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
1) 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.
1039 kB2) Aggiornamento - Aprile 2008
L'ipertensione arteriosa in età pediatrica: dall'inquadramento diagnostico alla terapia
- A. de Cunto, M. Maschio, M. Pennesi, A. Benettoni
- The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make identification and treatment of hypertension an important focus of physicians caring for children. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is an emerging condition in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Evaluation involves a thorough history and physical examination, laboratory tests, and specialized studies. Lifestyle modifications are advised for all patients and can be tried solely for those with blood pressures between the 95th and 99th percentiles. Drug therapy is indicated in children with blood pressures greater than the 99th percentile, secondary hypertension, coexisting diabetes, left ventricular hypertrophy, or those who fail a trial of non pharmacologic treatment.
3) Aggiornamento - Gennaio 2024
La cellulite orbitaria in età pediatrica: una proposta di gestione diagnostico-terapeutica
- Zama D, Altimari L, Ruscelli M, et al.
- The incidence of orbital cellulitis in the paediatric age is around 1.6/100,000 cases per year. Most cases are mild and limited to the preseptal space; however, severe and complicated cases are possible. Paediatricians should be able to recognize high-risk adverse outcome conditions that require prompt intervention. Clinical evaluation supported by laboratory workup is the key for the diagnosis. Intraorbital and intracranial complications may be ruled out through diagnostic imaging. Depending on the extension of the infection, clinicians may choose between conservative treatment with antibiotic therapy or surgical drainage at first. The paper proposes an algorithm to aid clinicians in the management of paediatric orbital cellulitis through the description of three emblematic clinical cases observed in the Paediatric Emergency Room.
5) Problemi speciali - Gennaio 2025
Il bambino che zoppica: quando bisogna… pensarle tutte
- Tumminelli C, Pastore S, Taddio A.
- Limping is a common clinical symptom in childhood and the diagnosis of the underlying cause may often be a challenge for the paediatrician. The paper describes the clinical manifestations, radiological pictures and disease course of other causes of limping in childhood, through a series of seven cases and a brief discussion of each disease.
6) 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.
8) Aggiornamento - Febbraio 2025
Torcicollo in età pediatrica: come orientarsi per non sbagliare
- Cruciani C, Borelli AI, Palluzzi F, et al.
- Torticollis is defined as a condition characterised by the deviation of the head to one side with the chin rotated in the opposite direction. Torticollis in paediatric age is a presenting symptom common to various underlying pathophysiological processes. It may occur at any age; indeed, there are congenital and acquired forms. The aetiology may be benign or potentially life-threatening, so knowing the main causes of torticollis is of fundamental importance. The objective of this discussion is providing the paediatrician with practical indications to orient themselves among the numerous differential diagnoses and ensure appropriate clinical management of the patient with torticollis. The first step consists in recognising the causes early and treating them promptly; the next step consists in identifying the underlying pathology and offering targeted treatment and follow-up.
9) L'angolo dell'immunologo - Ottobre 2001
Quando sospettare un’immunodeficienza
- A. Tommasini, A. Insalaco, C. Perez, A.R. Soresina, A. Plebani
12) 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.
13) Linee guida - Maggio 2024
La gestione della piastrinopenia immune acuta in età pediatrica
- Parodi E, Russo G. a nome del GdL AIEOP
- This report summarizes the most relevant issues of the document that the Working Group on Coagulation Disorders of the Italian Association of Paediatric Haematology and Oncology (AIEOP) developed to gather shared expert opinions on the management of newly diagnosed idiopathic thrombocytopenic purpura (ITP), updating previous guidelines and providing recommendations to paediatricians. These recommendations are not intended to be standards or fixed rules but rather a tool to support paediatricians in the management of the diagnostic work-up and treatment of children with newly diagnosed ITP.
14) La Pediatria sulla Grande Stampa - Supplemento 2024
La Pediatria sulla Grande Stampa 2024
- Alessandro Ventura
-
Nello Speciale 2024 c’è tutto quello che vi aspettate di trovare in uno Speciale: dal commento di una selezione di articoli della letteratura internazionale più qualificata (di molti dei quali si era già parlato sulla “gialla”), alla presenta-zione critica di casi clinici emblematici della pratica clinica quotidiana ma anche di altri, esemplificazione di quelle “rarità” che è sempre utile tenere a mente.
