Italian Journal of Pediatrics

Published by Springer Nature

Online ISSN: 1824-7288


Figure 1 Comparison of the presence of respiratory and atopic problems between the groups at 6-7 years of age.
Table 2 Laboratory tests results in the studied groups
Comparison of the presence of respiratory and atopic problems between the groups at 6–7 years of age.
Study flow-chart.
Comparison of forced expiratory volume measurements between the group of extremely low birthweight children and the group of full-term peers.
The prevalence and risk factors of allergic and respiratory symptoms in a regional cohort of extremely low birth weight children (<1000 g)
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January 2013


75 Reads



Klimek Malgorzata




Pietrzyk Jacek Jozef
Children who were <1000 g (ELBW extremely low birth weight) at birth more frequently present with wheezing which is the most common reason that pediatric consultation is sought. Therefore asthma is diagnosed very often. However is the asthma that is diagnosed in ELBW subjects atopic in origin, or is there a different etiology? To determine if ELBW infants are at higher risk for the development of allergic and respiratory symptoms and to establish if there were any specific risk factors for these symptoms. 81 children born with a mean birthweight of 845 g (91% of available cohort) were evaluated at the mean age 6.7 years. The control group included 40 full-term children. The children were examined for clinical signs of allergy, and were subjected to the following tests: serum total IgE, skin prick tests (SPT), exhaled nitric oxide measurement (FeNO) and spirometry. ELBW children had wheezing episodes more often (64% vs. 25%; OR (odds ratio): 5.38; 95% CI (confidence interval): 2.14-13.8) and were diagnosed more frequently with asthma (32% vs. 7.5%; OR: 5.83, 95% CI: 1.52-26) than their term born peers. The most important risk factors for wheezing persistence were hospitalization and wheezing episodes in first 24 months of life. Mean serum tIgE level (geometric mean: 32+/−4 vs. 56+/−4 kU/L; p=0.002) was higher and the number of children with positive results of tIgE level (12% vs. 32%; p=0.02) were more frequent in the control group. Children from the control group also more frequently had SPT, however this data was not statistically significant (11% vs. 24%; p=0.09). All of the ELBW had normal FeNO level (<=20 ppb), but 5 children from the control group had abnormal results (p=0.02). There was no difference between the groups in the occurrence of allergic symptoms. ELBW children have more frequent respiratory, but not allergic problems at the age of 6–7 years compared to children born at term. The need for rehospitalization in the first 2 years of life, was a more important risk factor of future respiratory problems at the age of 7 than perinatal factors, the diagnosis of bronchopulmonary dysplasia or allergy.

Figure 1 ROC curves during different hours of age: A) 24-60 h; B) 61-96. Full line and dashed line represent the BC and the JM-103 performance, respectively.
Table 1 Baseline characteristics of the study population
ROC curves during different hours of age: A) 24–60 h; B) 61–96. Full line and dashed line represent the BC and the JM-103 performance, respectively.
BiliCheck vs JM-103 in identifying neonates not at risk of hyperbilirubinaemia

July 2013


259 Reads

Transcutaneous bilirubinometry is widely used to predict hyperbilirubinemia by using several devices. The aim of this study was to compare the predictive ability of BiliCheck vs JM-103 in identifying neonates not at risk of significant hyperbilirubinemia, putting the data obtained with the two instruments on our transcutaneous bilirubin nomogram built with the BiliCheck. Transcutaneous bilirubin (TcB) measurement was performed when jaundice appeared in newborn babies and/or just before discharge from the hospital. It was performed at the forehead with the two instruments within 5 minutes by two experienced neonatologists, each one blind to the value obtained by the other. Blood samples were drawn to obtain total serum bilirubin (TSB) levels soon after TcB measurements. A total of 627 paired-sample measurements were obtained from 298 newborn babies. Out of the total population studied, 16 newborn babies (5.4%) showed significant hyperbilirubinemia defined as TSB value >17 mg/dL, or as need for phototherapy treatment according to the AAP guidelines. TcB measurements showed false negative results in the first 60 hours of life using both devices. After the 60th hour of life, TcB measurements using both devices successfully predicted newborn babies not at risk of significant hyperbilirubinemia, being the JM-103 more reliable than BC because of fewer false positive results. Our study shows that both BC and JM-103 can exclude subsequent significant hyperbilirubinemia when the measurements are performed after the 60th hour of life. Nevertheless, the transcutaneous pre-discharge screening should be considered only as the first step, and it has to be followed by a follow-up through the first days after discharge.

