Aggiornamento sulla terapia della piastrinopenia immune in età pediatrica.

La revisione pubblicata nel 2004 su questa rivista analizzava 4 anni di letteratura, fino al giugno 2003. Da allora poche sono le novità nell’ambito della piastrinopenia autoimmune (PTI), mancando soprattutto studi prospettici randomizzati e nuove linee guida che possano guidare il lavoro del clinico. Nell’ambito della PTI acuta si conferma il riscontro di una migliore efficacia delle immunoglobuline per via endovenosa (IVIG) nel raggiungere più velocemente conte piastriniche elevate. Nella pratica clinica si evidenzia da parte di molti ematologi pediatri statunitensi l’uso delle immunoglobuline anti-Rh (Ig anti-D) come prima scelta nella terapia della PTI all’esordio, nonostante .gli importanti effetti collaterali riportati. Protagonista più recente nella terapia della PTI cronica è l’anticorpo monoclonale Rituximab. In questi anni sono stati pubblicati alcuni studi che ne hanno evidenziato una buona efficacia (30-50%) nel trattamento sia della forma cronica che di quella refrattaria. L’International Childhood ITP Study Group (ICIS) ha dato il via alla creazione di registri internazionali che potranno fornire utili dati per nuovi studi prospettici e per linee-guida evidence-based

Observation on the newborn at risk of early-onset sepsis: The approach of the Emilia-Romagna Region (Italy) [Osservazione nel neonato a rischio di sepsi precoce: L'Approccio della Regione Emilia-Romagna]

L’approccio al neonato a rischio di infezione batterica precoce è un problema emergente e in continua evoluzione. In passato l’approccio era basato principalmente sull’esecuzione di test di laboratorio, che sono risultati però scarsamente predittivi e causa di ripetuti prelievi di sangue e antibiotico-terapie ingiustificate, con alterazioni del nascente microbiota intestinale e possibili effetti a lungo termine. La medicalizzazione di neonati asintomatici interferisce inoltre con l’allattamento al seno. Recenti esperienze in Friuli Venezia Giulia ed Emilia-Romagna suggeriscono come sia utile un approccio meno invasivo, basato essenzialmente sull’osservazione clinica attenta e ripetuta a orari standard di neonati asintomatici a termine o lievemente pretermine, indipendentemente dal loro grado di rischio. Tale approccio è utile a una diagnosi tempestiva, non separa le madri dai loro piccoli e conseguentemente non interferisce con lo sviluppo del nascente microbiota intestinale né con l’allattamento al seno.The approach to the newborn at risk of early-onset sepsis is a challenge. In the past the approach was mainly based on laboratory tests, which were poorly predictive and might cause repeated blood samples and unnecessary antibiotic therapies, with possible long-term side effects. The medicalisation of asymptomatic newborns also interferes with breastfeeding. Recent experiences carried out in the Friuli Venezia Giulia and Emilia-Romagna Regions (Italy) have suggested that a less invasive approach is useful. This approach is mainly based on careful and repeated clinical observations of asymptomatic full-term or late preterm infants at standard intervals, regardless of risk factors. Moreover, it is useful for a timely diagnosis, does not separate mothers from their neonates and consequently does not interfere with the development of the nascent intestinal microbiota and breastfeeding

Strategies for preventing group B streptococcal infections in newborns: A nation-wide survey of Italian policies

Background: There are no Italian data regarding the strategies for preventing neonatal group B streptococcal (GBS) infection. We conducted a national survey in order to explore obstetrical, neonatal and microbiological practices for the GBS prevention. Methods: Three distinct questionnaires were sent to obstetricians, neonatologists and microbiologists. Questionnaires included data on prenatal GBS screening, maternal risk factors, intrapartum antibiotic prophylaxis, microbiological information concerning specimen processing and GBS antimicrobial susceptibility. Results: All respondent obstetrical units used the culture-based screening approach to identify women who should receive intrapartum antibiotic prophylaxis, and more than half of the microbiological laboratories (58%) reported using specimen processing consistent with CDC guidelines. Most neonatal units (89 out of 107, 82%) reported using protocols for preventing GBS early-onset sepsis consistent with CDC guidelines. Conclusions: The screening-based strategy is largely prevalent in Italy, and most protocols for preventing GBS early-onset sepsis are consistent with CDC guidelines. However, we found discrepancies in practices among centers that may reflect the lack of Italian guidelines issued by public health organizations

Strategies for preventing group B streptococcal infections in newborns: A nation-wide survey of Italian policies

Background: There are no Italian data regarding the strategies for preventing neonatal group B streptococcal (GBS) infection. We conducted a national survey in order to explore obstetrical, neonatal and microbiological practices for the GBS prevention. Methods: Three distinct questionnaires were sent to obstetricians, neonatologists and microbiologists. Questionnaires included data on prenatal GBS screening, maternal risk factors, intrapartum antibiotic prophylaxis, microbiological information concerning specimen processing and GBS antimicrobial susceptibility. Results: All respondent obstetrical units used the culture-based screening approach to identify women who should receive intrapartum antibiotic prophylaxis, and more than half of the microbiological laboratories (58%) reported using specimen processing consistent with CDC guidelines. Most neonatal units (89 out of 107, 82%) reported using protocols for preventing GBS early-onset sepsis consistent with CDC guidelines. Conclusions: The screening-based strategy is largely prevalent in Italy, and most protocols for preventing GBS early-onset sepsis are consistent with CDC guidelines. However, we found discrepancies in practices among centers that may reflect the lack of Italian guidelines issued by public health organizations