Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

Background: In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine. Methods: Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published. Results: The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm. Conclusions: We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research

La patologia cariosa e metodiche di prevenzione

Questa guida nasce da un'equilibrata e consolidata collaborazione, che vede Pediatri di Famiglia (PdF) e Odontoiatri alleati nella campagna di prevenzione delle patologie odontoiatriche in età pediatrica, mettendo cosi in atto un progetto inter-societario. Nasce, certamente, con lo scopo specifico di affrontare la prevenzione delle patologie orali ma anche con quello di promuovere un rapido riconoscimento di queste patologie al fine di indirizzare i bambini e gli adolescenti alla consulenza odontoiatrica nei tempi e nei modi corretti e condivisi. L'impostazione schematica e pragmatica con cui e stata costruita fa di questa guida un valido strumento al quale il pediatra può facilmente attingere quando, soprattutto in termini di prevenzione, si trova di fronte ad un piccolo paziente che ha (o potrebbe avere) patologie di pertinenza di quest'ambito specialistico. La Guida, inoltre, fornisce cenni completi per l'inquadramento di molte patologie con le quali ci si confronta durante l'attività quotidiana

Chi supplementare con ferro?

Iron supports several biologic functions: an appropriate optimisation of its balance is necessary for both erythropoietic and nonerythropoietic functions (cell cycle, immune competence, brain functioning and development). In particular, iron is essential for NervousSystem development in the post-natal period, when complex neuronal connection are being completed: iron deficiency plays then anessential role in programming and influencing an optimal development of organs and systems. The large amount of scientific studies available on iron deficiency or iron deficiency anemia explains the large interest of the scientific community in the possible introduction of iron supplementation in different life eras

Morphological and molecular characterization of a hybrid zone between Prosopis alba and P. nigra in the Chaco region of northwestern Argentina

The Gran Chaco is the largest dry forest in South America. One of the key taxa of this biome is the genus Prosopis (Fabaceae) which contains several economically important species. One of the characteristics of this genus is its natural capacity to exchange genetic information among congeneric species, generating zones of high morphological and genetic variability at contact points. The study and management of these contact areas can contribute to the dynamic conservation of these native genetic resources. In this study, we analysed three sites within a gradient of land aridity, where P. nigra and P. alba grow in sympatry and apparently hybridize. This is the first study performed in both, Prosopis pure sites and hybrid swarm, which includes a spatially explicit approach and simultaneously analyses fruit and leaf morphological variation, together with molecular information (microsatellites markers). We performed a multivariate morphological analysis, Bayesian genetic clustering and multivariate associations between genetic and morphological variability in the pure parental populations and in the hybrid swarm, considering possible spatial autocorrelation. Bayesian cluster analysis revealed two distinct groups corresponding to each species, differentiating the pure morphotypes from sites 1 and 2. Site 3, corresponding to the hybrid swarm, was composed of pure P. alba and P. nigra trees and hybrid individuals. We found morphological and molecular evidence of hybridization between P. alba and P. nigra, and detected novel phenotypes in the hybrid site.Instituto de Fisiología y Recursos Genéticos VegetalesFil: Vega, Carmen Delcira . Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Fisiología y Recursos Genéticos Vegetales; ArgentinaFil: Teich, Ingrid. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Fisiología y Recursos Genéticos Vegetales; ArgentinaFil: Teich, Ingrid. Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto Multidisciplinario de Biología Vegetal (IMBIV). Laboratorio de Ecología Evolutiva - Biología Floral; ArgentinaFil: Acosta, Maria Cristina. Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto Multidisciplinario de Biología Vegetal (IMBIV). Laboratorio de Ecología Evolutiva - Biología Floral; ArgentinaFil: Acosta, Maria Cristina. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Lopez Lauenstein, Diego. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Fisiología y Recursos Genéticos Vegetales; ArgentinaFil: Verga, Anibal. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria La Rioja. Agencia De Extensión Rural La Rioja; ArgentinaFil: Cosacov, Andrea. Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto Multidisciplinario de Biología Vegetal (IMBIV). Laboratorio de Ecología Evolutiva - Biología Floral; Argentin

Complementary Feeding and Iron Status: “<i>The Unbearable Lightness of Being</i>” Infants

The complementary feeding (CF) period that takes place between 6 and 24 months of age is of key importance for nutritional and developmental reasons during the transition from exclusively feeding on milk to family meals. In 2021, a multidisciplinary panel of experts from four Italian scientific pediatric societies elaborated a consensus document on CF, focusing in particular on healthy term infants. The aim was to provide healthcare providers with useful guidelines for clinical practice. Complementary feeding is also the time window when iron deficiency (ID) and iron deficiency anemia (IDA) are most prevalent. Thus, it is appropriate to address the problem of iron deficiency through nutritional interventions. Adequate iron intake during the first two years is critical since rapid growth in that period increases iron requirements per kilogram more than at any other developmental stage. Complementary foods should be introduced at around six months of age, taking into account infant iron status

Breastfed and Formula-Fed Infants: Need of a Different Complementary Feeding Model?

