Prenatal tobacco smoke exposure increases hospitalizations for bronchiolitis in infants

BACKGROUND: Tobacco smoke exposure (TSE) is a worldwide health problem and it is considered a risk factor for pregnant women's and children's health, particularly for respiratory morbidity during the first year of life. Few significant birth cohort studies on the effect of prenatal TSE via passive and active maternal smoking on the development of severe bronchiolitis in early childhood have been carried out worldwide. METHODS: From November 2009 to December 2012, newborns born at ≥ 33 weeks of gestational age (wGA) were recruited in a longitudinal multi-center cohort study in Italy to investigate the effects of prenatal and postnatal TSE, among other risk factors, on bronchiolitis hospitalization and/or death during the first year of life. RESULTS: Two thousand two hundred ten newborns enrolled at birth were followed-up during their first year of life. Of these, 120 (5.4%) were hospitalized for bronchiolitis. No enrolled infants died during the study period. Prenatal passive TSE and maternal active smoking of more than 15 cigarettes/daily are associated to a significant increase of the risk of offspring children hospitalization for bronchiolitis, with an adjHR of 3.5 (CI 1.5-8.1) and of 1.7 (CI 1.1-2.6) respectively. CONCLUSIONS: These results confirm the detrimental effects of passive TSE and active heavy smoke during pregnancy for infants' respiratory health, since the exposure significantly increases the risk of hospitalization for bronchiolitis in the first year of lif

Risk factors for bronchiolitis hospitalization during the first year of life in a multicenter Italian birth cohort

BACKGROUND: Respiratory Syncytial Virus (RSV) is one of the main causes of respiratory infections during the first year of life. Very premature infants may contract more severe diseases and 'late preterm infants' may also be more susceptible to the infection. The aim of this study is to evaluate the risk factors for hospitalization during the first year of life in children born at different gestational ages in Italy. METHODS: A cohort of 33-34 weeks gestational age (wGA) newborns matched by sex and age with two cohort of newborns born at 35-37 wGA and > 37 wGA were enrolled in this study for a three-year period (2009-2012). Hospitalization for bronchiolitis (ICD-9 code 466.1) during the first year of life was assessed through phone interview at the end of the RSV season (November-March) and at the completion of the first year of life. RESULTS: The study enrolled 2314 newborns, of which 2210 (95.5 %) had a one year follow-up and were included in the analysis; 120 (5.4 %) were hospitalized during the first year of life for bronchiolitis. Children born at 33-34 wGA had a higher hospitalization rate compared to the two other groups. The multivariate analysis carried out on the entire population associated the following factors with higher rates for bronchiolitis hospitalization: male gender; prenatal treatment with corticosteroids; prenatal exposure to maternal smoking; singleton delivery; respiratory diseases in neonatal period; surfactant therapy; lack of breastfeeding; siblings <10 years old; living in crowded conditions and/or in unhealthy households and early exposure to the epidemic RSV season. When analysis was restricted to preterms born at 33-34 wGA the following variables were associated to higher rates of bronchiolitis hospitalization: male gender, prenatal exposure to maternal smoking, neonatal surfactant therapy, having siblings <10 years old, living in crowded conditions and being exposed to epidemic season during the first three months of life. CONCLUSION: Our study identified some prenatal, perinatal and postnatal conditions proving to be relevant and independent risk factors for hospitalization for bronchiolitis during the first year of life. The combination of these factors may lead to consider palivizumab prophylaxis in Italy

Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group

Preschool wheezing should be considered an umbrella term for distinctive diseases with different observable and measurable phenotypes. Despite many efforts, there is a large gap in knowledge regarding management of preschool wheezing. In order to fill this lack of knowledge, the aim of these guidelines was to define management of wheezing disorders in preschool children (aged up to 5 years). A multidisciplinary panel of experts of the Emilia-Romagna Region, Italy, addressed twelve different key questions regarding the management of preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes) and systematic reviews have been conducted on PubMed to answer these specific questions, with the aim of formulating recommendations. The GRADE approach has been used for each selected paper, to assess the quality of the evidence and the degree of recommendations. These guidelines represent, in our opinion, the most complete and up-to-date collection of recommendations on preschool wheezing to guide pediatricians in the management of their patients, standardizing approaches. Undoubtedly, more research is needed to find objective biomarkers and understand underlying mechanisms to assess phenotype and endotype and to personalize targeted treatment

Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic

The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic. Only, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted worldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high intensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with frailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic disorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular treatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity. However, any age, including infancy, could be affected by the pandemic. Based on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a Consensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the management of children and adolescents with allergic or immunologic diseases

Sorting fission from parasitic coincidences of neutrons and gamma rays in plastic scintillators using particle times of flight

