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 Dicembre 2021
1) Vaccinare - Dicembre 2021
- Documento approvato dalle Società e Associazioni pediatriche italiane
2) Consensus - Febbraio 2021
- Gruppo di Lavoro su Covid-19 in Pediatria della Regione
- Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has rapidly spread, becoming the first pandemic of the 21st century by death toll. Children appear to be less affected than adults, with a milder clinical presentation and a significantly lower mortality rate. However, serious complica-tions can occur in childhood, such as COVID-19 temporally related multisystem inflammatory syn-drome (MIS-C). Some aspects of SARS-CoV-2 infection in children and adolescents remain un-clear and the optimal treatment has not been defined. The Working Group on COVID-19 in Paediatrics of the Emilia-Romagna Region (RE-CO-PED) has produced a consensus document with practical recommendations based on a systematic review of the literature and on the clinical experi-ence of the expert group. Evidence is reported regarding prevention measures, diagnostic tools as well as home and hospital therapeutic management of complicated cases (MIS-C). The educational and psychological effects of the pandemic in the paediatric and adolescent age are reported, with the need to define coordinated interventions (between paediatricians, neurospychiatrists, psycholo-gists and educational services) for the prevention and treatment of documented emotional, relational and educational consequences caused by the lockdown, school closures and social distances.
3) La pagina gialla - Dicembre 2021 a cura di Alessandro Ventura
4) Farmacoriflessioni - Dicembre 2021
- Contorno S, Pecile PA.
- In the last twenty years, the international scientific literature paid particular attention to vitamin D deficiency. Many pathological conditions, like allergy, asthma, cancers, autoimmune, cardiovascular and infectious diseases were attributed to vitamin D deficiency. Could a single deficit be responsible for such a lot of different illnesses? Probably, it could not. The mistake lies in the interpretation of vitamin D suggested serum level cut-off. Vitamin D Recommended Dietary Allowance (RDA) of 20 ng/dl, which is the estimated need for people at the upper limit of the Gaussian distribution, was considered like a cut-off. Instead, almost the entire population (97.5%) shows vitamin D needs inferior to 20 ng/ml. This way, a screening based on a wrong cut-off can lead to a useless over-supplementation.
5) Aggiornamento - Dicembre 2021
- Pellegrin MC, Occhipinti A, Bossini B, et al.
- Hyperthyroidism is a rare clinical entity in paediatric age. In most cases the etiology is autoimmune and goiter represents the typical presentation. Ophthalmopathy is rare and can precede the diagnosis of autoimmune hyperthyroidism. Thyrotoxicosis caused by the hyperthyroid phase of Hashimoto’s thyroiditis must be carefully distinguished from Graves’ disease (GD), since the first condition has a better prognosis for spontaneous remission. Three treatment options are currently available for the management of paediatric GD. First-line therapy is antithyroid drugs, while thyroidectomy and radioiodine are considered on relapse. A lower remission rate and a higher risk of adverse events are observed after the first course of methimazole in childhood with respect to adulthood. Children and adolescents may require a prolonged antithyroid treatment, but an overall consensus regarding the optimal regimen is lacking.
6) Pagine elettroniche - Dicembre 2021
- Bacci C, Picariello S, Vierucci F, Bassi A, Mazzatenta C, Vaccaro A.
- Erythema nodosum is a panniculitis that can be triggered by many different stimuli. The paper describes the case of a child who presented with erythema nodosum as the unique clinical manifesta-tion of cat scratch disease. Bartonella henselae infection usually presents with non-tender papule in the scratch line followed by subsequent onset of regional lymphadenopathy eventually associated with systemic symptoms. It can also present with atypical manifestation, such as erythema nodosum. The heterogeneity of the clinical presentations makes the disease to be underdiagnosed, whereby it is important to recognize atypical manifestations. Therefore, it is recommended to include Bartonella henselae serology in the diagnostic evaluation of erythema nodosum.
6) Pagine elettroniche - Dicembre 2021
- Giordano S, Pirrone I, Restivo GA, et al.
- Background - Covid-19 is less frequent and milder in children than in adults. However, cases of multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (MIS-C) have been reported in children, whose phenotype resembles atypical Kawasaki disease.
Objectives - The paper describes the incidence as well as clinical, laboratory and radiological findings of MIS-C.
Materials and methods - In the Paediatric Infectious Disease Centre of Palermo (Italy), a targeted surveillance for MIS-C from March 2020 to January 2021 was conducted. Case definition included WHO, UK and US criteria.
Results - The paper reports the cases of 9 patients with MIS-C out of which 8 (88%) were hospitalized after September 2020. 44% were male and their median age was 6.5 years. Organ-system involvement included gastrointestinal (66%), cardiovascular (66%), mucocutaneous (88%), reticuloendothelial (77%) and respiratory (55%) systems. C-reactive protein (CRP), procalcitonin, D-dimer and pro-B-type natriuretic peptide levels (pro-BNP) were high in all patients. Chest radiography showed bilateral ground glass-opacities (55%) and pleural effusions (44%). Abdominal imaging findings included small-volume ascites (55%) and mesenteric lymphadenopathy (22%). Echocardiogram showed transient valves regurgitation (55%). In all the patients, the left ventricular ejection fraction was normal and coronary-artery aneurysms were not documented. They were treated with immunomodulating therapies. All patients neither received intensive care nor died.
Conclusions - MIS-C represents a new systemic inflammatory syndrome with a phenotype resembling Kawasaki disease. MIS-C remains a rare condition, in which gastrointestinal and mucocutaneous involvement is predominant, nevertheless cardiovascular involvement must be investigated. MIS-C could be suspected even if SARS-CoV-2 exposure precedes the onset of the symptoms by more than 6 weeks. In most cases, a good prognosis might be expected.
7) Il graffio - Dicembre 2021 a cura di Alessandro Ventura
8) Linee guida - Giugno 2015
- G. Cozzi, S. Pusceddu, L. Mambelli, E. Barbi, F. Marchetti
- Bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization
in children less than 1 year old. The American Academy of Pediatrics (AAP) and the Italian
Pediatric Society (SIP) have recently published new guidelines for the diagnosis,
management and prevention of bronchiolitis. Indications in the two documents are similar,
but bronchiolitis management is still debated. In particular pharmacological treatments
are not supported by enough evidence, whereas support therapy with oxygen, hydration
and nutrition seems the only useful option. The aim of the present work is to summarise
these new guidelines, adding a brief comment to each recommendation, in order
to produce a useful and practical everyday guide for the paediatrician.
9) Domande e risposte - Dicembre 2021 a cura di Giorgio Longo
10) Lettere - Dicembre 2021