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1. Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Prevention.

Author

Marchisio P, Bortone B, Ciarcià M, Motisi MA, Torretta S, Castelli Gattinara G, Picca M, Di Mauro G, Bonino M, Mansi N, Varricchio A, Marseglia GL, Cardinale F, Villani A, and Chiappini E

Subjects
Acute Disease, Adolescent, Child, Child, Preschool, Humans, Infant, Italy, Risk Factors, Secondary Prevention standards, Vaccination, Otitis Media prevention & control, Pediatrics organization & administration, Pediatrics standards
Abstract

Background: In recent years, new information has been acquired regarding the diagnosis, treatment and prevention of acute otitis media (AOM). The Italian Pediatric Society, therefore, decided to issue an update to the Italian Pediatric Society guidelines published in 2010., Methods: The search was conducted on Pubmed, and only those studies regarding the pediatric age alone, in English or Italian, published between January 1, 2010 and December 31, 2018, were included. Each study included in the review was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The quality of the systematic reviews was evaluated using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 appraisal tool. The guidelines were formulated using the GRADE methodology by a multidisciplinary panel of experts., Results: The importance of eliminating risk factors (passive smoking, environmental pollution, use of pacifier, obesity, limitation of day-care center attendance) and the promotion of breastfeeding and hygiene practices (nasal lavages) was confirmed. The importance of pneumococcal vaccination in the prevention of AOM was reiterated with regard to the prevention of both the first episode of AOM and recurrences. Grommets can be inserted in selected cases of recurrent AOM that did not respond to all other prevention strategies. Antibiotic prophylaxis is not recommended for the prevention of recurrent AOM, except in certain carefully selected cases. The use of complementary therapies, probiotics, xylitol and vitamin D is not recommended., Conclusions: The prevention of episodes of AOM requires the elimination of risk factors and pneumococcal and influenza vaccination. The use of other products such as probiotics and vitamin D is not supported by adequate evidence.

Published
2019
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2. Cerumen: A fundamental but neglected problem by pediatricians.

Author

Marchisio P, Pipolo C, Landi M, Consonni D, Mansi N, Di Mauro G, Salvatici E, Di Pietro P, Esposito S, Felisati G, and Principi N

Subjects
Acute Disease, Attitude of Health Personnel, Child, Child, Preschool, Ear Canal, Female, Humans, Infant, Male, Otitis Media diagnosis, Cerumen, Otolaryngology, Pediatrics, Practice Patterns, Physicians'
Abstract

Objectives: Under physiological conditions, cerumen (Ce) is regularly extruded from the ear canal by a self-cleaning mechanism. Failure of this mechanism leads to excessive accumulation or impaction of Ce. Limited data are available concerning the prevalence of cerumen in healthy and sick infants and children. We assessed the prevalence of Ce in a large population of infants and children and compared the Ce removal attitudes of paediatricians (PEDs) and otorhinolaryngologists (ENTs)., Methods: Children seen in November 2014 for acute respiratory infections, including suspected acute otitis media, or well-being visits, were enrolled. The following data were recorded: presence, laterality, and amount of Ce; presenting complaints and final diagnosis; attempt to remove Ce during the visit; and type of physician., Results: Among 819 children aged 1 month to 12 years, Ce was present in 594 (72.5%), of whom 478 (80.5%) had bilateral Ce, and 261 (43.9%) had Ce in a relevant amount (cerumen obstructing at least 50% of the ear canal). Presence of Ce was more common in younger and in African or Asian children. PEDs were less likely to remove cerumen than ENTs (28.8% vs 91.0%, p < 0.001) irrespective of age, gender, race and reason for visit. Ce was removed by PEDs in less than one-third of sick children with a final diagnosis of acute otitis media (AOM) (31.6%) compared with almost all the children by ENTs (95.6%, p < 0.001)., Conclusion: Ce is highly prevalent in healthy and sick children but is quite neglected by PEDs. Educational programs to reinforce the importance of Ce removal and to improve the techniques for removal in case of suspected AOM should be implemented and rigorously evaluated in order to avoid incorrect diagnosis and erroneous treatments., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Published
2016
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3. Development of an algorithm for the management of cervical lymphadenopathy in children: consensus of the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases and the Italian Society of Pediatric Otorhinolaryngology.