International audienceThis work addresses the use of plastic scintillators as an alternative to 3He detectors for radioactive waste drum characterization. The time response of scintillators is three orders of magnitude faster than that of gas proportional counters and they offer similar neutron detection efficiency at lower cost. However, they are sensitive to gamma rays and the commonly used Pulse Shape Discrimination technique is not possible with basic PVT scintillators. This paper reports on an innovative data processing technique allowing to extract spontaneous fission events from parasitic coincidences, such as those from the (α,n) reactions accompanied by correlated gamma rays or from pure gamma-ray sources emitting correlated radiations. The proposed approach makes advantage of differences in the pulse detection times recorded in measurements with the 252Cf, AmBe and 60Co sources. More precisely, a 2D histogram of time delays between the detected 2nd and 1st pulses, on the x-axis, and between the 3rd and 2nd pulses, on the y-axis, is found to allow for selection of a region of interest most relevant to spontaneous fission events.</jats:p

Pulsed neutron interrogation with PVT plastic scintillators to detect nuclear materials

International audienceIn the framework of homeland security, the Nuclear Measurements Laboratory of CEA Cadarache is studying the detection of Special Nuclear Materials hidden in sea-going cargo containers. Proof of principle experiments done in the DANAIDES facility of CEA Cadarache shows the feasibility of detecting some dozen of grams of highly enriched uranium by means of neutron interrogation with a 14 MeV D-T pulsed neutron generator and an array of EJ-200 plastic scintillators. We show that uranium can be detected by measuring correlated induced-fission prompt neutrons and gamma rays in coincidence, which is a first attempt with such detectors without neutron-gamma PSD capabilities, or more classically by detecting fission-induced delayed gamma rays

Study of gamma-ray background noise for radioactive waste drum characterization with plastic scintillators

In the framework of the radioactive waste drum characterization using neutron coincidence counting, the Nuclear Measurement Laboratory of CEA Cadarache is studying plastic scintillators as an alternative to ideal but costly 3He gas proportional counters. Plastic scintillators are at least 5 times cheaper for the same detection efficiency, and in addition, they detect fast neutrons about three orders of magnitude faster than 3He detectors. However, they are sensitive to gamma rays, which implies the necessity to identify precisely gamma background sources that may affect the useful signal. This paper presents a detailed analysis of the gamma-ray spectrum of a radioactive waste drum containing glove box filters contaminated by plutonium dioxide. Gamma emissions accompanying inelastic scattering (n,n’) and (α,n) reactions that can lead to neutron-gamma coincidences parasitizing useful coincidences from plutonium spontaneous fissions are identified. Some of these parasitic gamma rays having energies up to several MeV, we plan to reject high-energy scintillator pulses with an electronics rejection threshold above 1 MeV, which should preserve the major part of useful fission neutron pulses

Study of gamma-ray background noise for radioactive waste drum characterization with plastic scintillators

In the framework of the radioactive waste drum characterization using neutron coincidence counting, the Nuclear Measurement Laboratory of CEA Cadarache is studying plastic scintillators as an alternative to ideal but costly 3He gas proportional counters. Plastic scintillators are at least 5 times cheaper for the same detection efficiency, and in addition, they detect fast neutrons about three orders of magnitude faster than 3He detectors. However, they are sensitive to gamma rays, which implies the necessity to identify precisely gamma background sources that may affect the useful signal. This paper presents a detailed analysis of the gamma-ray spectrum of a radioactive waste drum containing glove box filters contaminated by plutonium dioxide. Gamma emissions accompanying inelastic scattering (n,n’) and (α,n) reactions that can lead to neutron-gamma coincidences parasitizing useful coincidences from plutonium spontaneous fissions are identified. Some of these parasitic gamma rays having energies up to several MeV, we plan to reject high-energy scintillator pulses with an electronics rejection threshold above 1 MeV, which should preserve the major part of useful fission neutron pulses

Management of children with acute asthma attack: A rand/ucla appropriateness approach

Bronchial asthma is the most frequent chronic disease in children and affects up to 20% of the pediatric population, depending on the geographical area. Asthma symptoms vary over time and in intensity, and acute asthma attack can resolve spontaneously or in response to therapy. The aim of this project was to define the care pathway for pediatric patients who come to the primary care pediatrician or Emergency Room with acute asthmatic access. The project was developed in the awareness that for the management of these patients, broad coordination of interventions in the pre-hospital phase and the promotion of timely and appropriate assistance modalities with the involvement of all health professionals involved are important. Through the application of the RAND method, which obliges to discuss the statements derived from the guidelines, there was a clear increase in the concordance in the behavior on the management of acute asthma between primary care pediatricians and hospital pediatricians. The RAND method was found to be useful for the selection of good practices forming the basis of an evidence-based approach, and the results obtained form the basis for further interventions that allow optimizing the care of the child with acute asthma attack at the family and pediatric level. An important point of union between the primary care pediatrician and the specialist hospital pediatrician was the need to share spirometric data, also including the use of new technologies such as teleconsultation. Monitoring the progress of asthma through spirometry could allow the pediatrician in the area to intervene early by modifying the maintenance therapy and help the patient to achieve good control of the disease