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1. Diagnosis and management of urinary tract infections in children aged 2 months to 3 years in the Italian emergency units: the ItaUTI study

Author

Cenzato, F, Milani, G, Amigoni, A, Sperotto, F, Bianchetti, M, Agostoni, C, Montini, G, Farello, G, Chiarelli, F, Greco, R, Di Lollo, F, Rocco Forte, F, Manieri, S, Carpino, L, Caloiero, M, Cirisano, A, Bragho, S, Della Casa, R, Nunziata, F, Pecoraro, C, Pacifico, R, Lanari, M, Ghizzi, C, Serra, L, Stella, M, Maggiore, G, Fiorini, R, Dodi, I, Morelli, A, Lughetti, L, Cella, A, Vergine, G, De Fanti, A, Dragovic, D, Santori, D, Cozzi, G, Cogo, P, Raponi, M, Lubrano, R, de Martinis, M, Gatto, A, Barbieri, M, Reale, A, Bracaglia, G, Piccotti, E, Borea, R, Gaiero, A, Martelli, L, Arrighini, A, Cianci, P, Cavalli, C, De Santis, L, Pietra, B, Biondi, A, Sala, M, Pogliani, L, Cherubini, S, Bellini, M, Bruni, P, Traina, G, Tommasi, P, Del Barba, P, Arrigoni, S, Salvini, F, Bernardo, L, Bertolozzi, G, Fasoli, S, Marseglia, G, Palumbo, E, Bosco, A, Mirri, G, Fabiani, E, Ruffini, E, Pieragostini, L, Fornaro, M, Ripanti, G, Pannoni, D, Enrico, F, Perona, A, Tappi, E, Nis Haitink, O, Rabbone, I, Capalbo, P, Urbino, A, Guala, A, Cosi, G, Barracchia, M, Martire, B, Cardinale, F, Moramarco, F, Perrone, C, Campanozzi, A, Cecinati, V, Canetto, A, Clemente, C, Cualbu, A, Narducci, F, Mula, G, Bulciolu, P, Antonucci, R, Gramaglia, G, Cavaleri, G, Salpietro, C, Corsello, G, Salvo, R, Palmeri, M, Vitale, M, Morgano, A, Falorni, S, Peroni, D, Masi, S, Bertini, A, Vaccaro, A, Vasarri, P, Reinstadler, P, Soffiati, M, Stefanelli, M, Verrotti di Pianella, A, Bertone, C, Marzini, S, Da Dalt, L, Rugolotto, S, Scozzola, F, Ecclesio Livio, L, Cinquetti, M, Silvagni, D, Bellettato, M, Cenzato F., Milani G. P., Amigoni A., Sperotto F., Bianchetti M. G., Agostoni C., Montini G., Farello G., Chiarelli F., Greco R., Di Lollo F., Rocco Forte F., Manieri S., Carpino L., Caloiero M., Cirisano A., Bragho S., Della Casa R., Nunziata F., Pecoraro C., Pacifico R., Lanari M., Ghizzi C., Serra L., Stella M., Maggiore G., Fiorini R., Dodi I., Morelli A., Lughetti L., Cella A., Vergine G., De Fanti A., Dragovic D., Santori D., Cozzi G., Cogo P., Raponi M., Lubrano R., de Martinis M., Gatto A., Barbieri M. A., Reale A., Bracaglia G., Piccotti E., Borea R., Gaiero A., Martelli L., Arrighini A., Cianci P., Cavalli C., De Santis L., Pietra B. C., Biondi A., Sala M., Pogliani L. M., Cherubini S., Bellini M., Bruni P., Traina G., Tommasi P., Del Barba P., Arrigoni S., Salvini F. M., Bernardo L., Bertolozzi G., Fasoli S., Marseglia G. L., Palumbo E., Bosco A., Mirri G., Fabiani E., Ruffini E., Pieragostini L., Fornaro M., Ripanti G., Pannoni D., Enrico F., Perona A., Tappi E., Nis Haitink O., Rabbone I., Capalbo P. T., Urbino A., Guala A., Cosi G., Barracchia M. G., Martire B., Cardinale F., Moramarco F., Perrone C., Campanozzi A., Cecinati V., Canetto A., Clemente C., Cualbu A., Narducci F., Mula G., Bulciolu P., Antonucci R., Gramaglia G., Cavaleri G., Salpietro C., Corsello G., Salvo R., Palmeri M., Vitale M. A., Morgano A., Falorni S., Peroni D., Masi S., Bertini A., Vaccaro A., Vasarri P., Reinstadler P., Soffiati M., Stefanelli M., Verrotti di Pianella A., Bertone C., Marzini S., Da