Monitoring the hospital management of acute asthma: the Italian Pediatric Network experience.

BACKGROUND: The Study Group on Accreditation and Quality Improvement of the Italian Society of Pediatrics has developed an observational study about the hospital management of pediatric patients affected by severe asthma, in order to evaluate how the Guidelines for severe asthma in childhood are applied in the daily practice. METHODS: This study included patients between 2 and 17 years, hospitalized or under short intensive observation for acute asthma. The data collection was carried out through the compilation of on-line forms. The statistical technique used was the Chi Square test. RESULTS: 409 forms were filled in by 32 Italian Centers. 17% of the patients showed severe asthma, 59% moderate and 24% mild. On arrival at the Emergency Room the oximetry was measured in 95% of the patients, the respiratory rate in 64% while the heart rate in 88% of them. 48% of the children were exposed to chest X-ray. More than half of the children received oxygen therapy, 98.5% received short-acting beta-2 agonists and systemic steroid therapy was given to 82% of children, mainly orally. At discharge only half of the children were provided with written instructions for the management of any subsequent asthmatic episode. The analysis of the collected data highlights that not all the children had their oxygen saturation measured, although this parameter is one of the main indicators of disease severity, as well as the respiratory rate, which was detected in a minimal percentage of cases. The frequency of chest X-ray was extremely high, even though it does not have any indication in the majority of asthma cases. The evaluation of the therapeutic treatment denotes an adequate use of the oxygen therapy according to the oximetry values found on arrival, but an abuse of steroid therapy. Critical issues emerge at discharge: children are not always educated about the home management of the disease and the self-evaluation of the illness seriousness. CONCLUSION: The pediatric network has become an excellent system of monitoring of the clinical management of asthmatic children, highlighting strengths and weaknesses on which to focus actions of improvement.

[Influence of maternal smoking on cord serum IgE levels in newborns]. / Influenza del fumo materno sui livelli di IgE totali su sangue del cordone ombelicale.

Allergic diseases are among the most common diseases in childhood and their prevalence is 14%. One of the most important pathogenetic factors is the ability to produce IgE and the measurement of cord serum IgE seems to be very important for early detection of newborns at risk. Besides, cigarette smoke, among the environmental factors, has been demonstrated to influence the immunologic system, inducing an increase in IgE production. The aim of this study is to evaluate fetal production of IgE in newborns with a family history of atopy and whose mother has been smoking during pregnancy. The measurement of cord serum IgE has been performed in 215 at term newborns (weight at birth > 2500 g, Apgar score at 5' > 7). A careful history has been obtained with particular regard at the presence of familiarity for allergies and a cigarette smoking during pregnancy. According to the history, children have been divided in 3 groups: Group 1: 126 newborns without familiar history of allergy and born from no smoking mothers (control group); Group 2: 46 newborns with familiar history for allergy and born from no smoking mothers; Group 3: 43 newborns without familiar history for allergy born from smoking mothers. The II and III groups of newborns present total IgE levels on cord serum significantly higher than the control group. Besides a positive correlation between the number of cigarettes smoked during pregnancy and the value of cord serum IgE has been detected. It is well known that both genetic and environmental factors play an important role in the pathogenesis of allergic diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pharmacokinetics of broxaterol in asthmatic children]. / Farmacocinetica del broxaterolo in bambini affetti da asma.

Pharmacological profile of broxaterol, a new beta adrenergic compound, was investigated in 12 asthmatic children (6 male and 6 female with age 8-13 years). This study was performed from November to May, and venous blood was collected after 30, 45, 120, 180, 240 minutes from administration of 0.5 mg broxaterol; the urine was collected every 4 hours drug intake (0-4, 4-8, 8-12 hours). Drug absorption proved very fast: T max was 0.9 hours and Cmax was 2.05 micrograms/ml. T 1/2 was 2.3 hours. The urine concentration of broxaterol in the urine 0-4 and 4-8 hours after administration, was 6.11 and 2.3% (as drug percentage), after 8 hours no broxaterol was evaluated in the urine. Pharmacological profile of broxaterol in asthmatic children and adults is comparable.

Prednisone treatment in newly diagnosed type I diabetic children: 1-yr follow-up.

Thirty-one children suffering from type I diabetes mellitus were arranged at onset of the disease in two different groups. Group 1 was treated with oral prednisone (60 mg X m-2 X day-1 for 14 days, 30 and 15 mg X m-2 X day-1 for 7 days). Group 2 matched the control group. All patients were treated with continuous subcutaneous insulin infusion for the first 15 days of treatment, and then with two daily injections of a mixture of intermediate- and fast-acting insulin. All subjects were followed for 1 yr. Group 1 required more insulin than group 2 after 30 days (1.5 +/- 0.3 vs. 0.6 $ 0.2 U X kg-1 X day-1, P less than .001) and after 60 days (0.8 +/- 0.1 vs. 0.5 +/- 0.06 U X kg-1 X day-1, P less than .001). After 3 mo, both groups reached the lowest mean stable HbA1 level (8.4 +/- 0.4 and 8.3 +/- 0.4% group 1 and 2 respectively). Between the 2nd and 9th mo of follow-up, mean postbreakfast C-peptide concentration increased in both groups. The highest levels of fasting C-peptide were reached by group 1 after 90 days (0.77 +/- 0.32 nM) and group 2 after 60 days (0.34 +/- 0.09 nM). The largest partial remission (C-peptide 0.3 nM, insulin requirement less than 0.5 U X kg-1 X day-1 and no glycosuria) was observed in group 1 after 180 days (5 of 16 patients) and in group 2 after 60 days (5 of 15 patients).(ABSTRACT TRUNCATED AT 250 WORDS)

Unusual renal involvement during diabetic ketoacidosis (DKA) in a newly diagnosed type I diabetic child.

A 10-year-old boy, in a precomatose state, was admitted to our Endocrine Unit for diabetic ketoacidosis. It took unusually long to reequilibrate the acidosis despite a bicarbonate drip. On the 4th day the patient suddenly complained of an acute abdominal pain associated with macrohematuria and oliguria; ankle edema was evident. No radio-opaque image was detected along the urinary tract. An intravenous pyelogram (IVP) showed an almost totally silent left kidney. Ten days later a control IVP showed complete normality of both kidneys. We postulated that the serious and protracted dehydration might have resulted in the formation of a blood clot along the renal tract and that the rehydration may have subsequently removed it.

Metabolic control in newly diagnosed type 1 diabetic children. Effect of continuous subcutaneous infusion.

15 insulin-dependent diabetic children at onset were randomly allocated to one of two different therapeutical protocols: continuous subcutaneous insulin infusion (CSII) and intensified conventional insulin treatment with three daily insulin injections (CIT). Both treatments were performed for 10 days; the initial insulin dose was 1.5 U/kg/day and thereafter the insulin dosage was modified in order to obtain a satisfactory control. Near-normal blood glucose levels were obtained after 24 h in the CSII group, and after 3 days in the CIT group. All subjects underwent 1 year of follow-up. HbA1 levels and insulin requirements decreased similarly in the two groups; C-peptide secretion did not increase significantly in both groups. A clear advantage of CSII cannot be assumed, and the usefulness of this therapeutical approach needs to be confirmed by further investigations.