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) 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) 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.
4) 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.
5) 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.
6) Problemi correnti - Giugno 2023
Faringotonsillite da streptococco, tempi di risposta all’antibiotico e implicazioni per la pratica corrente
- Iacono A, Mambelli L, De Nardi L, Marchetti F.
- An increase in Group A Streptococcal (GAS) infections higher than seasonally expected levels has been recently reported. Since GAS infections and correlated bacterial diffusion always start from an index case, adopting public health strategies based on ready isolation and treatment of GAS cases has become a relevant problem in the disease management. A systematic review recently published in Eurosurveillance aimed to estimate the pooled proportion of individuals who remained GAS throat culture-positive at set intervals after initiation of antibiotics. It was shown that antibiotic therapy acts on GAS leading to both clinical and microbiological recovery within 24 hours. This was confirmed for all the proven antibiotics, with amoxicillin remaining the drug of choice. Consequently, the child can return to school as early as the day after the beginning of the antibiotic therapy, without risks of infection for the community. About the 10% of children can maintain a positive swab after the start of antibiotic therapy: they are the asymptomatic GAS carriers and they are not to be chased. Furthermore, to avoid mistakes, asymptomatic children should not undergo GAS throat swab so as not to receive further and useless antibiotic therapies.
7) ABC - Aprile 2023
Le prove coagulative nel bambino che sanguina (prima parte)
- Del Monte F, Romano F, Parodi E, Ramenghi U.
- This brief report presents a practical approach to the diagnosis of the main coagulopathies in children with haemorrhagic manifestations. It discusses the clinical-anamnestic elements that should suggest further laboratory investigations. Then, after a brief review of coagulation physiology and main coagulation tests, three clinical scenarios based on PT and aPTT results are described. In particular, the paper focuses on the two most common congenital coagulopathies: haemophilia and von Willebrand disease. Recently, a new drug, emicizumab, has been introduced in the prophylaxis of severe haemophilia A, with great benefits on patients’ quality of life.
8) L'angolo dell'immunologo - Ottobre 2001
Quando sospettare un’immunodeficienza
- A. Tommasini, A. Insalaco, C. Perez, A.R. Soresina, A. Plebani
9) 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.
10) L'aria che tira - Aprile 2023
Amoxicillina: quando manca l’essenziale
- Marchetti F.
- The antibiotic amoxicillin is usually recommended as a first-line treatment for many common infections affecting children. Repeated lockdowns related to the coronavirus disease 2019 pandemic have contributed to supply difficulties for many drugs, including antibiotics. However, the risks associated with amoxicillin supply shortages appear not to have been sufficiently assessed, and the crisis we are facing today is serious and particularly dangerous for children’s health. Without rigorous measures to prevent shortages related to drug production and distribution, populations could face a post-antibiotic era in which common infections and minor injuries can result in serious life-threatening situations. The availability of medicines declared by WHO as essential should be guaranteed not only in production but also in fair distribution. And this principle must be ensured by national and international regulatory agencies.
11) Aggiornamento - Febbraio 2023
L'ossigenoterapia
- Traunero A, Lorenzon B, Amaddeo A, Barbi E.
- Oxygen supplementation represents a fundamental therapy in several clinical conditions, both acute and chronic. Starting from some concepts of respiratory physiopathology, this paper discusses the approach to a child with respiratory distress and respiratory failure, focuses on the main signs and symptoms of hypoxia, hypercapnia and increased work of breathing and explains the methods to assess the severity of the clinical status, highlighting the relevance of the SpO2/FiO2 ratio (peripheral oxygen saturation/inspiratory oxygen fraction). Furthermore, this work aims to summarize the main methods of oxygen delivery, their relative indications, by underlining advantages and possible complications such as blow-by oxygen, low flow nasal cannula and face mask (simple, Venturi, rebreathing and non-rebreathing). The focus is on two new oxygen delivery devices, High Flow Nasal Cannula (HFNC) and Continuous Positive Airway Pressure (CPAP), which in recent years have more and more been used not only in emergency units but also in paediatric wards.
12) Aggiornamento - Marzo 2023
Il bambino con anemia severa: proposta di gestione diagnostico-terapeutica
- Muratore E, Ruggi A, Abram N, et al.