Dalt L., Rugolotto S., Scozzola F., Ecclesio Livio L., Cinquetti M., Silvagni D., Bellettato M., Cenzato, F, Milani, G, Amigoni, A, Sperotto, F, Bianchetti, M, Agostoni, C, Montini, G, Farello, G, Chiarelli, F, Greco, R, Di Lollo, F, Rocco Forte, F, Manieri, S, Carpino, L, Caloiero, M, Cirisano, A, Bragho, S, Della Casa, R, Nunziata, F, Pecoraro, C, Pacifico, R, Lanari, M, Ghizzi, C, Serra, L, Stella, M, Maggiore, G, Fiorini, R, Dodi, I, Morelli, A, Lughetti, L, Cella, A, Vergine, G, De Fanti, A, Dragovic, D, Santori, D, Cozzi, G, Cogo, P, Raponi, M, Lubrano, R, de Martinis, M, Gatto, A, Barbieri, M, Reale, A, Bracaglia, G, Piccotti, E, Borea, R, Gaiero, A, Martelli, L, Arrighini, A, Cianci, P, Cavalli, C, De Santis, L, Pietra, B, Biondi, A, Sala, M, Pogliani, L, Cherubini, S, Bellini, M, Bruni, P, Traina, G, Tommasi, P, Del Barba, P, Arrigoni, S, Salvini, F, Bernardo, L, Bertolozzi, G, Fasoli, S, Marseglia, G, Palumbo, E, Bosco, A, Mirri, G, Fabiani, E, Ruffini, E, Pieragostini, L, Fornaro, M, Ripanti, G, Pannoni, D, Enrico, F, Perona, A, Tappi, E, Nis Haitink, O, Rabbone, I, Capalbo, P, Urbino, A, Guala, A, Cosi, G, Barracchia, M, Martire, B, Cardinale, F, Moramarco, F, Perrone, C, Campanozzi, A, Cecinati, V, Canetto, A, Clemente, C, Cualbu, A, Narducci, F, Mula, G, Bulciolu, P, Antonucci, R, Gramaglia, G, Cavaleri, G, Salpietro, C, Corsello, G, Salvo, R, Palmeri, M, Vitale, M, Morgano, A, Falorni, S, Peroni, D, Masi, S, Bertini, A, Vaccaro, A, Vasarri, P, Reinstadler, P, Soffiati, M, Stefanelli, M, Verrotti di Pianella, A, Bertone, C, Marzini, S, Da Dalt, L, Rugolotto, S, Scozzola, F, Ecclesio Livio, L, Cinquetti, M, Silvagni, D, Bellettato, M, Cenzato F., Milani G. P., Amigoni A., Sperotto F., Bianchetti M. G., Agostoni C., Montini G., Farello G., Chiarelli F., Greco R., Di Lollo F., Rocco Forte F., Manieri S., Carpino L., Caloiero M., Cirisano A., Bragho S., Della Casa R., Nunziata F., Pecoraro C., Pacifico R., Lanari M., Ghizzi C., Serra L., Stella M., Maggiore G., Fiorini R., Dodi I., Morelli A., Lughetti L., Cella A., Vergine G., De Fanti A., Dragovic D., Santori D., Cozzi G., Cogo P., Raponi M., Lubrano R., de Martinis M., Gatto A., Barbieri M. A., Reale A., Bracaglia G., Piccotti E., Borea R., Gaiero A., Martelli L., Arrighini A., Cianci P., Cavalli C., De Santis L., Pietra B. C., Biondi A., Sala M., Pogliani L. M., Cherubini S., Bellini M., Bruni P., Traina G., Tommasi P., Del Barba P., Arrigoni S., Salvini F. M., Bernardo L., Bertolozzi G., Fasoli S., Marseglia G. L., Palumbo E., Bosco A., Mirri G., Fabiani E., Ruffini E., Pieragostini L., Fornaro M., Ripanti G., Pannoni D., Enrico F., Perona A., Tappi E., Nis Haitink O., Rabbone I., Capalbo P. T., Urbino A., Guala A., Cosi G., Barracchia M. G., Martire B., Cardinale F., Moramarco F., Perrone C., Campanozzi A., Cecinati V., Canetto A., Clemente C., Cualbu A., Narducci F., Mula G., Bulciolu P., Antonucci R., Gramaglia G., Cavaleri G., Salpietro C., Corsello G., Salvo R., Palmeri M., Vitale M. A., Morgano A., Falorni S., Peroni D., Masi S., Bertini A., Vaccaro A., Vasarri P., Reinstadler P., Soffiati M., Stefanelli M., Verrotti di Pianella A., Bertone C., Marzini S., Da Dalt L., Rugolotto S., Scozzola F., Ecclesio Livio L., Cinquetti M., Silvagni D., and Bellettato M.

