Un versamento ostinato

In presenza di polmonite con versamento pleurico, dopo aver escluso gli agenti infettivi più probabili per età, in caso di manca- ta risposta alle terapie empiriche e in presenza di fattori di rischio epidemiologici in anamnesi, andrà ricercata l’ eziologia tuberco- lare del quadro polmonare. Quest’ ultima andrà esclusa anche nei casi di versamento pleurico isolato, non altrimenti spiegato, in pazienti provenienti da paesi ad alta endemia

Changes of intestinal microbiota in early life

There is increasing evidence that the intestinal microbiota plays a pivotal role in the maturation of the immune system and in the prevention of diseases occurring during the neonatal period, childhood and adulthood. A number of nonphysiological conditions during the perinatal period (ie caesarean section, prolonged hospitalization, formula feeding, low gestational age) may negatively affect the normal development of the microbiota, leading to decreased amounts of lactobacilli and bifidobacteria and increased amounts of Clostridia . In addition, perinatal antibiotics can cause intestinal dysbiosis that has been associated with short- and long-term diseases. For example, prolonged early empiric antibiotics increase the risk of necrotizing enterocolitis and late-onset sepsis in preterm neonates, whereas the administration of intrapartum antibiotic prophylaxis has been associated with inflammatory bowel diseases, obesity and atopic conditions, such as eczema and wheezing. Promoting breastfeeding, reducing the length of hospital stay, and reducing unnecessary antibiotic therapies are useful strategies to counterbalance unintended effects of these conditions

Complementary Feeding in Italy: From Tradition to Innovation

Complementary feeding (CF) is a pivotal phase of the individual’s growth, during which children develops their future dietary habits. To date, only few studies investigated and compared weaning modalities between different geographical areas. The aim of this article is to describe the current Italian practice for CF in healthy term infants among different areas (North, Center, South) of Italy. Two different multiple-choice questionnaires were produced and sent to 665 Italian primary care pediatricians (PCP) and 2023 families with children under 1 year of age. As emerged from our investigation, in Italy CF is usually started between the 5th and 6th month of life. The preferred approach (chosen by 77% of families) involves the use of home-cooked liquid or semi-liquid ailments, or industrial baby foods. A new CF modality is emerging, consisting of traditional complementary foods with adult food tastings (10% of families). Approximately 91% of pediatricians give written dietary suggestions, and 83% of families follow their advice. We found significantly divergent weaning habits among different areas of Italy. PCP have a key role in guiding parents during the introduction of new foods in their infant’s diet and should take this as an opportunity to educate the whole family to healthy dietary habits

Unusual meningitis caused by non-typhoid Salmonella in an italian infant: a case report.

Background: Non-typhoid Salmonella (NTS) is an important cause of bacterial meningitis in newborn and infants in developing countries, but rarely in industrialized ones. We describe an unusual presentation of bacterial meningitis in an infant, focusing on his diagnostic and therapeutic management. Case report: An Italian two-month old male presented high fever and diarrhea with blood, associated with irritability. Inflammatory markers were high, cerebrospinal fluid analysis was compatible with bacterial meningitides but microbiological investigations were negative. Salmonella enteritidis was isolated from blood. Cerebral ultrasound and MRI showed periencephalic collection of purulent material. Specific antibiotic therapy with cefotaxime was initiated with improvement of clinical conditions and blood tests. Brain MRI follow up improved progressively. Conclusions: Most of pediatric patients with NTS infection develop self-limited gastroenteritis, but in 3-8% of the cases complications such as bacteremia and meningitis may occur, especially in weak patients. Cerebral imaging can be useful to identify neurological findings. Although there is no standardized treatment for this condition, specific antibiotic therapy for at least four weeks is recommended. Neuroimaging follow up is required due to high risk of relapse

Antibiotic Exposure, Common Morbidities and Main Intestinal Microbial Groups in Very Preterm Neonates: A Pilot Study

Prematurity exposes newborns to increased risks of infections and it is associated with critical morbidities. Preterm infants often require antibiotic therapies that can affect the correct establishment of gut microbiota. The aim of this study was to investigate targeted intestinal bacteria in preterm neonates with common morbidities and receiving antibiotic treatments of variable duration. Stool samples were collected after birth, at 15, 30 and 90 days of life. qPCR quantification of selected microbial groups (Bifidobacterium spp., Bacteroides fragilis group, Enterobacteriaceae, Clostridium cluster I and total bacteria) was performed and correlation between their levels, the duration of antibiotic treatment and different clinical conditions was studied. An increasing trend over time was observed for all microbial groups, especially for Bifdobacterium spp. Prolonged exposure to antibiotics in the first weeks of life affected Clostridium and B. fragilis levels, but these changes no longer persisted at 90 days of life. Variations of bacterial counts were associated with the length of hospital stay, feeding and mechanical ventilation. Late-onset sepsis and patent ductus arteriosus reduced the counts of Bifidobacterium, whereas B. fragilis was influenced by compromised respiratory conditions. This study can be a start point for the identification of microbial biomarkers associated with some common morbidities and tailored strategies for a healthy microbial development

STEWARDSHIP ANTIMICROBICA NEL NEONATO E NEL PICCOLO LATTANTE Perché e come praticarla

Antimicrobial resistances are increasing worldwide, due to the misuse of antibiotic therapies in humans as well as in animals. It is expected that within a few decades, multi-resistant pathogens will become the leading cause of death worldwide. The misuse of antibiotics in the neonatal period depends on the lack of predictive diagnostic tests and the peculiarity of symptoms of sepsis, that frequently are vague and unspecific at the time of presentation. Policies to prevent the emergence of antimicrobial resistances rely on a judicious use of antibiotics, on protocols and additional measures shared from health care providers. This document summarizes recent indications issued in Emilia-Romagna Region (Italy) after reviewing the literature