- Anaemia is a common issue in the paediatric age group and it is not uncommon to encounter severe cases of anaemia in the Paediatric Emergency Unit. The correct identification of patients requiring urgent care is of central importance to provide timely interventions. However, considering that most patients are haemodynamically stable, transfusions are not always mandatory. Even in the setting of the Emergency Unit, the differential diagnosis can be narrowed with specific laboratory tests. The paper presents three exemplary cases from the experience of a Paediatric Emergency Unit that will help to provide a summary of the diagnostic and therapeutic approach to severe anaemia in infants and children.
13) Aggiornamento - Settembre 2023
Sindrome da ipersensibilità dei recettori della tosse (SIRT): “la tosse che fa tosse”
- Longo G.
- Dry cough usually accompanies the first few days of each “cold” (Upper Respiratory Tract Infection: URTI), but in some children, it always recurs with a particular intensity that “prevents sleep” and puts the whole family to the test. This cough is recognized to have an etiopathogenetic factor of an exaggerated sensitivity of cough sensory receptors. In the year 2000, the “Medico e Bambino” journal coined the acronym SIRT (Sindrome da Ipersensibilità dei recettori della Tosse - Cough Receptors Hypersensitivity Syndrome) to label this phenotype of cough. Today, this diagnosis is made more frequently especially by Italian family paediatricians who have learned to understand and recognize it. However, in the paediatric literature, SIRT still lacks recognition and an adequate description of its peculiar clinical characteristics. It is conceivable that SIRT corresponds to the persistent cough during the most acute phase of URTIs. The mechanisms by which viral infections induce the dysregulation of the cough reflex are now well understood, but why it remains unchanged over time in only certain individuals is still unknown. In adulthood, cough due to cough receptor hypersensitivity (Cough Receptor Hypersensitivity, CRH) has received much more attention, becoming an “umbrella” diagnosis for all “chronic” coughs of undefined cause. CRH recognizes the same mechanisms and causes at all ages, but there is a significant clinical difference that, in children, due to the high frequency of URTIs, it is characterized by recurrent episodes of acute cough, while in adults, CRH primarily manifests as a “chronic” cough induced by micro environmental stimuli (thermal, mechanical, chemical).
14) Aggiornamento monografico - Gennaio 2009
La porpora di Schönlein-Henoch
- L. Calligaris, L. Calligaris, F. Marchetti, E. Barbi, E. da Dalt, E. Panontin, L. Lepore, A. Ventura
- Henoch-Schönlein purpura (HSP) is the most common vasculitic disease of childhood. HSP is a multisystem immunoglobulin A-mediated vasculitis with a self-limited course usually affecting the skin, joints, gastrointestinal tract, and kidneys. HSP occurs most often in children before the age of 10 years, and classically presents with a unique distribution of the rash to the lower extremities and the buttocks. One third of these patients will have one or more recurrences of symptoms, usually within 6 weeks, but they may occur as late as 18 months later. The overall prognosis in HSP is excellent, but the long-term morbidity depends mainly on the renal involvement. In our opinion, actually, there are no data to recommend the routine use of corticosteroids in the management of uncomplicated HSP, in both the acute and chronic settings.
15) Farmacoriflessioni - Marzo 2023
Adrenalina, il farmaco salvavita
- Tumminelli C, Squillaci D, Calligaris L, et al.
- The administration of epinephrine is recommended in children with severe clinical conditions, such as in case of anaphylaxis, life-threatening asthma, shock and cardiac arrest. Due to the very low frequency of these conditions in common paediatric emergency settings in Italy, paediatricians may be unfamiliar with the use of this fundamental drug. This article presents the indications and ways of administration of epinephrine in the clinical contest in which is required, according to the current guidelines.
16) 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.
18) 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.
-
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.
19) 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.
20) 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.
1) 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) 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.
3) Problemi correnti - Giugno 2023
Faringotonsillite da streptococco, tempi di risposta all’antibiotico e implicazioni per la pratica corrente
- Iacono A, Mambelli L, De Nardi L, Marchetti F.
