Test rapido per patogeni respiratori e prescrizione di antibiotici in Pronto Soccorso nel bambino con patologia respiratoria acuta

Rapid respiratory pathogen testing and antibiotic prescribing in ED in children with acute respiratory illness There is high usage of antibiotics in the emergency department (ED) for children with acute respiratory illnesses. Studies have reported decreased antibiotic use among inpatients with rapid respiratory pathogen (RRP) testing. The present study aims to determine whether ED RRP testing leads to decreased antibiotic use and health care use among children with influenza-like illness (ILI) in an ED. A randomized clinical trial among children aged 1 to 18 years presenting to an ED with ILI from December 2018 to November 2019 was conducted. Patients were randomized in an intervention group or a control group (results not given, routine clinical care). Intention-to-treat analyses and modified intention-to-treat (clinician knows results) analyses were conducted. Primary outcome was antibiotic prescribing whereas influenza antiviral prescribing, ED length of stay, hospital admission, and recurrent health care visits were the secondary outcomes. Among 931 ED visits, a total of 795 RRP test results (85%) were positive. In the intention-to-treat intervention group, children were more likely to receive antibiotics, with no significant differences in antiviral prescribing, medical visits, and hospitalization. In inverse propensity-weighted modified intention-to-treat analyses, children with test results known were more likely to receive antivirals and be hospitalized; there was no significant difference in antibiotic prescribing. The use of RRP testing in the ED for ILI did not decrease antibiotic prescribing in this randomized clinical trial. There is a limited role for RRP pathogen testing in children in this setting.

5 giorni di antibiotico per le polmoniti non complicate sono sufficienti: i risultati di non inferiorità del SAFER RCT

5 days of antibiotic for uncomplicated pneumonia is enough: the non-inferiority results of the SAFER RCT The most important guidelines for the treatment of community-acquired pneumonia (CAP) indicate amoxicillin as the drug of first choice, however there is a lack of evidence-based indications about the duration of this therapy. This study conducted in 2 emergency departments in Canada randomized 281 children aged 6 months to 10 years with CAP without the need for hospitalization to treatment with high-dose amoxicillin for 5 days versus a traditional 10 day therapy. In terms of clinical recovery, both groups presented comparable results. In fact, the “per protocol” analysis, recommended for a “non-inferiority” design, did not formally provide this result. The exclusively clinical recruitment criteria (any investigations were optional), well reflect the reality of primary care, and the results, albeit with some limitations, suggest that in uncomplicated CAP, brief therapy should be considered in the guidelines.

Quanto funziona il cortisone per os nel broncospasmo acuto in età prescolare? Risultati non confortanti di un RCT

How does oral cortisone work in acute bronchospasm in preschool age? ARCT with not reassuring results. The 2021 guide of the Global Initiatve for Asthma (GINA) states that the use of oral steroids in preschool children with acute bronchospasm is only recommended in cases of severe exacerbation, however the literature continues to present conflicting results. The Wheeze and Steroids in Preschoolers (WASP) Study, conducted in 3 New Zealand emergency rooms, randomized 477 children aged 24–59 months with acute bronchospasm to receive oral prednisolone for 3 days versus placebo. The respiratory outcomes measured were conflicting: the change in severity score (PRAM) at 24 hours was not different between the 2 groups, while the absolute value of the score at both 4 and 24 hours (secondary outcomes) was significantly lower in the prednisolone group. Hospitalization rate, need for further oral prednisolone treatment, and intravenous drug use were also lower in the prednisolone group. It is debated whether the equivalence design of the study and the margins chosen by the authors for the primary outcome have attenuated the difference between the treatments.