Abstract

Urinary tract infections (UTIs) are among the most frequent bacterial diseases in infants and children. Physician adherence to recommendations is notoriously often poor, but no data are available on UTIs management in the emergency setting. In this multicenter national study, we investigated the policies regarding UTIs management in children aged 2 months to 3 years in Italian emergency units. Between April and June 2021, directors of the emergency units were invited to answer an online survey on the following items: diagnostic approach to children with fever without an apparent source, therapeutic approach to UTIs, the use of kidney and urinary tract ultrasound, and the criteria for hospitalization. A total of 121 (89%) out of 139 of invited units participated in the study. Overall, units manage children with a suspected or confirmed UTI according to available recommendations for most of the items. However, in almost 80% (n = 94) of units, a sterile perineal bag is used to collect urine for culture. When urine is collected by cathether, heterogeneity exists on the threshold of bacterial load considered for UTI diagnosis. Conclusions: Available recommendations on UTIs in children are followed by Italian emergency units for most of the items. However, the methods to collect urine specimens for culture, one of the crucial steps of the diagnostic work-up, often do not align with current recommendations and CFU thresholds considered for diagnosis largely vary among centers. Efforts should be addressed to validate and implement new child and family friendly urine collection techniques.What is Known:• Several guidelines are published on the management of children with suspected or confirmed urinary tract infection.• No data are available on the management of pediatric urinary tract infections in the emergency setting.What is New:• Almost 80% of the Italian emergency units employ a sterile perineal bag to collect urine for culture.• Diagnostic

Published
2022

2. Appropriate management of growth hormone deficiency during the age of transition: an Italian Delphi consensus statement

Author

Cannavo, S., Cappa, M., Ferone, D., Isidori, A. M., Loche, S., Salerno, M., Maghnie, M., Aimaretti, G., Ambrosio, M. R., Bellone, S., Caruso, M., Castello, R., Ceccato, F., Cerbone, T., Cherubini, V., de Carlo, E., De Sanctis, L., della Casa, S., Di Somma, C., Faienza, M. F., Gasco, V., Gaudino, R., Giacomozzi, C., Giavoli, C., Guazzarotti, L., Klain, A., Lania, A., Leonardi, D., Longhi, S., Lughetti, L., Maggio, M. C., Wasniewska, G. M., Mameli, C., Mauro, C., Giudice, E. M. D., Palermo, M. C. A., Parpagnoli, M., Persani, L., Pilotta, A., Pozzobon, G., Rochira, V., Rota, F., Sacco, M., Scarcella, S., Scavuzzo, F., Sinisi, A. A., Street, M. E., Tornese, G., Cannavò, S., Cappa, M., Ferone, D., Isidori, A. M., Loche, S., Salerno, M., Maghnie, M., Tornese, G., Cannavò, S, Cappa, M, Ferone, D, Isidori, A M, Loche, S, Salerno, M, Maghnie, M, and Maggio, Maria Cristina

Subjects
growth hormone deficiency, Settore MED/38 - Pediatria Generale E Specialistica, Endocrinology, age of transition, consensus, Italian Delphi consensus statement, Endocrinology, Diabetes and Metabolism, adolescent, growth hormone, transition, Transition age
Abstract