- An increase in Group A Streptococcal (GAS) infections higher than seasonally expected levels has been recently reported. Since GAS infections and correlated bacterial diffusion always start from an index case, adopting public health strategies based on ready isolation and treatment of GAS cases has become a relevant problem in the disease management. A systematic review recently published in Eurosurveillance aimed to estimate the pooled proportion of individuals who remained GAS throat culture-positive at set intervals after initiation of antibiotics. It was shown that antibiotic therapy acts on GAS leading to both clinical and microbiological recovery within 24 hours. This was confirmed for all the proven antibiotics, with amoxicillin remaining the drug of choice. Consequently, the child can return to school as early as the day after the beginning of the antibiotic therapy, without risks of infection for the community. About the 10% of children can maintain a positive swab after the start of antibiotic therapy: they are the asymptomatic GAS carriers and they are not to be chased. Furthermore, to avoid mistakes, asymptomatic children should not undergo GAS throat swab so as not to receive further and useless antibiotic therapies.
4) ABC - Aprile 2023
Le prove coagulative nel bambino che sanguina (prima parte)
- Del Monte F, Romano F, Parodi E, Ramenghi U.
- This brief report presents a practical approach to the diagnosis of the main coagulopathies in children with haemorrhagic manifestations. It discusses the clinical-anamnestic elements that should suggest further laboratory investigations. Then, after a brief review of coagulation physiology and main coagulation tests, three clinical scenarios based on PT and aPTT results are described. In particular, the paper focuses on the two most common congenital coagulopathies: haemophilia and von Willebrand disease. Recently, a new drug, emicizumab, has been introduced in the prophylaxis of severe haemophilia A, with great benefits on patients’ quality of life.
5) Aggiornamento - Febbraio 2023
L'ossigenoterapia
- Traunero A, Lorenzon B, Amaddeo A, Barbi E.
- Oxygen supplementation represents a fundamental therapy in several clinical conditions, both acute and chronic. Starting from some concepts of respiratory physiopathology, this paper discusses the approach to a child with respiratory distress and respiratory failure, focuses on the main signs and symptoms of hypoxia, hypercapnia and increased work of breathing and explains the methods to assess the severity of the clinical status, highlighting the relevance of the SpO2/FiO2 ratio (peripheral oxygen saturation/inspiratory oxygen fraction). Furthermore, this work aims to summarize the main methods of oxygen delivery, their relative indications, by underlining advantages and possible complications such as blow-by oxygen, low flow nasal cannula and face mask (simple, Venturi, rebreathing and non-rebreathing). The focus is on two new oxygen delivery devices, High Flow Nasal Cannula (HFNC) and Continuous Positive Airway Pressure (CPAP), which in recent years have more and more been used not only in emergency units but also in paediatric wards.
6) Aggiornamento - Marzo 2023
Il bambino con anemia severa: proposta di gestione diagnostico-terapeutica
- Muratore E, Ruggi A, Abram N, et al.
- Anaemia is a common issue in the paediatric age group and it is not uncommon to encounter severe cases of anaemia in the Paediatric Emergency Unit. The correct identification of patients requiring urgent care is of central importance to provide timely interventions. However, considering that most patients are haemodynamically stable, transfusions are not always mandatory. Even in the setting of the Emergency Unit, the differential diagnosis can be narrowed with specific laboratory tests. The paper presents three exemplary cases from the experience of a Paediatric Emergency Unit that will help to provide a summary of the diagnostic and therapeutic approach to severe anaemia in infants and children.
7) Aggiornamento - Settembre 2023
Sindrome da ipersensibilità dei recettori della tosse (SIRT): “la tosse che fa tosse”
- Longo G.
