RESUMO
Functional constipation (FC) is one of the most common disorders in childhood and has a negative impact on the quality of life of children. Scientific evidence regarding a causal relationship between FC and cow's milk allergy is controversial, as it is also reported by the latest European Society for Paediatric Gastroenterology, Hepatology and Nutrition-North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN-NASPGHAN) recommendations. In the case of FC, routine allergometric tests are not recommended and the cows' milk-free diet is only proposed in the case of laxative-resistant constipation and only following the advice of an expert. Instead, after a careful review of the literature and in view of the many clinical cases encountered in our clinical practice, we believe that it is useful to propose cows' milk-free diet as first line for the treatment of FC at least in pre-school children and in children with a personal or family history of atopy or with a previous diagnosis of cow's milk protein allergy.
Assuntos
Constipação Intestinal/dietoterapia , Hipersensibilidade a Leite/complicações , Leite/efeitos adversos , Animais , Criança , Pré-Escolar , Constipação Intestinal/etiologia , Resistência a Medicamentos , Feminino , Guias como Assunto , Humanos , Laxantes/uso terapêutico , Masculino , Proteínas do Leite/administração & dosagem , Proteínas do Leite/efeitos adversos , Qualidade de VidaAssuntos
Enterocolite , Hipersensibilidade Alimentar , Humanos , Enterocolite/diagnóstico , Enterocolite/imunologia , Enterocolite/etiologia , Hipersensibilidade Alimentar/diagnóstico , Criança , Proteínas Alimentares/efeitos adversos , Proteínas Alimentares/imunologia , Lactente , Pré-Escolar , Masculino , Feminino , Síndrome , Doença AgudaAssuntos
Vacina contra Varicela , Enterocolite , Vacina contra Sarampo-Caxumba-Rubéola , Ansiedade/epidemiologia , Varicela/prevenção & controle , Vacina contra Varicela/efeitos adversos , Criança , Enterocolite/epidemiologia , Humanos , Sarampo/prevenção & controle , Vacina contra Sarampo-Caxumba-Rubéola/efeitos adversos , Caxumba/prevenção & controle , Rubéola (Sarampo Alemão)/prevenção & controleRESUMO
Food protein-induced enterocolitis syndrome (FPIES) is a food allergy that results in repetitive vomiting, lethargy, and pallor within 1 to 4 hours of food ingestion. One of the issues in its management is the introduction of new foods. Over the past 25 years, suggestions have been made mainly based on the likelihood that a given food family could induce an episode of acute FPIES. Thus, foods have been categorized into low, moderate, and high risk. The suggestion was always to postpone the introduction of moderate- or high-risk foods, leaving the decision whether to introduce them at home or in hospital to the doctor. These suggestions were designed for all children with acute FPIES, regardless of their geographical area. However, it is true that these suggestions are the result of expert opinion. In recent years, studies have been published that have shown that the risk category of foods varies according to geographical area and so does the prevalence of single FPIES versus multiple FPIES. For this reason, we believe that the introduction of new foods in the child with acute FPIES can and should be tailored according to the geographical area.
Assuntos
Enterocolite , Hipersensibilidade Alimentar , Criança , Humanos , Lactente , Síndrome , Hipersensibilidade Alimentar/epidemiologia , Hipersensibilidade Alimentar/terapia , Vômito , Enterocolite/epidemiologia , Enterocolite/terapia , Alérgenos , Fenômenos Fisiológicos da Nutrição do Lactente , Proteínas Alimentares/efeitos adversosRESUMO
INTRODUCTION: We performed this study aiming to evaluate changes in epidemiology, clinical presentation and outcomes of children hospitalized for viral lower respiratory tract infections (LRTI). METHODS: We performed a retrospective study of children younger than 18 years of age hospitalized for LRTIs with a positive respiratory viral testing from 2018 to 2022. We compared need of pediatric intensive care unit (PICU), invasive ventilation, and other respiratory support, viral etiologies, clinical presentations, imaging, and laboratory results in the precovid (2018-2019) and covid (2020-2022) period. RESULTS: A total of 523 were included in the analysis. In the pandemic period, the detection of influenza was 95% less likely to occur (odds ratio [OR]: 0.05; 95% confidence interval [95% CI]: 0.02-0.12; p < .001), likewise the detection of adenovirus was 77% less likely to occur (OR: 0.23; 95% CI: 0.10-0.51; p < .001). In the pandemic period, the number of codetections increased from 15.52% in 2018 to 57.25% in 2022, resulting in a significantly increasing trend (p < .001). The odds of transfer to PICU was more than five times greater during the pandemic period (OR: 5.31; 95% CI: 1.78-15.86; p = .003). CONCLUSIONS: We found that the pattern of LRTI in children during COVID-19 pandemic significantly changed in terms of etiologies and increased severity.