Growth hormone deficiency (GHD) describes the impairment of growth hormone (GH) secretion by the pituitary somatotroph cells. GHD may be congenital, with causes, including genetic alterations and structural brain malformations, or acquired, including midline tumours, cranial irradiation, traumatic brain injury, central nervous system infections and inflammatory conditions. GHD in children is characterised by short stature, delayed bone maturation and abnormalities in substrate metabolism, body composition, physical and psychosocial functioning, all of which improve with recombinant human GH (rhGH) therapy. The diagnosis of GHD is based on clinical signs and symptoms, biochemistry and imaging. Although GH stimulation tests are considered the mainstay of diagnostic investigations, the results must be interpreted with caution owing to the variability in cut-off values and reproducibility. Transition refers to the physical and psychosocial changes in adolescent patients during the mid-teens to late teens (usually 15–18 years of age) until about 6–7 years after achievement of adult height. During the transition age, only a small residual capacity of longitudinal growth is left, but body maturity is not yet complete. Discontinuation of rhGH treatment at the end of longitudinal growth in adolescents with permanent GHD is associated with decreased muscle strength and mass, increased body fat (mainly in the abdomen), the arrest or reversal of muscle mass and bone mass density (BMD) gain and lipid profile deterioration. For these reasons, patients whose GHD persists during the transition age need to continue rhGH treatment to obtain full somatic maturation and normalisation of body composition, BMD, quality of life (QoL) and lipid metabolism. There is some evidence that rhGH treatment during transition may result in improved growth and bone health, as well as a better prognosis for metabolic and cardiovascular risks in the long term. Since these patients need to continue treatment to complete their body development, a multidisciplinary approach is required to ensure continuity of care during the transfer from paediatric to adult endocrinology services. Guidelines for the diagnosis and treatment of young adults with GHD have been published by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE), Endocrine Society, European Society of Paediatric Endocrinology (ESPE), Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society and Endocrine Society of Australia. However, clinical practice lacks uniformity in terms of diagnosis and treatment of transition-age patients, the impact of GH replacement during transition has not been adequately assessed in randomised clinical trials (RCTs), validated questionnaires to assess QoL in patients on rhGH treatment in the transition period are not available and there is still uncertainty about the multidisciplinary approach during transition [8]. Hence, a structured transition protocol is essential to establish the best practice for transitioning adolescents with GHD to adult care. A study in Italy in 2015 identified a low level of awareness of these issues in clinical practice and real-world gaps in the management of GHD patients during transition. To address these gaps and assist endocrinologists (adult and paediatric) in the diagnosis and treatment of GHD in transition-age patients, a Delphi consensus process was undertaken to develop clinically relevant recommendations. The current consensus statements address the diagnosis of GHD, benefits of treatment, monitoring and management of transition-age patients with GHD, along with treatment adherence and safety concerns.

Published
2023

8. Assesment of serum IGF-I concentrations in the diagnosis of isolated childhood-onset GH deficiency: A proposal of the Italian Society for Pediatric Endocrinology and Diabetes (SIEDP/ISPED)

Author

Federico, G., Street, Me, Maghnie, M, Caruso Nicoletti, M, Loche, S, Bertelloni, S, Cianfarani, S, Cicognani, A, Cesaretti, G, Lorini, R, Meschi, F, de Sanctis, V, Aimarretti, G, Antoniazzi, Franco, Arrigon, T, Bellone, J, Bellone, S, Bertalloni, S, Bozzola, M, Buzi, F, Cappa, M, Cistemino, M, De Luca, F, Del Vecchio, M, Galluzzi, F, Germani, D, Ghirri, P, Ghizzoni, L, Greggio, Na, Lughetti, L, Losi, S, Luciano, A, Maffeis, Claudio, Modestini, E, Pirazzoli, P, Pozzobon, G, Predieri, B, Rusconi, R, Slerno, Mc, Salvatoni, A, Scirè, G, Scommegna, S, Spadoni, Gl, Sposito, M, Wasniewska, Ml, Zampolli, M, and Zucchini, S.