Ma c’è anche una novità che speriamo possa incuriosirvi ed essere una occasione originale, sorprendente e soprattutto efficace di riflessione e di aggiornamento.
Un po’ per curiosità, un po’ per sentirsi al passo coi tempi (un bisogno questo che, inopportunamente, cresce con l’avanzare dell’età...), lo Speciale di questo anno, attraverso il canale interattivo ChatGpT, ha aperto le porte all’intelligenza artificiale (AI): al cui “sapere” molti di noi (soprattutto i più giovani ma non solo) si rivolgono quotidianamente per avere risposte alle più disparate domande: si tratti del risultato di una partita di calcio di 40 anni fa, della data di una battaglia medioevale, della linea di pensiero di un filosofo greco o anche, e questo ci riguarda da vicino nella pratica, delle ipotesi diagnostiche e della linea operativa da tenere davanti a un caso clinico con sintomi rari o comunque difficile da risolvere. È stato quindi proprio ad AI che ho chiesto di selezionare e recensire brevemente i 50 articoli usciti nella letteratura internazionale nel 2024 che riteneva più importanti e utili per il pediatra in ognuno dei diversi ambiti specialistici in cui si trova ad operare. Ho chiesto, in pratica, ad AI di proporci una sua personale Pagina Gialla dell’intero 2024. Una selezione delle recensioni scritte da AI, rigorosamente su sfondo giallo ma con qualche segno grafico che ne richiami l’”intelligente” Autore, apre ogni capitolo specialistico di questo Speciale, seguita dal commento e dall’approfondimento tematico da parte degli esperti dei diversi ambiti specialistici. Esperti che a volte si sono detti compiaciuti e d’accordo con le scelte e i commenti di AI; che altre volte hanno espresso e motivato il loro disaccordo; e che non di rado hanno colto AI in fallo per qualche imperfezione (falsità) nella citazione bibliografica e/o nella citazione degli Autori e/o nella corrispondenza tra commento e contenuto dell’articolo, anche se i concetti espressi sono stati sempre verosimili e comunque già proposti in diversa maniera e da autori diversi nella letteratura di anni precedenti.
Oltre che delle sue straordinarie potenzialità e applicazioni, della intelligenza artificiale abbiamo dunque avuto prova anche dei limiti: dovuti principalmente al fatto che si tratta di uno strumento di sapere programmato prima di tutto per gratificare l’interlocutore. E per dargli comunque delle risposte a prescindere dal fatto che sia realmente possibile darle o che occorra inventarle: pescando da quell’ infinito bagaglio di parole e linguaggi che poco senso rischiano di avere se non orientati dal pensiero e dalle esigenze dell’uomo.
Alla fine comunque un confronto tra AI ed esperti c’è stato, eccome! E speriamo che di questo confronto si sentano partecipi anche i lettori. Comunque sia, grazie alla bravura e all’esperienza (all’insostituibile pensiero critico e all’Intelligenza Naturale - IN) di questi ultimi ci sembra che in questo Speciale si sia concretizzata una straordinaria, inedita occasione di aggiornamento sui diversi aspetti specialistici del nostro lavoro. Particolarmente efficace, mi sembra: come del resto sempre accade quando l’aggiornamento nasce da un confronto, si tratti di esseri umani o di AI. Buona lettura. E come sempre Buon Anno per quel che resta dell’anno!
Alessandro Ventura
Consulta la versione sfogliabile.
-
Nello Speciale 2024 c’è tutto quello che vi aspettate di trovare in uno Speciale: dal commento di una selezione di articoli della letteratura internazionale più qualificata (di molti dei quali si era già parlato sulla “gialla”), alla presenta-zione critica di casi clinici emblematici della pratica clinica quotidiana ma anche di altri, esemplificazione di quelle “rarità” che è sempre utile tenere a mente.
16) Editoriali - Gennaio 2025
16) Editoriali - Gennaio 2025
17) La pagina gialla - Giugno 2025
a cura di Sara Lega19) Problemi correnti - Febbraio 2024
Tutta la tosse in una figura
- Longo G.
