Marcello Lanari

An area-based study on intrapartum antibiotic prophylaxis for preventing group B streptococcus early-onset disease: advances and limitations

Abstract Introduction: The prevalence of maternal group-B-streptococcus (GBS) colonization and risk factors (RFs) for neonatal early-onset disease (EOD) in Europe are poorly defined. Large-scale information concerning adherence to recommendations for preventing GBS-EOD are lacking. Materials and methods: This was a 3-month retrospective area-based study including all regional deliveries u2009≥35 weeks gestation (in 2012). The sensitivity, specificity, positive and negative predictive values, odds ratio and receiver operating characteristic (ROC) curve for intrapartum antibiotic prophylaxis (IAP) among full-term and preterm deliveries and prolonged membrane rupture (PROM) were calculated. Results: Among 7133 women, 259 (3.6%) were preterm (35–36 weeks gestation). Full-term women were 6874, and 876 (12.7%) had at least 1u2009RF. Most women (6495) had prenatal screening and 21.4% (1390) were GBS positive. IAP was given to 2369 (33.2%) women (preterm, nu2009=u2009166; full term, nu2009=u20092203). Compared to full-term, preterm women were less likely to receive IAP when indicated (73.2% versus 90.3%, pu2009<u20090.01). Full-term women represented the largest area under the curve (AUC, 0.87). PROM showed the highest sensitivity (98.6%), but the lowest specificity (6.9%) and AUC (0.53). Conclusions: Large-scale prenatal screening and IAP are feasible. Women delivering preterm are less likely to receive IAP when indicated. Most unnecessary antibiotics are given in cases of PROM.

Immune and inflammatory response in bronchiolitis due to respiratory Syncytial Virus and Rhinovirus infections in infants

Bronchiolitis is a common disease in infancy, mostly due to Respiratory Syncytial Virus and Rhinovirus. In addition to acute infection, viral bronchiolitis is responsible for sequelae including recurrent wheezing and asthma. The analysis of the viral characteristics and of the pathogenesis of the infection shows differences between the two viruses that may be helpful for the development of therapies and preventive strategies.

Respiratory Syncytial Virus: The Influence of Serotype and Genotype Variability on Clinical Course of Infection

Respiratory syncytial virus (RSV) belongs to the recently defined Pneumoviridae family, Orthopneumovirus genus. It is the leading cause of acute bronchiolitis and one of the most common causes of infant viral death worldwide, with infection typically occurring as recurrent seasonal epidemics. There are two major RSV subtypes, A and B, and multiple genotypes, which can coexist during RSV epidemic season every year and result in different disease severity. Recently, new RSV genomic sequences and analysis of RSV genotypes have provided important data for understanding RSV pathogenesis. Novel RSV strains do spread rapidly and widely, and a knowledge of viral strain-specific phenotypes may be important in order to include the more virulent strains in future therapeutical options and vaccine development. Here we summarize recent literature exploring genetic and molecular aspects related to RSV infection, their impact on the clinical course of the disease and their potential utility in the development of safe and effective preventive and therapeutic strategies.

Acute Asthma in the Pediatric Emergency Department: Infections Are the Main Triggers of Exacerbations

Background Asthma exacerbations are a common reason for Emergency Department (ED) visits in children. Aim To analyze differences among age groups in terms of triggering factors and seasonality and to identify those with higher risk of severe exacerbations. Methods We retrospectively revised the files of children admitted for acute asthma in 2016 in our Pediatric ED. Results Visits for acute asthma were 603/23197 (2.6%). 76% of the patients were <6 years old and 24% ≥6. Infections were the main trigger of exacerbations in both groups; 33% of the school-aged children had a triggering allergic condition (versus 3% in <6 years; p < .01). 191 patients had a previous history of asthma; among them, 95 were ≥6 years, 67% of whom were not using any controller medication, showing a higher risk of a moderate-to-severe exacerbation than those under long-term therapy (p < .01). Exacerbations peaked in autumn and winter in preschoolers and in spring and early autumn in the school-aged children. Conclusions Infections are the main trigger of acute asthma in children of any age, followed by allergy in the school-aged children. Efforts for an improved management of patients affected by chronic asthma might go through individualized action plans and possibly vaccinations and allergen-avoidance measures.

Update on Interventions in Prevention and Treatment of Pediatric Asthma

BACKGROUNDnAsthma represents a worldwide health problem with a strong morbidity and a major impact on the health care system. Multiple efforts have been made towards the development of new strategies for the prevention and treatment of this disorder. In the light of this the present review of the literature aimed at summarizing the latest advances in prevention and treatment of pediatric asthma with a focus on the most effective options of interventions during the first stages of life.nnnMETHODSnReferences were identified by searches of PubMed. Search terms used in the search were pediatric asthma, treatment and prevention. We included only meta-analysis, randomized controlled trials, reviews and systematic review articles pertaining to humans and subjects aged 0-18 years. All the interventions have been classified as non-pharmacological and pharmacological.nnnRESULTSnNon-pharmacological interventions have been focused in identifying the genetic and environmental factors underlying the pathogenesis of this disease, including the individual genetic susceptibility, the early allergic sensitization, the role of the environmental microbiome and the exposure to infections and to pollutants. Moreover, the optimization of the existing pharmacological strategies and the development of new treatment options have improved markedly the management of this disease, thereby reducing the health care costs and ameliorating the quality of life of patients.nnnCONCLUSIONnChildhood asthma prevention and treatment still represents a worldwide challenge. Future efforts should be aimed at identifying high risk target populations, minimizing the costs of each policy of intervention and increasing adherence to treatment strategies.