- Dry cough usually accompanies the first few days of each “cold” (Upper Respiratory Tract Infection: URTI), but in some children, it always recurs with a particular intensity that “prevents sleep” and puts the whole family to the test. This cough is recognized to have an etiopathogenetic factor of an exaggerated sensitivity of cough sensory receptors. In the year 2000, the “Medico e Bambino” journal coined the acronym SIRT (Sindrome da Ipersensibilità dei recettori della Tosse - Cough Receptors Hypersensitivity Syndrome) to label this phenotype of cough. Today, this diagnosis is made more frequently especially by Italian family paediatricians who have learned to understand and recognize it. However, in the paediatric literature, SIRT still lacks recognition and an adequate description of its peculiar clinical characteristics. It is conceivable that SIRT corresponds to the persistent cough during the most acute phase of URTIs. The mechanisms by which viral infections induce the dysregulation of the cough reflex are now well understood, but why it remains unchanged over time in only certain individuals is still unknown. In adulthood, cough due to cough receptor hypersensitivity (Cough Receptor Hypersensitivity, CRH) has received much more attention, becoming an “umbrella” diagnosis for all “chronic” coughs of undefined cause. CRH recognizes the same mechanisms and causes at all ages, but there is a significant clinical difference that, in children, due to the high frequency of URTIs, it is characterized by recurrent episodes of acute cough, while in adults, CRH primarily manifests as a “chronic” cough induced by micro environmental stimuli (thermal, mechanical, chemical).
8) Farmacoriflessioni - Marzo 2023
Adrenalina, il farmaco salvavita
- Tumminelli C, Squillaci D, Calligaris L, et al.
- The administration of epinephrine is recommended in children with severe clinical conditions, such as in case of anaphylaxis, life-threatening asthma, shock and cardiac arrest. Due to the very low frequency of these conditions in common paediatric emergency settings in Italy, paediatricians may be unfamiliar with the use of this fundamental drug. This article presents the indications and ways of administration of epinephrine in the clinical contest in which is required, according to the current guidelines.
9) 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.
-
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.
10) 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.
11) ABC - Maggio 2023
Le prove coagulative nel bambino sano (seconda parte)
- Romano F, Del Monte F, Ramenghi U, Parodi E.
- In Paediatrics, coagulation tests are often prescribed in children without bleeding symptoms, for example before surgery/invasive procedures, or in case of family history of coagulopathy. Moreover, sometimes impairment in coagulation tests is occasionally found in routine blood tests. This brief article presents a practical approach to guide the family paediatrician on the indications for coagulation tests and the interpretation of any abnormality found in otherwise “healthy” children.
12) La pagina gialla - Ottobre 2023
a cura di Alessandro Ventura13) La pagina gialla - Settembre 2023
a cura di Alessandro Ventura14) Farmacoriflessioni - Giugno 2023
Farmaci intranasali nel bambino: cosa devono sapere i pediatri
- Nisticò D, Marchetti F, Badina L, Barbi E, Cozzi G.
- The use of the intranasal route of administration to deliver drugs in children has become more and more popular in the last decades. Seizure, severe acute pain and severe hypoglycaemia in diabetic patients may be managed with intranasal drugs. The intranasal administration is minimally invasive, not painful, needleless and easy to learn and use. The evidence shows that it is a safe and effective way to deliver lipophilic drugs that are quickly absorbed. This article is a practical guide that provides indications, dosages and some “tricks” for this way of administration.
15) 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.
16) 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).
17) 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.
18) La pagina gialla - Febbraio 2023
a cura di Alessandro Ventura19) Focus - Aprile 2023
LE MALATTIE DEMIELINIZZANTI IN ETÀ PEDIATRICA
La sclerosi multipla in età pediatrica e adolescenziale- Carrozzi M, Iacono A, Gortani G, Piscaglia MG, Marchetti F, Barbi E.
- Multiple sclerosis (MS) is a chronic autoimmune disease that affects the myelin of the brain and spinal cord; it is characterized by recurrent episodes of demyelination in the central nervous system. Paediatric-onset multiple sclerosis (POMS) is a rare disease, with an estimated frequency of approximately 0.05-2.85 per 100,000 children. The diagnosis requires the spatial and temporal dissemination of the disease with clinical evaluation and with laboratory tests such as oligoclonal bands in the liquor and MRI of the brain and spinal cord. The treatment of the acute episode involves cortisone in high doses, then the immunomodulatory treatment (disease-modifying treatment - DMT) is started to prevent the recurrence of the episodes with consequent stabilization of the lesions that could anticipate the time of permanent disability. Hence, the paper aims to review the literature on POMS to guide physicians on the current understanding of its diagnosis and management.