- Cough is the most common cause of unscheduled paediatric visits. The figure in the article shows the main causes of paediatric coughs differentiated by duration, quality (dry or wet) and night-time coughing. With these few simple key anamnestic elements (and especially if confirmed and reinforced by being able to see, even in a simple video, the child coughing) a diagnosis may be made with reasonable certainty, saving specialist visits and diagnostic tests that are unlikely useful and potentially harmful.
20) Aggiornamento monografico - Maggio 2005
Sindrome adreno-genitale congenita da deficit di 21-idrossilasi
- A. Balsamo, A. Cicognani
- Congenital adrenal hyperplasia (CAH) refers to a group of inherited disorders of adrenal steroidogenesis. More than 90% of CAH is due to 21-hydroxylase deficiency (21-OH-D), found in 1:10.000 to 1:15.000 live births as classical form and detected in about 2:100 of certain populations as non classical form. Females with classical 21-OH-D present at birth genital virilization. Potentially life-threatening adrenal crisis may characterize two-third to three-quarters of patients of both sexes with the classical salt wasting (SW) form. Non classical patients may present as precocious pubarche in children or polycystic ovarian syndrome in young women. 21-OH-D is caused by CYP21 gene mutations which in more than 90% of the cases result from inter-genic recombination between the active CYP21 gene and the inactive CYP21P pseudogene. The degree to which each mutation impairs enzymatic activity is strictly correlated with the clinical severity of the disease. Glucocorticoid and mineralcorticoid replacement therapies are the basics of treatment, although alternative strategies of treatment are being developed. Neonatal screening may identify affected children before SW crises develop, reducing mortality of this disease. Prenatal diagnosis and treatment should be performed in families at risk for classical form, underlining them that long term results in dexamethasone treated subjects have however lacking. Long term outcome shows an adult height generally between 1 and 2 standard deviations under the familial target height and a fertility rate only moderately reduced in female more than in male treated patients.
1) Aggiornamento - Gennaio 2024
La cellulite orbitaria in età pediatrica: una proposta di gestione diagnostico-terapeutica
- Zama D, Altimari L, Ruscelli M, et al.
- The incidence of orbital cellulitis in the paediatric age is around 1.6/100,000 cases per year. Most cases are mild and limited to the preseptal space; however, severe and complicated cases are possible. Paediatricians should be able to recognize high-risk adverse outcome conditions that require prompt intervention. Clinical evaluation supported by laboratory workup is the key for the diagnosis. Intraorbital and intracranial complications may be ruled out through diagnostic imaging. Depending on the extension of the infection, clinicians may choose between conservative treatment with antibiotic therapy or surgical drainage at first. The paper proposes an algorithm to aid clinicians in the management of paediatric orbital cellulitis through the description of three emblematic clinical cases observed in the Paediatric Emergency Room.
2) Problemi speciali - Gennaio 2025
Il bambino che zoppica: quando bisogna… pensarle tutte
- Tumminelli C, Pastore S, Taddio A.
- Limping is a common clinical symptom in childhood and the diagnosis of the underlying cause may often be a challenge for the paediatrician. The paper describes the clinical manifestations, radiological pictures and disease course of other causes of limping in childhood, through a series of seven cases and a brief discussion of each disease.
4) Aggiornamento - Febbraio 2025
Torcicollo in età pediatrica: come orientarsi per non sbagliare
- Cruciani C, Borelli AI, Palluzzi F, et al.
- Torticollis is defined as a condition characterised by the deviation of the head to one side with the chin rotated in the opposite direction. Torticollis in paediatric age is a presenting symptom common to various underlying pathophysiological processes. It may occur at any age; indeed, there are congenital and acquired forms. The aetiology may be benign or potentially life-threatening, so knowing the main causes of torticollis is of fundamental importance. The objective of this discussion is providing the paediatrician with practical indications to orient themselves among the numerous differential diagnoses and ensure appropriate clinical management of the patient with torticollis. The first step consists in recognising the causes early and treating them promptly; the next step consists in identifying the underlying pathology and offering targeted treatment and follow-up.