Assuntos
COVID-19 , Infecções Respiratórias , Criança , Humanos , Lactente , Pandemias , Cidade de Roma , Estudos Retrospectivos , COVID-19/epidemiologia , Infecções Respiratórias/diagnóstico , Itália/epidemiologia , DemografiaRESUMO
BACKGROUND: The CHOP-INTEND is an established outcome measure used to assess motor function in young and weak SMA patients previously validated in type I infants older than 3 months. OBJECTIVE: The aim of our study was to assess the maturation of the CHOP-INTEND scores in a group of healthy infants, establishing which items of the scale can be reliably used in individuals younger than 3 months. METHODS: This is a prospective observational study. The whole cohort was divided into 5 age groups. Each of the 16 CHOP-INTEND items was analyzed looking at the frequency distribution of the scores in each age subgroup. An item was considered developmentally appropriate whenâ>â85% of the infants achieved a full score. RESULTS: our study includes 61 assessments collectedâ<â2 weeks, 25 at 2-4 weeks, 20 at 5-8 weeks, 25 at 9-12 weeks and 20 at 13-17 weeks. Eight of the 16 items were developmentally appropriate already in the first week and another by the end of the first month. The remaining 7 items had more variable responses in the first three months and full scores were consistently achieved only after the third month. CONCLUSIONS: Our findings suggest that the CHOP-INTEND can be used before the age of 3 months, but the results should be interpreted with caution, considering which items are developmentally appropriate at the time of testing. This will also help to establish whether the changes observed following early treatments are a sign of efficacy or at least partly reflect maturational aspects.
Assuntos
Atrofias Musculares Espinais da Infância , Lactente , Humanos , Atrofias Musculares Espinais da Infância/tratamento farmacológico , Avaliação de Resultados em Cuidados de Saúde , Estudos ProspectivosRESUMO
Objectives: Bronchiolitis remains a major cause of morbidity and mortality in children under 24 months. During the first year of the pandemic, non-pharmacological interventions resulted in a significant reduction of bronchiolitis cases. Early in 2021, a rebound of bronchiolitis was reported with a description of out-of-season outbreaks. In this study, we prospectively evaluated the impact of bronchiolitis in two Italian University centers located in different geographical areas, aiming to compare two post-pandemic bronchiolitis seasons (2021/22 and 2022/23) in terms of severity, outcomes, microbiology and temporal distribution. Methods: This was a bicentric prospective observational cohort study. All consecutive children under 24 months of age assessed in the participating institutions during the specified seasons and receiving a clinical diagnosis of bronchiolitis were included. Results: A total of 900 patients were enrolled. Patients in the second season were globally younger and had comorbidities less often. Temporal distribution changed between the two seasons. Of the patients, 56% were tested for RSV; 60% of these was positive. Patients with RSV were globally younger (3.5 months vs. 4.9, p < 0.001), more often had a need for any kind of respiratory and fluid support and more often needed ward or PICU admission. At the end of the ED visit, 430 patients were discharged home, 372 (41.3%) were admitted to an inpatient ward and 46 (5.1%) to a pediatric intensive care unit. Conclusions: The 2022/23 post-COVID bronchiolitis was mostly similar to that of 2021/22, and was in line with pre-pandemic expectations.
RESUMO
BACKGROUND: Limited data are available on the best option (short acting sedatives, opioids, or ketamine) in oncologic procedural sedation performed by non-anesthesiologists. The aim of the present prospective study is to compare the safety and efficacy of propofol-ketamine versus propofol alone, managed by trained pediatricians, in children with cancer undergoing painful procedures. PROCEDURES: Data on 121 children with acute lymphatic leukemia (ALL) undergoing procedural sedations (lumbar punctures and bone marrow aspirations) were prospectively collected and included drug doses, side effects, pain assessment, and sedation degree. Children were randomly assigned to one of the two groups: P (n = 62) receiving propofol alone and K (n = 59) in whom a ketamine-propofol combination was used. RESULTS: In group K, the total dose of propofol required was significantly lower than in group P (3.9 ± 3.6 mg/kg vs. 5.1 ± 3.6 mg/kg; P < 0.001). The incidence of hypotension was also significantly lower (11% vs. 39%; P < 0.001). Major O(2) desaturations (defined as SatO(2) < 88%) occurred principally in group P (7 vs. 1; P = 0.05). Both best analgesia and shorter recovery time were obtained with the propofol-ketamine association. No differences were observed in the degree of sedation and in the awakening quality score between the two groups. CONCLUSIONS: The combination of propofol and ketamine produced statistically significant clinical advantages combined with a higher profile of safety in children with cancer undergoing painful procedures.
