@article {10771, title = {Effectiveness of the facility-based maternal near-miss case reviews in improving maternal and newborn quality of care in low-income and middle-income countries: a systematic review.}, journal = {BMJ Open}, volume = {8}, year = {2018}, month = {2018 04 19}, pages = {e019787}, abstract = {

OBJECTIVES: The maternal near-miss case review (NMCR) has been promoted by WHO as an approach to improve quality of care (QoC) at facility level. This systematic review synthesises evidence on the effectiveness of the NMCR on QoC and maternal and perinatal health outcomes in low-income and middle-income countries (LMICs).

METHODS: Studies were searched for in six electronic databases (MEDLINE, Index Medicus, Web of Science, the Cochrane library, Embase, LILACS), with no language restrictions. Two authors independently screened papers and selected them for inclusion and independently extracted data. Maternal mortality was the primary outcome. Secondary outcomes included any outcome informing on any of the six dimensions of QoC: efficacy, safety, efficiency, equity, accessibility and timely care, acceptability and patient-centred care.

RESULTS: Out of 24 822 papers retrieved, 17 studies from 11 countries were included. Maternal mortality measured before and after the implementation of the NMCR cycle significantly decreased (OR 0.77, 95\% CI 0.61 to 0.98, eight studies, 55 573 043 women; I=39\%). A statistically significant reduction in the incidence of uterine rupture, postpartum haemorrhage and maternal sepsis was observed in three out of six studies. Ten studies reporting on maternal care process all showed some significant improvement when measured against predefined standards. All studies reported that the NMCR resulted in some amelioration of the facility structure (physical structure, staffing, equipment, training, organisation of care). Newborn outcomes were overall poorly reported; four studies showed no significant difference in perinatal mortality. Patient satisfaction and equity were also poorly reported.

CONCLUSIONS: Policy makers may consider implementing the maternal NMCR cycle approach among strategies aiming at improving QoC and reducing maternal mortality and morbidity in LMIC. Future studies should better document the effectiveness of the NMCR cycle particularly on outcomes reflecting patient-centred care and cost-effectiveness.

}, keywords = {Developing Countries, Female, Humans, Infant, Newborn, Maternal Mortality, Near Miss, Healthcare, Parturition, Patient Satisfaction, Perinatal Mortality, Postpartum Hemorrhage, Poverty, Pregnancy, Quality of Health Care, Uterine Rupture}, issn = {2044-6055}, doi = {10.1136/bmjopen-2017-019787}, author = {Lazzerini, Marzia and Richardson, Sonia and Ciardelli, Valentina and Erenbourg, Anna} } @article {10776, title = {Facilitators and barriers to the effective implementation of the individual maternal near-miss case reviews in low/middle-income countries: a systematic review of qualitative studies.}, journal = {BMJ Open}, volume = {8}, year = {2018}, month = {2018 Jun 30}, pages = {e021281}, abstract = {

BACKGROUND: The maternal near-miss cases review (NMCR), a type of clinical audit, proved to be effective in improving quality of care and decreasing maternal mortality in low/middle-income countries (LMICs). However, challenges in its implementation have been described.

OBJECTIVES: Synthesising the evidence on facilitators and barriers to the effective implementation of NMCR in LMICs.

DESIGN: Systematic review of qualitative studies.

DATA SOURCES: MEDLINE, LILACS, Global Health Library, SCI-EXPANDED, SSCI, Cochrane library and Embase were searched in December 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Qualitative studies exploring facilitators and/or barriers of implementing NMCR in LMIC were included.

DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data, performed thematic analysis and assessed risk of bias.

RESULTS: Out of 25 361 papers retrieved, 9 studies from Benin, Brazil, Burkina Faso, Cote D{\textquoteright}Ivoire, Ghana, Malawi, Morocco, Tanzania, Uganda could be included in the review. The most frequently reported barriers to NMCR implementation were the following: absence of national guidelines and local protocols; insufficient training on how to perform the audit; lack of leadership, coordination, monitoring and supervision; lack of resources and work overload; fear of blame and punishment; poor knowledge of evidenced-based medicine; hierarchical differences among staff and poor understating of the benefits of the NMCR. Major facilitators to NMCR implementation included: good leadership and coordination; training of all key staff; a good cultural environment; clear staff{\textquoteright}s perception on the benefits of conducting audit; patient empowerment and the availability of external support.