5) Linee guida - Maggio 2024
La gestione della piastrinopenia immune acuta in età pediatrica
- Parodi E, Russo G. a nome del GdL AIEOP
- This report summarizes the most relevant issues of the document that the Working Group on Coagulation Disorders of the Italian Association of Paediatric Haematology and Oncology (AIEOP) developed to gather shared expert opinions on the management of newly diagnosed idiopathic thrombocytopenic purpura (ITP), updating previous guidelines and providing recommendations to paediatricians. These recommendations are not intended to be standards or fixed rules but rather a tool to support paediatricians in the management of the diagnostic work-up and treatment of children with newly diagnosed ITP.
6) La Pediatria sulla Grande Stampa - Supplemento 2024
La Pediatria sulla Grande Stampa 2024
- Alessandro Ventura
-
-
Nello Speciale 2024 c’è tutto quello che vi aspettate di trovare in uno Speciale: dal commento di una selezione di articoli della letteratura internazionale più qualificata (di molti dei quali si era già parlato sulla “gialla”), alla presenta-zione critica di casi clinici emblematici della pratica clinica quotidiana ma anche di altri, esemplificazione di quelle “rarità” che è sempre utile tenere a mente.
Ma c’è anche una novità che speriamo possa incuriosirvi ed essere una occasione originale, sorprendente e soprattutto efficace di riflessione e di aggiornamento.
Un po’ per curiosità, un po’ per sentirsi al passo coi tempi (un bisogno questo che, inopportunamente, cresce con l’avanzare dell’età...), lo Speciale di questo anno, attraverso il canale interattivo ChatGpT, ha aperto le porte all’intelligenza artificiale (AI): al cui “sapere” molti di noi (soprattutto i più giovani ma non solo) si rivolgono quotidianamente per avere risposte alle più disparate domande: si tratti del risultato di una partita di calcio di 40 anni fa, della data di una battaglia medioevale, della linea di pensiero di un filosofo greco o anche, e questo ci riguarda da vicino nella pratica, delle ipotesi diagnostiche e della linea operativa da tenere davanti a un caso clinico con sintomi rari o comunque difficile da risolvere. È stato quindi proprio ad AI che ho chiesto di selezionare e recensire brevemente i 50 articoli usciti nella letteratura internazionale nel 2024 che riteneva più importanti e utili per il pediatra in ognuno dei diversi ambiti specialistici in cui si trova ad operare. Ho chiesto, in pratica, ad AI di proporci una sua personale Pagina Gialla dell’intero 2024. Una selezione delle recensioni scritte da AI, rigorosamente su sfondo giallo ma con qualche segno grafico che ne richiami l’”intelligente” Autore, apre ogni capitolo specialistico di questo Speciale, seguita dal commento e dall’approfondimento tematico da parte degli esperti dei diversi ambiti specialistici. Esperti che a volte si sono detti compiaciuti e d’accordo con le scelte e i commenti di AI; che altre volte hanno espresso e motivato il loro disaccordo; e che non di rado hanno colto AI in fallo per qualche imperfezione (falsità) nella citazione bibliografica e/o nella citazione degli Autori e/o nella corrispondenza tra commento e contenuto dell’articolo, anche se i concetti espressi sono stati sempre verosimili e comunque già proposti in diversa maniera e da autori diversi nella letteratura di anni precedenti.
Oltre che delle sue straordinarie potenzialità e applicazioni, della intelligenza artificiale abbiamo dunque avuto prova anche dei limiti: dovuti principalmente al fatto che si tratta di uno strumento di sapere programmato prima di tutto per gratificare l’interlocutore. E per dargli comunque delle risposte a prescindere dal fatto che sia realmente possibile darle o che occorra inventarle: pescando da quell’ infinito bagaglio di parole e linguaggi che poco senso rischiano di avere se non orientati dal pensiero e dalle esigenze dell’uomo.
Alla fine comunque un confronto tra AI ed esperti c’è stato, eccome! E speriamo che di questo confronto si sentano partecipi anche i lettori. Comunque sia, grazie alla bravura e all’esperienza (all’insostituibile pensiero critico e all’Intelligenza Naturale - IN) di questi ultimi ci sembra che in questo Speciale si sia concretizzata una straordinaria, inedita occasione di aggiornamento sui diversi aspetti specialistici del nostro lavoro. Particolarmente efficace, mi sembra: come del resto sempre accade quando l’aggiornamento nasce da un confronto, si tratti di esseri umani o di AI. Buona lettura. E come sempre Buon Anno per quel che resta dell’anno!