About the need to use specific population references in estimating paediatric hypertension: Sardinian blood pressure standards (age 11-14 years)

January 2012


93 Reads

Previous Italian paediatric blood pressure (BP) tables overestimated the prevalence of hypertension in adolescents of specific geographic areas, such as Sardinia, an island in the Mediterranean Sea. This is probably due to a not very homogeneous distribution of the subjects studied, most from Middle and Northern Italy, and the long period from the survey. BPs were repeatedly measured over a period of 3 years in 839 children (52.6% males. Age range: from 11 to 14 years during this period), using a standard mercury sphygmomanometer. For each gender, the specific percentile curves of systolic and diastolic BP were constructed. (corrected by the 50th percentile of height): males (11-14 YEARS): mean systolic BP (50th centile): from 111 to 115 mmHg. Hypertensive systolic BP (> 95th percentile): from 127 to 135 mmHg. Mean diastolic BP (50th centile): from 65 to 69 mmHg. Hypertensive diastolic BP (> 95th percentile): from 78 to 82 mmHg. Females (11-14 YEARS): mean systolic BP (50th centile): from 110 to 112 mmHg. Hypertensive systolic BP (> 95th percentile): from 127 to 130 mmHg. Mean diastolic BP (50th centile): from 65 to 67. Hypertensive diastolic BP (> 95th percentile): from 78 to 80 mmHg. Sardinian BP tables emphasizes the need to integrate the previous standards with more up-to-date and representative reports on Italian children, as periodically performed in the USA, in order to increase the number of subjects to be checked, and to obtain a national coverage better and more completely representative of every geographic area of our country.

The R156H variation in IL-12Rβ1 is not a mutation

February 2013


40 Reads

Palamaro et al. describe a child with recurrent bronchopneumonia and very high IgE levels in which a variation, R156H, was found in the IL12RB1 gene that encodes the IL-12Rβ1 chain. Based on the absence of this variation in 50 unrelated individuals they conclude it is a mutation. We (van de Vosse and van Dissel) feel there is no reason to suspect a defect in IL-12 signaling based on the clinical data, nor evidence for a functional defect in IL-12 signaling in this patient. In addition, the variation is not novel and known as a polymorphism. Without any functional evidence that R156H is a mutation, the current claim is not substantiated. Palamaro et al. respond to argue that the amino acid substitution, R156H described in the described case exerts a summatory effect, as a genetic cofactor, along with an additional and still unidentified molecular alteration of the same pathway.

123I-MIBG scintigrams taken before (A) and after (B)131I-MIBG treatment with allo-CBSCT.123I-MIBG accumulation decreased after treatment in the parietal bone and humerus (black arrows), but it was still detected in the thoracic vertebrae and femur (white arrows).
I-131-Metaiodobenzylguanidine therapy with allogeneic cord blood stem cell transplantation for recurrent neuroblastoma

October 2012


258 Reads

Iodine-131-metaiodiobenzylguanidine (131I-MIBG) therapy combined with allogeneic cord blood stem cell transplantation (SCT) was used to treat a 4-year-old girl with recurrent neuroblastoma. The patient experienced relapse 2 years after receiving first-line therapies, which included chemotherapy, surgical resection, irradiation, and autologous peripheral SCT. Although 131I-MIBG treatment did not achieve complete remission, the size of the tumor was reduced after treatment. Based on our findings, we suggest that 131I-MIBG treatment with myeloablative allogeneic SCT should be considered as first-line therapy for high-risk neuroblastoma patients when possible.

Craniofacial features and genomic oligo-array data observed in the patient. Frontal (a) and (b) lateral view of the 3-year-old patient carrying a de novo 13q13.3q21.31 interstitial deletion long face with curly hair, bilateral epicanthus, broad nasal bridge, short nose with a long philtrum, thin upper lip and modest micrognathia (c) Chromosome 13 profile from oligo array-CGH showing the 27.87 megabases deletion in 13q13.3q21.31 spanning from 37,447,455 -65,319,891 base pairs (for Methods see text).
De Novo 13q13.3-21.31 deletion involving RB1 gene in a patient with hemangioendothelioma of the liver

January 2014


145 Reads

Interstitial deletions of the long arm of chromosome 13 (13q) are related with variable phenotypes, according to the size and the location of the deleted region. The main clinical features are moderate/severe mental and growth retardation, cranio-facial dysmorphism, variable congenital defects and increased susceptibility to tumors. Here we report a 3-year-old girl carrying a de novo 13q13.3-21.32 interstitial deletion. She showed developmental delay, growth retardation and mild dysmorphism including curly hair, high forehead, short nose, thin upper lip and long philtrum. An abnormal mass was surgically removed from her liver resulting in a hemangioendothelioma. Array analysis allowed us to define a deleted region of about 27.87 Mb, which includes the RB1 gene. This is the first report of a 13q deletion associated with infantile hemangioendothelioma of the liver.

Table 1 Pediatric rhinocerebral zygomycosis: review of the literature from 1980 to 2013
Magnetic resonance imaging of head. A. Postgadolinium T1-weighted axial magnetic resonance image showing nonenhancing tissue (arrow) in the left nasal cavity and periorbital site compatible with necrotic mucosa. B. Similar technique showing note semiocclusion of the left internal carotid artery (arrow) and thrombosis of the right cavernous sinus, although there was no radiographic evidence of cerebral infarction.
Rhinocerebral zygomycosis with pansinusitis in a 14-year-old girl with type 1 diabetes: A case report and review of the literature
Zygomycosis is a rare life-threatening fungal infection affecting mostly patients with predisposing conditions such as diabetes mellitus, immunodeficiency, haemochromatosis or major trauma. We describe a case of rhinocerebral zygomycosis in a girl with type 1 diabetes and review previous published cases and treatment options. A 14-year-old girl with type 1 diabetes mellitus occurred with dental pain, facial swelling, ecchymosis and left eye decreased visual acuity, unresponsive to antibiotic therapy. The coltures of the sinusal mucosa were positive for fungal species belonging to the Zygomycetes. She performed antifungal therapy with posaconazole (POS) with a very slow improvement and a poor glycemic control, leading to blindness of the left eye. Our report adds further awareness on rhinocerebral zygomycosis and emphasizes on urgent diagnosis and timely management of this potentially fatal fungal infection through an adequate treatment.