Suboptimal nutrient quality/quantity during complementary feeding (CF) can impact negatively on infants’ healthy growth, even with adequate energy intake. CF must supplement at best human milk (HM) or formulas, which show nutritional differences. Considering this, a differentiated CF is probably advisable to correctly satisfy the different nutritional needs. To assess whether current needs at 6–24 months of age can still be met by one single CF scheme or different schemes are needed for breastfed vs. formula/cow’s milk (CM) fed infants, protein, iron and calcium intakes were assessed from daily menus using the same type and amount of solid food, leaving same amounts of HM and follow-up formula at 9 and again 18 months of age, when unmodified CM was added. Depending on the child’s age, calcium- and iron-fortified cereals or common retail foods were used. The single feeding scheme keeps protein intake low but higher than recommended, in HM-fed children while in formula/CM-fed ones, it achieves much higher protein intakes. Iron Population Recommended Intake (PRI) and calcium Adequate Intakes (AI) are met at the two ages only when a formula is used; otherwise, calcium-fortified cereals are needed. ESPGHAN statements on the futility of proposing different CF schemes according to the milk type fed do not allow to fully meet the nutritional recommendations issued by major Agencies/Organizations/Societies for all children of these age groups

Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow’s milk according to age: a systematic review

International audienceBackground: The diagnosis of IgE-mediated cow’s milk allergy is often based on anamnesis, and on specific IgE (sIgE) levels and/or Skin Prick Tests (SPT), which have both a good sensitivity but a low specificity, often causing positive results in non-allergic subjects. Thus, oral food challenge is still the gold standard test for diagnosis, though being expensive, time-consuming and possibly at risk for severe allergic reactions.Aim: The aim of the present study was to perform a systematic review of the studies that have so far analyzed the positive predictive values for sIgE and SPT in the diagnosis of allergy to fresh and baked cow’s milk according to age, and to identify possible cut-offs that may be useful in clinical practice.Methods: A comprehensive search on Medline via PubMed and Scopus was performed August 2017. Studies were included if they investigated possible sIgE and/or SPT cut-off values for cow’s milk allergy diagnosis in pediatric patients. The quality of the studies was evaluated according to QUADAS-2 criteria.Results: The search produced 471 results on Scopus, and 2233 on PubMed. Thirty-one papers were included in the review and grouped according to patients’ age, allergen type and cooking degree of the milk used for the oral food challenge.In children < 2 years, CMA diagnosis seems to be highly likely when sIgE to CM extract are ≥ 5 KUA/L or when SPT with commercial extract are above 6 mm or Prick by Prick (PbP) with fresh cow’s milk are above 8 mm. Any cut-offs are proposed for single cow’s milk proteins and for baked milk allergy in children younger than 2 years. In Children ≥ 2 years of age it is hard to define practical cut-offs for allergy to fresh and baked cow’s milk. Cut-offs identified are heterogeneous.Conclusions: None of the cut-offs proposed in the literature can be used to definitely confirm cow’s milk allergy diagnosis, either to fresh pasteurized or to baked milk. However, in children < 2 years, cut-offs for specific IgE or SPT seem to be more homogeneous and may be proposed

Inhaled corticosteroids use in childhood respiratory diseases: an italian survey on pediatricians' prescription habits

BACKGROUND: A national consensus document on inhaled corticosteroids (ICS) use in childhood, produced by the main Italian pediatric scientific societies, has been recently released. The aim of this study was to gather information on the current pediatricians' ICS prescription habits in Italy for the management of the most common pediatric respiratory diseases, namely allergic rhinitis (AR), asthma, preschool wheezing and laryngitis.METHODS: From the 1st October 2018 to the 31st January 2019 a link to an online questionnaire was sent monthly through a newsletter to the members of the Italian Society of Pediatrics. The questionnaire included 18 items on ICS use in the most common pediatric respiratory diseases. Data collection and reporting was based on STROBE Statement Checklist for cross-sectional studies.RESULTS: One thousand-two questionnaires were returned from primary care pediatricians (39.1%), hospital pediatricians (38.7%), private practicers (16.4%), university pediatricians (3.1%) and Pediatrics residents (2.7%). We found a good adherence to the international guidelines on AR, with prevalent use of oral antihistamine (60.6%) in the secretive phenotype and nasal ICS in the obstructive phenotype (64.8%). In asthma exacerbations ICS are not used in 53.4% of cases, but they are used at high dose in 27.9% and at low dose in 18.7% of cases. In intermittent asthma, ICS are not chosen as a daily controller therapy in 54.1% of cases, while they are chosen as a low dose daily therapy in 44.5% of cases (high dose in 1.4%). In children with persistent asthma, ICS are chosen as a daily low dose therapy in 67.4% of cases and as a daily high dose therapy in 31%. In the management of preschool wheezing, when a long-term treatment is needed, ICS are chosen both alone and in association with antileukotrienes in 71.4% of cases. Children affected by recurrent asthma exacerbations and wheezing are closely followed up, in particular by their primary care pediatricians. The preference for certain molecules in the treatment of different respiratory diseases also emerged.CONCLUSIONS: Pediatricians' ICS prescription habits in Italy should be improved, especially in the management of asthma. Future surveys on a more numerous sample will be useful to analyze differences in prescription habits on the basis of pediatricians' work settings and geographical distribution