A Multicenter Retrospective Survey regarding Diabetic Ketoacidosis Management in Italian Children with Type 1 Diabetes

We conducted a retrospective survey in pediatric centers belonging to the Italian Society for Pediatric Diabetology and Endocrinology. The following data were collected for all new-onset diabetes patients aged 0-18 years: DKA (pH < 7.30), severe DKA (pH < 7.1), DKA in preschool children, DKA treatment according to ISPAD protocol, type of rehydrating solution used, bicarbonates use, and amount of insulin infused. Records (n = 2453) of children with newly diagnosed diabetes were collected from 68/77 centers (87%), 39 of which are tertiary referral centers, the majority of whom (n = 1536, 89.4%) were diagnosed in the tertiary referral centers. DKA was observed in 38.5% and severe DKA in 10.3%. Considering preschool children, DKA was observed in 72%, and severe DKA in 16.7%. Cerebral edema following DKA treatment was observed in 5 (0.5%). DKA treatment according to ISPAD guidelines was adopted in 68% of the centers. In the first 2 hours, rehydration was started with normal saline in all centers, but with different amount. Bicarbonate was quite never been used. Insulin was infused starting from third hour at the rate of 0.05-0.1 U/kg/h in 72% of centers. Despite prevention campaign, DKA is still observed in Italian children at onset, with significant variability in DKA treatment, underlying the need to share guidelines among centers

Efficacy and safety of growth hormone treatment in children with short stature: the Italian cohort of the GeNeSIS clinical study

Purpose: We examined auxological changes in growth hormone (GH)-treated children in Italy using data from the Italian cohort of the multinational observational Genetics and Neuroendocrinology of Short Stature International Study (GeNeSIS) of pediatric patients requiring GH treatment. Methods: We studied 711 children (median baseline age 9.6&nbsp;years). Diagnosis associated with short stature was as determined by the investigator. Height standard deviation score (SDS) was evaluated yearly until final or near-final height (n&nbsp;=&nbsp;78). Adverse events were assessed in all GH-treated patients. Results: The diagnosis resulting in GH treatment was GH deficiency (GHD) in 85.5&nbsp;% of patients, followed by Turner syndrome (TS 6.6&nbsp;%). Median starting GH dose was higher in patients with TS (0.30&nbsp;mg/kg/week) than patients with GHD (0.23&nbsp;mg/kg/week). Median (interquartile range) GH treatment duration was 2.6 (0.6\u20133.7) years. Mean (95&nbsp;% confidence interval) final height SDS gain was 2.00 (1.27\u20132.73) for patients with organic GHD (n&nbsp;=&nbsp;18) and 1.19 (0.97\u20131.40) for patients with idiopathic GHD (n&nbsp;=&nbsp;41), but lower for patients with TS, 0.37 ( 120.03 to 0.77, n&nbsp;=&nbsp;13). Final height SDS was&nbsp;&gt; 122 for 94&nbsp;% of organic GHD, 88&nbsp;% of idiopathic GHD and 62&nbsp;% of TS patients. Mean age at GH start was lower for organic GHD patients, and treatment duration was longer than for other groups, resulting in greater mean final height gain. GH-related adverse events occurred mainly in patients diagnosed with idiopathic GHD. Conclusions: Data from the Italian cohort of GeNeSIS showed auxological changes and safety of GH therapy consistent with results from international surveillance databases

Efficacy and safety of growth hormone treatment in children with short stature: the Italian cohort of the GeNeSIS clinical study

Purpose: We examined auxological changes in growth hormone (GH)-treated children in Italy using data from the Italian cohort of the multinational observational Genetics and Neuroendocrinology of Short Stature International Study (GeNeSIS) of pediatric patients requiring GH treatment. Methods: We studied 711 children (median baseline age 9.6&nbsp;years). Diagnosis associated with short stature was as determined by the investigator. Height standard deviation score (SDS) was evaluated yearly until final or near-final height (n&nbsp;=&nbsp;78). Adverse events were assessed in all GH-treated patients. Results: The diagnosis resulting in GH treatment was GH deficiency (GHD) in 85.5&nbsp;% of patients, followed by Turner syndrome (TS 6.6&nbsp;%). Median starting GH dose was higher in patients with TS (0.30&nbsp;mg/kg/week) than patients with GHD (0.23&nbsp;mg/kg/week). Median (interquartile range) GH treatment duration was 2.6 (0.6\u20133.7) years. Mean (95&nbsp;% confidence interval) final height SDS gain was 2.00 (1.27\u20132.73) for patients with organic GHD (n&nbsp;=&nbsp;18) and 1.19 (0.97\u20131.40) for patients with idiopathic GHD (n&nbsp;=&nbsp;41), but lower for patients with TS, 0.37 ( 120.03 to 0.77, n&nbsp;=&nbsp;13). Final height SDS was&nbsp;&gt; 122 for 94&nbsp;% of organic GHD, 88&nbsp;% of idiopathic GHD and 62&nbsp;% of TS patients. Mean age at GH start was lower for organic GHD patients, and treatment duration was longer than for other groups, resulting in greater mean final height gain. GH-related adverse events occurred mainly in patients diagnosed with idiopathic GHD. Conclusions: Data from the Italian cohort of GeNeSIS showed auxological changes and safety of GH therapy consistent with results from international surveillance databases

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

Growth patterns in children treated for Acute Lymphoblastic Leukemia (ALL): Relationship with cranial irradiation