Chromosome 16p11.2 deletions: another piece in the genetic puzzle of childhood obesity

June 2010


108 Reads

Ipercaloric diet and reduced physical activity have driven the rise in the prevalence of childhood obesity over a relatively short time interval. Family and twin studies have led to the conclusion that the strong predicitve value of parental body mass index (BMI) mainly stems from genetic rather than environmental factors. Whereas the common polygenic obesity arises when an individual genetic make-up is susceptible to an environment that promotes energy consumption over energy expenditure, monogenic obesity, on the contrary, is the obesity associated with a single gene mutation, which is sufficient by itself to cause weight gain in a food abundant context. Genes involved in the leptin-melanocortin pathway are often mutated in these cases. The cumulative prevalence of monogenic obesity among children with severe obesity is about 5%. Recently, deletions in the region p11.2 of the chromosome 16 encompassing the gene SH2B1, which is involved in the leptin and insulin signaling, have been reported in about 0.5% of children with severe early-onset obesity. These patients show extreme hyperphagia, severe insulin resistance and, in some cases, mild developmental delay.

The patient at one (a), two (b) and three (c) years of age with typical 3-M syndrome facial features including frontal bossing, relatively increased head circumference, triangular face, hypoplastic midface, low nasal bridge, depressed nasal root, fleshy upturned nose, long philtrum, full lips, and pointed, prominent chin.
Patient at 15 (a) and 17.5 (b) years showing facial dismorphism, short stature, broad thorax, sternum carinatum.
Radiographic features of the adult 3-M syndrome patient. On the lateral lumbar spinal radiograph (left panel), vertebral bodies are relatively tall and short. Lumbar hyperlordosis is caused by the short femoral necks. In the central panel, note the short femoral necks with anterior rotation of the pelvis (small foramina obturatoria). The ribs and the visible part of the femoral shafts are slender. The distance between the vertebral pedicles remains constant from L1 to L5. The tibia and fibula (right panel) are relatively inconspicuous. The radiographic features fitting with the diagnosis of 3-M are the tall and narrow vertebral bodies and slender tubular bones; other features of a chondrodysplasia, such as platyspondily or metaphyseal and epiphyseal changes, are typically absent.
Growth chart for height of the patient from birth until adult age. TH=target height.
3-M syndrome associated with growth hormone deficiency: 18 year follow-up of a patient

March 2013


2,791 Reads

3-M syndrome is a rare autosomal recessive disorder that causes short stature, unusual facial features and skeletal abnormalities. Mutations in the CUL7, OBSL1 and CCDC8 genes could be responsible for 3-M syndrome. Here we describe the growth and evolution of dismorphic features of an Italian boy with 3-M syndrome and growth hormone deficiency (GHD) from birth until adulthood. He was born full term with a very low birth weight (2400 g=−3.36 standard deviation score, SDS) and length (40.0 cm =−6.53 SDS). At birth he presented with a broad, fleshy nose with anteverted nostrils, thick and patulous lips, a square chin, curvilinear shaped eyebrows without synophrys, short thorax and long slender bones. Then, during childhood tall vertebral bodies, hip dislocation, transverse chest groove, winged scapulae and hyperextensible joints became more evident and the diagnosis of 3-M syndrome was made; this was also confirmed by the finding of a homozygous deletion in exon 18 of the CUL7 gene, which has not been previously described. The patient also exhibited severe GHD (GH <5 ng/ml) and from the age of 18 months was treated with rhGH. Notwithstanding the early start of therapy and good compliance, his growth rate was always very low, except for the first two years of treatment and he achieved a final height of 132 cm (−6.42 SDS).

Figure 1 CUM imaging: IV° grade bilateral VUR. 
Figure 2 Facial features of the proband. 
Chromosome 18q-Syndrome and 1p terminal duplication in a patient with bilateral vesico-ureteral reflux: Case report and literature revision
Background Vesico-ureteral reflux (VUR) is a dynamic event in which a retrograde flow of urine is present into the upper tracts. VUR may occur isolated or in association with other congenital abnormalities or as part of syndromic entities. We present a patient with a bilateral primary VUR, syndromic disease caused by a large deletion of 18q (18q21.3-qter) and terminal duplication of 1p (1p36.32-p36.33). Case report The patient was 8 years old female with a disease including moderate growth retardation, psychomotor retardation, facial dysmorphism, single umbilical artery, umbilical hernia, urachal remnant, bilateral congenital clubfeet and renal-urinary disease. Chromosomal analysis and Array-CGH revealed two heterozygous chromosomal rearrangements: 1p terminal duplication and de novo 18q terminal deletion. She referred to our clinic to evaluation of bilateral hydronephrosis and right renal cortex thinning. Voiding cystourethrography demonstrated bilateral grade IV VUR and dimercaptosuccinic acid renal scintigraphy confirmed right renal cortex thinning and showed a cortical uptake of 75% of the left kidney and 25% of the right kidney. The patient underwent ureterovesical reimplantation after failure of 3 endoscopic submeatal Deflux injections with VUR resolution. Conclusions This is the first report involving a patient with 18q-syndrome and contemporary presence of 1p chromosomal terminal duplication. The coexistence of two chromosomal rearrangements complicates the clinical picture and creates a chimeric disorder (marked by characteristics of both chromosomal anomalies). Kidney problems, primarily VUR is reported in 15% of patients affected by 18-q syndrome and no cases is reported in the literature regarding a correlation between VUR and 1p36 chromosomal duplication.