Alessandro Ventura
Consulta la versione sfogliabile.
-
Nello Speciale 2024 c’è tutto quello che vi aspettate di trovare in uno Speciale: dal commento di una selezione di articoli della letteratura internazionale più qualificata (di molti dei quali si era già parlato sulla “gialla”), alla presenta-zione critica di casi clinici emblematici della pratica clinica quotidiana ma anche di altri, esemplificazione di quelle “rarità” che è sempre utile tenere a mente.
7) La pagina gialla - Giugno 2025
a cura di Sara Lega8) Problemi correnti - Febbraio 2024
Tutta la tosse in una figura
- Longo G.
- Cough is the most common cause of unscheduled paediatric visits. The figure in the article shows the main causes of paediatric coughs differentiated by duration, quality (dry or wet) and night-time coughing. With these few simple key anamnestic elements (and especially if confirmed and reinforced by being able to see, even in a simple video, the child coughing) a diagnosis may be made with reasonable certainty, saving specialist visits and diagnostic tests that are unlikely useful and potentially harmful.
9) Aggiornamento - Settembre 2024
Ematuria e proteinuria
- Scaramuzzino F, Burlo F, Delcaro G, et al.
- Proteinuria and haematuria are common findings in children. However, they are indicative of a renal or urinary condition only in a minority of cases. The probability of an underlying disease causing haematuria and /or proteinuria increases when they are associated and in the presence of symptoms that suggest kidney damage, such as oedema, hypertension, or kidney failure. Transient and orthostatic proteinurias are benign conditions that do not require further investigations. Proteinuria should always be investigated when constant or heavy. If patients present with nephrotic syndrome, oedema and hypoalbuminemia, proteinuria is always pathologic. Tubular proteinuria should always be ruled out, in particular in male subjects with persistent proteinuria. Haematuria can be glomerular or non-glomerular and may present as gross haematuria or can only be detected microscopically. Macroscopic haematuria should always be investigated as it may be associated with benign conditions (fever, exertion, dehydration, nutcracker syndrome), but also with several conditions such as glomerular diseases or urolithiasis. The urine colour, the urinary sediment, the morphology of red blood cells, kidney function, the presence of proteinuria and the medical history help in the differential diagnosis. On the other hand, microscopic haematuria should be investigated only when persistent or if there is a positive family history. This paper presents 5 illustrative cases to highlight the above points.
10) Farmacoriflessioni - Giugno 2025
Trattamento della scabbia
- Sapigni E, Nigro R, Mattei G, Matteo G, Di Nuzzo S, Motolese A, Corazza M, Conti A, Marchetti F.
- Scabies, a parasitic dermatosis caused by Sarcoptes scabiei, is classified by the World Health Organization as a neglected tropical disease due to its global burden. In recent years, the Emilia-Romagna Region has reported a significant increase in scabies cases, with higher incidence among males, children, adolescents and young adults. This guideline aims to provide evidence-based recommendations for the diagnosis, treatment and management of scabies, by focusing on target populations and types of scabies, with specific consideration for paediatric patients. The guideline was developed by a multidisciplinary team of dermatologists, paediatricians, public health officials and pharmacists from the Emilia-Romagna Region. It is based on systematic reviews, meta-analyses and international guidelines published in the last six years (2019-2024). Permethrin 5% topical cream remains the first-line therapy. Benzyl benzoate and oral ivermectin are effective alternatives in selected cases; oral ivermectin is specifically recommended for treating large groups or patients with extensive eczema. Crusted scabies requires a combination of topical and systemic agents, along with keratolytics. Early treatment of close contacts and a structured two-week follow-up are also recommended. A practical section on paediatric topical application is included to assist caregivers and improve compliance. This guideline supports healthcare professionals in the standardised management of scabies and emphasizes the need for effective interventions to address the rising incidence of cases.
11) Protocolli di diagnosi e terapia - Maggio 2025
Facciamo il punto sull’anemia falciforme
- Tessitore A, Cuzzubbo D, Russo G.