Risk scoring tool to predict respiratory syncytial virus hospitalisation in premature infants

The objective was to develop a risk scoring tool which predicts respiratory syncytial virus hospitalisation (RSVH) in moderate‐late preterm infants (32‐35 weeks’ gestational age) in the Northern Hemisphere.

An oesophageal spring

Oesophageal foreign bodies (OFBs) are a relatively common emergency in young children. OFBs are complicated by significant morbidity and mortality because their ingestion often occurs without witnesses, leading to a delay in diagnosis and treatment. We report an occult OFB in an 11-month-old infant who initially presented without any specific respiratory symptoms, mimicking a respiratory infection. Worsening of the patient’s cough, which did not show any improvement, despite treatment, and progressive onset of gastrointestinal manifestations (dysphagia, vomiting, and drooling) led to the diagnosis of an OFB (metallic spring). The complex and long-term clinical course of the patient highlights the need of promptly recognizing the presence of an occult OFB. This is because rapid diagnosis and treatment are essential for preventing severe and sometimes irreversible complications.

Upside-down position for the out of hospital management of children with supraventricular tachycardia

BACKGROUNDnThe upside-down position is a little known modified Valsalva manoeuvre (VM). The aim of this study was to investigate the safety and the efficacy of the upside-down position for the treatment of paroxysmal SVT in children.nnnMETHODSnTwenty-four paediatric patients followed for SVT were enrolled. The patients were assigned (1:1) to a standard VM or to an upside-down position at the first episode of SVT at home. If no cardioversion occurred, a second attempt was undertaken with the other VM. At the patients first relapse, the intervention protocol was applied in the opposite order at home.nnnRESULTSnThe upside-down position compared to standard VM reached 67% vs 33% rate of cardioversion at a first attempt, followed by 50% vs 0% rate of cardioversion in patients who had failed the first attempt. After having reversed the order of intervention in case of SVT recurrence, we recorded 67% vs 25% and 71% vs 42% success rates in favour of the upside-down position. There were no adverse events.nnnCONCLUSIONnThe upside-down position was safe and tended to be more effective than standard VM for out of hospital SVT treatment. Doctors and parents should be more aware of this effective but overlooked manoeuvre.

Tricky case of Takayasu arteritis in a young child presenting with heart failure and femoral pulses

A 6-year-old African girl was admitted with heart failure, tachycardia with gallop rhythm and hepatomegaly. Peripheral pulse examination showed absence of the right brachial and carotid pulses, but femorals were palpable; and right carotid and paraumbilical systolic murmurs were noted. Four limbs’ blood pressure discrepancy was present (right arm 100/70u2009mmxa0Hg, left arm 141/87u2009mmxa0Hg, right leg 123/82u2009mmxa0Hg, left leg 117/76u2009mmxa0Hg). Echocardiography showed left atrial and ventricular dilatation and severe dysfunction, with normal aortic arch but abdominal coarctation. CTxa0angiography showed occlusion of the brachiocephalic trunk, and the right subclavian artery, as well as stenosis of the right common carotid artery, and abdominal coarctation at …

Clinical evaluation of the new Roche platform of serological and molecular cytomegalovirus-specific assays in the diagnosis and prognosis of congenital cytomegalovirus infection

Clinical evaluation of the Elecsys® CMV IgM, IgG, IgG Avidity and COBAS AmpliPrep/COBAS TaqMan CMV (COBAS CMV) assays (Roche Diagnostics AG) in the diagnosis and prognosis of congenital CMV infection was performed. In this study, 150 preselected clinical samples (50 primary infection sera, 50 amniotic fluid [AF] and 50 newborn urine) were processed using Roche serological/molecular CMV-specific tests. Results were compared with those obtained by routine assays (comparator assays). The Elecsys® CMV IgM and IgG assays showed a perfect agreement (100%) with the comparator assays. Using the combination of the Elecsys® CMV IgM and IgG Avidity assays results, a primary infection was identified in 100% of cases. Inappropriate avidity CMV IgG values in two samples with very low IgG values (<6 AU/mL) were observed. COBAS CMV assay showed an agreement equal to 98% and 100% with comparator assays by processing AF and urine samples, respectively. Among AF with quantitative results, Lins concordance correlation was 0.933 and comparator-COBAS CMV assays gave CMV-DNA loads differing by <0.5 log10 DNA. Finally, higher CMV-DNA levels in AF samples were associated with a symptomatic outcome (p=0.003). The Roche CMV-specific assays compared well with the comparator assays, thus providing to be suitable for clinical use.