Author

Chiappini E, Camaioni A, Benazzo M, Biondi A, Bottero S, De Masi S, Di Mauro G, Doria M, Esposito S, Felisati G, Felisati D, Festini F, Gaini RM, Galli L, Gambini C, Gianelli U, Landi M, Lucioni M, Mansi N, Mazzantini R, Marchisio P, Marseglia GL, Miniello VL, Nicola M, Novelli A, Paulli M, Picca M, Pillon M, Pisani P, Pipolo C, Principi N, Sardi I, Succo G, Tomà P, Tortoli E, Tucci F, Varricchio A, de Martino M, and Italian Guideline Panel For Management Of Cervical Lymphadenopathy In Children

Subjects
Child, Communicable Diseases diagnosis, Communicable Diseases epidemiology, Communicable Diseases therapy, Humans, Italy epidemiology, Lymphatic Diseases diagnosis, Lymphatic Diseases epidemiology, Algorithms, Disease Management, Lymphatic Diseases therapy, Otolaryngology standards, Pediatrics standards, Societies, Medical standards
Abstract

Unlabelled: Cervical lymphadenopathy is a common disorder in children due to a wide spectrum of disorders. On the basis of a complete history and physical examination, paediatricians have to select, among the vast majority of children with a benign self-limiting condition, those at risk for other, more complex, diseases requiring laboratory tests, imaging and, finally, tissue sampling. At the same time, they should avoid expensive and invasive examinations when unnecessary. The Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases, the Italian Society of Pediatric Otorhinolaryngology, and other Scientific Societies, issued a National Consensus document, based on the most recent literature findings, including an algorithm for the management of cervical lymphadenopathy in children., Methods: The Consensus Conference method was used, following the Italian National Plan Guidelines. Relevant publications in English were identified through a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through March 21, 2014., Results: Basing on literature results, an algorithm was developed, including several possible clinical scenarios. Situations requiring a watchful waiting strategy, those requiring an empiric antibiotic therapy, and those necessitating a prompt diagnostic workup, considering the risk for a severe underling disease, have been identified., Conclusion: The present algorithm is a practice tool for the management of pediatric cervical lymphadenopathy in the hospital and the ambulatory settings. A multidisciplinary approach is paramount. Further studies are required for its validation in the clinical field.

Published
2015
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4. "Mi voglio bene": a pediatrician-based randomized controlled trial for the prevention of obesity in Italian preschool children.

Author

Brambilla P, Bedogni G, Buongiovanni C, Brusoni G, Di Mauro G, Di Pietro M, Giussani M, Gnecchi M, Iughetti L, Manzoni P, Sticco M, and Bernasconi S

Subjects
Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Italy epidemiology, Male, Obesity epidemiology, Prevalence, Prognosis, Registries, Time Factors, Breast Feeding epidemiology, Feeding Behavior physiology, Obesity prevention & control, Pediatrics methods, Physicians, Primary Prevention methods
Abstract

Background: The first years of life are crucial to start preventive interventions that can have an impact on lifestyle and later overweight and obesity. Under the Italian National Health System (INHS), children are cared for by family pediatricians who perform health balances at regular intervals. The Italian Society of Preventive and Social Pediatrics (SIPPS) has designed a randomized controlled trial (RCT) to evaluate the effectiveness of family pediatricians for the prevention of childhood obesity in preschool children. We report the rationale and protocol of such trial, named the "Mi voglio bene" ("I love myself") study., Methods: "Mi voglio bene" is a parallel-arm RCT. Family pediatricians willing to participate to the trial will be randomly assigned to a control group and to an experimental group. The control group will provide the usual standard of care while the experimental group will implement 10 preventive actions (promotion of breastfeeding, avoidance of solid foods, control of protein intake, avoidance of sugar-sweetened beverages, avoidance of bottle, active means of transportation, identification of early adiposity rebound, limitation of television viewing, promotion of movement, and teaching portion size) at 10 time points during a 6-yr follow-up. The main outcome measures is the prevalence of overweight and obesity at 6 years of age. The experimental intervention is expected to reduce the prevalence of overweight and obesity from 25% to 20% and the study requires a total of 3610 children. Each pediatrician will enroll 30 consecutive newborns into the study so that a total of 120 pediatricians will participate to the study., Discussion: "Mi voglio bene" is expected to provide important information for the INHS and possibly other institutional child care settings about the effectiveness of a pediatrician-based approach to the prevention of childhood obesity. We published this study protocol with the aim of opening a discussion with all people interested in fighting childhood obesity and to receive useful criticisms.

Published
2010
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6. Medical education and attitudes about acute otitis media guidelines: a survey of Italian pediatricians and otolaryngologists.