CONCLUSIONS: In planning the NMCR implementation in LMICs, policy-makers should consider actions to prevent and mitigate common challenges to successful NMCR implementation. Future studies should aim at documenting facilitators and barriers to NMCR outside the African Region.

}, issn = {2044-6055}, doi = {10.1136/bmjopen-2017-021281}, author = {Lazzerini, Marzia and Ciuch, Margherita and Rusconi, Silvia and Covi, Benedetta} } @article {10863, title = {Quality of care for children with acute malnutrition at health center level in Uganda: a cross sectional study in West Nile region during the refugee crisis.}, journal = {BMC Health Serv Res}, volume = {18}, year = {2018}, month = {2018 07 17}, pages = {561}, abstract = {

BACKGROUND: Arua district, in Uganda, hosts some of the largest refugee camps in the country. The estimated prevalence of moderate and severe acute malnutrition in children is higher than the national estimates (10.4 and 5.6\% respectively, compared to 3.6 and 1.3\%). This study aimed at assessing the quality of care provided to children with acute malnutrition at out-patient level in such a setting.

METHODS: Six facilities with the highest number of children with malnutrition were selected. The main tool used was the National Nutrition Service Delivery Assessment Tool, assessing 10 key areas of service delivery and assigned a score as either poor, fair, good or excellent. Health outcomes, quality of case management and data quality were assessed from the health management information system and from the official nutrition registers.

RESULTS: All facilities except two scored either poor or fair under all the 10 assessment areas. Overall, 33/60 (55\%) areas scored as poor, 25/60 (41\%) as fair, 2/60 (3.3\%) as good, and none as excellent. Main gaps identified included: lack of trained staff; disorganised patient flow; poor case management; stock out of essential supplies including ready-to-use therapeutic foods; weak community linkage. A sample coverage of 45.4\% (1020/2248) of total children admitted in the district during the 2016 financial year were included. The overall mean cure rate was 52.9\% while the default rate was 38.3\%. There was great heterogeneity across health facilities in health outcomes, quality of case management, and data quality.

CONCLUSION: This study suggests that quality of care provided to children with malnutrition at health center level is substandard with unacceptable low cure rates. It is essential to identify effective approaches to enhance adherence to national guidelines, provision of essential nutritional commodities, regular monitoring of services and better linkage with the community through village health teams.

}, keywords = {Child Nutrition Disorders, Child, Preschool, Cross-Sectional Studies, Health Facilities, Humans, Nutrition Assessment, Nutritional Status, Prevalence, Quality of Health Care, Refugee Camps, Refugees, Uganda}, issn = {1472-6963}, doi = {10.1186/s12913-018-3366-5}, author = {Wanzira, Humphrey and Muyinda, Richard and Lochoro, Peter and Putoto, Giovanni and Segafredo, Giulia and Wamani, Henry and Lazzerini, Marzia} } @article {10855, title = {What is the quality of the maternal near-miss case reviews in WHO European Region? Cross-sectional study in Armenia, Georgia, Latvia, Republic of Moldova and Uzbekistan.}, journal = {BMJ Open}, volume = {8}, year = {2018}, month = {2018 04 12}, pages = {e017696}, abstract = {

OBJECTIVES: The maternal near-miss case review (NMCR) cycle is a type of clinical audit aiming at improving quality of maternal healthcare by discussing near-miss cases. In several countries this approach has been introduced and supported by WHO and partners since 2004, but information on the quality of its implementation is missing. This study aimed at evaluating the quality of the NMCR implementation in selected countries within WHO European Region.

DESIGN: Cross-sectional study.

SETTINGS: Twenty-three maternity units in Armenia, Georgia, Latvia, Moldova and Uzbekistan.

ASSESSMENT TOOLS: A predefined checklist including 50 items, according to WHO methodology. Quality in the NMCR implementation was defined by summary scores ranging from 0 (totally inappropriate) to 3 (appropriate).

