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) Consensus - Febbraio 2021
Gestione del Covid-19 in età pediatrica: documento di consenso
- Gruppo di Lavoro su Covid-19 in Pediatria della Regione Emilia-Romagna (RE-CO-PED)
- 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.
933 kB2) Linee guida - Giugno 2015
Le nuove Linee Guida sulla bronchiolite
- 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.
3) Lettere - Gennaio 2022
4) Vaccinare - Dicembre 2021
La vaccinazione per il Covid-19 in bambini di età compresa tra i 5 e gli 11 anni
- Documento approvato dalle Società e Associazioni pediatriche italiane
5) News box - Gennaio 2022
a cura di Federico MarchettiLa variante Omicron e gli scenari possibili
- Marchetti F.
6) News box - Aprile 2022
a cura di Federico Marchetti7) Editoriali - Settembre 2022
8) Lettere - Settembre 2022
12) L'intervista - Maggio 2022
a cura di Alessandro Ventura13) Editoriali - Ottobre 2022
Screening per streptococco B in gravidanza, possiamo migliorarlo?
- Berardi A, Creti R.
14) Editoriali - Giugno 2022
15) Domande e risposte - Novembre 2022
a cura di Giorgio Longo16) Farmacoriflessioni - Novembre 2010
Trattamento antibiotico di osteomielite, artrite settica
e piomiosite- F. Marchetti, E. Rizzello, F. Poropat, F. Rovere, C. Germani, G. Messi, S. Demarini, M. Carbone, S. Furlan, P. Tamaro, M. Busetti, A. Ventura
- Evidence for the choice or duration of antibiotic treatment for bone, joint infections and pyomyositis is scarce and no randomised trials (RCT) have been done in children and adolescents. The recommendations contained in this work come from the audit on the management of children with osteomyelitis, septic arthritis and pyomyositis hospitalized at the Institute for Child Health “Burlo Garofolo”, Trieste, Italy in the last 8 years. The antibiotic regimen should be based on likelihood of the organisms involved and current local sensitivity patterns, modified subsequently by results of Gram stain and culture. Because probable pathogen in all risk groups is Staphylococcus aureus, initial antibiotic treatment should have bactericidal activity against this bacterium. Suitable choices include β-lactamase-stable penicillins (such as oxacillin and similar) for the treatment of bone and joint infections (with the exception of newborns). For the cases of pyomyositis, findings of studies have consistently showed a worrying increase in meticillin-resistant Staphylococcus aureus infection and the choice of vancomicin or clindamycin seems to be reasonable. As to the duration of the treatment, 4 RCT on paediatric patients reported that the shorter courses of parenteral antibiotic therapy do not appear to influence response rates for children with acute hematogenous osteomyelitis.
18) Domande e risposte - Ottobre 2022
a cura di Giorgio Longo1) 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.
2) 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.
3) Problemi correnti - Aprile 2022
Il sintomo febbre: l’interpretazione e la corretta gestione
- Altimari L, Troisi A, Marchetti F.
- In paediatric age, fever represents one of the main reasons for parental concern and the main cause of access to the emergency room. Against "fever phobia", it is essential that the paediatrician spends some time explaining to parents that fever is a defence mechanism against infection and that it should be treated rationally, with the objective of making the child feel better and not making them heal faster. Furthermore, it is useful to provide parents with indications on how to measure body temperature and advice on clinical signs to pay attention to, besides fever. Indeed, in addition to temperature, there are other parameters to evaluate in a febrile child, some clearly measurable, others for which it is necessary for the doctor to evaluate the child "face to face". It is on this issue that the main guidelines on the management of febrile children are based, whose objective is to help the paediatrician to identify those few children who have a severe disease and therefore deserve prompt treatment and investigations. The article shows current evidence on the role of fever, the most correct methods for its measurement, the reasonable use of drugs for the symptomatic control of fever and the approach to be followed in the management of fever in the child aged less than 5 years.
4) Farmacoriflessioni - Settembre 2022
Terapia farmacologica in urgenza
- Squillaci D, Tumminelli C, Molina Ruiz I, et al.