Assuntos
Sedação Consciente/métodos , Hipnóticos e Sedativos/uso terapêutico , Ketamina/uso terapêutico , Neoplasias/cirurgia , Pediatria/métodos , Propofol/uso terapêutico , Biópsia por Agulha , Exame de Medula Óssea , Criança , Feminino , Humanos , Masculino , Médicos , Punção Espinal/métodosRESUMO
We report the case of a 13-year-old boy with an abrupt onset of leg pain and muscle weakness, incapability of deambulation and a laboratory picture of exercise-induced acute rhabdomyolysis. Intravenous hyperhydration and forced diuresis were adopted to avoid renal complications. No evidence of articular or residual muscular damage was appreciated in the short-term. The recurrence of rhabdomyolysis required a muscular biopsy showing a disturbance of fatty acid ß-oxidation pathway.
Assuntos
Exercício Físico , Erros Inatos do Metabolismo/patologia , Limitação da Mobilidade , Rabdomiólise/patologia , Adolescente , Carnitina O-Palmitoiltransferase/deficiência , Humanos , Masculino , Erros Inatos do Metabolismo/complicações , Erros Inatos do Metabolismo/fisiopatologia , Debilidade Muscular/etiologia , Debilidade Muscular/patologia , Debilidade Muscular/fisiopatologia , Rabdomiólise/etiologia , Rabdomiólise/fisiopatologiaAssuntos
Gangliosidose GM1/complicações , Gangliosidose GM1/diagnóstico , Mancha Mongólica/diagnóstico , Mancha Mongólica/etiologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/etiologia , Diagnóstico Diferencial , Gangliosidose GM1/patologia , Humanos , Lactente , Masculino , Mancha Mongólica/patologia , Neoplasias Cutâneas/patologiaRESUMO
AIM: To assess the impact of the coronavirus disease 2019 (COVID-19) outbreak on pediatric emergency department (ED) visits for acute bronchiolitis during the epidemic season. METHODS: A retrospective analytical cross-sectional study was performed in our hospital, analyzing medical charts of all children under 2 years of age with a diagnosis of acute bronchiolitis admitted to our ED in the last years. Demographics and clinical data of patients affected with acute bronchiolitis during the 2020-2021 season-COVID-19 outbreak-were compared to those of the 5 previous years. RESULTS: We observed an average drop of 84% of the rate of acute bronchiolitis managed by pediatricians in ED in 2020-2021 compared with bronchiolitis seasons of 5 previous years. We also reported, during the COVID-19 outbreak, a higher number of children affected by acute bronchiolitis referred to ED as Emergency Consultations who required hospitalization. Regarding etiological agents, no differences in respiratory virus circulation, especially RSV, were observed in the two groups. The multivariate analysis showed no correlation between the diagnosis of RSV bronchiolitis and COVID-19 period or prematurity; lower age was associated with an increased likelihood of exhibiting RSV bronchiolitis (odds ratio 0.9; 95% confidence interval 0.86-0.95 p < .01). CONCLUSION: Our data emphasize the reduction in the rate of admission to pediatric ED for acute bronchiolitis during the COVID-19 outbreak, regardless of changes in circulating respiratory viruses. Therefore we want to highlight the importance of nonpharmacological preventive hygiene measures that should be maintained even at the end of the COVID-19 outbreak.
