Beneficial therapeutic effects of vitamin C on recurrent respiratory tract infections in children: preliminary data.

BACKGROUND: The aim of this study was to demonstrate whether supplementation of vitamin C has a beneficial effect in the prevention of recurrent respiratory tract infections (RTIs) in children. Moreover, we evaluate the main risk factors that predispose to the development of this disease. METHODS: Sixty children have been enrolled in the study and randomized into two groups: the control group (G1 N.=33) and the group at risk of recurrent RTIs (G2 N.=27). To G2 group was administered every day 100% orange juice with the content of vitamin C 70 mg. RESULTS: Significant reduction in the incidence rate of RTIs (episodes pre-treatment: 182-6.75 episodes/child, after-treatment: 71-2.62 episodes/child, P<0.05), were observed in G2 group. CONCLUSIONS: The administration of vitamin C had a beneficial effect in our group of children with recurrent RTIs, reducing the number of infective episodes.

Attention-deficit/hyperactivity disorder and enuresis: a study about effectiveness of treatment with methylphenidate or desmopressin in a pediatric population.

BACKGROUND: The aim of this study was to evaluate the effectiveness of treatment with methylphenidate or desmopressin (dDAVP) in patients with comorbid attention-deficit/hyperactivity disorder (ADHD) and enuresis. METHODS: We enrolled 103 patients affected by ADHD and 125 patients with monosymptomatic nocturnal enuresis (NE). Data were collected between January 2014 and December 2015. The study was carried out in compliance with the Helsinki Declaration. RESULTS: About children with ADHD, 9/103 (8.7%) were also suffering from NE; of those 8/9 followed treatment with methylphenidate and cognitive behavioral therapy. After 3 months 2/8 (25%, CI 95%: 8-65%) showed improvements, remaining 75% has been increased dosage of methylphenidate. After 6 months a response was achieved in 6/8 (75%, CI 95%: 35-96%) children and 1/8 was lost to follow-up. Furthermore the drug withdrawal showed a recurrence of symptoms both ADHD and NE in 1/7 (14.3%, CI 95%: 0.3-57%) vs. 6/7 (85.7%, CI 95%: 42-99%) that not presented recurrences. About children with NE enrolled at Campus Bio-Medico University it was found that 4/125 (3.8%) children were also suffering from ADHD; 3/4 (75%) treated with dDAVP and motivational therapy, of those 2/3 (66.7%, CI 95%: 9-99%) showed no improvements of symptoms vs. 1/3 (33.3%, CI 95%: 0.8-90%) that showed partial response with a reduction of wet-nights. CONCLUSIONS: It is important the service of recruitment of patients with NE. In fact considering NE in a Child Neuropsychiatry Service where patients belong to a diagnosis of ADHD and NE is an incidental finding, this one is not considered as the addressee of treatment, but the therapy is directed to the neuro-behavioral problem using specific drugs and therapies, which are resolutive in the enuretic disorder.

Association among nocturnal enuresis, body weight and obstructive sleep apnea in children of south Italy: an observational study.

BACKGROUND: To evaluate the rate of nocturnal enuresis (NE), body weight and obstructive sleep apnea in children 5 to 10 years of age in South Italy and the possible association among these disorders. METHODS: We have administered 1100 validated questionnaires, in Italian language, to parents and we have analyzed data with a logistic regression. RESULTS: Forty-two percent of children had a BMI≥85th (group 1) vs 58.0% normal weight children at the same age (group 2). There is a higher number of overweight males compared to females without statistically differences. In group 1 there was a higher number of children with NE and obstructive sleep disorders and some children present with the association among these three disorders. CONCLUSIONS: There are no statistically differences between two study groups for the association body weight-NE, body weight-NE-obstructive sleep disorders.

Desmopressin 120 mcg, 180 mcg, 240 mcg: The right treatment for the right patient.

