caso

D’Agostin M, Catania MA, Giambrone C, Corsello G.
Neonatal hypotonia, bronchopulmonary dysplasia, necrotizing enterocolitis and persistent hypoglycemia are some of the main topics in neonatology. This work aims to summarize these four neonatal conditions through illustrative clinical cases. The first issue concerns neonatal hypotonia, which can constitute a pivotal sign in the diagnosis of hypoxic ischemic encephalopathy. However, neonatal hypotonia can be present in several other conditions, such as sepsis and neurological or neuromuscular diseases. The second issue is about bronchopulmonary dysplasia, a disease that mainly affects extremely premature infants. Many therapeutic strategies have been proposed to prevent this disease, such as less invasive ventilation and an early use of inhaled and systemic corticosteroids. Long-term respiratory sequelae in infants with bronchopulmonary dysplasia remain one of the main causes of hospitalization in these children in their early years of life. The third issue is necrotizing enterocolitis, a disease that can affect both term and preterm newborns. Multiple risk factors are involved in the pathogenesis of this disease such as an abnormal peripheral perfusion due to congenital heart diseases, small for gestational age (SGA), sepsis, hypoxic-ischemic encephalopathy, chorioamnionitis, intrauterine growth restriction (IUGR). On the other hand, breastfeeding can play as a preventive factor. Finally, the last topic is about the management of persistent hypoglycaemia, a condition that can be caused by the combination of one of the following mechanisms: inadequate glucose supply in an infant with low glycogen stores (preterm, IUGR, SGA); excessive insulin production (maternal diabetes, large for gestational age); failure of counter-regulatory response to hy-poglycaemia (pituitary or adrenal deficiency).

non disponibile pdf 99 kB

6) Linee guida - Gennaio 2023

Rene singolo congenito

Gruppo di lavoro sulle malformazioni congenite dei reni e delle vie urinarie della SINePe
In recent years, several studies have been published on the prognosis of children with congenital solitary kidney (CSK), but a worldwide consensus on management and follow-up is still lacking. Recently, the Italian Society of Pediatric Nephrology has published a consensus statement with recommendations for the diagnosis and management of the CSK. This article presents a compendium of the recommendations, including diagnostic approach, nutritional and lifestyle habits - with special attention to sports participation - and follow-up. Any antenatal suspicion/diagnosis of CSK should be confirmed by neonatal ultrasound (US), however the routine use of further imaging is not recommended. A normal CSK is expected to undergo compensatory enlargement, which should be assessed by US. In infants and children that show compensatory enlargement of the CSK at diagnosis, urinalysis is recommended but blood tests or genetic analysis are not. Extra-renal malformations should be searched for, in particular genital tract malformations in females. Protein and salt intake should not be restricted, but excess should be avoided. Sport participation should not be limited. A lifelong follow-up is recommended, tailored on risk stratification as follows: low risk - CSK with compensatory enlargement -, - medium risk - CSK without compensatory enlargement and/or additional malformations of the kidney or urinary tract - and high risk - decreased glomerular filtration rate and/or proteinuria, and/or hypertension -.

non disponibile pdf 128 kB

7) Appunti di Neuropsichiatria - Gennaio 2023

Screening del funzionamento psicologico: l’ottavo segno

Ghirigato E, Corona F, Cozzi G, Carucci S, Barbi E.
Mental health problems are a significant cause of disability in children and adolescents. The most common are anxiety, depression, eating disorders and somatic symptom disorder. All these disorders have a negative impact on the child/adolescent functioning and they may lead to more severe psychiatric illnesses. For these reasons, paediatricians should be able to identify the patients with high risk of psychological dysfunction, by knowing the right questions to ask and using some simple psychological assessment tools (Paediatric symptom checklist, Strengths and Difficulties Questionnaire, HEADS-ED) that can help patients to receive the psychological/neuropsychiatric support they need as soon as possible.

non disponibile pdf 98 kB

8) Pagine elettroniche - Gennaio 2023

L’integrazione di differenti prospettive sullo sviluppo del bambino: l’osservazione del genitore e quella del pediatra

Clavenna A, Segre G, Roberti E, et al.
Objective - To assess the feasibility of a shared approach that combines the clinical expertise of family paediatricians and the perspectives of parents in the early identification of potential disorders in children using standard clinical practice tools.
Study design - Within the NASCITA birth cohort, in addition to the family paediatrician’s clinical evaluation, the M-CHAT-R was completed by parents to assess the child’s language, social skills, behaviour, and sensory areas. Parents were also asked to complete the PSI-SF to verify the magnitude of stress in the parent-child system. Univariate and multivariate analyses were performed to evaluate the association between child and parental characteristics and the presence of warning signs.
Results - The follow-up assessment was completed for 435 infants: 69 (15.8%) presented warning signs: 43 in the paediatrician’s assessment and 36 in the M-CHAT-R (10 in both). A total of 16 children (14 with warning signs) received a diagnosis after a specialist evaluation. Being male (OR = 2.42, 95% CI: 1.20-4.86) and having sleep disorders (OR = 2.48, 95% CI 1.19-5.71) was associated with a greater likelihood of warning signs in the multivariate analysis, while reading aloud was a protective factor (not exposed versus exposed, OR = 3.14; 95% CI 1.60-6.17). For 73 children (18.4%), at least one parent tested positive for PSI-SF. An increased prevalence of parental distress was observed in children with warning signs (OR 2.36, 95% CI 1.27-4.37).
Conclusions - Integrating physician and parental perspectives during well-child visits and in clinical practice appears feasible and can improve the identification of children at risk of developmental disorders.

non disponibile pdf 357 kB

8) Pagine elettroniche - Gennaio 2023

Kawasaki? Adenovirus? Kawasaki da adenovirus o con adenovirus?

Accomando F, Aricò MO, Valletta E.
Kawasaki disease (KD) still represents a challenge for differential diagnosis because it shares clinical features with other infectious diseases. Adenovirus infection has many symptoms that can be found among the diagnostic criteria of KD. However, the two entities have some minor differences that are useful to distinguish them. It is quite important, even with a positive PCR test for adenovirus, not to exclude a possible KD to avoid a diagnosis delay and possible severe complications.

non disponibile pdf 357 kB

8) Pagine elettroniche - Gennaio 2023

“Sembrava un lombrico”: la cisti del rafe mediano

Romano S, Conti R.
The Authors describe the rare (and striking) case of a 4-year-old child with an infected median raphe cyst.

non disponibile pdf 357 kB

10) Domande e risposte - Gennaio 2023

a cura di Giorgio Longo

Orticaria da FANS, orticaria post-infettiva
Vaccinazione anti-HPV

non disponibile pdf 44 kB