Reduction of adult height is a well-recognized complication in long-term ALL survivors who received 18 Gy or more prophylactic cranial radiotherapy (RT) during their oncological treatment in childhood. Whether changes in the pubertal timing or obesity play a role in height loss of these subjects is poorly understood. Growth patterns of 74 survivors of childhood leukaemia were analyzed: group A (16M-8F) underwent chemotherapy (CT) plus RT (18Gy); group B (30M-30F) underwent only chemotherapy. Mean age at diagnosis was 6.0\ub13.2yrs, mean follow-up 10.7\ub13yrs. Thirty-two pts (16M) had attained final height at the time of evaluation. Height (H), final height (FH), target height (TH), FH-TH, and body mass index (BMI) were evaluated at diagnosis, stop-therapy and yearly until adulthood, and converted to z scores (SD) for age and sex. Bone age (Bayley-Pinneau) and pubertal stage (Tanner) were also assessed. In group A mean FH-SD was lower than H-SD at the end of therapy (p&lt;0.01) whereas in group B this difference was not found. FH-SD was lower (p&lt;0.005) in group A than group B only in females. FH-TH did not differ between the two groups. The onset of puberty in groups A and B did not vary neither between girls (10.1\ub11.9yrs vs 10.8\ub10.2yrs), nor between males (12.0\ub11.1yrs vs 11.5\ub11.7yrs); mean age of menarche occurred respectively at 12.4\ub11.2yrs and 11.9\ub11yr, testicular volume \ub315ml was found at 14.8\ub11.1yrs and 14.9\ub11.9yrs. Mean BMI-SD of groups A and B did not differ neither between males (0.6\ub11.2 vs 0.51\ub10.6), nor between females (-0.42\ub10.4 vs -0.59\ub11.9). Males and females submitted to cranial irradiation show a significant height loss during the follow-up, compared to subjects treated only with chemotherapy. Their growth impairment may be not detectable during the early period of follow-up, but only during the pubertal growth spurt. For this reason GH status should be reassessed in all these subjects at puberty

Esperienza sul campo. A distanza di anni cosa permane nei bambini diabetici ormai adulti dell'esperienza al campo scuola?

Il lavoro ha valutato, a distanza di oltre 20 anni, l'efficacia del campo scuola per bambini diabetici, organizzato dalla U.O. di Pediatria della AUSL di Rimini, in 23 giovani adulti, di età compresa tra 1 20 e 40 anni (età media 10 anni). I dati sono stati raccolti tramite un questionario anonimo. I risultati ottenuti dall'indagine confermano che, a distanza di anni, l'esperienza del campo scuola viene ricordata dalla maggior parte dei pazienti come un momento importante che ha contribuito ad ottimizzare l'autogestione del diabete, le proprie abilità tecniche e l'acettazione della malattia, favorendo inoltre un normale inserimento nel gruppo dei coetanei e nel mondo del lavoro. Questa esperienza dovrà essere estesa a gruppi più ampi di pazienti per confermare i positivi risultati ottenuti nella presente indagine

Grave tetania correlata a ipocalcemia e iperfosfatemia severa indotta da clistere evacuativo

L’utilizzo dei clisteri contenenti fosfati è frequente nei bambini affetti da stipsi e in letteratura sono stati documentati casi di tossicità secondaria al loro uso in pazienti con anomalie intestinali, atrofia muscolare spinale o displasia renale. Presentiamo il caso di una severa diselettrolitemia e compromissione delle condizioni cliniche secondari all’utilizzo di clisteri contenenti fosfato in un bambino senza patologie preesistenti. Un bambino di 5 anni di nazionalità cinese è giunto presso il Servizio di Urgenze Pediatriche per dolori addominali e stipsi ostinata da circa 10 giorni. Dopo la somministrazione di 2 clisteri contenenti fosfato, le condizioni cliniche sono improvvisamente peggiorate con obnubilamento del sensorio, respiro superficiale e ipertono muscolare periferico. Gli esami hanno documentato la presenza di ipocalcemia severa (calcemia 1,8 mmol/l) e di iperfosforemia di grado elevato (fosfati 102,7 mmol/l). Le condizioni cliniche sono rapidamente migliorate dopo la somministrazione di calcio endovena con successiva, completa normalizzazione clinica. I clisteri contenenti fosfato possono favorire la comparsa di eventi potenzialmente fatali e per tale motivo devono essere sempre usati con cautela, sotto stretto monitoraggio clinico, anche in soggetti senza fattori clinici predisponenti

Stroke cerebellare e dissezione dell’arteria vertebrale in una adolescente [Cerebellar stroke and vertebral artery dissection in an adolescent]

A 13-year-old girl presented with progressive frontal he-adache, dizziness, vomiting and hypotonia, with heat sen-sation and hyperidrosis. She referred a “contraction” of the neck some days before, while she was doing gymna-stics. The only physical sign was coarse tremor of the left lower limb to the test Mingazzini. Laboratory and radio-logic exams were normal, but cerebral MRI and angio-MRI put in evidence some ischemic spots in the left cere-bellar emisphere and cerebellar vermis; they originated from a dissection of the vertebral artery, evidenced by an angio-MRI of the supra-aortic arteries. After 10 months of low dose acetylsalicylic acid therapy, symptoms resol-ved almost completely, with no new ischemic events. The cerebellar lesions were resolving, as well as the small pseudoaneurysm at the level of dissection. Cerebellar stroke is rare in children, the spontaneous dissection of the vertebral arteries can be one of the possible etiolo-gies, even with no history of cervical trauma