BACKGROUND: The first-line drug therapy for patients with nocturnal enuresis (NE) associated with nocturnal polyuria and normal bladder function is desmopressin (dDAVP). OBJECTIVE: To evaluate if increasing dose of oral desmopressin lyophilisate (MELT) can improve response rates to dDAVP and is useful in enuretic children. MATERIALS AND METHODS: We enrolled a total of 260 children all diagnosed with NE. Enuretic children were treated with increasing MELT at a dose of 120, 180 and 240 mcg a day. RESULTS: We included in our study a total of 237 children, 164 males (69.2%) and 73 females (30.8%) aged between 5 and 18 years (mean age 10.32 ± 2.52 years). Of the 237 patients enrolled in the study and treated with MELT 120 mcg, a full response was achieved in 135 (56.9%). A partial response was achieved in 21 (8.9%) patients, therefore the dose was increased up to 180 mcg, with further improving symptoms (14.3%) or full response (9.5%), and up to 240 mcg, without usefulness. CONCLUSIONS: MELT at the dose of 120 mcg resulted efficacy and safety; the increased dose up to 180 mcg resulted poorly efficacy; finally, the further increase up to 240 mcg did not improve the symptoms with the increased risk of side effects.

The impact of motivational therapy in the management of enuretic children.

OBJECTIVE: The aim of this study is to determine the impact of a motivational therapy (MT) on the outcomes for individuals diagnosed with nocturnal enuresis (NE). MATERIAL AND METHODS: We enrolled 158 patients with NE referred to the Service of Pediatrics, Campus Bio-Medico University Hospital of Rome, from January 2013 to September 2017. Of these, 21 were excluded because they didn't meet the inclusion criteria. The study was carried out in compliance with the Helsinki Declaration. RESULTS: A hundred and thirty seven enuretic patients [100 (72.9%) male and 37 (27.1%)] female patients with a median age of 8.8 years were included in the study. The patients were assigned to receive pharmacological therapy with desmopressin (dDAVP) (G1) (n=51), MT (G2) (n=33) and both of them (G3) (n=53). The three groups were homogeneous, with no significant differences in gender, age and family history of NE. In G1, 30/51 (58.82%) children achieved response vs. 1/33 (3.0%) children in G2 vs. 35/53 (66.04%) children in G3. About these results, The differences between G2 vs. G1 (p<0.01) and vs. G3 (p<0.01) were statistically significant while the difference between G1 vs G3 was not statistically significant (p=0.45). CONCLUSION: Our study underlines the importance of MT in the management of NE and highlights the safety of treatment and the positive effect of MT on the compliance and the adherence to pharmacological therapy. Considering the importance of the impact of such evidence on children's lifestyle, we expect that further study with a larger sample size may confirm our hypothesis.

The adverse effects of oral desmopressin lyophilisate (MELT): personal experience on enuretic children.

OBJECTIVE: The aim of this study was to evaluate adverse effects of oral desmopressin lyophilisate (MELT) in enuretic children. MATERIAL AND METHODS: We enrolled 260 children with nocturnal enuresis (NE) referred to the Pediatric Service, 'Campus Bio-Medico' University of Rome, from April 2014 to April 2017 in the study, of these 23 were excluded. The study was characterized by 2 phases. During Phase 1 a careful patient's medical history was obtained and physical examination was performed. After 3 months of treatment with MELT (Minirin/DDAVP®) at the dose of 120 mcg a day, a micturition diary was kept, adherence to therapy and any possible adverse effects were checked during the Phase 2. The study was carried out in compliance with the Helsinki Declaration. RESULTS: Among 237 patients included in the study 11 male and 6 female (n=17; 7.2%) patients with a mean age 10.06±2.49 years, reported 22 adverse effects, with an absolute risk of 7.17%. In particular, 5 neurological symptoms, 3 gastrointestinal effects, 4 sleep disturbances, 8 psycho-behavioral disorders, 2 symptoms of fatigue were reported. CONCLUSION: In our study MELT with its higher bioavailability guaranteed lower frequency of adverse effects which resolved spontaneously and rapidly. The MELT formulation actually represents the first line and safe treatment for the NE.

Cyberbullying a modern form of bullying: let's talk about this health and social problem.

Cyberbullying or electronic aggression has already been designated as a serious public health threat. Cyberbullying should also be considered as a cause for new onset psychological symptoms, somatic symptoms of unclear etiology or a drop in academic performance. Pediatricians should be trained to play a major role in caring for and supporting the social and developmental well-being of children.

