@article {10815, title = {Meconium-stained amniotic fluid: a risk factor for postpartum hemorrhage.}, journal = {Ther Clin Risk Manag}, volume = {14}, year = {2018}, month = {2018}, pages = {1671-1675}, abstract = {

Background/aim: Clinical data with respect to the impact of meconium on the risk of maternal hemorrhage are scarce. Therefore, in this study, we aimed to determine whether meconium-stained amniotic fluid (MSAF) represents a risk factor for postpartum hemorrhage (PPH) after vaginal delivery in a large unselected population.

Patients and methods: A retrospective cohort study evaluated 78,542 consecutive women who had a vaginal delivery between 24th and 44th weeks of gestation. The women who had undergone cesarean section were excluded to avoid possible bias. Postpartum blood loss was measured with graduated blood sack. Postpartum blood loss between 1,000 and 2,000 mL and >2,000 mL were classified as moderate and severe PPH, respectively.

Results: A total of 74,144 patients were available for analysis. According to the color of amniotic fluid (AF), two groups of patients were identified: MSAF (n=10,997) and clear AF (n=63,147). The rates of severe and massive PPH were found to be significantly higher in the MSAF group than that of clear AF group (OR=1.3, 95\% CI: 1.2-1.5, <0.001 and OR=2.5, 95\% CI: 1.5-4.2, <0.001). Operative vaginal delivery rate was found to be higher in the MSAF group than that of clear AF group, but the difference was only borderline significant (OR=1.5, 95\% CI: 1.0-2.2, =0.05). There were no significant differences between the MSAF and the clear AF groups with respect to episiotomies, second- or third-degree perineal tears, vaginal-perineal thrombus, cervical lacerations, vaginal births after cesarean section, twin deliveries, and placental retention rates.

Conclusion: To the best of our knowledge, this is the first clinical study that has investigated the role of MSAF as a risk factor for PPH after vaginal delivery in an unselected population. Our results suggest that MSAF is significantly associated with higher risk of moderate and severe PPH than clear AF.

}, issn = {1176-6336}, doi = {10.2147/TCRM.S150049}, author = {Bouch{\`e}, Carlo and Wiesenfeld, Uri and Ronfani, Luca and Simeone, Roberto and Bogatti, Paolo and Skerk, Kristina and Ricci, Giuseppe} } @article {10431, title = {Multicenter randomized, double-blind controlled trial to evaluate the efficacy of laser therapy for the treatment of severe oral mucositis induced by chemotherapy in children: laMPO RCT.}, journal = {Pediatr Blood Cancer}, volume = {65}, year = {2018}, month = {2018 Aug}, pages = {e27098}, abstract = {

OBJECTIVES: To demonstrate the efficacy of laser photobiomodulation (PBM) compared to that of placebo on severe oral mucositis (OM) in pediatric oncology patients. The primary objective was the reduction of OM grade (World Health Organization [WHO] scale) 7 days after starting PBM. Secondary objectives were reduction of pain, analgesic consumption, and incidence of side effects.

METHODS: One hundred and one children with WHO grade~>~2 chemotherapy-induced OM were enrolled in eight Italian hospitals. Patients were randomized to either PBM or sham treatment for four consecutive days (days +1 to +4). On days +4, +7, and +11, OM grade, pain (following a 0-10 numeric pain rating scale, NRS) and need for analgesics were evaluated by an operator blinded to treatment.

RESULTS: Fifty-one patients were allocated to the PBM group, and 50 were allocated to the sham group. In total, 93.7\% of PBM patients and 72\% of sham patients had OM grade~<~3 WHO on day +7 (P~=~0.01). A significant reduction of pain was registered on day +7 in the PBM versus sham group (NRS 1 [0-3] vs. 2.5 [1-5], P~<~0.006). Reduced use of analgesics was reported in the PBM group, although it was not statistically significant. No significant adverse events attributable to treatment were recorded.

CONCLUSIONS: PBM is a safe, feasible, and effective treatment for children affected by chemotherapy-induced OM, as it accelerates mucosal recovery and reduces pain.

}, issn = {1545-5017}, doi = {10.1002/pbc.27098}, author = {Gobbo, Margherita and Verzegnassi, Federico and Ronfani, Luca and Zanon, Davide and Melchionda, Fraia and Bagattoni, Simone and Majorana, Alessandra and Bardellini, Elena and Mura, Rosamaria and Piras, Alessandra and Petris, Maria Grazia and Mariuzzi, Maria Livia and Barone, Angelica and Merigo, Elisabetta and Decembrino, Nunzia and Vitale, Marina Consuelo and Berger, Massimo and Defabianis, Patrizia and Biasotto, Matteo and Ottaviani, Giulia and Zanazzo, Giulio Andrea} } @article {3615, title = {Management of central venous catheters in pediatric onco-hematology using 0.9\% sodium chloride and positive-pressure-valve needleless connector.}, journal = {Eur J Oncol Nurs}, volume = {18}, year = {2014}, month = {2014 Aug}, pages = {393-6}, abstract = {

PURPOSE: To describe, in a sample of pediatric onco-hematological patients, the rate of occlusions in unused central venous catheters (CVC) flushed once a week with a 0.9\% sodium chloride solution through a positive-pressure-valve needleless connector.