The patient's usual face.
The patient's growth chart.
The patient at 18 months.
18q deletion in a cystic fibrosis infant, increased morbidity and challenge for correct treatment choices: A case report

May 2011


131 Reads

Cystic Fibrosis (CF) is the most frequent recessive disease of Caucasian patients. Association with other diseases or syndromes has previously been reported. Co-morbidity may be a challenge for clinicians, who have to face more severe problems. We have described a CF infant, F508del homozygote, diagnosed by neonatal screening, who also had a chromosome 18q terminal deletion [del (18)(q22-qter)]. Some clinical features of the 18q deletion: e.g., cardiopathy, gastro-oesophageal reflux and severe muscular hypotonia, worsened the CF clinical picture and his quality of life, with repeated pulmonary exacerbations and failure to thrive in the first six months of life. The treatment strategy was chosen following an accurate multi-disciplinary team study of overlapping chromosome syndrome and CF symptoms. The use of a gastrostomy device for enteral nutrition together with a new device (Ez-PAP) for chest physiotherapy led to normal growth, a notably reduced hospitalization rate and improved quality of life. This case shows how co-morbidities worsening the clinical course of a "complicated patient" can be faced thanks to unconventional therapies that represent a challenge for clinicians.

Table 2 Infant, neonatal and post-neonatal mortality rates by 5-year intervals and geographical areas in Italy, years 1991-2009
Trends in infant, neonatal and post-neonatal mortality rates in Italy, years 1991–2009. Dashed lines: quadratic regression slopes. Source: ISTAT. Health for All-Italia. Year 2012. (
Geographical distribution of average infant mortality rates in Italy for the years 2007–2009. Source: ISTAT. Health for All-Italia. Year 2012. (
Temporal and geographical trends in infant, neonatal and post-neonatal mortality in Italy between 1991 and 2009

March 2013


133 Reads

Background Infant mortality is a key indicator of child and population health. The aim of this study is to analyse the trends in infant mortality rates (IMRs) and their components (neonatal mortality rates-NMRs and post-neonatal mortality rates-PNMRs) from 1991 to 2009 both at the national level and across the three Italian large geographical macro-areas (North, Center, South). Methods Using data extracted from the Health for All-Italy database, IMRs, NMRs and PNMRs were calculated for the 19 Italian Regions and 2 Autonomous provinces for the years 1991–2009. Relative risks and attributable fractions were calculated for Southern and Central Italy compared with Northern Italy. Temporal trends were analysed using the robust polynomial Poisson regression models. Results During the study period there was a 54% decline in IMR (from 7.72/1000 to 3.55/1000), a 57% decline in NMR (from 5.87/1000 to 2.55/1000) and a 46% decline in PNMR (from 1.85/1000 to 1/1000). In particular, we found a strong decline in IMRs and NMRs from 1991 to 2000/2001, and a weaker decline starting from 2002/2003. Moreover, we found a slight decrease in PNMRs until 2001/2002, and no significant variations starting from 2003. Despite these reductions, important geographical variations persisted: in 2006–2009, the most recent data available, the excess of infant mortality in Southern Italy compared with the North was 27%. Conclusions During the period 1991–2009 Italy experienced a significant decline in IMRs, NMRs and PNMRs. We observed the same pattern for the temporal trends of these indicators across the North, the Center and South of Italy. Despite this decline, geographical disparities persisted.

Table 2 Overall prevalence of CD in 2005 (AGA) and in 2009 (ATTG)
Table 3 Costs of screening
“Screening from 1993 to 2005”.
“Screening from 2006 to 2009”.
“Results of screening”.
Mass population screening for celiac disease in children: The experience in Republic of San Marino from 1993 to 2009

