Jenny Bua

Can body mass index accurately predict adiposity in newborns

Body mass index (BMI) is correlated with body fatness and risk of related diseases in children and adults. Proportionality indexes such as BMI and ponderal index (PI) have been suggested as complementary measures in neonatal growth assessment. Yet, they are still not used in neonates and their correlation with fatness is unknown. The aim of the study was to test the hypothesis that BMI z-score would predict neonatal adiposity. Body composition measurements (ie, fat mass, fat-free mass) by air displacement plethysmography (PEA POD, LMI, Concord-USA), weight and length were obtained in 200 infants ≥36 weeks’ gestational age (GA) at birth. Linear regression analysis showed a direct association between BMI z-score and %fat mass (r2=0.43, p<0.0001). This association was confirmed independently from sex, GA and maternal prepregnancy BMI. BMI z-score predicted adiposity better than PI. However, both BMI z-score and PI were poor predictors of adiposity at birth.

The awareness among paediatricians of off-label prescribing in children: A survey of Italian hospitals

ObjectiveTo investigate paediatricians’ perception and awareness of off-label (OL) and unlicensed drug usage in clinical practice.MethodsWe conducted a questionnaire-based, observational study involving 28 departments/speciality units of four tertiary paediatrics Italian hospitals. The questionnaire was sent to a designated paediatrician in each department/speciality unit with the request that they summarise their awareness of OL prescriptions after a group discussion with all paediatricians working in the same department/unit.ResultsA total of 95 drugs were identified. The most common perceived reasons detected for OL use were age and formulation. Corticosteroids, ACE-inhibitors, β-blockers and calcium-antagonists were most frequently indicated as OL for formulation, while ACE-inhibitors, new generation anti-epilepsy drugs, immunosuppressants, ketorolac and propofol as OL for age. Adrenaline, midazolam and ACE-inhibitors were indicated as unlicensed for route of administration. We found a high concordance between the OL drugs identified by physicians and those reported in the “Italian Summary Product Characteristics”.ConclusionsItalian paediatricians perceived different drugs as unlicensed/OL from those identified by existing prescriptions studies. These perceived drugs may represent a priority in tackling the problem of OL usage in the hospital practice. The review of the Italian Summary Product Characteristics of some of the drugs identified, together with the monitoring of permanent clinical practice and with new clinical research, may be a step forward to reduce OL use in children.

Management of cryptorchidism: a survey of clinical practice in Italy

BackgroundAn evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. In Italy, current practices on UT management are little known. Our aim was to describe the current management of UT in a cohort of Italian children in comparison with the Consensus guidelines. As management of retractile testis (RT) differs, RT cases were described separately.MethodsOurs is a retrospective, multicenter descriptive study. An online questionnaire was filled in by 140 Italian Family Paediatricians (FP) from Associazione Culturale Pediatri (ACP), a national professional association of FP. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006. Data on 169 children were obtained. Analyses were descriptive.ResultsOverall 24% of children were diagnosed with RT, 76% with UT. Among the latter, cryptorchidism resolved spontaneously in 10% of cases at a mean age of 21.6 months. Overall 70% of UT cases underwent orchidopexy at a mean age of 22.8 months (SD 10.8, range 1.2-56.4), 13% of whom before 1 year. The intervention was performed by a paediatric surgeon in 90% of cases, with a success rate of 91%. Orchidopexy was the first line treatment in 82% of cases, while preceded by hormonal treatment in the remaining 18%. Hormonal treatment was used as first line therapy in 23% of UT cases with a reported success rate of 25%. Overall, 13 children did not undergo any intervention (mean age at last follow up 39.6 months). We analyzed the data from the 5 Italian Regions with the largest number of children enrolled and found a statistically significant regional difference in the use of hormonal therapy, and in the use of and age at orchidopexy.ConclusionsOur study showed an important delay in orchidopexy. A quarter of children with cryptorchidism was treated with hormonal therapy. In line with the Consensus guidelines, surgery was carried out by a paediatric surgeon in the majority of cases, with a high success rate.

When off-label is a good practice: the example of paracetamol and salbutamol

Throughout Europe, between 11% and 80% of drugs prescribed for children are either not specifically licensed for human use (unlicensed) or are prescribed outside the terms of their product licence in relation to dosage, age, indication and route of administration (off-label, OL) both in the hospital and community settings.1 Some steps to try to solve the problem of OL have recently been taken. In December 2006, new European legislation was approved, the aim of which is to ensure that drugs used by children are subject to high-quality research by giving financial incentives to the drug industry.2 Another important step is the recognition of …

Advising Mothers on the Use of Medications during Breastfeeding A Need for a Positive Attitude

The use of medications by the nursing mother is a common reason for interrupting breastfeeding. Few drugs have been demonstrated to be absolutely contraindicated during breastfeeding. Excessive caution may lead health professionals to unnecessarily advise to interrupt breastfeeding, without assessing the latest evidence or considering the risk–benefit ratio of taking a medication versus terminating breastfeeding. To foster an appropriate approach toward the use of medications in breastfeeding women, the Italian Society of Perinatal Medicine created the following policy statement.