Author

Marchisio P, Mira E, Klersy C, Pagella F, Esposito S, Bianchini S, Di Mauro G, Fusi M, Nazzari E, Tagliabue M, Bellussi L, and Principi N

Subjects
Acute Disease, Cross-Sectional Studies, Health Knowledge, Attitudes, Practice, Humans, Italy, Middle Aged, Physicians standards, Practice Guidelines as Topic, Attitude of Health Personnel, Otitis Media diagnosis, Otolaryngology education, Otolaryngology standards, Pediatrics education, Pediatrics standards
Abstract

Background: Medical education and guidelines have been advocated as major means of improving the management of otitis media. Limited data are available concerning medical education in acute otitis media (AOM), and the association between medical education and attitudes about AOM guidelines has never been explored., Objectives: To assess the prevalence of medical education concerning AOM, of a positive attitude toward AOM guidelines and of appropriate diagnostic methods in a large sample of Italian pediatricians (PEDs) and otolaryngologist (ENTs) and to look for possible associations between them., Subjects and Methods: This cross-sectional survey was based on the responses of 2012 physicians (1160 PEDs and 852 ENTs) to a mailed anonymous questionnaire., Results: Very few (9%) of the responders had received any AOM medical education during medical school, but the number increased during residency (38%) and peaked in the postresidency period (53%) with slight differences between PEDs and ENTs. Forty percent reported a positive attitude toward AOM guidelines, with PEDs having a better attitude than ENTs (46% vs. 32%, P < 0.001). An appropriate diagnostic method for AOM was reported by only 21% of the physicians (PEDs 11% vs. ENTs 35%, P < 0.001). AOM medical education during postresidency and reporting the use of appropriate diagnostic methods were significantly associated with a positive attitude about AOM guidelines., Conclusions: Specific educational programs concerning AOM should be implemented and rigorously evaluated, before physicians become fully trained PEDs and ENTs, and maintained during postresidency. Evidence-based guidelines should be further incorporated into everyday practice of both PEDs and ENTs.

Published
2009
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7. [Acute, subacute and recurrent bacterial rhinosinusitis in pediatrics: guidelines of the Study Group of the Italian Society for Pediatric Infectious Diseases (SITIP)].

Author

Esposito S, Marseglia G, Novelli A, de Martino M, Di Mauro G, Gabiano C, Galli L, De Luca G, Leo G, Navone C, Nicoletti G, Passali D, Serra A, Vierucci A, and Principi N

Subjects
Acute Disease, Humans, Italy, Recurrence, Communicable Diseases complications, Pediatrics methods, Pediatrics standards, Rhinitis microbiology, Societies, Medical
Published
2007

10. Recommendations for pediatric tuberculosis vaccination in Italy

Author

Montagnani, C, Esposito, S, Galli, L, Chiappini, E, Principi, N, de Martino, M, Bosis, S, Tagliabue, C, Senatore, L, Ascolese, B, Villani, A, Lancella, L, Cursi, L, Grandin, A, Marabotto, C, Ciofi, D, Festini, F, Anziati, M, Becciani, S, Remaschi, G, Sollai, S, Tersigni, C, Venturini, E, Guarino, A, Lo Vecchio, A, Scotto, R, Gabiano, C, Garazzino, S, Le Serre, D, Raffaldi, I, Bernardi, F, Bertazzoni, E, Blasi, F, Bocchino, M, Assante, L, Castagnola, E, Losurdo, G, Codecasa, L, Di Mauro, G, Faccini, M, Marseglia, G, Mascolo, A, Di Comite, A, Stronati, M, Matteelli, A, Migliori, Gb, D’Ambrosio, L, Centis, R, Pasinato, Cirillo, Tortoli, Russo, Scaglione, F, Scala, E, and Tomà, P

Subjects
Pediatrics, medicine.medical_specialty, Tuberculosis, Immunology, Breastfeeding, Tuberculin, Reviews, Disease, Tuberculous meningitis, 03 medical and health sciences, 0302 clinical medicine, children, prevention, BCG, tuberculosis, vaccination, vaccine, 030225 pediatrics, medicine, Immunology and Allergy, Humans, 030212 general & internal medicine, Immunization Schedule, Pharmacology, business.industry, medicine.disease, Settore MED/38, Pediatric tuberculosis, Vaccination, Italy, BCG Vaccine, business, BCG vaccine
Abstract

Bacillus Calmette-Guerin (BCG) vaccine is still the only vaccine approved for the prevention of tuberculosis (TB), and is widely used in highly endemic countries, where all newborns receive a single intradermal dose immediately after birth; however, the recommendations concerning its use in Europe vary widely from country to country. This document describes the recommendations of a group of Italian scientific societies concerning its pediatric use in Italy, the persistence of the protection it provides, its safety, its interference with tuberculin skin test (TST) responses, and the children who should be vaccinated. The experts conclude that BCG vaccination provides a good level of protection against tuberculous meningitis and disseminated forms, and a fair level of protection against pulmonary disease; the protective effective lasts at least 10 years, and revaccination offers no advantages over a single administration. The vaccine is safe in immunocompetent subjects, and affects the response to a TST for at least 6 y On the basis of these observations, we recommend its use in Italy in all TST-negative immunocompetent newborns and breastfeeding infants aged