Ambiente e Salute News n.11 - settembre-ottobre 2021

Environment and health news This issue of Ambiente e salute news comes out shortly after two significant events: the COP26 which took place in Glasgow in November 2021 with media coverage inversely proportional to the results, and a support initiative, Ride for Their Lives initiative which led pediatricians and international health workers on bicycles from London to Glasgow to reiterate that individual behaviors are also indispensable to protect our planet for the future of our children, and that it is necessary for the medical profession to mobilize much more in this direction. This concept was reiterated once again by the authors and readers of the bmj, as seen in this statement: https://blogs.bmj.com/bmj/2021/10/24/we-must-protect-our-planet-for-our-childrens-future/. Our alleged powerlessness in the face of the complexity of climate change can be overcome through awareness of what we know and what we can put into practice, and this belief also supports this column: https://blogs.bmj.com/bmj/2021/10/24/the-climate-crisis-how-do-we-show-we-care/. As in the previous issues, we summarize here briefly the main articles published in the monitored journals, among which numerous are precisely those relating to climate change and air pollution. This issue is based on the systematic review of the September and October 2021 publications.

Ambiente e Salute News n.9 - maggio-giugno 2021

Environment and health news The column on the environment edited by the group of Pediatricians for a Possible World of the Pediatric Cultural Association opens in this issue with the summary of an important WHO document on risks related to electronic waste landfills. As in the previous issues, the main articles published in the monitored journals are then summarized. All articles and editorials deemed worthy of attention are listed divided by topic, with a concise comment. Among the many we point out an important study on the health effects of climate changes. This number is based on the systematic review of the May-June 2021 publications.

Migliorare la comunicazione in ambulatorio riduce la prescrizione degli antibiotici per le infezioni respiratorie: i risultati di un RCT

Improving communication in the office reduces the prescription of antibiotics for respiratory infections: the results of an RCT Effective communication with parents in the clinic can reduce inappropriate antibiotic prescriptions in primary care for upper respiratory tract infections (URTI). In this American RCT with a gradual wedge of good methodological quality, the distance training program 'DIALOGUE AROUND RESPIRATORY ILLNESS TREATMENT' (DART QI), allows an overall reduction of 7% in the probability of prescribing antibiotics for URTI between the baseline period and post-surgery.

È possibile predire nell’infanzia le capacità scolastiche e di linguaggio ad 11 anni: i risultati di uno studio di coorte in Australia

It is possible to predict school and language skills at age of 11: the results of a cohort study in Australia Early language skills are essential for preschool learning and subsequent school results, however it is not clear at what time it is possible to predict the subsequent difficulties in an optimal way early, for a timely intervention. This Australian study followed 1.910 children from the age of 7.5-10 months, collecting data on 12 risk factors associated with language development. A subgroup of 839 children was analyzed with full follow-up at 11 years, language assessment at 2, 4, 5, 7 years and evaluation of school results with national tests at 8, 10 and 12 years. Early risk factors were good predictors of school achievement at 11. Language proficiency at 4 years was the best predictor of language outcomes at 11 years. The need for early support to the family environment in the presence of risk factors is confirmed and the best time to decide the need for intervention on language development is identified at the age of 4.

Effetti della lettura ad alta voce oltre il linguaggio: l’ autoregolazione come mediatore

Effects of reading aloud beyond language: self-regulation as a mediator Reading aloud is a family activity which, if carried out frequently in the first years of life, supports the child’s linguistic and alphabetic development. Being a social process, shared reading in the family improves the child’s psychosocial development and parenting skills. It has recently been shown that cognitive and linguistic stimulation are associated with an improvement in self-regulation skills. This article describes the most recent findings on the importance of conversation during shared reading and the relationship of this activity with self-regulation and parenting.

Ambiente e Salute News n.11 - settembre-ottobre 2021

Less is more: measuring body temperature during well child visits is not good for the child A recent retrospective study found the risk of prescribing unnecessary tests and therapies to the child in case of routine fever measurement during the well child visit. The article of the month discusses the need to offer clinical pathways based on evidence-based medicine.

Ambiente e Salute News n.10 - luglio-agosto 2021

Environment and health news This issue of the heading on the environment comes out shortly from the publication of the new WHO Guidelines on Air Quality that have further reiterated the danger of air pollutants even at very low concentrations. This important document was accompanied by an article signed by 40 international associations of doctors, scientists and patients in which serious responses to this problem are asked by politics, which we invite you to read in full. As in the previous issues, the main articles published in the monitored journals are summarized here, many of which are precisely those relating to air pollution. All articles and editorials considered worthy of attention are listed by topic, with a summary comment. This number is based on the systematic review of the July and August 2021 publications.