- Emergency cases are rare events in the paediatric emergency department. Nevertheless, paediatricians working at the emergency department should be able to provide the appropriate pharmacological intervention. This retrospective study, performed at the paediatric emergency department of the Institute for Maternal and Child Health IRCCS “Burlo Garofolo” in Trieste (Italy), analysed 251 emergency cases. The most frequently reported emergencies were related to respiratory and neurological diseases. Oxygen, bronchodilators, fluids and anticonvulsants were the drugs most frequent-ly administered. The results were discussed according to the recent literature evidence.
5) Aggiornamento - Aprile 2022
La sincope in età pediatrica
- Corona F, Tessitore A, Bobbo M, Barbi E, Cozzi G.
- Syncope is a loss of consciousness with or without prodromes characterized by fast onset, short duration and spontaneous recovery. It is a frequent cause of recourse to the consultation of a paediatrician. The most frequent cause of syncope in paediatric patients is vasovagal, a benign condition for which only behavioural therapy is required. Cardiogenic syncope, even though it is rare, must always be excluded from the evaluation by looking for the red flags for non-vasovagal syncope.
6) Consensus - Novembre 2019
La sindrome nefrosica in età pediatrica
- Consensus della Società Italiana di Nefrologia Pediatrica (SINePe)
- In Italy are not guidelines for the management of idiopathic nephrotic syndrome (NS) in paediatric age. The choice of a treatment with steroids has always been based on the clinical experience of each centre. The present Consensus of the Italian Paediatric Nephrology Association, updated as an overview of the literature in August 2015, aims to provide a multidisciplinary review on the diagnosis and treatment of NS at the onset by proposing a shared therapeutic protocol for both hospital and family paediatricians. The Consensus gives recommendations on the early recognition and treatment of complications (oedema, hypovolemia, infections and thromboembolic events) as well as on the definition of cortico-resistance and indications on the performance of kidney biopsy.
7) La Pediatria sulla Grande Stampa - Supplemento 2021
La Pediatria sulla Grande Stampa 2021
- Alessandro Ventura
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Nonostante tutto (è il caso di dirlo perché i “nonostante” sono stati tanti nel 2021: l’insicurezza che la pandemia ha
trasmesso, le stranezze epidemiologiche, i cambiamenti dell’organizzazione del lavoro e in molti casi la difficoltà di lavorare come avremmo voluto, gli stessi pensieri che frullano per la testa, un po’ di depressione forse - ma forse sto parlando solo di me -) la Pediatria ha fatto i suoi passi in avanti anche nel 2021. O quantomeno ha dato segno di sé, della sua vitalità, del suo stare al passo e del suo voler affrontare i problemi emergenti oltre che i problemi di sempre.
Di questa vitalità, di questa voglia di restare sul pezzo, di continuare ad avere un senso e di farsi sentire ci dà testimonianza la ricchezza degli studi, dei casi clinici e dei contributi editoriali di ambito pediatrico usciti sulle riviste più
prestigiose. Come ogni anno, di quanto uscito sulla “grande stampa” ho colto e selezionato (con tutti i limiti dati dal
piacere e dal poco sapere personale) una minuscola parte che vi rigiro un po’ riflettuta e un po’ commentata, in questo
speciale: con il divertimento e l’entusiasmo comunque che la lettura e la divulgazione di un bell’articolo sa suscitare, si
tratti di uno studio clinico controllato, di una nuova terapia resa possibile dalla ricerca di base avanzata, dell’approfondimento di qualche aspetto della salute fisica e mentale del bambino nella società di oggi o di un caso clinico ben presentato e discusso.
Mi piace credere, mi fa bene pensare (anche se non ne sono sicuro), che la lettura di questo speciale, anche a spizzichi e bocconi, possa almeno un po’ appassionare e divertire anche voi. Un abbraccio tardivo di buon anno e, al caso, buona lettura!
Alessandro Ventura
Consulta la versione sfogliabile.