Published
2015

11. Management of acute pharyngitis in children: summary of the Italian National Institute of Health guidelines

Author

Chiappini, E, Principi, N, Mansi, N, Serra, Agostino, De Masi, S, Camaioni, A, Esposito, S, Felisati, G, Galli, L, Landi, M, Speciale, Am, Bonsignori, F, Marchisio, P, de Martino, M, Collaborators Becherucci P, Italian Panel on the Management of Pharyngitis in C. h. i. l. d. r. e. n., Bellussi, L, De Gaudio, M, Di Simone, L, Di Mauro, G, Di Pietro, P, Festini, F, Gaini, Rm, Maiolino, Luigi, Mele, G, Marseglia, Gl, Novelli, A, Pisani, P, Puglisi, S, Rugiu, Mg, Tovo, Pa, Tulimiero, P, Varricchio, A, Venturini, E, Rosati, G. V., Chiappini, E, Principi, N, Mansi, N, Serra, A, De Masi, S, Camaioni, A, Esposito, S, Felisati, G, Galli, L, Landi, M, Speciale, A, Bonsignori, F, Marchisio, P, and de Martino, M

Subjects
Pediatrics, medicine.medical_specialty, MEDLINE, Acute Pharyngitis, Government Agencies, medicine, Humans, Pharmacology (medical), Child, Pharmacology, Acute Disease, Evidence-Based Medicine, Italy, Pharyngitis, Practice Guidelines as Topic, business.industry, Evidence-based medicine, Guideline, Amoxicillin, Government Agencie, Penicillin, Systematic review, Pharyngiti, medicine.symptom, business, medicine.drug, Human
Abstract

Background Discrepancies in the management of pharyngitis in children have been reported in Europe and the United States, and recommendations concerning the use of clinical scores, rapid antigen diagnostic tests (RADTs) or throat cultures, and the indications for antibiotic treatment largely differ. Objective This article summarizes the Italian guidelines on the management of pharyngitis in children issued by the National Institute of Health. Methods A multidisciplinary panel of experts (the Guidelines Development Group) developed and used a set of key questions to conduct a systematic review of the literature. Relevant publications in English were identified through a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through April 30, 2011. Final recommendations were scaled according to the Italian National Guidelines Program grading. Results Eighteen clinical questions were defined, and 44 recommendations were issued. None of the available scoring systems is sufficiently accurate to identify group A β-hemolytic streptococci (GABHS) pharyngitis in settings with low prevalence for rheumatic disease. RADT should be performed by trained personnel in every child with a history and signs/symptoms suggestive of GABHS pharyngitis. RADT is not recommended in children with a McIsaac score of 0 or 1 with ≥2 signs/symptoms suggestive of viral infection. Backup culture in children with negative RADT result is not recommended. Culture test with antibiotic susceptibility assay should be performed exclusively for epidemiologic purposes. Streptococcal antibody titers are of no value in diagnosing acute pharyngitis. Antibiotic therapy is recommended in microbiologically documented GABHS pharyngitis. Because penicillin V is not available in Italy, amoxicillin (50 mg/kg/d in 2–3 doses orally) for 10 days is the first choice of treatment. In noncompliant cases, benzathine penicillin may be administered. Although not routinely recommended due to the high cost and wide spectrum of activity, a 5-day course with a second-generation cephalosporin may be used in noncompliant cases. Macrolides should be limited to children with demonstrated type I hypersensitivity to penicillin. Ibuprofen or paracetamol is recommended for relief of pain or fever associated with discomfort. Because the carrier state is not associated with increased risk of suppurative complications and risk of GABHS transmission to contacts is minimal, the carrier state should never be investigated and treated. Recommendations for the management of suppurative complications are given. Conclusions This guideline provides a comprehensive, evidence based, tool for the diagnosis and therapy of acute pharyngitis in children.

