Minerva pediatrica
-
Review Comparative Study
New diagnostic and therapeutic options in bacterial meningitis in infants and children.
Bacterial meningitis continues to be an important cause of mortality and morbidity in neonates and children through the world. Current strategies to prevention and therapy of bacterial meningitis are compromised by incomplete understanding of the pathogenesis, emergence of antimicrobial resistant microorganisms and lack of simple diagnostic tools in resource-limited settings. ⋯ Suspected bacterial meningitis is a medical emergency and requires empiric antimicrobial therapy without delay, but recognition of pathogens with increasing resistance to antimicrobial agents is an important factor in selection of empiric antimicrobial regimen. A more complete knowledge on the pathogenesis of meningitis is likely to help in development of new diagnostic and therapeutic options for infants and children with bacterial meningitis.
-
Comparative Study
The optimal organization of pediatric emergency services.
The care for the acutely ill and injured child has undergone marked improvements in the last two decades. In the developed world children are receiving better care in the prehospital setting and in the emergency department (ED). ⋯ A better understanding of the ED model and appreciation of factors contributing to its input, throughput and output informed policy makers of the reasons for overcrowding and informed solutions. Systematic triage of patients, utilization of fast-track areas within the ED, bed-side registration and nurse-initiated protocols, have all been suggested as promising tools to overcome overcrowding.
-
Rotavirus is the leading cause of severe, dehydrating diarrhea worldwide and is responsible for more than 600 000 child deaths every year. In June 2009, the World Health Organization recommended inclusion of rotavirus vaccination in all national immunization programs. This universal endorsement of rotavirus vaccination should help the world's poorest countries to provide rotavirus vaccine to the poorest children, in order to achieve the Millennium Development Goal #4 of decreasing child mortality by two-thirds by 2015. This review will focus on the nature and epidemiology of the virus and on the history of rotavirus vaccine, its availability and current recommendations about its administration.
-
Parenteral nutrition associated liver disease is the most common complication of pediatric short bowel syndrome (SBS). There is emerging evidence that the disease may be reversed with the use of parenteral lipid emulsions derived from fish-oils, which contain significant concentrations of omega-3 fatty acids (w3FA). This paper will review the rationale for the use of parenteral lipid emulsions containing w3FA in SBS and the evidence for their efficacy. Given the promising results and apparent safety of these emulsions, we shall also consider what the current role for PN lipid emulsions containing w3FA in children with SBS should be.
-
The improvement of the imaging has considerably increased the number of cases of neuoroblastoma, diagnosed in preborn age. The authors present a case of neonatal neuroblastoma diagnosed in prenatal age and managed with a multidisciplinary approach. The authors report the case of R. ⋯ For patients younger than 18 months there is no therapeutic gold standard for the treatment of suprarenal masses of neoplastic origin, and the approach is still controversial. The complete excision of the mass should be taken in consideration in presence of an increasing neoformation, and should not include any chemotherapeutical or radiation therapy for stage I, II, IVs (INSS) or L1, MS (INGRSS) neoformations. In conclusion, the effectiveness of a multidisciplinary approach of neonatal neuroblastoma is higher in the early diagnosis and in an accurate staging of the disease, which is fundamental for the favourable prognosis.