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 Agosto 2024
1) Aggiornamento - Giugno 2024
Il bambino che ritorna perché ha sempre la febbre: capire, sapere e saper fare
- De Nardi L, Insalaco A, De Benedetti F.
- Fever is a very common symptom in children, mostly due to infections. It is a physiological body defence mechanism against damage. However, when it is recurring, it is difficult to understand which are the underlying causes. Recurrent fever is most commonly due to trivial infections of the 1st infancy. However, it can seldom be the expression of inborn errors of immunity, monogenic periodic fevers, neoplasm, or other rheumatologic conditions. What comes with the fever (i.e. specific accompanying signs and symptoms) is essential to distinguish between such different diseases. This paper aims to provide an overview on the causes of recurrent fever in paediatrics, providing a practical guide to assist the paediatrician who needs to disentangle between different diagnoses.
1116 kB2) La pagina gialla - Giugno 2024
a cura di Alessandro Ventura3) Aggiornamento - Maggio 2024
L’otite esterna acuta: dalla diagnosi al trattamento
- Lavezzo G, Pietrolati G, Iacono A, Marchetti F.
- Acute otitis externa (AOE) is an infection of the external auditory canal with peak incidence between 5 and 9 years of age. Predisposing factors are the summer period, water sports and duct injuries (e.g. cotton buds). The diagnosis is clinical and the responsible agents are mainly bacteria (Pseudomonas Aeruginosa followed by Staphylococcus Aureus). The therapy involves the local use of acidifiers and/or antiseptics for mild forms while for moderate forms topical antibiotics (in monotherapy or in combination with cortisone and/or anaesthetics). The use of systemic antibiotics should be reserved only for severe forms or those not responsive to topical therapy.
4) Aggiornamento - Ottobre 2007
La splenomegalia
- M. Rabusin, F. Patarino
- The spleen in infants and children is involved in a wide variety of pathological conditions. Splenic disorders may be isolated like splenic cysts or, more frequently, due to multiorgan or systemic disease including hepatic diseases, malignancy, hemoglobinopathy, infectious diseases and storage diseases. The Authors review the role of the laboratory test, the ultrasonography and the peripheral blood smear in orienting the differential diagnosis. Invasive procedure as bone marrow aspiration, lymph node biopsy, hepatic biopsy or fine needle splenic biopsy are often warranted to estabilish the cause of splenomegaly.
5) Problemi correnti - Dicembre 2004
L’impetigine
- A. Lenhardt, J. Bua, F. Marchetti
- As a rule bollous impetigo is caused by Staphylococcus aureus. Non bullous, or contagious, impetigo is also caused by Staphylococcus aureus, less frequently by its association with Streptococcus pyogenes. Controlled studies showed that topical antibiotics such as mupirocine and fusidic acid are at least as effective as oral antibiotics. Oral antibiotics remain the treatment of choice in case of familial cases, of perioral localisation and of systemic involvement. In these cases, although controlled studies are not available, 1st and 2nd generation cephalosporins, amoxicillin-clavulanic and macrolides are recommended.
6) Ricerca - Giugno 2024
Routine del sonno e risvegli notturni nei bambini durante i primi due anni di vita
- Segre G, Clavenna A, Roberti E, Campi R, Rapisardi G, Bonati M.
- Background - Previous studies analyzed the characteristics and prevalence of sleep problems in Italian children. However, less attention is shed on the factors involved in sleep disturbances in the first two years of life.
Aims - To provide a developmental trajectory of Italian infants’ sleep patterns during the first two years of life and to analyze what factors affect it most over time.
Materials and Methods - Data for this study were collected within the NASCITA cohort. During the well-child visits conducted at 6, 12, and 24 months, paediatricians asked parents to report if their children had any sleep disturbances, particularly frequent night awakenings. Univariate and multivariable analyses were performed to test the association between child and family variables and the likelihood of frequent awakenings.