Changes in trajectories of physical growth in a domestic adoptees sample: A preliminary study.

Ferrara P, Cutrona C, Guadagno C, Amodeo ME, Del-Vescovo E, Ianniello F, Petitti T. Changes in trajectories of physical growth in a domestic adoptees sample: A preliminary study. Turk J Pediatr 2018; 60: 464-466. Internationally adopted infants experienced profound institutional deprivation in early infancy. Adoption may have a positive effect on child development, providing a massive catch-up growth in the developmental parameters. In this preliminary study we examined the effect of family deprivation on abandoned children placed in high quality foster care during infancy. We also investigated the presence of a growth delay in Italian domestic adoptees at the time of family placement and the potential physical recovery after adoption. Anthropometric measures (weight, length or height /head circumference) and Body Mass Index (BMI) were measured on arrival (T0) and 6 (T1), 12 (T2) and 24 months (T3) after adoption. The results show moderate delays in physical growth on the children`s arrival into the adoptive family and a significant catch-up growth in all auxological parameters from T < sub > 0 < /sub > to T < sub > 3 < /sub > . This is one of few Italian studies that points out a positive change in trajectories of growth after child adoption.

The impact of an educational program on recognition, treatment and report of child abuse.

BACKGROUND: Pediatricians play a crucial role in the identification and management of child abuse and neglect (CAN) but they often don't have a formal specialized training. METHODS: We analysed retrospectively data about patients, 0 - 18 years of age, victims of CAN between 1 April 2005 and 30 April 2015. The aim of the study was to evaluate the effect of a multidisciplinary educational program, "CAN: prevention strategies, individuation and treatment", on the knowledge, case recognition, treatment and follow-up of physicians of Gemelli University Hospital in Rome, regarding physical, sexual abuse and neglect. This program, in 3 different editions biannually, respectively in May-July 2010, November-January 2012 and February-May 2014, was based on 4 sessions, each one of 2 days. RESULTS: Considering the number of victims of CAN between 2005 and 2015 we observed 66 cases of maltreatment. We divided the study population in 2 groups: group A, before the educational programs, patients evaluated from 1 April 2005 to 30 July 2010; group B, after the educational program from 1 August 2010 to 30 April 2015. We observed 23 children in group A and 43 children in group B with an improvement of 87%. Analyzing our data about sex, nationality, type of perpetrators, we found that: 37/66 (56%) of children were females compared to 29/66 (44%) males; 41/66 (62%) of children came from Italy compared to 25/66 (38%) of foreign children; 52/66 (79%) of the perpetrators of abuse were parents or family members compared to acquaintances 10/66 (15%) and to strangers 4/66 (6%). CONCLUSIONS: Considering the prevalence of CAN, the need to develop clinically competent clinicians and the improving of residency education in child maltreatment is imperative. Improving the clinical skills of pediatricians to identify and evaluate CAN may lead to reduce morbidity and mortality of these children.

Melatonin's Effect on the Efficacy of Desmopressin in the Treatment of Enuresis.

PURPOSE: This study aims to evaluate and compare the efficacy of exogenous melatonin associated with desmopressin (dDAVP) and dietary recommendations. METHODS: A total of 189 patients were enrolled from the Service of Pediatrics, Campus Bio-Medico University Hospital of Rome, from January 2013 to June 2015. Of the 189 original patients, 153 children, aged between 5 and 14 years (mean age, 8.7 years) were included in the study. After clinical evaluation and a 3-month period of observation without treatment, children were assigned to receive treatment in one of 3 groups: group 1, dDAVP at a dose of 120 mcg a day (Minirin); group 2, dDAVP at a dose of 120 mcg and dietary recommendations; or group 3, dDAVP at a dose of 120 mcg, dietary recommendations, and melatonin at a dose of 1 mg a day (Melamil plus). Each patient was treated for 3 months. RESULTS: After the 3 months of therapy, a desiderable response was achieved in 30 of 51 patients (58.82%) treated with dDAVP, 35 of 53 patients (66.04%) treated with dDAVP and dietary recommendations, and 35 of 49 patients (71.43%) treated with dDAVP, dietary recommendations, and melatonin. CONCLUSIONS: Although not statistically significant, the results show that the association between dDAVP treatment with dietary recommendations and melatonin could be considered a safe and effective treatment of NE. Considering that the statistically insignificant results might be due to the small sample size, the study will be continued to increase the number of subjects.