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Nonostante tutto (è il caso di dirlo perché i “nonostante” sono stati tanti nel 2021: l’insicurezza che la pandemia ha
trasmesso, le stranezze epidemiologiche, i cambiamenti dell’organizzazione del lavoro e in molti casi la difficoltà di lavorare come avremmo voluto, gli stessi pensieri che frullano per la testa, un po’ di depressione forse - ma forse sto parlando solo di me -) la Pediatria ha fatto i suoi passi in avanti anche nel 2021. O quantomeno ha dato segno di sé, della sua vitalità, del suo stare al passo e del suo voler affrontare i problemi emergenti oltre che i problemi di sempre.
Di questa vitalità, di questa voglia di restare sul pezzo, di continuare ad avere un senso e di farsi sentire ci dà testimonianza la ricchezza degli studi, dei casi clinici e dei contributi editoriali di ambito pediatrico usciti sulle riviste più
prestigiose. Come ogni anno, di quanto uscito sulla “grande stampa” ho colto e selezionato (con tutti i limiti dati dal
piacere e dal poco sapere personale) una minuscola parte che vi rigiro un po’ riflettuta e un po’ commentata, in questo
speciale: con il divertimento e l’entusiasmo comunque che la lettura e la divulgazione di un bell’articolo sa suscitare, si
tratti di uno studio clinico controllato, di una nuova terapia resa possibile dalla ricerca di base avanzata, dell’approfondimento di qualche aspetto della salute fisica e mentale del bambino nella società di oggi o di un caso clinico ben presentato e discusso.
8) La pagina gialla - Settembre 2022
a cura di Alessandro Ventura10) La pagina gialla - Giugno 2022
a cura di Alessandro Ventura11) La pagina gialla - Gennaio 2022
a cura di Alessandro Ventura12) Linee guida - Giugno 2021
Ingestione di corpi estranei e di caustici nei bambini
- Bramuzzo M, Oliva S a nome del Gruppo di Lavoro SIGENP e AIGO
- Foreign bodies or caustic ingestion is a frequent occurrence in children and can result in significant morbidity. Managing these conditions requires different levels of experience and expertise. An en-doscopy is often necessary but an incorrect use of this procedure is common. Indications and timing of endoscopy mainly depends on the clinical conditions of the child, the type of object and its posi-tion or the type of substance. The Italian Society of Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP) together with the Italian Association of Gastroenterologists and Hospital En-doscopists (AIGO) has produced the first Italian guidelines for the management of the ingestion of foreign and caustic bodies in children.
13) Aggiornamento - Settembre 2022
La calcolosi delle vie urinarie in età pediatrica a tutto tondo
- Faraguna MC, Terranova CM, Peccatori N, Gnech M, Berrettini A, Melzi ML.
- Overall, the incidence of paediatric urolithiasis is increasing; 50-90% of cases are due to metabolic alterations, 3-30% are associated with urinary tract infections and the remaining cases are idiopathic. About 20-30% of children, especially boys who are younger than 2 years of age, present an anatomic urinary tract anomaly. The main symptom is abdominal pain; however, young children tend to have subtle manifestations. Abdominal ultrasound is the first-line imaging technique. Conservative treatment with fluid intake, pain relievers and alpha-adrenergic blockers are used during the acute episode, whereas a surgical treatment is indicated in selected cases. Since there is an increased rate of recurrence in comparison to adulthood, abundant hydration and changes in dietary habits have a central role in the prevention of paediatric urolithiasis. It is very important to perform a metabolic evaluation when the acute episode is resolved, as 50% of the cases present an underlying metabolic disorder. If a metabolic abnormality is diagnosed, specific preventive interventions should be undertaken. The paper presents the clinical case of an infant who during a Proteus mirabilis urinary tract infection has developed obstructive acute kidney injury due to a stone in the distal urethra. The incidence of urinary stones caused by urinary tract infection is decreasing, however this eventuality should be considered.
14) La pagina gialla - Aprile 2022
a cura di Alessandro Ventura15) L'angolo degli specializzandi - Gennaio 2022
a cura di Sara LegaIpoglicemie neonatali: dal sapere al saper fare
- Schiulaz I, Paviotti G.