- Sickle cell disease (SCD) is an increasingly relevant condition in Italy due to rising immigration from high-prevalence regions. Early diagnosis through newborn screening and comprehensive management - including hydroxyurea, antibiotic prophylaxis, transfusions and bone marrow transplantation - are essential to improve outcomes. The article covers key clinical issues, from early detection and vaccination to innovative treatments like gene therapy. Its goal is to provide paediatricians with practical guidance for recognizing and treating SCD in children effectively.
12) Farmacoriflessioni - Febbraio 2025
Corticosteroidi topici nel trattamento della fimosi
- Traunero A, Scarpa MG, Tornese G.
- Phimosis is the complete or partial inability to retract the foreskin over the glans. Usually, it is a physiological condition, present from birth, and in the majority of cases resolves with variable timing during growth. Pathological phimosis occurs when the failure to retract the foreskin is caused by a distal scar tissue, secondary to recurrent balanoposthitis, trauma, or balanitis xerotica obliterans. The physiological and asymptomatic forms should not be treated as they tend to resolve spontaneously, while treatment should be reserved for its pathological or symptomatic forms, in case of balanoposthitis or recurrent urinary infections, paraphimosis and symptomatic vesicoureteral reflux or hydroureteronephrosis. This article analyses the previous studies on the use of topical steroids in the treatment of phimosis. The literature shows their high rate of efficacy in improving or resolving this condition, without significant differences between low-medium and high-potency steroids, and the absence of adverse effects. Therefore, the use of topical steroids in the distal stenotic portion of the foreskin, applied for a month (and possibly repeatable), is an optimal strategy in the initial management of phimosis, reserving surgery (circumcision) as a second-line treatment in case of failed conservative therapy.
13) Problemi correnti - Novembre 2024
Infezioni delle vie urinarie: dalla diagnosi alla terapia
- De Pra S, Benvenuto S, Pennesi M.
- Urinary tract infections (UTIs) are a common occurrence in the paediatric population and are often paucisymptomatic in children under two years of age. A definitive diagnosis is obtained through urine culture, which should be collected using invasive methods or midstream urine. Intravenous (IV) therapy is indicated for infants under two months of age, in cases of complicated UTIs, or when there is a suspicion of poor therapeutic adherence. The effectiveness of oral antibiotic therapy (OS) has not shown to be inferior to that of IV therapy in other cases. Two large studies have shown that the effectiveness of a 5-day antibiotic therapy is not inferior to a 10-day one. The addition of corticosteroids, although it is safe, does not show solid evidence regarding its benefit and remains at the clinician's discretion. After a first episode of UTI, a renal ultrasound should always be performed to rule out underlying conditions such as vesicoureteral reflux or renal hypodysplasia. Other diagnostic investigations, such as voiding cystourethrography and renal scintigraphy with MAG3 or DMSA, should be performed only as a second step if specific abnormalities are detected on ultrasound or if there are specific clinical findings. UTIs rarely result in renal scarring, which is more often associated with congenital conditions. Moreover, unilateral renal scars are very rarely correlated with a decline in renal function. The usefulness of antibiotic prophylaxis in VUR (vesicoureteral reflux) has been questioned by numerous studies, which have demonstrated its limited effectiveness in reducing the recurrence of UTIs and its ineffectiveness in preventing renal scars, both in children with low-grade and high-grade VUR.
14) Linee guida - Gennaio 2022
Le nuove linee guida ESPGHAN 2020 per la diagnosi di celiachia: passo dopo passo
- Mandile R, Auricchio R.
- In 2020 new guidelines for the diagnosis of paediatric coeliac disease were published by the ESPGHAN Society. Just one algorithm is indicated for both symptomatic and asymptomatic patients, HLA haplotype typing is no more suggested and anti-tissue transglutaminase antibodies are identified as the best test for screening for all ages. The present article explains how to manage critically this new diagnostic protocol for coeliac disease in children.
15) Aggiornamento - Marzo 2025
Glomerulonefriti acute: tre facce della stessa medaglia
- Iacono A, Cunsolo M, Spallino E, et al.