RESULTS: Quality of the NMCR implementation was heterogeneous among different countries, and within the same country. Overall, the first part of the audit cycle (from case identification to case analysis) was fairly well performed (mean score 2.00, 95\% CI 1.94 to 2.06), with the exception of the {\textquoteright}inclusion of users{\textquoteright} views{\textquoteright} (mean score 0.66, 95\% CI 0.11 to 1.22), while the second part (developing recommendations, implementing them and ensuring quality) was poorly performed (mean score 0.66, 95\% CI 0.11 to 1.22). Each country had at least one champion facility, where quality of the NMCR cycle was acceptable. Quality of the implementation was not associated with its duration. Gaps in implementation were of technical, organisational and attitudinal nature.

CONCLUSIONS: Ensuring quality in the NMCR may be difficult but achievable. The high heterogeneity in results within the same country suggests that quality of the NMCR implementation depends, to a large extent, from hospital factors, including staff{\textquoteright}s commitment, managerial support and local coordination. Efforts should be put in preventing and mitigating common barriers that hamper successful NMCR implementation.

}, keywords = {Armenia, Checklist, Cross-Sectional Studies, Female, Georgia, Humans, Latvia, Maternal Mortality, Medical Audit, Moldova, Near Miss, Healthcare, Pregnancy, Pregnancy Complications, Quality Improvement, Uzbekistan}, issn = {2044-6055}, doi = {10.1136/bmjopen-2017-017696}, author = {Bacci, Alberta and Hodorogea, Stelian and Khachatryan, Henrik and Babojonova, Shohida and Irsa, Signe and Jansone, Maira and Dondiuc, Iurie and Matarazde, George and Lazdane, Gunta and Lazzerini, Marzia} } @article {10473, title = {Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Clinical and Hypoxemic Childhood Pneumonia over Three Years in Central Malawi: An Observational Study.}, journal = {PLoS One}, volume = {12}, year = {2017}, month = {2017}, pages = {e0168209}, abstract = {

BACKGROUND: The pneumococcal conjugate vaccine{\textquoteright}s (PCV) impact on childhood pneumonia during programmatic conditions in Africa is poorly understood. Following PCV13 introduction in Malawi in November 2011, we evaluated the case burden and rates of childhood pneumonia.

METHODS AND FINDINGS: Between January 1, 2012-June 30, 2014 we conducted active pneumonia surveillance in children <5 years at seven hospitals, 18 health centres, and with 38 community health workers in two districts, central Malawi. Eligible children had clinical pneumonia per Malawi guidelines, defined as fast breathing only, chest indrawing +/- fast breathing, or, >=1 clinical danger sign. Since pulse oximetry was not in the Malawi guidelines, oxygenation <90\% defined hypoxemic pneumonia, a distinct category from clinical pneumonia. We quantified the pneumonia case burden and rates in two ways. We compared the period immediately following vaccine introduction (early) to the period with >75\% three-dose PCV13 coverage (post). We also used multivariable time-series regression, adjusting for autocorrelation and exploring seasonal variation and alternative model specifications in sensitivity analyses. The early versus post analysis showed an increase in cases and rates of total, fast breathing, and indrawing pneumonia and a decrease in danger sign and hypoxemic pneumonia, and pneumonia mortality. At 76\% three-dose PCV13 coverage, versus 0\%, the time-series model showed a non-significant increase in total cases (+47\%, 95\% CI: -13\%, +149\%, p = 0.154); fast breathing cases increased 135\% (+39\%, +297\%, p = 0.001), however, hypoxemia fell 47\% (-5\%, -70\%, p = 0.031) and hospital deaths decreased 36\% (-1\%, -58\%, p = 0.047) in children <5 years. We observed a shift towards disease without danger signs, as the proportion of cases with danger signs decreased by 65\% (-46\%, -77\%, p<0.0001). These results were generally robust to plausible alternative model specifications.

CONCLUSIONS: Thirty months after PCV13 introduction in Malawi, the health system burden and rates of the severest forms of childhood pneumonia, including hypoxemia and death, have markedly decreased.