October 2013


114 Reads

Prevalence of celiac disease in developed countries is assessed about 1:100--1:150. The real prevalence is unknown because mass screenings are expensive and difficult to organize. Moreover celiac disease can affect people at every age and studies on asymptomatic subjects at different ages are not comparable. In this study we wanted to know the real prevalence of celiac disease in children in the Republic of San Marino. We also analysed concordance of different tests used and costs of mass screening. The study started in 1993. From 1993 to 1997 children aged 6, 10 and 14 were screened. Since 1997 only children aged 6 were monitored, in order to have a homogeneous population. In fact, every child born since 1980 was taken into account. Children were recruited by classroom lists of students for general paediatric examination. Until 2005 the screening test was based on dosage of antibodies anti-gliadin (AGA) IgA and IgG on venous blood. Since 2006 these tests were replaced by anti-transglutaminase IgA antibodies (ATTG). Anti-endomysial antibodies (EMA) were performed if result of any between either AGA or ATTG tests was positive or borderline; if EMA was positive, then an endoscopy with histological examination was performed to confirm the final diagnosis. Attendance to paediatric examination was 96%, submission to blood test was 87%. 42 on 5092 (0,8%; 1:125) children resulted affected by celiac disease. Histology always confirmed diagnosis by serology except for two cases. AGA test (until 2005) yielded 28 on 4304 (0,7% 1:143); ATTG test (since 2006) revealed 14 positive cases on 788 (1,8%; 1:55) leading to a larger percentage of diagnosis. EMA antibodies always confirmed positivity of ATTG. Prevalence of celiac disease in children of Republic of San Marino is comparable to other North-European Countries. Sensitivity of ATTG proved much higher than that of anti-gliadin antibodies. Concordance between ATTG and EMA was 100%. Concordance between serology and histology was approximately 100%. Cost of screening was yearly about 5000 euros (250 children screened every year).

Bacterial isolates of early onset sepsis (n = 229)
Bacterial isolates of early-onset neonatal sepsis and their antibiotic susceptibility pattern between 1998 and 2004: An audit from a center in India

July 2011


139 Reads

Epidemiology and surveillance of neonatal sepsis helps in implementation of rational empirical antibiotic strategy. To study the frequency of bacterial isolates of early onset neonatal sepsis (EONS) and their sensitivity pattern. In this retrospective study, a case of EONS was defined as an infant who had clinical signs or born to mothers with potential risk factors for infection, in whom blood culture obtained within 72 hours of life, grew a bacterial pathogen. Blood culture sample included a single sample from peripheral vein or artery. Relevant data was obtained from the unit register or neonatal case records. Of 2182 neonates screened, there were 389 (17.8%) positive blood cultures. After excluding coagulase-negative Staphylococci (160), we identified 229 EONS cases. Preterm neonates were 40.6% and small for gestational age, 18.3%. Mean birth weight and male to female ratio were 2344.5 (696.9) g and 1.16:1 respectively. Gram negative species represented 90.8% of culture isolates. Pseudomonas (33.2%) and Klebsiella (31.4%) were common among them. Other pathogens included Acinetobacter (14.4%), Staphylococcus aureus (9.2%), E.coli (4.4%), Enterobacter (2.2%), Citrobacter (3.1%) and Enterococci (2.2%). In Gram negative group, best susceptibility was to Amikacin (74.5%), followed by other aminoglycosides, ciprofloxacin and cefotaxime. The susceptibility was remarkably low to ampicillin (8.4%). Gram positive group had susceptibility of 42.9% to erythromycin, 47.6% to ciprofloxacin and above 50% to aminoglycosides. Of all isolates, 83.8% were susceptible to either cefotaxime or amikacin Gram-negative species especially Pseudomonas and Klebsiella were the predominant causative organisms. Initial empirical choice of cefotaxime in combination with amikacin appeared to be rational choice for a given cohort.

Patient’s growth pattern. Height velocity deceleration was observed when the patient was 15 years old. The arrow indicates the time GH-RH plus arginine dynamic test was performed. Final height was below mid-parental height.
Graphic representation of GH-RH plus arginine dynamic test demonstrating GH deficiency in the patient. The patient is represented by ▲.
Involvement of endocrine system in a patient affected by Glycogen storage disease 1b: Speculation on the role of autoimmunity

March 2014


171 Reads

Glycogen storage disease type 1b (GSD1b) is an inherited metabolic defect of glycogenolysis and gluconeogenesis due to mutations of the SLC37A4 gene and to defective transport of glucose-6-phosphate. The clinical presentation of GSD1b is characterized by hepatomegaly, failure to thrive, fasting hypoglycemia, and dyslipidemia. Patients affected by GSD1b also show neutropenia and/or neutrophil dysfunction that cause increased susceptibility to recurrent bacterial infections. GSD1b patients are also at risk for inflammatory bowel disease. Occasional reports suggesting an increased risk of autoimmune disorders in GSD1b patients, have been published. These complications affect the clinical outcome of the patients. Here we describe the occurrence of autoimmune endocrine disorders including thyroiditis and growth hormone deficiency, in a patient affected by GSD1b. This case further supports the association between GSD1b and autoimmune diseases.

