Minerva pediatrica
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Evidence on the efficacy of standardised phytoterapic extracts for the prevention of recurrent respiratory tract infections (RRTIs) in children is reviewed. Echinacea extracts are widely used in European countries and in the United States as immune-stimulating agents. However, further prospective, appropriately powered clinical studies are required to confirm their benefits in reducing duration and severity of RRTIs.
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Neonatal sepsis occurs from 1 to 21 newborns out of 1 000 live births with mortality rates as high as 30% up to 69%. The most important risk factors are prematurity, low birth weight, invasive medical procedure and prolonged hospitalization in neonatal intensive care units. An aimed and restrictive antibiotic therapy has an outstanding importance to reduce both morbidity-mortality rates and multiple drug-resistance. ⋯ This article reviews the immunologic function and practical use of C reactive protein (CRP) and other markers in the diagnosis of neonatal sepsis. While CRP is a specific late infection marker, cytokines, cell surface markers and procalcitonin (PCT) are early infection markers. The use of multiple markers as CRP, PCT, IL-6, IL-8, CD64, CD11b is useful both to early (24-48 h) diagnose of neonatal sepsis, and to monitorate the antibiotic treatment while waiting for the results of cultural examinations.
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Because of the limited number of comprehensive paediatric centres, providing the entire continuum of paediatric care, including subspecialty care, and generally serving as regional referral centres for tertiary paediatrics, paediatric emergency care in Italy is often provided in adult facilities within primarily adult hospital institutions. Consequently, most paediatricians working in hospitals with a separate paediatric ward or department provide Emergency Department (ED) on-call coverage with serious liability concerns: such concerns are due to the fact that successful care of infants and children in an emergency situation requires appropriately sized equipment, well trained staff, appropriate and specialised triage and destination guidelines but, unfortunately, not all Italian facilities fulfil all these criteria. Risk management training of the entire ED staff may reduce the institution's involvement in malpractice litigation. ⋯ Furthermore, in our paper we aimed to highlight the importance of aspects with a potential risk exposure in our profession, such as informed consent, exculpatory release forms, incident reports and complete ED record documentation of paediatric patients. In addition to that, the quality of care provided at ED in Italy has been assessed by analysing ED-related paediatric malpractice claims in the last 10 years. Finally, the importance of a joint commission within the Italian Paediatrics Society is underlined in order to discuss practice guidelines for paediatricians involved in emergency care.
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Newer immunosuppressive agents have dramatically reduced the rates of acute graft rejection over the last decade but may have exacerbated the problem of post-transplant infections. Causes of early mortality include graft dysfunction and sepsis. Late mortality occurs mainly due to sepsis. ⋯ Moreover, potentially promising immunomodulatory approaches, i.e. human activated protein C, immunomodulatory diets containing L-arginine and fish oil, selective cytokine blockade, platelet-activating factor receptor antagonist, LPS receptor CD14 blockade and G-CSF, for the treatment of immunodysfunction in septic patients will be outlined in this review article. Most of them, however, have not been tested in the clinical arena in transplanted patients. Thus, the main part of the article, immunomodulation during sepsis in organ transplanted children is quite speculative and based on immunomodulatory strategies in other non-transplanted septic patients.
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Endoscopic third-ventriculostomy (ETV) became the treatment of choice for non-communicating hydrocephalus and its effectiveness is largely reported. On the contrary, specific articles on complications and failures of this technique are very rare and this review aims at supplying further information about it. Therefore, an analysis of the main and up-to-date series is made and exhaustive data about complications and failures of ETV and about their incidence are obtained. ⋯ Moreover, this study showed both the risk that the endoscopic procedure must be suspended (intra-operative failure) and the risk of an early (before 1 month) or delayed (even some years after the intervention) narrowing of the ventriculostomy. The rate of and the reasons for failure have been analysed and the success of a second ETV has been estimated. The results of this analysis suggest that the children proposed for ETV are carefully selected and meticulously studied during the follow-up.