}, keywords = {Child, Child Mortality, Cost of Illness, Dose-Response Relationship, Immunologic, Geography, Humans, Hypoxia, Malawi, Pneumococcal Vaccines, Pneumonia, Pneumococcal, Time Factors, Vaccines, Conjugate}, issn = {1932-6203}, doi = {10.1371/journal.pone.0168209}, author = {McCollum, Eric D and Nambiar, Bejoy and Deula, Rashid and Zadutsa, Beatiwel and Bondo, Austin and King, Carina and Beard, James and Liyaya, Harry and Mankhambo, Limangeni and Lazzerini, Marzia and Makwenda, Charles and Masache, Gibson and Bar-Zeev, Naor and Kazembe, Peter N and Mwansambo, Charles and Lufesi, Norman and Costello, Anthony and Armstrong, Ben and Colbourn, Tim} } @article {10522, title = {Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan.}, journal = {Bull World Health Organ}, volume = {95}, year = {2017}, month = {2017 Jun 01}, pages = {397-407}, abstract = {

OBJECTIVE: To determine whether periodic supportive supervision after a training course improved the quality of paediatric hospital care in Kyrgyzstan, where inappropriate care was common but in-hospital postnatal mortality was low.

METHODS: In a cluster, randomized, parallel-group trial, 10 public hospitals were allocated to a 4-day World Health Organization (WHO) course on hospital care for children followed by periodic supportive supervision by paediatricians for 1~year, while 10 hospitals had no intervention. We assessed prospectively 10 key indicators of inappropriate paediatric case management, as indicated by WHO guidelines. The primary indicator was the combination of the three indicators: unnecessary hospitalization, increased iatrogenic risk and unnecessary painful procedures. An independent team evaluated the overall quality of care.

FINDINGS: We prospectively reviewed the medical records of 4626 hospitalized children aged 2 to 60~months. In the intervention hospitals, the mean proportion of the primary indicator decreased from 46.9\% (95\% confidence interval, CI: 24.2 to 68.9) at baseline to 6.8\% (95\% CI: 1.1 to 12.1) at 1~year, but was unchanged in the control group (45.5\%, 95\% CI: 25.2 to 67.9, to 64.7\%, 95\% CI: 43.3 to 86.1). At 1~year, the risk ratio for the primary indicator in the intervention versus the control group was 0.09 (95\% CI: 0.06 to 0.13). The proportions of the other nine indicators also decreased in the intervention group ( < 0.0001 for all). Overall quality of care improved significantly in intervention hospitals.

CONCLUSION: Periodic supportive supervision for 1~year after a training course improved both adherence to WHO guidelines on hospital care for children and the overall quality of paediatric care.

}, keywords = {Child, Child Care, Cluster Analysis, Hospitalization, Hospitals, Public, Humans, Kyrgyzstan, Medical Audit, Pediatricians, Professional Role, Prospective Studies, Quality Improvement}, issn = {1564-0604}, doi = {10.2471/BLT.16.176982}, author = {Lazzerini, Marzia and Shukurova, Venera and Davletbaeva, Marina and Monolbaev, Kubanychbek and Kulichenko, Tatiana and Akoev, Yuri and Bakradze, Maya and Margieva, Tea and Mityushino, Ilya and Namazova-Baranova, Leyla and Boronbayeva, Elnura and Kuttumuratova, Aigul and Weber, Martin Willy and Tamburlini, Giorgio} } @article {8491, title = {Dyslipidemia, Diet, and Physical Exercise in Children on Treatment with Anti-Retroviral Medication in El Salvador: A Cross-Sectional Study.}, journal = {Pediatr Infect Dis J}, year = {2016}, month = {2016 May 31}, abstract = {

BACKGROUND: Dyslipidemias are common in HIV-infected children, especially if treated with protease-inhibitors, but there are few data on how to treat dyslipidemias in this population. We estimated the dislypidemia prevalence and its association with treatment, diet, and physical exercise in children on anti-retroviral treatment at the El Salvador reference center for pediatric HIV care (CENID).

METHODS: Information was gathered regarding socio-demographic characteristics, treatment, diet, and physical activity of 173 children aged 5-18 years and receiving anti-retroviral therapy.Triglycerides, total cholesterol, low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), viral load, and CD4 T-lymphocytes were measured. Abnormal concentrations were defined as triglycerides >=130 mg/dl in 10- to 18-year-olds and >=100 mg/dl in <10 year-olds; total cholesterol >=200 mg/dl; LDL-C >=130 mg/dl; and HDL-C <=35 mg/dl.We adjusted four different multivariate models to assess the independent association of each type of dyslipidemia with protease-inhibitors, diet, and physical exercise.