Subjects
medicine.medical_specialty, Pediatric endocrinology, Endocrinology, Diabetes and Metabolism, Dwarfism, Acid-labile subunit, GH deficiency, GH secretion, IGF-binding protein-3, IGF-I, Age of Onset, Algorithms, Biomarkers, Child, Dwarfism, Pituitary, Endocrinology, Human Growth Hormone, Humans, Insulin-Like Growth Factor I, Italy, Puberty, Societies, Medical, ACID-LABILE SUBUNIT, Medical, Diabetes mellitus, Internal medicine, medicine, Children, IGF-1, business.industry, medicine.disease, Growth hormone secretion, Pituitary, Societies, business, GH Deficiency
Abstract

The diagnosis of GH deficiency (GHD) is based on the measurement of peak GH responses to pharmacological stimuli. Pharmacological stimuli, however, lack precision, accuracy, are not reproducible, are invasive, non-physiological and some may even be hazardous. Furthermore, different GH commercial assays used to measure GH in serum yield results that may differ considerably. In contrast to GH, IGF-I can be measured on a single, randomly-obtained blood sample. A review of the available data indicates that IGF-I measurement in the diagnosis of childhood-onset isolated GHD has a specificity of up to 100%, with a sensitivity ranging from about 70 to 90%. We suggest an algorithm in which circulating levels of IGF-I together with the evaluation of auxological data, such as growth rate and growth, may be used to assess the likelihood of GHD in pre-pubertal children.

Published
2006

14. Assesment of serum IGF-I concentrations in the diagnosis of isolated childhood-onset GH deficiency: A proposal of the Italian Society for Pediatric Endocrinology and Diabetes (SIEDP/ISPED)

Author

Federico, G., Street, M. E., Maghnie, M., Caruso-Nicoletti, M., Loche, S., Bertelloni, S., Cianfarani, S., Cicognani, A., Cesaretti, G., Lorini, R., Meschi, F., Sanctis, V., Aimarretti, G., Antoniazzi, F., Arrigo, T., Bellone, J., Bellone, S., Bertalloni, S., Bozzola, M., Buzi, F., Cappa, M., Cistemino, M., Luca, F., Del Vecchio, M., Galluzzi, F., Germani, D., Ghirri, P., Ghizzoni, L., Greggio, N. A., Lughetti, L., Losi, S., Luciano, A., Maffeis, C., Modestini, E., Pirazzoli, P., Pozzobon, G., Predieri, B., Rusconi, R., Slerno, M. C., Alessandro Salvatoni, Scirè, G., Scommegna, S., Spadoni, G. L., Sposito, M., Wasniewska, M., Zampolli, M., and Zucchini, S.

17. ß-ENDORPHIN SECRETION IS NOT INFLUENCED BY HYPERGLYCEMIA OR HYPERINSULINEMIA IN OBESE CHILDREN

Author

Ghizzoni, L, Bernasconi, S, Lughetti, L, Volta, C, Facchinetti, F, and Genazzani, A R

Abstract

An increased opioidergic tone has been demonstrated in obese subjects and ascribed to the metabolic derangements of obesity. Based on the different beta-endorphin (ß-EP) responses to oral (OGTT) and intravenous (IVGTT) glucose tolerance test, it has been suggested that the increased ß-EP levels detected in obese adult patients are not only originated from the pituitary but also from peripheral sites as the gastrointestinal tract. To assess whether ß-EP levels are affected by the hyperglycemia and/or hyperinsulinemia obtained by the enteral or parenteral administration of glucose in children, 24 obese children (14 F and 10 M, aged 6-17 yr) underwent either an OGTT (1.75 g/kg of glucose) or IVGTT (0.5 g/kg of glucose). Blood samples were obtained before and 0,30,60,90 and 120 min after the po glucose administration and -15, -1, before and 1,3,5,7,10,15,30,60, min after the iv glucose dose for measurements of blood insulin, ß-EP and glucose levels. Insulin plasma levels significantly increased following both tests. In contrast, ß-EP blood concentration did not vary after either the po cr iv administration of glucose. No significant correlation between insulin and ß-EP plasma levels was found. The results of the present study suggest that ß-EP secretion of obese children is not influenced by metabolic factors such as hyperglycemia and/or hyperinuslinemia as that of obese adult subjects.

