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Pattern and appropriateness of antibiotic prescriptions for upper respiratory tract infections in primary care paediatric patients.
Bianco, A, Licata, F, Nobile, CG, Napolitano, F, Pavia, M
International journal of antimicrobial agents. 2022;(1):106469
Abstract
OBJECTIVES The aim of this cross-sectional study was to investigate the pattern of antibiotic prescriptions for upper respiratory tract infections (URTIs) in children seen by primary care paediatricians (PCPs). METHODS Data were collected from face-to-face interviews administered to a sample of parents of outpatient children aged 0-14 years in two regions in Southern Italy. To be eligible, children had to be diagnosed with sinusitis, pharyngotonsillitis, otitis media, bronchitis, influenza or a common cold. The presence of an indication of antibiotic therapy was evaluated according to national and international guidelines. RESULTS An antibiotic prescription was indicated in 57 (10.1%) of the sampled patients, of whom 33.3% did not receive an antibiotic prescription; among the 508 patients for whom an antibiotic prescription was not indicated, 27.4% received a prescription. Of all PCP consultations, 72% were appropriate (an antibiotic was prescribed when indicated and not prescribed when not indicated), whilst an antibiotic prescription not indicated by guidelines was given to 24.6% of the participants, and 3.4% of the sample did not receive an antibiotic prescription when indicated. The most frequently prescribed antibiotic was amoxicillin with clavulanic acid. A rapid microbiological examination was performed in two patients. CONCLUSIONS The study findings highlight a high rate of sub-optimal antibiotic therapeutic profile. Over-prescription of antibiotic therapy and the use of broad-spectrum molecules are widespread in children with URTIs. Antibiotic under-prescription, which may deprive paediatric patients of an effective treatment when indicated, also occurs.
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The Many Roles of Pediatric Integrated Behavioral Health Specialists.
Lu, S, O'Halloran, T, Soares, N
Pediatric clinics of North America. 2021;(3):541-549
Abstract
The primary care pediatric setting is intended to provide continuous and comprehensive care throughout a child's life, ensuring overall well-being. Routinely scheduled well-child visits are ideal to assess developmental progress, environmental health, behavior/psychosocial issues, and other concerns. Delivering integrated behavioral health (IBH) in the primary care setting may aid in identifying any early concerns or difficulties and provides resources and support when these issues first emerge; thus, promoting the child's well-being. IBH should be engaged early and often to establish a relationship with families and follow them as the child develops, regardless of the presence of a precipitating behavior concern.
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Complementary Feeding and Iron Status: "The Unbearable Lightness of Being" Infants.
Miniello, VL, Verga, MC, Miniello, A, Di Mauro, C, Diaferio, L, Francavilla, R
Nutrients. 2021;(12)
Abstract
The complementary feeding (CF) period that takes place between 6 and 24 months of age is of key importance for nutritional and developmental reasons during the transition from exclusively feeding on milk to family meals. In 2021, a multidisciplinary panel of experts from four Italian scientific pediatric societies elaborated a consensus document on CF, focusing in particular on healthy term infants. The aim was to provide healthcare providers with useful guidelines for clinical practice. Complementary feeding is also the time window when iron deficiency (ID) and iron deficiency anemia (IDA) are most prevalent. Thus, it is appropriate to address the problem of iron deficiency through nutritional interventions. Adequate iron intake during the first two years is critical since rapid growth in that period increases iron requirements per kilogram more than at any other developmental stage. Complementary foods should be introduced at around six months of age, taking into account infant iron status.
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Distilling the Key Elements of Pediatric Appendicitis Clinical Practice Guidelines.
Ingram, MC, Harris, CJ, Studer, A, Martin, S, Berman, L, Alder, A, Raval, MV
The Journal of surgical research. 2021;:105-112
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Abstract
BACKGROUND Use of clinical practice guidelines (CPGs) have been shown to reduce care delays, optimize resource utilization, and improve patient outcomes. We conducted a systematized review to identify key elements that should be included in an evidence-based CPG for pediatric appendicitis. METHODS We characterized key decision points and content areas from CPGs developed from 2000 to 2019 that were identified using publicly available platforms and manual search/personal communications. RESULTS Twenty-seven CPGs were reviewed with content saturation achieved after reviewing eight. We found 16 key elements spanning from triage to postoperative care. Elements with high accord among CPGs included use of laparoscopy and delay of postoperative imaging for abscess screening until postoperative day seven. For simple appendicitis, all CPGs endorsed antibiotic cessation, diet advancement, and early activity, and 11 CPGs included same-day discharge. Elements with heterogeneity in decision-making included antibiotic selection/duration for perforated appendicitis, criteria defining perforation, and utility of postoperative laboratory evaluations. CONCLUSIONS Development of an evidence-based CPGs for pediatric appendicitis requires attention to a finite number of key decision points and content areas. Existing literature demonstrates improved patient outcomes with CPG implementation.
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Front-Of-Pack Nutrition Labelling: A Position Statement of the European Academy of Paediatrics and the European Childhood Obesity Group.
