Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics

The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase

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

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

Italian survey on general pediatricians’ approach to children with gastroesophageal reflux symptoms

The aim of the present study was to investigate the current approach of Italian general pediatricians to children with gastroesophageal reflux (GER) symptoms, evaluating the implementation of the 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines. One hundred randomly identified Italian general pediatricians were asked to complete a case report-structured questionnaire investigating their approach to infants, children, and adolescents with symptoms suggestive of GER. Only 2 % of them showed complete adherence to the guidelines. Thirty-nine percent of them diagnosed GER disease based on clinical symptoms, irrespective of the age of the child; 56 % prescribed proton pump inhibitors (PPIs) in infants with unexplained crying and/or distressed behavior and 38 % in infants with uncomplicated recurrent regurgitation and vomiting; 57 % prescribed PPIs in children younger than 8-12 years of age with vomiting and heartburn, without specific testing; and 54 % discontinued PPI therapy abruptly. The overall rate of pediatricians over-prescribing PPIs was 79 %. Conclusion: According to our findings, most Italian general pediatricians do not seem to follow the recommendations of the 2009 NASPGHAN-ESPGHAN reflux guidelines and often prescribe PPIs despite a lack of efficacy for the symptoms being treated. We are well aware that the guidelines address the average situation and that the evaluation of individual patients may frequently reveal reasons for opening criteria for exceptions. Nevertheless, the over-diagnosis of gastro-esophageal reflux disease (GERD) places undue burden on both families and national health system which has not been impacted by the publication of international guidelines

CONSENSUS INTERSOCIETARIA - L’uso dei corticosteroidi inalatori in età evolutiva

Questo documento è frutto di una collaborazione tra operatori di tutte le aree e affronta il tema dell’impiego appropriato degli steroidi inalatori. Un progetto ambizioso che ha incontrato non poche difficoltà e che non è in grado di dare risposte definitive a tutto, ovviamente, ma ha moltissimi pregi. Innanzitutto la chiarezza della definizione dei contesti clinici in cui si possono utilizzare i corticosteroidi inalatori; ad esempio, wheezing (bronchite asmatiforme) ed asma prescolare nel documento sono dichiaratamente sinonimi per semplificarne l’approccio e questo è certamente arbitrario. Ovviamente wheezing ed asma non sono affatto sinonimi, ma la definizione di asma a questa età è particolarmente difficile, implica una storia e un assetto clinico-immunologico particolare, mentre il documento è e deve essere uno strumento agile che consente di affrontare il sintomo indipendentemente dalla diagnosi precisa che scaturirà dalla osservazione prospettica del bambino. In questa ottica, le differenze tra asma e wheezing sfumano. Il secondo punto di forza è rappresentato dalla ampia e approfondita disanima della letteratura con un approccio estremamente rigoroso che ha consentito di trarre messaggi chiari ove le evidenze convergevano e messaggi invece di minor forza laddove le diverse linee guida (o i dati della letteratura) non davano indicazioni univoche o addirittura davano indicazioni discordantiUn ultimo punto, non certo di minor rilievo, è rappresentato dalla sintesi dei dosaggi degli steroidi che sono riportati nei foglietti illustrativi e i dosaggi indicati dalle maggiori linee guida. Nessun documento ad oggi ha affrontato specificamente un argomento tanto delicato e davvero un grande impegno è stato profuso nella sua realizzazione. Infine va sottolineato lo sforzo per focalizzare solo l’impiego dei corticostreroidi inalatori, resistendo alla tentazione di aggiungere indicazioni per farmaci diversi dagli steroidi. Non è un documento sulla terapia dell’asma e dello wheezing, della rinite, della rinosinusite, adenoidite e laringite, ma solo un documento che sottolinea e supporta le indicazioni, non indicazioni, dosi e molecola di steroide più indicata in quella situazione clinica sulla base dei dati EBM e indipendentemente dall’impiego di altri farmaci

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

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