16) Aggiornamento - Marzo 2021
Decifrare la bassa statura nei bambini
- Chiarelli F, Castorani V, Polidori N
- Short stature is the most common cause of referral to paediatricians. Only a minority of children with short stature have an underlying pathology. Although well-established diagnostic and management paradigms do exist, recent advances in molecular technologies have significantly improved our understanding of the genetic causes of short stature. Therefore, after the exclusion of nutritional, hormonal, inflammatory or systemic disorders, or skeletal dysplasias and syndromes, genetic causes should be ever supposed and genetic evaluation considered. An appropriate diagnosis of short stature should be performed as early as possible and personalized treatment should be started in a timely manner. Novel treatment approaches have been also proposed both as diagnostic tools and as therapeutic agents to optimize the approach to short stature. Therefore, detailed characterization of children with poor growth is necessary to perform a tailored diagnostic and therapeutic workup with the aim to decipher the causes of short stature better.
17) Ricerca - Maggio 2022
Due anni di MIS-C: peculiarità cliniche e orizzonti terapeutici
- Mambelli L, Uva A, Iacono A, Del Vecchio L, Bianchedi I, Nuzzo A, Malta B, Marchetti F.
- Introduction - MIS-C is the most relevant complication of SARS-CoV-2 infection and has an incidence of 1 case / 2,200 children and adolescents with previous infection. The clinical picture is characterized by a multiorgan involvement and an insufficiently known response to therapy.
Objectives - Retrospective analysis carried out in the Paediatric Department of the Ravenna Hospital from April 2020 to March 2022 of the cases admitted with MIS-C, with description of the presentation characteristics, the differences with respect to Kawasaki disease and the therapeutic strategies adopted also with regard to the clinical response.
Results - Thirteen cases diagnosed with MIS-C with an average age of 6 years and four months were hospitalized, 4 cases were of Italian origin, 6 of Balkan and 3 of African. All the cases presented with fever> 39 ° C with severe malaise / irritability, associated with skin rash in 9 cases, conjunctivitis in 7 and cheilitis in 5. The most prominent manifestations of organ involvement were abdominal pain / diarrhoea (N = 9), myocardial dysfunction in the absence of coronary involvement (N = 5), presence of pulmonary thickening (N = 5), painful laterocervical lymphadenitis with reduced neck motility (N = 5), subnephrotic proteinuria (N = 7) and hypertransaminasaemia (N = 8). Two cases with “encephalitic-like” psychomotor slowing, one with important ascites and one with oedema of the para/retropharyngeal tissues were clinically relevant for the severity of the onset. Twelve cases were treated with IVIG and methylprednisolone (2 mg /kg), 4 of them were found to be non-responders and required the use of steroid boluses (4 cases) and anakinra (4 cases), in three of the latter in association with steroid boluses, with rapid and decisive clinical response.
Conclusions - The serious clinical manifestations that characterize MIS-C do not concern only cardiac involvement. Therapy with an IL-1 inhibitor, anakinra, must also be envisaged as a possible first-line treatment in case of a particularly severe clinical picture at the onset.
18) Problemi speciali - Marzo 2022
Approccio pratico al bambino “sempre stanco”
- Gortani G.
- Fatigue is a common, nonspecific symptom with many different aetiologies. The term “fatigue” can be used to describe muscular weakness, difficulty or inability to initiate activity (subjective sense of weakness), reduced capacity to maintain activity (easy fatigability) and excessive daytime sleepiness. Understanding which is the main symptom of “fatigue” facilitates diagnosis and treatment. In older children fatigue is a common expression of somatic symptom disorder.
20) Farmacoriflessioni - Ottobre 2021
La polmonite acquisita in comunità
- Iacono A, Troisi A, Marchetti F
- Community-acquired pneumonia (CAP) is one of the most common serious infections in children. The appropriate duration of antimicrobial therapy is unclear. In current practice antibiotic treatment courses of 10 days are prescribed in mild-moderate CAP, while up to 14-21-day courses in severe and complicated cases. The results of the SAFER (Short-Course Antimicrobial Therapy for Paediatric Respiratory Infections) study found that the “short therapy” appeared to be comparable to standard care for the treatment of previously healthy children with CAP not requiring hospitalization. Clinical practice guidelines should recommend 5 days of amoxicillin for paediatric pneumonia management in accordance with antimicrobial stewardship principles.