Diarrhoea and Acute Respiratory Infections Prevalence and Risk factors Among Under-Five Children in Iraq in 2000

February 2009


206 Reads

Diarrhoea and acute respiratory conditions are common medical conditions among under-five children in resource-limited and conflict situations. The present study was conducted to estimate the prevalence and associated factors for acute respiratory conditions and diarrhoea among children under the age of five years in Iraq in 2000. Data for the Iraqi Multiple Indicator Cluster Survey were obtained from UNICEF. We estimated the prevalence of acute respiratory conditions and diarrhoea. Assessment of the associations between these two medical conditions on one hand and socio-demographic and environmental variables on the other was done using logistic regression analysis. Weighted analysis was conducted to account for complex survey design. A total of 14,676 children under the age of 5 years were reported by their mothers in the study. Of these 50.4% were males. About half (53.9%) of the children had complete vaccination status. Overall, 21.3% of the children had diarrhoea, and 6.9% had acute respiratory infection (ARI) in the last two weeks. In multivariate analysis, diarrhoea was associated with age of child, area of residence, maternal education, source of water, toilet facility, disposal of children' stool and disposal of dirty water. Compared to children aged 48-59 months, children in the age groups 6-11 months and 12-23 months were 2.22 (95%CI [2.02, 2.44]) and 1.84 (95%CI [1.71, 2.00]) times more likely, respectively, to have diarrhoea. Children whose mothers had no formal education were 11% (AOR = 1.11, 95%CI [1.04, 1.18]) more likely to have diarrhoea compared to children with mothers who had attained secondary level of education. Compared to children who belonged to households with unprotected well or river as the main source of water, children who belonged to households with piped water were 32% (AOR = 1.32, 95%CI [1.17, 1.48]) more likely to have diarrhoea while those who belonged to households with protected well were 26% (AOR = 0.74, 95%CI [0.62, 0.89]) less likely to have diarrhoea. Age of child, toilet facility, wealth, and sex of child were significantly associated with ARI. In a study of under-five children in Iraq in 2000, we found that history of diarrhoea and ARI were negatively associated with lower socio-economic status, adequate disposal of children's stool and dirty water, but the results were inconsistent in terms of access to potable water and sanitation facilities possibly due to non-functioning of water and sewage plants after the war. Improvement in water quality and sanitation are vital in the reduction of diarrhoeal diseases.

Table 2 indicates that subjects who reported substance use (alcohol or drug use) were more likely to be in a physical
Bullying victimization and physical fighting among Venezuelan adolescents in Barinas: Results from the Global School-Based Health Survey 2003

November 2009


330 Reads

Violence among adolescents has untoward psycho-social and physical health effects among this age group. Most of the literature on this topic has been from high-income nations, and little information has come from middle- and low-income nations. This study was done to assess the relationship between physical fighting and bullying victimization among Venezuelan school-going adolescents in Barinas. We used data from the 2003 Global School-Based Health Survey conducted among in-school adolescents in Barinas, Venezuela. We estimated the prevalence of bullying victimization and physical fighting. We also conducted Logistic regression analysis to assess the association between a selected list of explanatory variables and physical fighting. We hypothesized that there would be a dose-response relationship between physical fighting and number of times the adolescent reported being a bullied in the past 30 days. A total of 2,249 adolescent students participated in the survey. However data on sex (gender) were available for only 2,229 respondents, of whom 31.2 (47.4% males and 17.0% females) reported having been involved in a physical fight in the last 12 months. Some 31.5% (37.0% males and 27.0% females) reported having been bullied in the past 30 days. There was a dose-response relationship between bullying victimization and physical fighting (p-trend < 0.001). Compared to subjects who were not bullied, those who reported being bullied were more likely to engage in physical fighting after controlling for age, sex, substance use (smoking, alcohol drinking or drug use), and parental supervision. Physical fighting and bullying victimization experience is common among in-school adolescents in Barinas, Venezuela. The fact that victims of bullying were more likely to have engaged in physical fighting may be evidence supporting the notion that "violence begets more violence".

Figure 1 Life Expectancy (LE) and Healthy Life Expectancy (HLE) at birth (in years) -Women 2004-2008 (5 years). Figure A: LE for European (minimum, maximum, average) and Italian women (green line). Figure B: HLE for European (minimum, maximum, average) and Italian women (orange line in declining trend).  
Figure 2 Life Expectancy (LE) and Healthy Life Expectancy (HLE) at birth (in years)-Women 2004-2008 (5 years). Figure A: LE for European (minimum, maximum, average) and Italian women (green line). Figure B: HLE for European (minimum, maximum, average) and Italian women (orange line in declining trend).
In Italy, healthy life expectancy drop dramatically: From 2004 to 2008 there was a 10 years drop among newborn girls

May 2012


159 Reads

In this short essay, we would like to address a severe divergence observed in Italy between Life Expectancy (LE) and Healthy Life Expectancy (Healthy LE) and a unique trend of worsening in Healthy LE, compared to the other European countries. Both issues emerge in recent data by EUROSTAT Report. The analysis used by the authors of the EUROSTAT report is based on Sullivan method which combines 2 type of variables: mortality and morbidity data. While several European countries started to deal with comparable data about LE since 1960, in Italy, analogous data were available for the first time in EUROSTAT Report only in 1985. In Italy, in the period 1985-2008, there was a good progressive increase in L.E., following the best European values. Nevertheless, while until 2004 Italy was among the European best countries in terms of both LE and Healthy LE at birth, four years later in 2008 there was a shocking loss of 10 years of Healthy LE at birth in newborn girls. In the process, they lost their 2-years previous advantage with respect to males (the latter lost only 6 years of Healthy LE, in the same time span). Looking at healthy LE at age 65 in respect to 2004, Italian women in 2008 could expect to live healthy only about 7 years (as much as men) versus the almost 15 years of the European best values (14 years for men). It is legitimate to wonder why no one official comment has been produced as a reaction after the first year of spectacular decline in Healthy Life Years in Italy: in counter-tendency with European values, from 2004 to 2008 there is a clear evidence of a 10 years drop in Healthy LE among newborn girls. The problem has not been taken into consideration even when the situation clearly appeared to worsen in the following years, dropping 4-6 more years for males and females in 2006 (for newborn babies); two more years of healthy life expectancy have been lost between 2006 and 2007 for each gender. One more year of Healthy Life Expectancy is lost in 2008. And data have not been made available any more, since then, from Italy.