Published
1993
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18. Diagnosis and management of urinary tract infections in children aged 2 months to 3 years in the Italian emergency units: the ItaUTI study

Author

Francesca, Cenzato, Milani, Gregorio P., Angela, Amigoni, Francesca, Sperotto, Bianchetti, Mario G., Carlo, Agostoni, Giovanni, Montini, Farello, Giovanni, Francesco, Chiarelli, Greco, Rita, Franco Di Lollo, Fabio Rocco Forte, Sergio, Manieri, Luigi, Carpino, Mimma, Caloiero, Anastasia, Cirisano, Salvatore, Bragh(`(o)), Roberto Della Casa, Felice, Nunziata, Carmine, Pecoraro, Rosario, Pacifico, Marcello, Lanari, Chiara, Ghizzi, Laura, Serra, Marcello, Stella, Giuseppe, Maggiore, Roberto, Fiorini, Icilio, Dodi, Andrea, Morelli, Lorenzo, Lughetti, Andrea, Cella, Gianluca, Vergine, Alessandro De Fanti, Danica, Dragovic, Daniele, Santori, Giorgio, Cozzi, Paola, Cogo, Marilena, Raponi, Riccardo, Lubrano, Mauro de Martinis, Antonio, Gatto, Maria Antonietta Barbieri, Antonino, Reale, Giorgio, Bracaglia, Emanuela, Piccotti, Riccardo, Borea, Alberto, Gaiero, Laura, Martelli, Alberto, Arrighini, Paola, Cianci, Claudio, Cavalli, Leonardina De Santis, Benedetta Chiara Pietra, Andrea, Biondi, Marco, Sala, Pogliani, Laura M., Simonetta, Cherubini, Marta, Bellini, Paola, Bruni, Giovanni, Traina, Paola, Tommasi, Paolo Del Barba, Sergio, Arrigoni, Salvini, Filippo M., Luca, Bernardo, Giuseppe, Bertolozzi, Silvia, Fasoli, Gian Luigi Marseglia, Emilio, Palumbo, Annalisa, Bosco, Gianpaolo, Mirri, Elisabetta, Fabiani, Ermanno, Ruffini, Luisa, Pieragostini, Martina, Fornaro, Gabriele, Ripanti, Donnina, Pannoni, Felici, Enrico, Anna, Perona, Eleonora, Tappi, Oscar Nis Haitink, Ivana, Rabbone, Pina Teresa Capalbo, Antonio, Urbino, Andrea, Guala, Gianluca, Cosi, Maria Gabriella Barracchia, Baldassarre, Martire, Fabio, Cardinale, Fulvio, Moramarco, Carmelo, Perrone, Angelo, Campanozzi, Valerio, Cecinati, Alessandro, Canetto, Ciro, Clemente, Antonio, Cualbu, Fabio, Narducci, Giuseppina, Mula, Pasquale, Bulciolu, Roberto, Antonucci, Giuseppe, Gramaglia, Giuseppe, Cavaleri, Carmelo, Salpietro, Giovanni, Corsello, Rosario, Salvo, Marcello, Palmeri, Maria Assunta Vitale, Ambra, Morgano, Susanna, Falorni, Diego, Peroni, Stefano, Masi, Alessio, Bertini, Angelina, Vaccaro, Pierluigi, Vasarri, Petra, Reinstadler, Massimo, Soffiati, Maurizio, Stefanelli, VERROTTI di PIANELLA, Alberto, Catherine, Bertone, Stefano, Marzini, Liviana Da Dalt, Simone, Rugolotto, Floriana, Scozzola, Luca Ecclesio Livio, Mauro, Cinquetti, Davide, Silvagni, Massimo Bellettato and, Cenzato F., Milani G.P., Amigoni A., Sperotto F., Bianchetti M.G., Agostoni C., Montini G., Farello G., Chiarelli F., Greco R., Di Lollo F., Rocco Forte F., Manieri S., Carpino L., Caloiero M., Cirisano A., Bragho S., Della Casa R., Nunziata F., Pecoraro C., Pacifico R., Lanari M., Ghizzi C., Serra L., Stella M., Maggiore G., Fiorini R., Dodi I., Morelli A., Lughetti L., Cella A., Vergine G., De Fanti A., Dragovic D., Santori D., Cozzi G., Cogo P., Raponi M., Lubrano R., de Martinis M., Gatto A., Barbieri M.A., Reale A., Bracaglia G., Piccotti E., Borea R., Gaiero A., Martelli L., Arrighini A., Cianci P., Cavalli C., De Santis L., Pietra B.C., Biondi A., Sala M., Pogliani L.M., Cherubini S., Bellini M., Bruni P., Traina G., Tommasi P., Del Barba P., Arrigoni S., Salvini F.M., Bernardo L., Bertolozzi G., Fasoli S., Marseglia G.L., Palumbo E., Bosco A., Mirri G., Fabiani E., Ruffini E., Pieragostini L., Fornaro M., Ripanti G., Pannoni D., Enrico F., Perona A., Tappi E., Nis Haitink O., Rabbone I., Capalbo P.T., Urbino A., Guala A., Cosi G., Barracchia M.G., Martire B., Cardinale F., Moramarco F., Perrone C., Campanozzi A., Cecinati V., Canetto A., Clemente C., Cualbu A., Narducci F., Mula G., Bulciolu P., Antonucci R., Gramaglia G., Cavaleri G., Salpietro C., Corsello G., Salvo R., Palmeri M., Vitale M.A., Morgano A., Falorni S., Peroni D., Masi S., Bertini A., Vaccaro A., Vasarri P., Reinstadler P., Soffiati M., Stefanelli M., Verrotti di Pianella A., Bertone C., Marzini S., Da Dalt L., Rugolotto S., Scozzola F., Ecclesio Livio L., Cinquetti M., Silvagni D., and Bellettato M.