Focus on desmopressin and enuresis: a review of literature.

Nocturnal enuresis (NE) is a common disorder in children. Choice of treatment depends on the frequency and severity of symptoms, the child's age and motivation. Treatment options for NE are alarm, desmopressin and imipramine. In particular, the main desmopressin therapeutical effect is the antidiuretic activity. The different formulations of desmopressin are an injectable solution, an oral tablet formulation and the recent oral lyophilisate (MELT). MELT with its higher biodisponibility guarantees the same therapy response of other formulations with a lower doses and it represents the first line and safety treatment for the NE.

Immunization status of children in foster homes: the first Italian data.

BACKGROUND: The aim of this paper was to evaluate vaccination coverage among children living in forest homes. METHODS: Data come from pediatric evaluation of a sample of children in group-homes in Rome, between September 2011 and April 2012, and compared vs. general population group. RESULTS: As for About children in foster homes it was found that 91/112 children (81.2%) had the vaccine coverage for all vaccines that compose the hexavalent (diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis and Haemophilus influenzae type b) vaccine; 88/112 (78.6%) have been vaccinated for measles-mumps-rubella; 10/112 (8.9%) were vaccinated with meningococcal vaccine; 15/112 (13.4%) have been vaccinated with vaccine antipneumococcal. The data compared with general population showed a difference between the two groups (P<0.0001). CONCLUSION: The vaccination status is an important gauge to evaluate the quality of assistance in children in the general population and more than in this vulnerable group of children.

Second-generation immigrant children: health prevention for a new population in terms of vaccination coverage and health assessment.

BACKGROUND: In recent years the total number of foreigners taking up residence in Italy is increasing: the number of children born in Italy to foreign parents currently account for 15% of all babies born in the country. This population is generally referred to as "second-generation immigrants". We evaluated the health conditions of this particular population by investigating the vaccination coverage and auxological data in a group of foreign children living in a foster care setting and by comparing them to those regarding a group of foreign children living with their own parents. METHODS: This study was conducted in a foster care association in Rome. The Pediatric Unit of "A. Gemelli" Hospital, Rome, provided all data for comparison. Two groups of children (group 1: 60 children from a foster care association; group 2: 91 children living with their parents; group 3: 112 healthy controls) with similar characteristics were taken into consideration. RESULTS: There were statistical differences between groups: the administration rate of hexavalent vaccine was significantly higher in group 2 than in group 1 (84.6% vs. 65.0%) (P<0.01); the administration rate of measles, mumps and rubella vaccine, again, was significantly higher in group 2 compared to group 1 (69.0% vs. 47.5%) (P<0.05); the administration rate of heptavalent pneumococcal vaccine, however, was higher in group 1 (21/60; 35.0%) than in group 2 (20/91; 21.9%) (P>0.05), although the administration rate of serogroup C meningococcal vaccine was lower in group 1 (10/60; 16.7%) compared to group 2 (17/91; 18.7%) (P>0.05). As for auxological parameters, there were no statistical differences between groups. CONCLUSIONS: The data presented in this study seem to suggest the need for a special health programme to be promoted by the Italian National Health System in order to address the needs of the particular risk group of second-generation immigrant children. Vaccination coverage should be especially boosted, and pediatricians should have a key role in terms of awareness raising and education of immigrant families.

Femicide and murdered women's children: which future for these children orphans of a living parent?

BACKGROUND: To assess the prevalence of femicides in Italy over the last three years and the potential long lasting effects of these traumatic events for the children of a woman who dies a violent death. METHODS: The data used in this study come from an internet search for the number of femicides occurring in Italy between 1(st) January, 2012 and 31(st) October, 2014. RESULTS: The total number of femicides was 319; the average age of murdered women was 47.50 ± 19.26. Cold arms in the form of sharp object -mostly knives- have caused the death of 102/319 women; firearms were used in 87/319 cases; asphyxiation was the chosen method in 52/319 cases. About the place where the femicides occurred, 209/319 were committed inside the victim's house. Children of women who died a violent death were 417 with a total of 180 minors in less than three years. A total of 52/417 children were witness to the killing and, among these 30/52 were minors; in 18/417 cases, children were murdered together with their mother and among these 9/18 were minors. CONCLUSIONS: Long-term studies are needed to ascertain what happens to these children, to understand what are the most appropriate psychological treatments, the best decisions about the contact with their father and the best placement for these children.