Published
2012

12. Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

Author

Vassilios Fanos, Fabio Cardinale, Salvatore Barberi, Alberto Villani, Carlo Caffarelli, Giovanni Simeone, Elena Chiappini, Roberto Bernardini, Monica Malventano, Luca De Franciscis, Annalisa Capuano, Stefano Luciani, Renato Turra, Stefania Zanconato, Domenico Minasi, Paolo Becherucci, Annamaria Bianchi, Marzia Duse, Paolo Biasci, Marcello Bergamini, Francesca Santamaria, Giuseppe Di Mauro, Serenella Castronuovo, Adima Lamborghini, Gian Luigi Marseglia, Francesco Paravati, Giovanni Battista Pajno, Alberto Martelli, Elio Novembre, Gabriella Di Mauro, Francesco Macrì, Giorgio Piacentini, Maria Carmen Verga, Giovanna Tezza, Iride Dello Iacono, Lucia Leonardi, Mattia Doria, Michele Miraglia Del Giudice, Giovanna De Castro, Raffaele Falsaperla, Luciana Indinnimeo, Riccardo Lubrano, Valentina Ferraro, Renato Cutrera, Lucia Diaferio, Vito Leonardo Miniello, Giampaolo Ricci, Melissa Borrelli, Gabriella Pozzobon, Agostino Nocerino, Germana Nardini, Francesco Di Mauro, Fabio Decimo, Anna Maria Zicari, Diego Peroni, Mariangela Tosca, Maria Di Cicco, Fabio Midulla, Luigi Masini, Amelia Licari, Carlo Alfaro, Valeria Caldarelli, Caterina Di Mauro, Elena Galli, Carlo Capristo, Cristina Piersantelli, Sergio Renzo Morandini, Massimo Landi, Giovanni Cerimoniale, Valter Spanevello, Daniele Giovanni Ghiglioni, Ahmad Kantar, Dora Di Mauro, Cristina Di Mauro, Giovanni Corsello, Attilio Varricchio, Duse, M., Santamaria, F., Verga, M. C., Bergamini, M., Simeone, G., Leonardi, L., Tezza, G., Bianchi, A., Capuano, A., Cardinale, F., Cerimoniale, G., Landi, M., Malventano, M., Tosca, M., Varricchio, A., Zicari, A. M., Alfaro, C., Barberi, S., Becherucci, P., Bernardini, R., Biasci, P., Caffarelli, C., Caldarelli, V., Capristo, C., Castronuovo, S., Chiappini, E., Cutrera, R., De Castro, G., De Franciscis, L., Decimo, F., Iacono, I. D., Diaferio, L., Di Cicco, M. E., Di Mauro, C., Di Mauro, D., Di Mauro, F., Di Mauro, G., Doria, M., Falsaperla, R., Ferraro, V., Fanos, V., Galli, E., Ghiglioni, D. G., Indinnimeo, L., Kantar, A., Lamborghini, A., Licari, A., Lubrano, R., Luciani, S., Macri, F., Marseglia, G., Martelli, A. G., Masini, L., Midulla, F., Minasi, D., Miniello, V. L., del Giudice, M. M., Morandini, S. R., Nardini, G., Nocerino, A., Novembre, E., Pajno, G. B., Paravati, F., Piacentini, G., Piersantelli, C., Pozzobon, G., Ricci, G., Spanevello, V., Turra, R., Zanconato, S., Borrelli, M., Villani, A., Corsello, G., Peroni, D., Duse, Marzia, Santamaria, Francesca, Verga, Maria Carmen, Bergamini, Marcello, Simeone, Giovanni, Leonardi, Lucia, Tezza, Giovanna, Bianchi, Annamaria, Capuano, Annalisa, Cardinale, Fabio, Cerimoniale, Giovanni, Landi, Massimo, Malventano, Monica, Tosca, Mariangela, Varricchio, Attilio, Zicari, Anna Maria, Alfaro, Carlo, Barberi, Salvatore, Becherucci, Paolo, Bernardini, Roberto, Biasci, Paolo, Caffarelli, Carlo, Caldarelli, Valeria, Capristo, Carlo, Castronuovo, Serenella, Chiappini, Elena, Cutrera, Renato, De Castro, Giovanna, De Franciscis, Luca, Decimo, Fabio, Iacono, Iride Dello, Diaferio, Lucia, Di Cicco, Maria Elisa, Di Mauro, Caterina, Di Mauro, Cristina, Di Mauro, Dora, Di Mauro, Francesco, Di Mauro, Gabriella, Doria, Mattia, Falsaperla, Raffaele, Ferraro, Valentina, Fanos, Vassilio, Galli, Elena, Ghiglioni, Daniele Giovanni, Indinnimeo, Luciana, Kantar, Ahmad, Lamborghini, Adima, Licari, Amelia, Lubrano, Riccardo, Luciani, Stefano, Macrì, Francesco, Marseglia, Gianluigi, Martelli, Alberto Giuseppe, Masini, Luigi, Midulla, Fabio, Minasi, Domenico, Miniello, Vito Leonardo, Del Giudice, Michele Miraglia, Morandini, Sergio Renzo, Nardini, Germana, Nocerino, Agostino, Novembre, Elio, Pajno, Giovanni Battista, Paravati, Francesco, Piacentini, Giorgio, Piersantelli, Cristina, Pozzobon, Gabriella, Ricci, Giampaolo, Spanevello, Valter, Turra, Renato, Zanconato, Stefania, Borrelli, Melissa, Villani, Alberto, Corsello, Giovanni, Di Mauro, Giuseppe, Peroni, Diego, and Marzia Duse, Francesca Santamaria, Maria Carmen Verga, Marcello Bergamini, Giovanni Simeone, Lucia Leonardi, Giovanna Tezza, Annamaria Bianchi, Annalisa Capuano, Fabio Cardinale, Giovanni Cerimoniale, Massimo Landi, Monica Malventano, Mariangela Tosca, Attilio Varricchio, Anna Maria Zicari, Carlo Alfaro, Salvatore Barberi, Paolo Becherucci, Roberto Bernardini, Paolo Biasci, Carlo Caffarelli, Valeria Caldarelli, Carlo Capristo, Serenella Castronuovo, Elena Chiappini, Renato Cutrera, Giovanna De Castro, Luca De Franciscis, Fabio Decimo, Iride Dello Iacono, Lucia Diaferio, Maria Elisa Di Cicco, Caterina Di Mauro, Cristina Di Mauro, Dora Di Mauro, Francesco Di Mauro, Gabriella Di Mauro, Mattia Doria, Raffaele Falsaperla, Valentina Ferraro, Vassilios Fanos, Elena Galli, Daniele Giovanni Ghiglioni, Luciana Indinnimeo, Ahmad Kantar, Adima Lamborghini, Amelia Licari, Riccardo Lubrano, Stefano Luciani, Francesco Macrì, Gianluigi Marseglia, Alberto Giuseppe Martelli, Luigi Masini, Fabio Midulla, Domenico Minasi, Vito Leonardo Miniello, Michele Miraglia Del Giudice, Sergio Renzo Morandini, Germana Nardini, Agostino Nocerino, Elio Novembre, Giovanni Battista Pajno, Francesco Paravati, Giorgio Piacentini, Cristina Piersantelli, Gabriella Pozzobon, Giampaolo Ricci, Valter Spanevello, Renato Turra , Stefania Zanconato, Melissa Borrelli, Alberto Villani, Giovanni Corsello, Giuseppe Di Mauro, Diego Peroni