Assuntos
Bronquiolite , COVID-19 , Bronquiolite/epidemiologia , Criança , Estudos Transversais , Surtos de Doenças , Serviço Hospitalar de Emergência , Hospitalização , Humanos , Lactente , Itália/epidemiologia , Estudos Retrospectivos , SARS-CoV-2RESUMO
The causal connection between serum biomarkers and COVID-19 severity or pathogenicity in children is unclear. The aim of this study was to describe clinical and immunological features of children affected by COVID-19. The secondary aim was to evaluate whether these cytokines could predict severity of COVID-19. All children (aged 0-18) admitted to the Pediatric Emergency Department and tested with nasopharyngeal swab for SARS-CoV-2 were recruited and assigned to three groups: COVID-19, other infections, control group. Clinical and laboratory data of these patients, including circulating cytokine levels, were analyzed in three groups. Fever was the most frequent symptom in COVID-19 (67.3%). Neutropenia was found in the COVID-19 group (p < 0.05); no difference was observed for lymphocyte counts in the three groups. Higher levels of IL-6 and TNF-alpha were found in the COVID-19 group compared to other infections and control groups (p = 0.014 and p = 0.001, respectively). Whereas, in the COVID-19 group, no difference was observed as for the same cytokines among sub-groups of different disease severity (p = 0.7 and p = 0.8). Serum levels of IL-6 and TNF-alpha were higher in COVID-19 children than in children with other infectious diseases, but those levels did not correlate with disease severity. Clinical studies in a large pediatric population are necessary to better define the role of the immune-mediated response in SARS-CoV-2 infections in children.
Assuntos
COVID-19/metabolismo , COVID-19/virologia , Citocinas/biossíntese , Interações Hospedeiro-Patógeno , SARS-CoV-2/fisiologia , Fatores Etários , Biomarcadores , COVID-19/epidemiologia , COVID-19/imunologia , Criança , Pré-Escolar , Comorbidade , Feminino , Interações Hospedeiro-Patógeno/imunologia , Humanos , Masculino , Índice de Gravidade de DoençaRESUMO
Right chorioretinitis and bilateral pseudopapilledema were firstly appreciated in a 9-month-old child with neonatal findings of aseptic chronic meningitis, framed in the context of CINCA syndrome at 1 year. Therapeutical response to various combinations of drugs was inconsistent until 7 years, when anakinra was started with immediate clinical and laboratory improvement. A state of severe retinal dystrophy of post-inflammatory origin became evident on funduscopy, optical coherence tomography and visual electrophysiology tests at the age of 10 years, which remained stationary after 1 year of anakinra treatment.
Assuntos
Síndromes Periódicas Associadas à Criopirina/complicações , Retina/imunologia , Doenças Retinianas/genética , Doenças Retinianas/imunologia , Antirreumáticos/uso terapêutico , Proteínas de Transporte/genética , Criança , Síndromes Periódicas Associadas à Criopirina/tratamento farmacológico , Síndromes Periódicas Associadas à Criopirina/fisiopatologia , Progressão da Doença , Humanos , Inflamação/complicações , Inflamação/tratamento farmacológico , Inflamação/fisiopatologia , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Interleucina-1/metabolismo , Masculino , Proteína 3 que Contém Domínio de Pirina da Família NLR , Receptores de Interleucina-1/antagonistas & inibidores , Receptores de Interleucina-1/metabolismo , Retina/metabolismo , Retina/fisiopatologia , Doenças Retinianas/fisiopatologia , Resultado do TratamentoRESUMO
A 3-month-old child was first treated for incomplete Kawasaki syndrome with three cycles of intravenous immunoglobulins and aspirin, then with methylprednisolone which led to fever remission. The same child was re-hospitalized after a 10-month-period of well-being for the suspicion of a new episode of Kawasaki syndrome, which appeared to be immunoglobulin-resistant: extensive testing failed to provide an alternative diagnosis of any infectious or infiltrative disease. Diagnosis of systemic onset-juvenile idiopathic arthritis was postulated upon the long persistence of fever and inflammatory signs, which subsided only after starting corticosteroid treatment.
Assuntos
Artrite Juvenil/diagnóstico , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Diagnóstico Diferencial , Glucocorticoides/uso terapêutico , Humanos , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Prednisona/uso terapêutico , Resultado do TratamentoRESUMO
Food-dependent exercise-induced anaphylaxis (FDEIA) is an IgE-mediated allergy resulting from the combination of the ingestion of an offending food and physical exercise. According literature, oral food challenge (OFC) followed by physical exercise (OFCPE) should be considered the diagnostic gold standard. In the absence of adverse reactions, other cofactors should be added (e.g. acetylsalicylic acid, alcohol in adulthood), one at a time. But many other factors increase patient's reactivity. This could reduce the sensitivity of the OFCPE and, consequently, make instructions for patients less reliable. On the other hand, the addition of cofactors not reported by the patient may reduce test specificity. With the help of two exemplary stories, that present opposite outcomes, diagnostic difficulties of FDEIA are discussed.