Oral ondansetron versus domperidone for acute gastroenteritis in pediatric emergency departments: Multicenter double blind randomized controlled trial

The use of antiemetics for vomiting in acute gastroenteritis in children is still a matter of debate. We conducted a double-blind randomized trial to evaluate whether a single oral dose of ondansetron vs domperidone or placebo improves outcomes in children with gastroenteritis. After failure of initial oral rehydration administration, children aged 1-6 years admitted for gastroenteritis to the pediatric emergency departments of 15 hospitals in Italy were randomized to receive one oral dose of ondansetron (0.15 mg/kg) or domperidone (0.5 mg/kg) or placebo. The primary outcome was the percentage of children receiving nasogastric or intravenous rehydration. A p value of 0.014 was used to indicate statistical significance (and 98.6% CI were calculated) as a result of having carried out two interim analyses. 1,313 children were eligible for the first attempt with oral rehydration solution, which was successful for 832 (63.4%); 356 underwent randomization (the parents of 125 children did not give consent): 118 to placebo, 119 to domperidone, and 119 to ondansetron. Fourteen (11.8%) needed intravenous rehydration in the ondansetron group vs 30 (25.2%) and 34 (28.8%) in the domperidone and placebo groups, respectively. Ondansetron reduced the risk of intravenous rehydration by over 50%, both vs placebo (RR 0.41, 98.6% CI 0.20-0.83) and domperidone (RR 0.47, 98.6% CI 0.23-0.97). No differences for adverse events were seen among groups. In a context of emergency care, 6 out of 10 children aged 1-6 years with vomiting due to gastroenteritis and without severe dehydration can be managed effectively with administration of oral rehydration solution alone. In children who fail oral rehydration, a single oral dose of ondansetron reduces the need for intravenous rehydration and the percentage of children who continue to vomit, thereby facilitating the success of oral rehydration. Domperidone was not effective for the symptomatic treatment of vomiting during acute gastroenteritis

Reflex anal dilatation: An observational study on non-abused children

Aim: Reflex anal dilatation (RAD) is considered as a possible sign of anal abuse, however studies evaluating its prevalence in non-abused children are limited. The aim of this study was to evaluate the prevalence of RAD in a convenience sample of children with no suspicion of abuse admitted to a Pediatric Emergency Department (PED). Methods: Prospective observational study including children admitted to the PED of Padova, Italy, between January and June 2011. Patients with no suspicion of abuse and for whom ano-genital examination was part of their medical evaluation were included. Children were excluded if in critical clinical conditions or if any suspicion of abuse arose during medical evaluation. Presence/absence of RAD and of factors favoring its appearance were recorded for each patient. Results: Two-hundred and thirty children (median age of 12 months, interquartile range 5-35 months) were finally included. A positive RAD was reported in 14 (6.1%, CI 95% 3.4-10). Only 3 patients (1.3%, CI 95% 0.3-3.7) showed a positive RAD in the absence of any predisposing factor. Conclusions: RAD is an infrequent sign in non-abused children and it is particularly rare in the absence of any predisposing factor. Case-control studies are necessary to better clarify its diagnostic relevance

Neurodevelopment of infants with prenatal exposure to polybrominated diphenyl ethers

[[abstract]]The study aimed to examine the impact of prenatal exposure to polybrominated diphenyl ethers (PBDEs) on infant neurodevelopment. PBDEs levels in 36 cord blood samples were analyzed with a high-resolution-gas-chromatograph/high-resolution-mass-spectrometer and infant neurodevelopment was assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. The mean and median of Σ(11)PBDEs were 6.63 and 4.63 ng/g lipid, respectively. As compared to the lower PBDEs group (Σ(11)PBDEs 4.63 ng/g lipid) had a significantly higher actual odds ratio (OR = 1.13, p < 0.05) of the cognition score as well as a lower odds ratio (OR = 0.904, p < 0.01) of the adaptive behavior score, suggesting that prenatal PBDEs exposure may potentially affect infant neurodevelopment

COVID-19 Pandemic: Perspective of an Italian Tertiary Care Pediatric Center

Since February 2020, Italy has been faced with the dramatic spread of novel Coronavirus SARS-CoV-2. This impetuous pandemic infection forced many hospitals to reorganize their healthcare systems. Predicting a rapid spread of the SARS-CoV-2 virus within our region, the Department for Women's and Children's Health promptly decided (i) to revise the distribution of the clinical areas in order to create both designated COVID-19 and COVID-19-free areas with their own access, (ii) to reinforce infection prevention control (IPC) measures for all healthcare workers and administrative staff and (iii) to adopt the new "double-gate approach": a phone call pre-triage and nasopharyngeal swab for SARS-CoV-2 detection before the admission of all patients and caregivers. Between 21 February 2020 till 04 May 2020, only seven physicians, two nurses and two of the administrative staff resulted positive, all during the first week of March. No other cases of intra-department infection were documented among the healthcare workers since all the preventive procedures described above were implemented. It is predicted that similar situations can happen again in the future, and thus, it is necessary to be more prepared to deal with them than we were at the beginning of this COVID-19 pandemic

SIS-PED admission criteria for administration of MMR/MMRV vaccines.

<p>SIS-PED admission criteria for administration of MMR/MMRV vaccines.</p

SIS-PED admissions for allergies.

<p>SIS-PED admissions for allergies.</p

Follow-up of vaccination plan of referrals to Padua SIS-PED, 2002–2015.

<p>Follow-up of vaccination plan of referrals to Padua SIS-PED, 2002–2015.</p

Routine childhood and adolescent vaccines in Italy.

<p>Routine childhood and adolescent vaccines in Italy.</p