Subjects
Male, Delphi Technique, Rhinosinusitis, Respiratory Tract Diseases, Delphi method, Rhinosinusiti, Laryngitis, Adrenal Cortex Hormone, Pediatrics, 0302 clinical medicine, Adrenal Cortex Hormones, Multidisciplinary approach, Inhaled corticosteroid, 030212 general & internal medicine, Child, Respiratory Tract Disease, Rhiniti, Societies, Medical, Rhinitis, education.field_of_study, Inhaled corticosteroids, Wheezing, General Medicine, Settore MED/38, Systematic review, Italy, Laryngotracheitis, Child, Preschool, Laryngotracheiti, Female, medicine.symptom, Human, medicine.medical_specialty, Consensus, Adolescent, Population, Consensu, RJ1-570, 03 medical and health sciences, Intervention (counseling), Administration, Inhalation, medicine, Laryngospasm, Humans, Adenoid hypertrophy, education, Intensive care medicine, Asthma, business.industry, Research, Infant, medicine.disease, 030228 respiratory system, business
Abstract

Background In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine. Methods Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published. Results The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm. Conclusions We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research.

Published
2021

13. Vitamin D in pediatric age: consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians

Author

Irene Cetin, Giuseppe Di Mauro, Francesco Vierucci, Rino Agostiniani, Daniele Giovanni Ghiglioni, Fabio Cardinale, Domenico Careddu, Flavia Prodam, Diego Peroni, Luigi Terracciano, Giuseppe Saggese, Elena Chiappini, Giovanni Corsello, Michele Miraglia Del Giudice, Maddalena Massari, Gian Luigi De' Angelis, Emanuele Miraglia del Giudice, Gianni Bona, Saggese, Giuseppe, Vierucci, Francesco, Prodam, Flavia, Cardinale, Fabio, Cetin, Irene, Chiappini, Elena, De Angelis, Gian Luigi, Massari, Maddalena, Miraglia Del Giudice, Emanuele, Miraglia Del Giudice, Michele, Peroni, Diego, Terracciano, Luigi, Agostiniani, Rino, Careddu, Domenico, Ghiglioni, Daniele Giovanni, Bona, Gianni, Di Mauro, Giuseppe, Corsello, Giovanni, and Saggese G, Vierucci F, Prodam F, Cardinale F, Cetin I, Chiappini E, De' Angelis GL, Massari M, Miraglia Del Giudice E, Miraglia Del Giudice M, Peroni D, Terracciano L, Agostiniani R, Careddu D, Ghiglioni DG, Bona G, Di Mauro G, Corsello G

