La Pediatria medica e chirurgica : Medical and surgical pediatrics
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Review Comparative Study
[Role of extracorporeal circulation in reversible acute cardiorespiratory insufficiency in neonatal and pediatric intensive care].
In the present study we try to analyze indications, contra-indication, side effects and limits of the use of extracorporeal circulation in neonatal and pediatric patients affected by reversible acute cardiorespiratory failure. The greatest experience on this technique has been achieved in the neonatal age (about 6000 newborns have been treated until now), while the employment in the pediatric age appears more recent (about 500 patients). Moreover, we focused on the drop-in criteria for neonatal and pediatric patients and on the clinical aspects and laboratory findings which can anticipate the surviving rate; the latter appears in any case much greater in the neonatal patient compared to the other pediatric ages.
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Through a careful examination of the up-to-date literature on the subject, the Authors provide a full account of the present knowledge about the physiopathology of the status asthmaticus; at the same time they draw a practical exhaustive guide to the treatment to be carried out in hospital. The work arises from the considerable increase of mortality rate, due to asthma, recorded in the last few years.
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We report a study of 128 patients, affected by cystic fibrosis, followed by Ospedale Bambino Gesù Center for diagnosis and therapy of cystic fibrosis. We evaluated, in a retrospective study, the principal symptoms at diagnosis of cystic fibrosis, underlining the frequent finding of not classically related symptoms. ⋯ Furthermore, we report the percentages of diagnostic mistakes, which preceded cystic fibrosis diagnosis (22% of total). Considering the incidence of the disease in Italy (1:3000 live births), a careful valuation of related symptoms is necessary, even if gastrointestinal and/or respiratory disturbances are mild or underestimated, in order to reduce median age at diagnosis, still too high in Italy, compared to that reported by many North-European countries.
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Cow's milk protein is quite commune in infancy (2-3% in first year of age). Casein, beta-lactoglobulin and alpha-lactalbumin are the main allergens of cow's milk. ⋯ Moreover, the authors present their studies on immunogenicity of hydrolysed formulae. At the end they suggest the therapeutic strategy in the cow's milk protein allergy.
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The aim of this paper is evaluate the risk and the benefit to tonsillectomy and adenoidectomy in very young children. Between January 1989 and May 1993 we have operated on 166 children less than 3 years old (98 adenoidectomies and 68 adenotonsillectomies). 19 one year old children were submitted to adenoidectomy and 7 to tonsillectomy, the youngest was 7 months old. The indication for adenoidectomy were prevalent mouth breathing, snoring and recurrent otitis media; the criteria for tonsillectomy have been obstructive sleep problems, history of snoring, eating and swallowing disorders (97% of cases) and recurrent viral tonsillitis (3% of cases). ⋯ No child had postoperative bleeding. No child has been readmitted for dehydration. We conclude after this study that tonsillectomy and adenoidectomy can be a safe procedure also in very young children.