A focus on recent cases of suicides among Italian children and adolescents and a review of literature.

Suicidal behaviors are among the leading causes of death worldwide. The large spread of suicide suggests that educational programs and literature to parents or guardians should include information about the potential risks and potential consequences of the onset of the idea of suicide in children. We identified 55 cases of suicide among children and young adults <18-year-old occurring in Italy between 1st January, 2011 and 31st December, 2013. The results point to the need to increase our understanding of the dramatic rise in suicidal behaviors during childhood/adolescence and of the causal pathways linking these behaviors to child-adolescent mental disorders. During routine care visits, pediatricians should be skilled to recognize risk factors for adolescent suicide in order to intervene appropriately.

Oral desmopressin lyophilisate (MELT) for monosymptomatic enuresis: structured versus abrupt withdrawal.

OBJECTIVE: To investigate whether a structured withdrawal program from a sublingual formulation of fast-melting oral desmopressin lyophilisate (MELT) is superior to a sudden withdrawal from this formulation in the treatment of monosymptomatic nocturnal enuresis. MATERIALS AND METHODS: One hundred and three children presented to our pediatric nephrology outpatient clinic for bedwetting. Eighty-one children, aged between 5½ and 14 years (mean age 8.64 years), were treated with MELT at a dosage of 120 mcg a day. Responders were randomized to been withdrawn from therapy, after 3 months, abruptly or in a structured withdrawal program (60 mcg/day for 15 days and then 60 mcg every second evening for another 15 days). Main outcome parameter was relapse rate 1 month after the end of treatment. Relapse was defined as bedwetting occurring more than 2 nights per month after the 1-month treatment-free period. RESULTS: Relapse rate at 1 month after the end of treatment was 47.83% in the group on a structured program versus 45.83% in the abrupt termination group (p = 0.89). CONCLUSION: Our study suggests that a structured withdrawal program from MELT therapy doesn't offer advantages compared to an abrupt termination in children with monosymptomatic nocturnal enuresis.

Children left unattended in parked vehicles: a focus on recent italian cases and a review of literature.

Every year a lot of children die from heat stroke and hyperthermia because they have been left unattended in closed automobiles. These fatalities have augmented slightly in the past decade, but they are a poor recognized type of vehicle injury and little research has been done to discover the circumstances surrounding the fatal event. Two factors make children more prone to hyperthermia than adults: children have a greater surface area body mass ratio than adults and their thermoregulation is less efficient than adults. A scientific explanation about how it can happen that a parent leaves his child unattended in the car could be related to the Working Memory (WM): stress increases interference from irrelevant information, impairing selective attention and WM and influencing behavior. In the last two years in Italy 16 cases of child hyperthermia due to abandonment in motor vehicle were identified. These findings suggest that educational programs and literature for parents regarding automobile safety should include information about the potential dangers of heat stress, in fact, as these events are mostly unintentional, legislative efforts may be vain.

The physical and mental health of children in foster care.

BACKGROUND: To evaluate physical and mental health in children in foster care and comparison with general population. METHODS: The study is carried out between September 2011 and April 2012 into nine group homes in Rome. It involved 112 children ranging in age 2-17 years, living in temporary care facilities or institutes. All data came out of clinical history and physical exams, validated by a pediatrician. Such data were being then compared with samples of general population. RESULTS: Significant themes were high percentage of children with psychiatric disorders in foster care (22.3%); high percentage of psychiatric disorders diagnosed immediately while arriving at the foster care (56%); no significant differences in weight, height and BMI between children in foster care and general population; significant differences (P<0.05) for allergy, gastrointestinal diseases and caries between children in foster care and general population. CONCLUSION: The results suggest that the physical health of children in group homes is no worse than that of children living care in their own homes and that the foster care provides necessary conditions to support the growth of the children and their physical, mental and social needs.