Subjects
Pediatrics, medicine.medical_specialty, Consensus, Adolescent, Supplementation, Consensu, 030209 endocrinology & metabolism, Review, Adolescents, Vitamin, vitamin D deficiency, law.invention, Nutritional Rickets, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, 030225 pediatrics, Vitamin D and neurology, medicine, Musculoskeletal health, Humans, Vitamin D, Child, Pathological, Children, Societies, Medical, Dietary Supplement, vitamin D children, Vitamin d supplementation, business.industry, lcsh:RJ1-570, Infant, Newborn, Infant, Hypovitaminosis D, lcsh:Pediatrics, Pediatric age, General Medicine, Vitamins, medicine.disease, Vitamin D Deficiency, Italy, Child, Preschool, Pediatrics, Perinatology and Child Health, Dietary Supplements, Deficiency, business, Human
Abstract

Vitamin D plays a pivotal role in the regulation of calcium-phosphorus metabolism, particularly during pediatric age when nutritional rickets and impaired bone mass acquisition may occur. Besides its historical skeletal functions, in the last years it has been demonstrated that vitamin D directly or indirectly regulates up to 1250 genes, playing so-called extraskeletal actions. Indeed, recent data suggest a possible role of vitamin D in the pathogenesis of several pathological conditions, including infectious, allergic and autoimmune diseases. Thus, vitamin D deficiency may affect not only musculoskeletal health but also a potentially wide range of acute and chronic conditions. At present, the prevalence of vitamin D deficiency is high in Italian children and adolescents, and national recommendations on vitamin D supplementation during pediatric age are lacking. An expert panel of the Italian Society of Preventive and Social Pediatrics reviewed available literature focusing on randomized controlled trials of vitamin D supplementation to provide a practical approach to vitamin D supplementation for infants, children and adolescents.

Published
2017

14. Rational use of antibiotics for the management of children's respiratory tract infections in the ambulatory setting: an evidence-based consensus by the Italian Society of Preventive and Social Pediatrics

Author

Francesco Rossi, Maria Chiara Colombo, Nicola Principi, Claudio Cricelli, Concetta Rafaniello, Giuseppe Di Mauro, Eugenia Bruzzese, Filippo Festini, Luisa Galli, Rachele Mazzantini, Maurizio de Martino, Annalisa Capuano, Elena Chiappini, Liberata Sportiello, Susanna Esposito, Paola Marchisio, Vito Leonardo Miniello, Alfredo Guarino, Francesco Tancredi, Elisabetta Venturini, Chiappini, E, Mazzantin, R, Bruzzese, Eugenia, Capuano, A, Colombo, M, Cricelli, C, Di Mauro, G, Esposito, S, Festini, F, Guarino, Alfredo, Miniello, Vl, Principi, N, Marchisio, P, Rafaniello, C, Rossi, F, Sportiello, L, Tancredi, F, Venturini, E, Galli, L, de Martino, M., Chiappini, Elena, Mazzantini, Rachele, Capuano, Annalisa, Colombo, Maria, Cricelli, Claudio, Di Mauro, Giuseppe, Esposito, Susanna, Festini, Filippo, Miniello, Vito Leonardo, Principi, Nicola, Marchisio, Paola, Rafaniello, Concetta, Rossi, Francesco, Sportiello, Liberata, Tancredi, Francesco, Venturini, Elisabetta, Galli, Luisa, and de Martino, Maurizio

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Pediatrics, Evidence-based practice, Respiratory tract infection, medicine.drug_class, Antibiotics, Guideline, Guidelines, Respiratory tract infections, Acute Pharyngitis, Antibiotic resistance, Anti-Bacterial Agent, Ambulatory Care, medicine, Humans, Child, Intensive care medicine, Sinusitis, Children, Evidence-Based Medicine, business.industry, Medicine (all), Antibiotic, Perinatology and Child Health, medicine.disease, Drug Utilization, Anti-Bacterial Agents, Pneumonia, Pediatrics, Perinatology and Child Health, Ambulatory, business, Human
Abstract