Results - 2,973 toddlers were included in this study; 875 (29.4%) toddlers presented frequent awakenings in at least one visit (peak of prevalence of 19.8% at 12 months). Bed-sharing (adjusted OR 2.53; 95% CI: 2.05-3.12) and living in the North of Italy (aOR 2.25; 95% CI:1.80-2.81) were the variables more strongly associated with an increased likelihood of frequent awakenings in the binomial logistic regression, while sleeping alone was associated with a decreased chance (aOR 0.62; 95% CI 0.45-0.89).
Conclusion - The current study identifies some early predictors of frequent awakenings during the first two years of life. Since optimal sleep practices in children are essential for their development, paediatric care practices must define and integrate early effective interventions.
7) Casi indimenticabili - Giugno 2024
Vaccinare è meglio che curare: una sfida contro la pertosse
- Cavallaro C, Maltese C, Lagalla LM, et al.
- The Authors describe 16 cases of whooping cough in children under one year of age. In no case had the mother been vaccinated during pregnancy.
7) Casi indimenticabili - Giugno 2024
Vomito mattutino e cefalea: pensa male
- Fenato A.
- The paper reports the case of a six-year-old child with progressively worsening headaches and morning vomiting over several months, initially attributed to an emotional disturbance. A pilocytic astrocytoma of the posterior cranial fossa was eventually diagnosed.
7) Casi indimenticabili - Giugno 2024
Una bambina che non vuole camminare
- Penco A.
- The paper describes the case of an eight-year-old girl presenting with limping, worsening bilateral foot sole pain: the unmistakable symptoms (refusal to stand and walk) contributed to the diagnosis of conversion/factitious disorder.
8) Farmacoriflessioni - Aprile 2007
La terapia del croup
- F. Marchetti, P. Salierno
- Viral croup is the most common cause of upper airway obstruction in children from 6 months to 6 years of age. Parainfluenza virus accounts for the majority of cases. More than 80% of children have mild symptoms and in approximately 60% to 95% of children, the symptoms disappear within 2 and 5 days, respectively. Based on the results of systematic review, glucocorticoid treatment was associated with an improvement in the Westley score at 6 hours and at 12 hours. Fewer return visits and/or (re)admissions occurred in patients treated with glucocorticoids (relative risk 0.50; 0.36 to 0.70). The setting, severity of croup, route of administration (oral or nebulised) and dose, and study quality, did not influence the effectiveness of treatment. Nebulised adrenaline should be reserved for patients with moderate to severe croup. Simultaneous administration of glucocorticoid and adrenaline reduces the rate of intubation in patients with severe croup. Mist/humidified air provides no additional symptom improvement.
9) L'angolo dell'immunologo - Ottobre 2001
Quando sospettare un’immunodeficienza
- A. Tommasini, A. Insalaco, C. Perez, A.R. Soresina, A. Plebani
10) Linee guida - Ottobre 2020
La prima infezione urinaria febbrile in bambini di età compresa tra 2 mesi e 3 anni
- Gruppo di lavoro sulle infezioni delle vie urinarie della Società Italiana di Nefrologia Pediatrica (SINePe)
- The aim was to update the recommendations for the diagnosis, treatment and follow-up of the first febrile urinary tract infection in young children, which were first published in 2012 and endorsed by the Italian Society of Paediatric Nephrology. The Italian recommendations were revised on the basis of a review of the literature published from 2012 to October 2018. An ad hoc evaluation of the risk factors, which were published in the previous recommendations, was carried out to identify children with high-grade vesicoureteral reflux or renal scarring. When evidence was not available, the working group held extensive discussions during various meetings and through email exchanges. Four major modifications have been introduced. The method for collecting urine for culture and its interpretation has been re-evaluated. The algorithm that guides clinical decisions to proceed with voiding cystourethrography has been reformulated. The suggested antibiotics have been revised and further restrictions of the use of antibiotic prophylaxis have been recommended. These updated recommendations have now been endorsed by the Italian Society of Paediatric Nephrology and the Italian Society for Paediatric Infectivology. They can also be used to compare other available recommendations, as a worldwide consensus in this area is still lacking.