Pneumococcal vaccination for acute otitis media

1describe a signifi cant reduction in the incidence of a fi rst episode of acute otitis media (AOM) associated with the use of a new vaccine containing pneumococcal capsular polysaccharides conjugated to Haemophilus-infl uenzae-derived protein D. They conclude that these results are clinically relevant. We do not agree. The trial showed a 33·6% relative reduction (95% CI 20·8–44·3) for the fi rst episode of AOM, which corresponds to an absolute reduction of 6·7% of all AOM episodes and to a number needed to treat of 15 children. For the strategy to be eff ective, four doses need to be given, which means that 60 vaccine doses are necessary to prevent one episode of AOM. AOM is certainly one of the most common paediatric diseases, but it recovers without antibiotic treatment in about 80% of children. 2 Practice guidelines based on a “wait-andsee” strategy are eff ective in primary care. 2,3

Video capsule endoscopy and intestinal involvement in systemic vasculitis

hronic leucocytoclastic vasculitis of the small and medium essels. Her disease started with skin involvement characerised by diffuse purpuric lesions, followed by neurological pisodes characterised by aphasia, headaches and conscience isorders due to acute cerebral ischaemic events. At the last follow-up visit, she presented a new flarep of disease with purpuric lesions involving legs and toes Fig. 1). She also reported several episodes of abdominal ain accompanied by bloody stools and vomiting. In order to etter estimate the involvement of her gastrointestinal tract, e performed a gastroscopy and colonoscopy which both roved negative. A video capsule endoscopy with PillCamTM B videocapsule was therefore performed, revealing dissemnated purpuric lesions, with a very similar appearance to hose on the skin, and involving several tracts of the small owel mucosa (Fig. 2). Video capsule endoscopy, introduced less than 10 years go, has certainly revolutionised the management of gastroinestinal disorders as it has become a first-line tool to detect bnormalities in the small bowel [1]. As in our case, its role in etter understanding, following-up and hence guiding treatent choices in systemic vasculitis involving the digestive ract is now being defined. It is only recently that reports on ideo capsule endoscopy use in various vasculitis conditions ave started to appear in the literature [2,3].

Higher growth, fat and fat-free masses correlate with larger cerebellar volumes in preterm infants at term

Smaller cerebellar volumes in very low‐birthweight (VLBW) infants at term have been related to adverse cognitive outcomes, and this study evaluated whether these volumes were associated with a growth in body composition during hospital stays.

Impact of Surgery for Neonatal Gastrointestinal Diseases on Weight and Fat Mass

OBJECTIVE To compare growth, fat mass (FM), and fat-free mass in surgical infants vs matched controls at similar postconceptional age (PCA). STUDY DESIGN Anthropometric and body composition measurements by air-displacement plethysmography (PeaPod-Infant Body Composition System; LMI, Concord, California) were performed at the same PCA in 21 infants who received gastrointestinal surgery and in 21 controls matched for gestational age, birth weight, and sex. RESULTS Despite similar anthropometry at birth, postsurgical infants were shorter (50.4 [4.7] cm vs 53.2 [4.1] cm, P = .001), lighter (3516 [743] g vs 3946 [874] g, P < .001), and had lower FM content (%FM 14.8 [4.7]% vs 20.2 [5.8]%, P < .0001) than their peers at similar PCA (43 [4] weeks). All surgical infants but 1 (20/21) received parenteral nutrition (PN). Mean PN duration was 40 (30) days. Five infants in the control group received PN because of prematurity for 15 (9-30) days. Nine infants in the surgical group and 1 in the control group had PN-associated cholestasis. CONCLUSIONS Neonates having surgery for gastrointestinal diseases were shorter, had lower weight, and lower FM content than their peers, despite receiving more PN. Body composition evaluation and monitoring may help optimize growth in these newborns.

Maternal Holding vs Oral Glucose Administration as Nonpharmacologic Analgesia in Newborns: A Functional Neuroimaging Study

Maternal Holding vs Oral Glucose Administration as Nonpharmacologic Analgesia in Newborns: A Functional Neuroimaging Study Nonpharmacologic analgesia is administered in newborns using, for example, sweet solutions, breastfeeding, or maternal holding.1,2 Nonpharmacologic analgesia can decrease pain during minor procedures, such as a heel prick for blood sampling. From a neurophysiological standpoint, a previous study1 has demonstrated that, during a heel prick, oral glucose administration is associated with no significant cortical activation and therefore may interfere with the pain-associated response at the cortical level. Conversely, breastfeeding analgesia is associated with generalized cortical activation and may act by multisensory stimulation, possibly overwhelming the perception of pain.1 We aimed to study the effect of 2 nonpharmacologic analgesic methods (administration of an oral glucose solution and maternal holding) on neonatal cortical activation during a heel prick. We tested the hypothesis that analgesia associated with maternal holding would differ from that associated with oral glucose administration and would be mediated by a difference in cortical activation.