European journal of pediatrics
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Case Reports
Anaphylaxis to sheep's milk cheese in a child unaffected by cow's milk protein allergy.
A 5-year-old atopic boy unaffected by cow's milk protein allergy experienced several anaphylactic reactions after eating food containing "pecorino" cheese made from sheep's milk. Prick-prick tests were strongly positive to sheep's buttermilk curd and 'pecorino' sheep's cheese. Skin prick tests to fresh sheep's milk and to goat's milk were also positive, whereas they were negative to all cow's milk proteins, to whole pasteurized cow's milk and to cheese made from cow's milk. Specific IgE antibodies were negative to all cow's milk proteins. ⋯ Sheep's milk and cheese derived from sheep's milk may cause severe allergic reactions in children affected and, as we report, in children not affected by cow's milk protein allergy.
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Of all newborn infants, 5% require some degree of basic life support at birth. Newborn resuscitation therefore is one of the most frequent procedures carried out in medicine. It is therefore important that the routines in use are evidence based. ⋯ Training programmes, identification of risk cases and preparation for resuscitation should be part of the routine in all delivery units. It is underlined that the need for oxygen, external heart massage or medication is rare. Most depressed newborn infants manage well with suctioning, gentle tactile stimulation or a few ventilations with a bag and mask.
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Inhaled nitric oxide (iNO) improves oxygenation in near-term and term newborns with persistent pulmonary hypertension of the newborn (PPHN), and decreases the need for treatment with extracorporeal membrane oxygenation. However, some patients with PPHN either do not respond or have only transient improvements in oxygenation during iNO therapy. Extrapulmonary shunting associated with high pulmonary vascular resistance in PPHN can cause critical hypoxaemia; however, the syndrome of PPHN is often associated with severe parenchymal lung disease (e.g., meconium aspiration pneumonitis, bacterial pneumonia, and surfactant deficiency) which causes intrapulmonary shunting. It is increasingly recognized that the effective use of iNO requires adequate lung inflation to optimize delivery of the drug within the lung. High frequency oscillatory ventilation (HFOV) causes safe and effective lung recruitment when an appropriate strategy is applied and has recently been shown to improve the response to iNO when parenchymal lung disease occurs in association with PPHN. ⋯ Recent studies have shown that HFOV augments the response to iNO in PPHN associated with meconium aspiration syndrome or diffuse parenchymal lung disease (pneumonia, respiratory distress syndrome). Suboptimal lung inflation compromises the efficacy of iNO in PPHN, and may in part explain the reported differences in iNO response rates.