Subjects
Catheter, Urinary tract, Emergency department, Pediatrics, Perinatology and Child Health, Guidelines, Infants, Infection, Survey, Urine, Infant, Guideline
Abstract

Urinary tract infections (UTIs) are among the most frequent bacterial diseases in infants and children. Physician adherence to recommendations is notoriously often poor, but no data are available on UTIs management in the emergency setting. In this multicenter national study, we investigated the policies regarding UTIs management in children aged 2 months to 3 years in Italian emergency units. Between April and June 2021, directors of the emergency units were invited to answer an online survey on the following items: diagnostic approach to children with fever without an apparent source, therapeutic approach to UTIs, the use of kidney and urinary tract ultrasound, and the criteria for hospitalization. A total of 121 (89%) out of 139 of invited units participated in the study. Overall, units manage children with a suspected or confirmed UTI according to available recommendations for most of the items. However, in almost 80% (n = 94) of units, a sterile perineal bag is used to collect urine for culture. When urine is collected by cathether, heterogeneity exists on the threshold of bacterial load considered for UTI diagnosis. Conclusions: Available recommendations on UTIs in children are followed by Italian emergency units for most of the items. However, the methods to collect urine specimens for culture, one of the crucial steps of the diagnostic work-up, often do not align with current recommendations and CFU thresholds considered for diagnosis largely vary among centers. Efforts should be addressed to validate and implement new child and family friendly urine collection techniques. What is Known:• Several guidelines are published on the management of children with suspected or confirmed urinary tract infection.• No data are available on the management of pediatric urinary tract infections in the emergency setting. What is New:• Almost 80% of the Italian emergency units employ a sterile perineal bag to collect urine for culture.• Diagnostic CFU thresholds largely vary among centers.

Published
2022

19. Impact of nutrition since early life on cardiovascular prevention.

Author

Guardamagna O, Abello F, Cagliero P, and Lughetti L

Subjects
Adolescent, Child, Child, Preschool, Humans, Infant, Infant, Newborn, Primary Prevention, Risk Factors, Cardiovascular Diseases prevention & control, Nutritional Status
Abstract

The cardiovascular disease represents the leading cause of morbidity and mortality in Western countries and it is related to the atherosclerotic process. Cardiovascular disease risk factors, such as dyslipidemia, hypertension, insulin resistance, obesity, accelerate the atherosclerotic process which begins in childhood and progresses throughout the life span. The cardiovascular disease risk factor detection and management through prevention delays the atherosclerotic progression towards clinical cardiovascular disease. Dietary habits, from prenatal nutrition, breastfeeding, complementary feeding to childhood and adolescence nutrition play a basic role for this topic.The metabolic and neuroendocrine environment of the fetus is fundamental in the body's "metabolic programming". Further several studies have demonstrated the beneficial effects of breastfeeding on cardiovascular risk factors reduction. Moreover the introduction of complementary foods represents another important step, with particular regard to protein intake. An adequate distribution between macronutrients (lipids, proteins and carbohydrates) is required for correct growth development from infancy throughout adolescence and for prevention of several cardiovascular disease risk determinants in adulthood.The purpose of this review is to examine the impact of nutrition since early life on disease.

Published
2012
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