Background: Several guidelines for the management of respiratory tract infections in children are available in Italy, as well as in other European countries and the United States of America. However, poor adherence to guidelines and the sustained inappropriate use of antibiotics have been reported. In the outpatient setting, almost half of antibiotics are prescribed for the treatment of common respiratory tract infections. In Italy the antibiotic prescription rate is significantly higher than in other European countries, such as Denmark or the Netherlands, and also the levels of antibiotic resistance for a large variety of bacteria are higher. Therefore, the Italian Society of Preventive and Social Paediatrics organised a consensus conference for the treatment of respiratory tract infections in children to produce a brief, easily readable, evidence-based document. Methods: The conference method was used, according to the National Institute of Health and the National Plan Guidelines. A literature search was performed focusing on the current guidelines for the treatment of airway infections in children aged 1 month-18 years in the ambulatory setting. Results: Recommendations for the treatment of acute pharyngitis, acute otitis media, sinusitis, and pneumonia have been summarized. Conditions for which antibiotic treatment should not be routinely prescribed have been highlighted. Conclusion: This evidence-based document is intended to accessible to primary care pediatricians and general practice physicians in order to make clinical practice uniform, in accordance with the recommendations of the current guidelines. © 2013 Elsevier Ltd.

Published
2014

15. Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants

Author

Francesco Paravati, Giovanni A. Rossi, Roberto Bernardini, Marco Cappa, Gianpaolo Donzelli, Luigi Memo, Carlo Minetti, Giampietro Chiamenti, Filippo Festini, Andrea Biondi, Giuseppe Magazzù, Pierluigi Colonna, Silvia Vandini, Marcello Lanari, Carlo Catassi, Alessandro Rimini, Giovanni Corsello, Giuseppe Di Mauro, Susanna Esposito, Paolo Manzoni, Antonio Francesco Urbino, Marina Picca, Paolo Biban, Costantino Romagnoli, Eugenio Baraldi, Eugenio Baraldi, Marcello Lanari, Paolo Manzoni, Giovanni A Rossi, Silvia Vandini, Alessandro Rimini, Costantino Romagnoli, Pierluigi Colonna, Andrea Biondi, Paolo Biban, Giampietro Chiamenti, Roberto Bernardini, Marina Picca, Marco Cappa, Giuseppe Magazzù, Carlo Catassi, Antonio Urbino, Luigi Memo, Gianpaolo Donzelli, Carlo Minetti, Francesco Paravati, Giuseppe Di Mauro, Filippo Festini, Susanna Esposito, Giovanni Corsello, Baraldi, E, Lanari, M, Manzoni, P, Rossi, GA, Vandini, S, Rimini, A, Romagnoli, C, Colonna, P, Biondi, A, Biban, P, Chiamenti, G, Bernardini, R, Picca, M, Cappa, M, Magazzu, G, Catassi, C, Urbino, AF, Memo, L, Donzelli, G, Minetti, C, Paravati, F, Di Mauro, G, Festini, F, and Corsello, G

Subjects
Pediatrics, Bronchiolitis, Bronchopulmonary dysplasia, Congenital heart diseases, Immunodeficiency, Oxygen therapy, Prematurity, Prevention, Prophylaxis, Respiratory syncytial virus, Review, Severity of Illness Index, Settore MED/38 - Pediatria Generale E Specialistica, Adrenergic beta-2 Receptor Antagonists, Vitamin D, Children, Respiratory distress, Vitamins, Environmental exposure, Patient Discharge, Anti-Bacterial Agents, Bronchodilator Agents, Hospitalization, Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA, bronchiolitis, medicine.drug, Palivizumab, Respiratory Therapy, medicine.medical_specialty, Epinephrine, Decision Making, Antibodies, Monoclonal, Humanized, Antiviral Agents, Intensive Care Units, Neonatal, Bronchiolitis, Respiratory syncytial virus, Prematurity, Bronchopulmonary dysplasia, Congenital heart diseases, Immunodeficiency, Oxygen therapy, Prevention, Prophylaxis, medicine, Humans, Acute bronchiolitis, Medical history, Consensus Document, Intensive care medicine, Glucocorticoids, Asthma, Saline Solution, Hypertonic, Primary Health Care, business.industry, Nebulizers and Vaporizers, Infant, Newborn, Oxygen Inhalation Therapy, Humidity, Environmental Exposure, Acute bronchiolitis, Consensus Document, medicine.disease, Hypertonic saline, business
Abstract

Acute bronchiolitis is the leading cause of lower respiratory t ract infection and hospitalization in children less than 1y ear of age worldwide. It is usually a mild disease, but some children may develop severe symptoms, requiring hospital admission and ventilatory support in the ICU. Infants with pre-existing risk factors (prematurity, bronchopulmonary dysplasia, congenital heart diseases and immunodeficiency) may be predisposed to a severe form of the disease. Clinical diagnosis of bronchiolitis is manly based on medical history and physical examination (rhinorrhea, cough, crackles, wheezing and signs of respiratory distress). Etiological diagnosis, with antigen or genome detection to identify viruses involved, may have a role in reducing hospital transmission of the infection. Criteria for hospitalization include low oxygen saturation (

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