METHOD: Retrospective cohort study. Subjects aged 0-17 years were identified through a manual search in medical and nursing records and were observed for two years or until the occurrence of one of the following events: start or resume of continuous infusion; CVC removal; death. The primary study outcome was the frequency of CVC occlusion (partial or complete).

RESULTS: Fifty-one patients were identified (median age 6 years). The median duration of follow-up was 169 days (IQR 111-305). During the follow up period, 14 patients (27\%) had one CVC occlusion, in 2 cases (4\%) the occlusion was complete, in 12 (23\%) partial. All the occlusions were solved without the need for catheter removal. The lumen diameter <= 4.2 vs > 4.2 French showed a statistically significant association with occlusion at multivariate analysis (OR 4.0; 95\% CI 1.1-14.7).

CONCLUSIONS: Our findings are reassuring with respect to the management of the CVC using the adopted protocol. The study provides useful information for patient care, by verifying the performance of the adopted CVC management protocol and by identifying critical areas for nursing care.

}, keywords = {Adolescent, Catheter Obstruction, Catheterization, Central Venous, Central Venous Catheters, Child, Child, Preschool, Cohort Studies, Equipment Design, Female, Hematology, Humans, Infant, Infant, Newborn, Italy, Male, Oncology Nursing, Pediatric Nursing, Practice Guidelines as Topic, Retrospective Studies, Sodium Chloride}, issn = {1532-2122}, doi = {10.1016/j.ejon.2014.03.010}, author = {Buchini, Sara and Scarsini, Sara and Montico, Marcella and Buzzetti, Roberto and Ronfani, Luca and Decorti, Cinzia} } @article {1902, title = {Management of cryptorchidism: a survey of clinical practice in Italy.}, journal = {BMC Pediatr}, volume = {12}, year = {2012}, month = {2012}, pages = {4}, abstract = {

BACKGROUND: An evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. In Italy, current practices on UT management are little known. Our aim was to describe the current management of UT in a cohort of Italian children in comparison with the Consensus guidelines. As management of retractile testis (RT) differs, RT cases were described separately.

METHODS: Ours is a retrospective, multicenter descriptive study. An online questionnaire was filled in by 140 Italian Family Paediatricians (FP) from Associazione Culturale Pediatri (ACP), a national professional association of FP. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006. Data on 169 children were obtained. Analyses were descriptive.

RESULTS: Overall 24\% of children were diagnosed with RT, 76\% with UT. Among the latter, cryptorchidism resolved spontaneously in 10\% of cases at a mean age of 21.6 months. Overall 70\% of UT cases underwent orchidopexy at a mean age of 22.8 months (SD 10.8, range 1.2-56.4), 13\% of whom before 1 year. The intervention was performed by a paediatric surgeon in 90\% of cases, with a success rate of 91\%. Orchidopexy was the first line treatment in 82\% of cases, while preceded by hormonal treatment in the remaining 18\%. Hormonal treatment was used as first line therapy in 23\% of UT cases with a reported success rate of 25\%. Overall, 13 children did not undergo any intervention (mean age at last follow up 39.6 months). We analyzed the data from the 5 Italian Regions with the largest number of children enrolled and found a statistically significant regional difference in the use of hormonal therapy, and in the use of and age at orchidopexy.

CONCLUSIONS: Our study showed an important delay in orchidopexy. A quarter of children with cryptorchidism was treated with hormonal therapy. In line with the Consensus guidelines, surgery was carried out by a paediatric surgeon in the majority of cases, with a high success rate.

}, keywords = {Child, Preschool, Chorionic Gonadotropin, Cryptorchidism, Gonadotropin-Releasing Hormone, Guideline Adherence, Humans, Infant, Italy, Male, Middle Aged, Orchiopexy, Pediatrics, Physician{\textquoteright}s Practice Patterns, Practice Guidelines as Topic, Questionnaires, Retrospective Studies, Treatment Outcome}, issn = {1471-2431}, doi = {10.1186/1471-2431-12-4}, author = {Marchetti, Federico and Bua, Jenny and Tornese, Gianluca and Piras, Gianni and Toffol, Giacomo and Ronfani, Luca} }