Minerva pediatrica
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Idiopathic nephrotic syndrome (INS) is probably due to a plasma factor of immunologic origin. This circulating factor probably interacts with the glomerular filtration barrier and is responsible for massive proteinuria. Most patients respond to steroids. ⋯ Whereas the treatment of the primary course of INS is well established, steroid dependent and steroid resistant forms are still a challenge for pediatric nephrologists. Both under-treatment with multiple relapses with disease or steroid associated morbidity on the one hand and over-treatment with specific side effects of immunosuppressive drugs may have severe consequences for the patients. The narrow path between steroid side effects and potential nephrotoxicity emphasizes the need for individualized management in severe form of INS.
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Acute kidney injury (AKI) affects 5% of critically ill hospitalized children and is a risk factor for increased morbidity and mortality. The current review focuses on new definitions of acute kidney injury, standardized to reflect the entire spectrum of the disease, as well as on ongoing research to identify early biomarkers of kidney injury. Its also provides an overview of current practice and available therapies, with emphasis on new strategies for the prevention and pharmacological treatment of diarrhea-associated hemolytic uremic syndrome. Furthermore, a decision-making algorithm is presented for the use of renal replacement therapies in critically ill children with AKI.
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The advances in perinatal care have led to a significant increase in neonatal survival rate but also to the rise of the number of invasive procedures. Several scientific studies show that newborns are able to feel pain more intensely than adults. Despite this evidence, neonatal pain and the right to an appropriate analgesia are systematically underestimated, ignoring ethical and moral principles of beneficence and non-maleficence. ⋯ The right to analgesia, fundamental principle, is fully incorporated in the Italian code of Medical deontology (article 3). The doctor who does not use analgesia for newborns' treatment can be indicted by the Italian penal code (art.582 and 583), aggravated by being the victim an infant, who is unable to defend himself. To avoid penal consequences, a careful education and attention are needed: "pediatric analgesia" should become a basic teaching in Universities and in specialization schools; analgesic treatments should be mandatory and annotated in the patient's file even for minor potentially painful procedures.
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The aim of this paper was to assess brain injury occurrence among in vitro fertilization (IVF) babies. ⋯ In IVF babies, brain injury occurred more frequently than in the rest of population. This is probably due to a higher rate of premature births and low birth weight in IVF population. Anyway, this data should be disclosed to future parents to make an informed decision.
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Fluid balance management in pediatric critically ill patients is a challenging task, since fluid overload (FO) in the pediatric ICU is considered a trigger of multiple organ dysfunction. Pediatric patients with congenital heart disease (CHD) have several pre, intra and postoperative risk factors of derangements in fluid management. In particular, the smallest patients with acute kidney injury are at highest risk of developing severe interstitial edema, capillary leak syndrome and FO. ⋯ The present review will discuss recent literature addressing the issue of fluid balance in critically ill children with CHD, dosages, benefits and drawbacks of diuretic therapy, alternative diuretic/nephroprotective drugs currently proposed in the pediatric cardiac surgery setting. Monitoring of fluid balance will be reviewed. Specific modalities of pediatric extracorporeal fluid removal will be presented.