Although the effectiveness of probiotics has only been proven in specific conditions, their use in children is massively widespread because of their perception as harmless products. Recent evidence ...raises concerns about probiotics’ safety, especially but not only in the paediatric population due to severe opportunistic infections after their use. This review aimed at summarising available case reports on invasive infections related to probiotics’ use in children. For this purpose, we assessed three electronic databases to identify papers describing paediatric patients with documented probiotic-derived invasive infections, with no language restrictions. A total of 49 case reports from 1995 to June 2021 were identified. The infections were caused by Lactobacillus spp. (35%), Saccharomyces spp. (29%), Bifidobacterium spp. (31%), Bacillus clausii (4%), and Escherichia coli (2%). Most (80%) patients were younger than 2 years old and sepsis was the most observed condition (69.4%). All the patients except one had at least one condition facilitating the development of invasive infection, with prematurity (55%) and intravenous catheter use (51%) being the most frequent. Three (6%) children died. Given the large use of probiotics, further studies aiming at evaluating the real incidence of probiotic-associated systemic infections are warranted.
Background Different definitions of family-centred care (FCC) exist in the newborn setting, and many FCC interventions have been tested, while a comprehensive review synthesising characteristics of ...existing intervention studies is still lacking. Objective This review aims at summarising the characteristics of randomised controlled trials (RCTs) on FCC interventions in neonatal intensive care units. Methods We searched PubMed, Embase, Web of Science and the Cochrane Library up to 31 January 2022, and reference lists of included studies and other reviews. Interventions were grouped into five categories according to a previous Cochrane review: (1) family support, (2) educational, (3) communication, (4) environmental interventions and (5) family-centred policies. Subgroup analyses by time period (RCTs published before vs after 2016) and by country income (based on the World Bank Classification) were conducted. Results Out of 6583 retrieved studies, 146 RCTs met the eligibility criteria, with 53 (36.3%) RCTs published after 2016. Overall, 118 (80.8%) RCTs were conducted in high-income countries, 28 (19.1%) in middle-income countries and none in low-income countries. Only two RCTs were multicountry. Although mothers were the most frequent caregiver involved, fathers were included in 41 RCTs (28.1%). Very few studies were conducted in at-term babies (nine RCTs); siblings (two RCTs) and other family members (two RCTs), maternity care units (two RCTs). The role of health professionals was unclear in 65 (44.5%) RCTs. A large variety of intervention combinations was tested, with 52 (35.6%) RCTs testing more than 1 category of interventions, and 24 (16.4%) RCTs including all 5 categories. Conclusion There is a large and rising number of RCTs on FCC interventions in neonatal intensive care units, with specific research gaps. The large variety of FCC interventions, their high complexity, the need to tailor them to the local context and major gaps in implementation suggest that implementation research is the current priority.
Background
Cystic fibrosis (CF) is a genetic disease that causes progressive lung disease with major impact on the quality of life. Lung ultrasound (LUS) allows to assess the lung involvement through ...the artefacts analysis and is increasingly used in children but is not yet used to monitor people with CF(pwCF). The main aim of this study was to describe the LUS pattern of pwCF during their routinary check‐up visit. The secondary objective was to correlate the LUS findings with pulmonary function indices.
Methods
We performed a cross‐sectional observational study, enrolling adolescents and young adults with CF. Each patient underwent clinical assessment, measurement of SpO2, assessment of lung function by spirometry and LUS.
Results
Twenty‐nine subjects with CF were included. The most frequent alterations were consolidations (72.4%) located in the left apical anterior and right apical posterior regions followed by interstitial syndrome (65.5%). The 41.4% of cases presented the lingula involvement, characterized by a consolidation with static air bronchogram, and 55.2% showed pleural irregularity mainly in the posterior apical regions. A significant correlation was found between the LUS total score and spirometric indices: FEV1 (p = .003), FVC (p = .002), Tiffenau Index <80% (p = .014), and FEF 25–75 (p = .004).
Conclusions
Our study describes LUS findings in pwCF. It also showed a correlation between LUS score and the patients' lung function measured by spirometric indices. We conclude that LUS may be useful in routine monitoring of pwCF in combination with clinical and spirometric assessment.
AimMany family-centred care (FCC) interventions have been studied in the in the setting of neonatal intensive units (NICUs), but a systematic review analysing characteristics of existing intervention ...studies was lacking. We analysed characteristics of randomised controlled trials (RCTs) on FCC interventions in NICUs.Material and MethodWe searched PubMed, EMBASE, Web of Science and the Cochrane library up to January 31, 2022, reference lists of included studies and reviews. Interventions were grouped in five categories: family support; educational; communication; environmental; policies. Subgroup analyses by time-period and country income were conducted.ResultsOut of 6583 retrieved studies, 146 RCTs were identified, with 53 (36.3%) RCTs published after 2016. Overall, 118 (80.8%) RCTs were conducted in high-income countries, 26 (17.8%) in middle-income countries, none in low-income countries. Only 2 RCTs were multi-country. 92 RCTs (63.0%) measured outcomes in children, 90 RCTs (61.6%) in parents, 32 RCTs (21.9%) in fathers, 1 RCTs in health professionals. The role of health professional, both in delivering and in receiving the interventions (e.g. training), was unclear in 65 (44.5%) RCTs. A large variety of intervention combinations was tested, with 52 (35.6%) RCTs testing more than one category of interventions, 24 (16.4%) RCTs including all five categories. A total of 77 different interventions/intervention packages were tested, reporting on 359 outcomes, with a lack of head-to-head studies comparing the same interventions. We developed menus of interventions and of related measuring methods, grouped in categories (by target population and outcomes type).Abstract OP-081 Figure 1Number of RCTs testing each category of FCC interventions (N=146).When interventions were classified into the five categories of FCC, a large variety of interventions and intervention combinations was observed. Notes: in addition to the RCTs shown in the figure, 2 RCTs (1.4%) tested environmental interventions as single interventions and 2 RCTs (1.4%) tested family-centred policies as single category interventions. Abbreviations: RCT=randomized controlled trial; FCC=family-centred care (figure 1).ConclusionsThere is a large and raising number of RCTs on FCC interventions in NICUs, and specific research gaps. The large variety of FCC interventions, their high complexity, the need to tailor them to context, and major gaps in implementation, suggest that implementation research is the current priority. The menus developed may favour both further research and implementation.
Despite advances in acute graft-versus-host disease (aGVHD) prophylaxis, current pharmacological approaches fail to prevent aGVHD. The protective effect of defibrotide on GVHD incidence and GVHD-free ...survival has not been sufficiently studied. 91 pediatric patients included in this retrospective study were divided into two groups based on defibrotide use. We compared the incidence of aGVHD and chronic GVHD-free survival between the defibrotide and control groups. The incidence and severity of aGVHD were significantly lower in patients who received defibrotide prophylactic administration than in the control group. This improvement was observed in the liver and intestinal aGVHD. No defibrotide prophylaxis benefit was observed in the prevention of chronic GVHD. The pro-inflammatory cytokine levels were significantly higher in the control group. Our findings suggest that prophylactic administration of defibrotide in pediatric patients significantly reduces the incidence and severity of aGVHD, with a modification of cytokine pattern, both strongly coherent with the protective drug's action. This evidence adds to pediatric retrospective studies and preclinical data suggesting a possible defibrotide role in this setting.
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