Advances in paediatrics in 2016: current practices and challenges in allergy, autoimmune diseases, cardiology, endocrinology, gastroenterology, infectious diseases, neonatology, nephrology, neurology, nutrition, pulmonology

Abstract

This review reports main progresses in various pediatric issues published in Italian Journal of Pediatrics and in international journals in 2016. New insights in clinical features or complications of several disorders may be useful for our better understanding. They comprise severe asthma, changing features of lupus erythematosus from birth to adolescence, celiac disease, functional gastrointestinal disorders, Moebius syndrome, recurrent pneumonia. Risk factors for congenital heart defects, Kawasaki disease have been widely investigated. New diagnostic tools are available for ascertaining brucellosis, celiac disease and viral infections. The usefulness of aCGH as first-tier test is confirmed in patients with neurodevelopmental disorders. Novel information have been provided on the safety of milk for infants. Recent advances in the treatment of common disorders, including neonatal respiratory distress syndrome, hypo-glycemia in newborns, atopic dermatitis, constipation, cyclic vomiting syndrome, nephrotic syndrome, diabetes mellitus, regurgitation, short stature, secretions in children with cerebral palsy have been reported. Antipyretics treatment has been updated by national guidelines and studies have excluded side effects (e.g. asthma risk during acetaminophen therapy). Vaccinations are a painful event and several options are reported to prevent this pain. Adverse effects due to metabolic abnormalities are reported for second generation antipsychotic drugs.

Increased Risk of Recurrent Acute Respiratory Infections in Children with Congenital Heart Disease: A Prospective Cohort Study

“…Another study showed that children with acyanotic CHD experienced 4.94 (SD 2.54) episodes of ARI annually, which was significantly higher compared to cyanotic CHD at 2.41 (SD 1.89), (p=0.01). (27) The incidence of ARI episodes in acyanotic left-to-right shunt is significantly higher (5.08 (SD 2.55)) than conotruncal anomaly, which was similar with our findings. Some authors define recurrent ARI as respiratory infections occurring at least six times per year or at least three times per year if it involves the lower respiratory tract.…”

Medications used in paediatric intensive care by continuous infusion: Do the technical aspects of the package inserts corroborate scientific evidence?

“…Drugs that are not used via a continuous infusion pump and drugs from different classes of cardiovascular system and nervous system, according to the ATC, were excluded. Thirteen drugs used via continuous infusion pump in intensive care units in the treatment of patients using invasive mechanical ventilation, in the treatment of hemodynamic instability and in the maintenance of fluid balance, were selected for the study 11–17 . Such conditions, prevalent in complex patients requiring intensive care 18–20 .…”

“…In the first stage of the study, medications widely used by CI in paediatric and neonatal ICU's were selected, which according to level 1 of the Anatomical Therapeutic Chemical Classification (WHO, 2020) were classified as medications for the central nervous system (morphine, ketamine, fentanyl, midazolam and dexmedetomidine), and for the cardiovascular system (epinephrine, norepinephrine, dopamine, dobutamine, milrinone, nitroprusside, nitroglycerin and furosemide) 11–17 …”

Omalizumab et immunothérapie allergénique : cas clinique et revue de la littérature

“…La forme sévère de l'asthme est rare chez l'enfant. Elle représente 5% des enfants asthmatiques [1]. Dans la littérature, selon les données du « Global Initiative for Asthma and the National Asthma Education and Prevention Program Guidelines for the Diagnosis and Management of Asthma » (GINA 2017) [2], l'asthme sévère se définit selon le niveau de traitement nécessaire au contrôle des symptômes et des exacerbations avec souvent nécessité de traitements multiples dont des corticoïdes inhalés à forte dose.…”

“…Dans la littérature, selon les données du « Global Initiative for Asthma and the National Asthma Education and Prevention Program Guidelines for the Diagnosis and Management of Asthma » (GINA 2017) [2], l'asthme sévère se définit selon le niveau de traitement nécessaire au contrôle des symptômes et des exacerbations avec souvent nécessité de traitements multiples dont des corticoïdes inhalés à forte dose. C'est une pathologie hétérogène avec une grande variabilité des manifestations cliniques entre les patients [1,2].…”