- The phenotypic variability of a single pathology complicates the diagnostic and therapeutic approaches, particularly for its more complex and less common forms. The paper describes three clinical cases of post-infectious glomerulonephritis, all presenting with macrohaematuria but evolving with different outcomes, ranging from clinical-laboratory findings to varying therapeutic management, including supportive therapies and the use of immunosuppressive treatments. Although acute post-infectious glomerulonephritis is typically a self-limiting condition, the third clinical case presented with rapidly progressive renal failure accompanied by a sudden clinical deterioration, requiring both haemodialysis and immunosuppressive therapy. The discussion of these three clinical cases - different sides of the same medal - aims to emphasise the extreme phenotypic variability of a single disease and the importance of early diagnostic and therapeutic evaluation.
16) Aggiornamento - Maggio 2023
Vasculiti facili e difficili: cosa deve sapere e saper fare un pediatra
- De Nardi L, Petrone MI, Benvenuto S, et al.
- Vasculitis is defined by a state of inflammation of the blood vessel walls. It can result in formation of either aneurysms or stenosis with ischemia and necrosis. The heterogeneity of clinical presentation depends on the type and size of the vessels involved, which leads to different patterns of organ damage. The skin is usually involved but not necessarily as a first manifestation of disease. Indeed, significant organ damage may occur at any time in the disease course and may precede other symptoms with significant morbidity and mortality, especially in case of diagnostic delay. The most common vasculitides in childhood are IgA-associated vasculitis (Schönlein-Henoch purpura) and Kawasaki disease. Other vasculitides are much rarer, often arising with insidious symp- toms that make them life-threatening. This paper aims to review the literature on paediatric vasculitides providing a practical guide to disentangle between different diagnoses. It also provides an overview that underlines the key differences in vasculitis presentation, management and follow-up.
17) La pagina gialla - Settembre 2025
a cura di Sara Lega18) Binomi - Settembre 2025
a cura di Alessandro Ventura19) Linee guida - Ottobre 2025
Diarrea emorragica acuta, infezione da Escherichia coli produttori di Shiga tossine e sindrome emolitica uremica
- Documento d’indirizzo inter-societario
- Haemolytic uremic syndrome (HUS) associated with Shiga toxin-producing Escherichia coli (STEC) infection is a major individual and public health challenge and is the leading cause of acute kidney injury in children. In Western countries, HUS complicates about 15% of STEC infections, which usually present with acute bloody diarrhoea (ABD). At least 6-7% of cases of ABD in children (rising to 15-20% during summer) are caused by STEC. The widespread use of molecular microbiology techniques enables the diagnosis of STEC infection before HUS onset in an increasing number of patients and generates a window of preventive and/or therapeutic opportunities. Given the rapid progression of the disease, all children with ABD should be tested as early as possible for Shiga toxin (Stx) encoding genes. Stx-positive patients should then be closely monitored for HUS development by urine dipstick for the development of haemoglobinuria. This proactive diagnostic approach allows the application of measures aimed to prevent or mitigate the severity of HUS among which stands the early and generous fluid administration. Moreover, although antibiotics are not recommended in STEC infections, recent data suggest a promising potential preventive role for bacteriostatic agents (e.g. azithromycin), if administered early during the infection. The aim of the present contribution is to share the approach to ABD and STEC infection as endorsed by the scientific societies actively engaged in this area (AMCLI, SIGENP, SIMEUP, SIN, SIP, SIPPS, SITIP). The goal is to promote the early diagnosis of STEC infection by molecular microbiology of ABDs nationwide, thereby improving the understanding of the mechanisms of disease spreading and hopefully reducing the incidence of HUS and its case fatality rate as well as improving both short- and long-term outcomes.
20) Aggiornamento - Aprile 2025
Parvovirus: un solo virus per tante malattie
- Burlo F, Colussi L, Zanchi C, Bloise S, Marchetti F, Cozzi G.
- Parvovirus B19 causes a wide range of clinical manifestations, with a peak incidence between 5 and 15 years of age. The spectrum of clinical manifestations associated with Parvovirus infection varies depending on the host's age, haematological status and immune status. While common manifestations are generally easy to identify and allow an immediate diagnosis, uncommon ones often lead to confusion and diagnostic delays. The paper describes five cases of Parvovirus B19 infection with atypical presentation: dactylitis, cholestatic hepatitis, reactivation of autoimmune hepatitis, cerebellitis, and haemophagocytic lymphohistiocytosis.