@article {10780, title = {First urinary tract infections in children: the role of the risk factors proposed by the Italian recommendations.}, journal = {Acta Paediatr}, volume = {108}, year = {2019}, month = {2019 Mar}, pages = {544-550}, abstract = {

AIM: In 2009, the Italian society for paediatric nephrology suggested the need for cystography, following a first febrile urinary tract infection (UTI), only in children at high risk for dilating vesicoureteral reflux or in the event of a second infection. The aim of this study was to evaluate the adequacy of the risk factors proposed by the Italian guidelines.

METHODS: Children aged 2-36~months, managed by 10 Italian hospitals between 2009 and 2013, with a first febrile UTI were retrospectively evaluated.

RESULTS: Four hundred and fourteen children were included: 51\% female, mean age eight months. Escherichia coli was responsible of 84\% UTIs. 269 children (65\%) presented at least one risk factor, thus were further investigated: 44\% had a reflux. The presence of a pathogen other than E.~coli significantly predicted high-grade reflux, both in the univariate (Odd Ratio 2.52, 95\% Confidence Interval 1.32-4.81, p~<~0.005) and multivariate analysis (OR 2.74, 95\% CI: 1.39-5.41, p: 0.003). 26/145 children (18\%) with no risk factors experienced a second UTI, which prompted the execution of cystography, showing a dilating reflux in 11.

CONCLUSION: Among the risk factors proposed by the Italian guidelines, only the presence of a pathogen other than E.~coli significantly predicted reflux. Cystography can be postponed in children with no risk factors.

}, issn = {1651-2227}, doi = {10.1111/apa.14506}, author = {Alberici, I and La Manna, A and Pennesi, M and Starc, M and Scozzola, F and Nicolini, G and Toffolo, A and Marra, G and Chimenz, R and Sica, F and Maringhini, S and Monasta, L and Montini, G} } @article {1876, title = {First trimester maternal serum PIGF, free β-hCG, PAPP-A, PP-13, uterine artery Doppler and maternal history for the prediction of preeclampsia.}, journal = {Placenta}, volume = {33}, year = {2012}, month = {2012 Jun}, pages = {495-501}, abstract = {

OBJECTIVE: To evaluate the detection of pregnancy hypertensive disorders by integrating maternal history, serum biomarkers and uterine artery Doppler in the first trimester.

METHODS: We prospectively recruited 2118 women that underwent an 11-13 weeks aneuploidy screening. We gathered information on maternal history, uterine artery Doppler and serum biomarkers (PAPP-A, PlGF, PP-13 and free β-hCG). Models were developed for the prediction of overall preeclampsia (PE), early-onset PE, late-onset PE and gestational hypertension (GH). For each outcome, we performed a multivariate logistic regression starting from the saturated model: adopting a step-down procedure we excluded all factors not statistically significant (p > 0.05). Sensitivity models only for statistically significant parameters were calculated from the ROC curves for fixed false-positive rates (FPR).

RESULTS: Among 2118 women, 46 (2.17\%) developed GH and 25 (1.18\%) were diagnosed with PE, including 12 (0.57\%) early-onset PE and 13 (0.61\%) late-onset PE. For a fixed FPR of 10 and 5\%, serum PlGF, free β-hCG and chronic hypertension identified respectively 67 and 75\% of women who developed early-onset PE. In the model for the prediction of overall PE the combination of the uterine artery Doppler pulsatility index (UtA PI) with PlGF and chronic hypertension reached a sensitivity of 60\% for a 20\% of FPR.

CONCLUSION: An integration of maternal characteristics and first trimester maternal serum biomarkers (free β-hCG and PlGF) provided a possible screening for early-onset PE. In the overall PE model, UtA PI turned out to be statistically significant but did not improve the detection rate.

}, keywords = {Adult, Biological Markers, Chorionic Gonadotropin, beta Subunit, Human, Cohort Studies, Female, Galectins, Humans, Hypertension, Pregnancy-Induced, Pre-Eclampsia, Pregnancy, Pregnancy Complications, Pregnancy Proteins, Pregnancy Trimester, First, Pregnancy-Associated Plasma Protein-A, Prospective Studies, Ultrasonography, Prenatal, Uterine Artery, Uterus}, issn = {1532-3102}, doi = {10.1016/j.placenta.2012.03.003}, author = {Di Lorenzo, G and Ceccarello, M and Cecotti, V and Ronfani, L and Monasta, L and Vecchi Brumatti, L and Montico, M and D{\textquoteright}Ottavio, G} }