Seasonal trend of RSV infection in 335 enrolled infants.
Epidemiological assessment of Respiratory Syncytial Virus infection in hospitalized infants, during the season 2005–2006 in Palermo, Italy

May 2009


72 Reads

Respiratory Syncytial Virus (RSV) is the leading cause of hospitalization for lower respiratory tract infections (LRTI) in young children worldwide.We evaluate the epidemiological and clinical patterns of RSV infection in infants hospitalized for LRTI in in Palermo, South Italy, Sicily. We collected the demographic details of infants hospitalized to G. Di Cristina Children's Hospital in Palermo for LRTI between November 2005 and May 2006. We also included all cases occurred in newborns hospitalized in the Neonatal Intensive Care Unit (NICU) Of Palermo. During the studied period, 335/705 hospitalized infants for LRTI were enrolled in the study. The trend of hospitalization started in late winter and lasting until May 2006 with an epidemic peak in spring. 178/335 infants tested for viral infection showed RSV disease. Three cases occurred in preterm newborns hospitalized from birth in NICU. The likelihood to be RSV+, rather than RSV negative (RSV-) was higher for infants < 6 months and lower for infants with history of breast feeding (P < 0.05). RSV infection was associated with a higher likelihood to be admitted to intensive care unit and to a longer hospitalization and oxygen therapy. The study shows that, in Sicily, RSV is an important cause of LRTI in infants. The seasonal distribution shows that both LRTI and RSV infections peak in late spring, in contrast to Northern Italy. Our data could help to define the regional appropriate start of prophylactic interventions.

Table 2 SDO (hospital discharge records) for the most prevalent diseases classified by Aggregate Clinical Codes (ACC) SDO Classified by Aggregate Clinical Codes Total
Most frequent causes of health migration in Campania region children.
Most frequent causes of children migration subdivided for provinces.
Pediatric migratory flows from Campania region in years 2002–06 (panel A) and 2006–10 (panel B).
Results of self-administered questionnaires.
Characterization and burden of Campania children health migration across Italian regions during years 2006-2010: Chance and/or necessity?

October 2012


551 Reads

Background To evaluate medical, economical and sociological variables underlying avoidable pediatric migration from Campania region. Methods Analysis of years 2006–2010 hospital discharge records, extracted from the archive of Regional Health Agency (ArSan), classified by Major Diagnostic Categories, Aggregate Clinical Codes, Discipline of dismissal, Local Health Authorities of residence, and age group 0–14 years (excluding those of healthy newborns). Sociological variables were evaluated by questionnaires. Results A total of 68,316 hospital discharge records were released by extra-regional structures. Major diagnostic categories and Discipline of dismissal indicated that the most implicated diseases (nervous system and mental disorders, hematology-oncology, and bone diseases) were not always of very high complexity. The total cost paid by the Campania Region was 124.700.000 Euros. The need for more specialized hospital pediatric units and/or with more pediatric subspecialties in the native region was pointed out by most of the self-administered questionnaires. Conclusions Pediatric migration is an important phenomenon with evident implications. The identification of the most concerned sub-specialties here reported can give useful information aiming to assist in the improvement of the existing pediatric resources in Campania region in the wider context of the national global child health advancement.

Figure 1: Algorithm for the management of an adverse reaction to vaccine.
Table 2 Previous dose of vaccine reactions
Table 3 Vaccines causing the reaction
Table 4 Reactions caused by vaccines
Vaccine risk assessment in children with a referred reaction to a previous vaccine dose: 2009–2011 retrospective report at the Bambino Gesu’ children hospital, Rome, Italy

March 2014


220 Reads

During the last century, mass vaccination programs have achieved considerable success across the world in immunizing against several serious infectious diseases. However, vaccinations are threatened by their own success after results have been obtained: the more the incidence of potentially devastating diseases decreases, thanks to the success of vaccination programs, the more public attention shifts towards real or alleged "side effects" of vaccines. We analyze the experience of 153 children with "reaction to a previous vaccine dose" continuing the vaccination protocol in the safe environment of the Center for risk vaccination at the Bambino Gesu Children's Hospital IRCCS in Rome, from 2009 to 2011. To assess the suitability for vaccination, a specialized pre-vaccination advice and a skin prick test (SPT) was undergone, according to Wood's guideline; 151 children were SPT negative and full vaccine was administered. Of the 153 children examined just 13 had symptoms suggestive of IgE-mediated reaction-type reactions with angioedema manifestations. Among them, 2 had positive STP, which required alternative measures of administration of the vaccine. No cases of post vaccination reaction was reported and no vaccination program was stopped due to a severe reaction. Inadequate levels of immunization against infectious diseases remain a significant problem for public health. However, the reasons for incomplete vaccination and non-adoption of vaccination services are manifold. To maintain public confidence in vaccines, advanced immunization programs must include activities for monitoring the safety of the vaccine at the individual level and pursuing specialized counseling pre-and post-vaccination for those at risk. Our results underlined a gap between true and referred adverse reactions and are consistent with vaccine safety. Anyway, a continuous assessment of the risks and benefits of vaccination is required and the results must be disclosed in order to strengthen confidence in the existing and in the new immunization programs.

