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

Human milk, a concrete risk for infection?

Breastfeeding should be considered a public health issue and the reference normative standards for infant feeding at least to the 6th month of life, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Numerous studies demonstrate that breastfeeding results in improved infant and maternal health. Moreover the reduction of the risk of severe retinopathy of prematurity, sepsis and necrotizing enterocolitis is particularly evident in preterm infants. There are a limited number of medical conditions in which breastfeeding is contraindicated, including some maternal infectious diseases. During breastfeeding the baby can be infected by mother's pathogens with several routes of transmission that can be considered, such as respiratory secretions and droplets (e.g. Adenovirus, Influenza virus, Respiratory Syncytial Virus, Haemophilus, Mycoplasma) direct contact with lesions in the breast and nipple (e.g. HSV 1-2, VZV, Treponema) and breast milk. Frequently, in case of infection, different routes of transmission are contemporary implicated. The basic assumption is that breastfeeding is rarely contraindicated during maternal infections, a few exceptions are HTVL-I and HIV in industrialized country. The theoretic risk for transmission trough breast milk should be discussed and balanced with the benefits of breast milk, so the mother and parents can make an informed decision concerning infant feeding

Identification of a diffuse form of hyperinsulinemic hypoglycemia by 18-fluoro-L-3,4 dihydroxyphenylalanine positron emission tomography/CT in a patient carrying a novel mutation of the HADH gene

Objective: Familial hyperinsulinism is the most common cause of hypoglycemia in infancy (HI), leasing to severe neurologic disabilities if not promptly treated. The recent application of positron emission tomography (PET/CT) scanning with 18F-DOPA has improved the capa-bility to distinguish the two histopathologic forms of HI (focal and diffuse), whose differen-tiation heavily influences the therapeutic management of the patient. Case report: We describe the case of a patient presenting severe hypoglycemia from infancy. High concentration of insulin suggested the diagnosis of congenital hyperinsulinism. Medical treatment was able to obtain a satisfactory metabolic response. Results: The patient underwent PET/CT scanning, revealing a diffuse form of the disease. The absence of mutations in KCNJ11 and ABCC88 genes (responsible for 50% of HI familial cases), and whole genome single nucleotide polymorphisms analysis by microarray suggested the HADH gene as a likely candidate in this case. Sequence analysis revealed a novel homo-zygous nonsense mutation (R236X) in HADH gene. Conclusions: This case indicate that mutations of HADH gene should be sought in hyperin-sulinemic patients in whom diffuse form of HI and autosomal recessive inheritance can be presumed, when KCNJ11 and ABCC88 genes mutational screening is negative