Dereń, K, Dembiński, Ł, Wyszyńska, J, Mazur, A, Weghuber, D, Łuszczki, E, Hadjipanayis, A, Koletzko, B
Annals of nutrition & metabolism. 2021;(1):23-28
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Abstract
BACKGROUND Due to the growing risk of obesity and related diseases in the population of children, effective preventive measures are of great importance. Front-of-pack (FOP) nutrition labelling may contribute to health promotion by increasing consumer awareness on the nutritional qualities of packaged foods and purchasing decisions, and it may stimulate food providers to improve the composition of products. SUMMARY Appropriate labelling should enable customers to make healthy choices quickly and intuitively. Key Messages: The European Academy of Paediatrics and the European Childhood Obesity Group makes an appeal to European Union legislators to immediately introduce a mandatory, uniform, and interpretative FOP nutrition labelling system.
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Developments in pediatrics in 2020: choices in allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, ortopedics, respiratory tract illnesses and rheumatology.
Caffarelli, C, Santamaria, F, Procaccianti, M, Piro, E, Delle Cave, V, Borrelli, M, Santoro, A, Grassi, F, Bernasconi, S, Corsello, G
Italian journal of pediatrics. 2021;(1):232
Abstract
In this article, we describe the advances in the field of pediatrics that have been published in the Italian Journal of Pediatrics in 2020. We report progresses in understanding allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, orthopedics, respiratory tract illnesses, rheumatology in childhood.
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Probiotics in Pediatrics. A Review and Practical Guide.
Depoorter, L, Vandenplas, Y
Nutrients. 2021;(7)
Abstract
The potential benefit of the administration of probiotics in children has been studied in many settings globally. Probiotics products contain viable micro-organisms that confer a health benefit on the host. Beneficial effects of selected probiotic strains for the management or prevention of selected pediatric conditions have been demonstrated. The purpose of this paper is to provide an overview of current available evidence on the efficacy of specific probiotics in selected conditions to guide pediatricians in decision-making on the therapeutic or prophylactic use of probiotic strains in children. Evidence to support the use of certain probiotics in selected pediatric conditions is often available. In addition, the administration of probiotics is associated with a low risk of adverse events and is generally well tolerated. The best documented efficacy of certain probiotics is for treatment of infectious gastroenteritis, and prevention of antibiotic-associated, Clostridioides difficile-associated and nosocomial diarrhea. Unfortunately, due to study heterogeneity and in some cases high risk of bias in published studies, a broad consensus is lacking for specific probiotic strains, doses and treatment regimens for some pediatric indications. The current available evidence thus limits the systematic administration of probiotics. The most recent meta-analyses and reviews highlight the need for more well-designed, properly powered, strain-specific and dedicated-dose response studies.
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Current updates in diagnosis and management of eosinophilic esophagitis.
Rustagi, S, Mullins, D, Yanney, E
Current problems in pediatric and adolescent health care. 2020;(5):100783
Abstract
Eosinophilic esophagitis is a relatively new, moderately-well understood disease. It is one of the leading causes of dysphagia in the pediatric population. Thought to be triggered by food ingestion, it is distinctly different from food allergies. Although endoscopy is required for diagnosis, this article will review warning signs and symptoms that aid with evaluation and diagnosis of this disease. Treatment modalities and management are evolving and more research is needed.
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The Effects of the Rome IV Criteria on Pediatric Gastrointestinal Practice.
Baaleman, DF, Di Lorenzo, C, Benninga, MA, Saps, M
Current gastroenterology reports. 2020;(5):21
Abstract
PURPOSE OF REVIEW To evaluate the impact of the implementation of the Rome IV criteria on pediatric gastrointestinal practice. RECENT FINDINGS In 2016, the Rome IV criteria were published, providing an update of symptom-based criteria to diagnose children with functional gastrointestinal disorders (FGIDs). For neonates and toddlers, Wessel's criteria for diagnosing infant colic were abandoned, and a differentiation was made between toilet-trained and non-toilet-trained children in the diagnosis of functional constipation. For children and adolescents, two new disorders (functional nausea and functional vomiting) are described, and in the diagnosis of functional dyspepsia, pain does not have to be the chief complaint anymore. This change has made functional dyspepsia the most common functional abdominal pain disorder, exceeding the prevalence of irritable bowel syndrome (IBS). Lastly, the diagnosis of abdominal migraine was narrowed, causing an appropriate drop in its prevalence.
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Pediatric screening tools for malnutrition: an update.
Hulst, JM, Huysentruyt, K, Joosten, KF
Current opinion in clinical nutrition and metabolic care. 2020;(3):203-209
Abstract
PURPOSE OF REVIEW There is ongoing interest in nutritional screening tools in pediatrics to facilitate the identification of children at risk for malnutrition who need further assessment and possible nutritional intervention. The choice for a specific tool depends on various factors. This review aims to provide an overview of recent progress in pediatric nutritional screening methods. RECENT FINDINGS We present recent studies about newly developed or adjusted tools, the applicability of nutritional screening tools in specific populations, and how to implement screening in the overall process of improving nutritional care in the pediatric hospital setting. SUMMARY Three new screening tools have been developed for use on admission to hospital: two for the mixed pediatric hospitalized population and one for infants. A simple weekly rescreening tool to identify hospital-acquired nutritional deterioration was developed for use in children with prolonged hospital stay. Different from most previous studies that only assessed the relationship between the nutritional risk score and anthropometric parameters of malnutrition, new studies in children with cancer, burns, and biliary atresia show significant associations between high nutritional risk and short-term outcome measures such as increased complication rate and weight loss. For implementation of a nutritional care process incorporating nutritional screening in daily practice, simplicity seems to be of great importance.