Table 1 Main data about pediatric population enrolled to receiving vaccination against A/H1N1 pandemic flu in the health district of Piacenza 
Table 2 Probability to be classified as patient at risk based on group membership 
Immunization against A/H1N1 pandemic flu (2009–2010) in pediatric patients at risk. What might be the most effective strategy? The experience of an health district of Northern Italy

May 2012


75 Reads

Vaccination coverage rates against pandemic flu were far below those required by Italian Public Health Authorities.The aim of this retrospective study was to assess how the management of vaccination against pandemic flu in the Health District of Piacenza (Northern Italy) had conditioned the adherence of patients at risk to the H1N1flu immunization program. From a population of 27.018 children aged between 6 months and 16 years, 2361 pediatric patients considered at risk according to the guidelines of the Ministry of Health were enrolled to receive pandemic flu vaccination.Children enrolled in the immunization program were vaccinated with one of the following three options:A) by their pediatrician in his office after contacting him directly or by phoneB) by their pediatrician in his office or in a public Health District office with the assistance of a nurse after an appointment had been booked by patient's parents using a dedicated free of charge phone numberC) by a doctor of the public Health District after an appointment had been booked as for option B RESULTS: The best outcomes of population vaccination coverage for pandemic flu were achieved when patients were vaccinated with option B (44.2%). For options A and C rates coverage results were 22.8% (OR 2,69) and 24.9% (OR 2, 39) respectively. The results of this study may be taken into account by the public health Authorities when planning the management of future immunization campaigns out of the usual vaccination schedule or in an emergency event.

Progress in pediatrics in 2011. Choices in endocrinology, gastroenterology, hemato-oncology, infectious diseases, otolaryngology, pharmacotherapy and respiratory tract illnesses
Main progresses in endocrinology, gastroenterology, hemato-oncology, infectious diseases, otolaryngology, pharmacotherapy, and respiratory tract illnesses selected from articles published in The Italian Journal of Pediatrics in 2011 were reviewed. Risk factors for gastroenteritis and appendicitis in developing countries may be useful in improving our understanding of these diseases. Childhood hearing impairment is a world-wide problem which continues to have an high prevalence in newborns. Among the mechanisms of diseases, obese children often have asthma and high hepcidin levels that may reduce serum iron concentrations. In cystic fibrosis, 18q distal deletion has been described as a novel mutation. Hypothyroidism in children with central nervous system infections may increase mortality rates. Infrared tympanic thermometer (IRTT) in oral mode for the measurement of body temperature may be useful in fever screening in a busy setup. In newborns, the transmission of CMV infection through breast milk may be prevented through freezing or pasteurization. Recent advances in treatment of constipation, urinary tract infections, leukemia, pain in children with cancer, neonates with sepsis or difficult weaning from mechanical ventilation will likely contribute towards optimizing management of these common disorders. The work of the Family Pediatricians Medicines for Children Research Network aims to develop competence, infrastructure, networking and education for pediatric clinical trials.

Progress in Pediatrics in 2012: Choices in allergy, endocrinology, gastroenterology, hematology, infectious diseases, neurology, nutrition and respiratory tract illnesses
This review will provide new information related to pathophysiology and management of specific diseases that have been addressed by selected articles published in the Italian Journal of Pediatrics in 2013, focusing on allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses in children. Recommendations for interpretation of skin prick test to foods in atopic eczema, management of allergic conjunctivitis, hypertension and breastfeeding in women treated with antiepileptic drugs and healthy breakfast have been reported. Epidemiological studies have given emphasis to high incidence of autoimmune disorders in patients with Turner syndrome, increasing prevalence of celiac disease, frequency of hypertension in adolescents, incidence and risk factor for retinopathy of prematurity. Advances in prevention include elucidation of the role of probiotics in reducing occurrence of allergies and feeding intolerance, and events of foetal life that influence later onset of diseases. Mechanistic studies suggested a role for vitamin D deficiency in asthma and type 1 diabetes and for reactivation of Varicella-Zoster virus in aseptic meningitis. Regarding diagnosis, a new mean for the diagnosis of hyperbilirubinaemia in newborns, a score for recognition of impaired nutritional status and growth and criteria for early Dyke-Davidoff-Masson Syndrome have been suggested. New therapeutic approaches consist of use of etanercept for reducing insulin dose in type 1 diabetes, probiotics in atopic eczema, and melatonin in viral infections.

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