RESULTS: Of the 173 children, 83 (48\%) had hypertriglyceridemia and 25 (14.5\%) hypercholesterolemia. High LDL-C concentrations were observed in 17 children (9.8\%) and low HDL-C in 38 (22\%). Treatment with protease-inhibitors was significantly associated with hypertriglyceridemia (Prevalence Ratio (PR) 2.8; 95\%CI 2.0-3.8) and hypercholesterolemia (PR 9.0; 95\%CI 3.6-22.2).Higher adherence to a "high fat/sugar diet" was associated with hypercholesterolemia (PR 1.6; 95\%CI 1.1-2.3) and high LDL-C (PR 1.7; 95\%CI 1.0-2.9).Compared with those exercising <3 times/week, children exercising >=7 times were less likely to have low HDL-C (PR=0.4; 95\%CI 0.2-0.7).

CONCLUSIONS: These results suggest that a healthy diet and exercise habits can contribute to controlling some aspects of the lipid profile in this population.

}, issn = {1532-0987}, doi = {10.1097/INF.0000000000001244}, author = {Sonego, Michela and Sagrado, Maria Jos{\'e} and Escobar, Gustavo and Lazzerini, Marzia and Rivas, Estefanie and Mart{\'\i}n-Ca{\~n}avate, Rocio and de L{\'o}pez, Elsy P{\'e}rez and Ayala, Sandra and Castaneda, Luis and Aparicio, Pilar and Custodio, Estefan{\'\i}a} } @article {8285, title = {Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001-12: a retrospective observational study.}, journal = {Lancet Glob Health}, volume = {4}, year = {2016}, month = {2016 Jan}, pages = {e57-68}, abstract = {

BACKGROUND: Few studies have reported long-term data on mortality rates for children admitted to hospital with pneumonia in Africa. We examined trends in case fatality rates for all-cause clinical pneumonia and its risk factors in Malawian children between 2001 and 2012.

METHODS: Individual patient data for children (<5 years) with clinical pneumonia who were admitted to hospitals participating in Malawi{\textquoteright}s Child Lung Health Programme between 2001 and 2012 were recorded prospectively on a standardised medical form. We analysed trends in pneumonia mortality and children{\textquoteright}s clinical characteristics, and we estimated the association of risk factors with case fatality for children younger than 2 months, 2-11 months of age, and 12-59 months of age using separate multivariable mixed effects logistic regression models.

FINDINGS: Between November, 2012, and May, 2013, we retrospectively collected all available hard copies of yellow forms from 40 of 41 participating hospitals. We examined 113 154 pneumonia cases, 104 932 (92{\textperiodcentered}7\%) of whom had mortality data and 6903 of whom died, and calculated an overall case fatality rate of 6{\textperiodcentered}6\% (95\% CI 6{\textperiodcentered}4-6{\textperiodcentered}7). The case fatality rate significantly decreased between 2001 (15{\textperiodcentered}2\% [13{\textperiodcentered}4-17{\textperiodcentered}1]) and 2012 (4{\textperiodcentered}5\% [4{\textperiodcentered}1-4{\textperiodcentered}9]; ptrend<0{\textperiodcentered}0001). Univariable analyses indicated that the decrease in case fatality rate was consistent across most subgroups. In multivariable analyses, the risk factors significantly associated with increased odds of mortality were female sex, young age, very severe pneumonia, clinically suspected Pneumocystis jirovecii infection, moderate or severe underweight, severe acute malnutrition, disease duration of more than 21 days, and referral from a health centre. Increasing year between 2001 and 2012 and increasing age (in months) were associated with reduced odds of mortality. Fast breathing was associated with reduced odds of mortality in children 2-11 months of age. However, case fatality rate in 2012 remained high for children with very severe pneumonia (11{\textperiodcentered}8\%), severe undernutrition (15{\textperiodcentered}4\%), severe acute malnutrition (34{\textperiodcentered}8\%), and symptom duration of more than 21 days (9{\textperiodcentered}0\%).

INTERPRETATION: Pneumonia mortality and its risk factors have steadily improved in the past decade in Malawi; however, mortality remains high in specific subgroups. Improvements in hospital care may have reduced case fatality rates though a lack of sufficient data on quality of care indicators and the potential of socioeconomic and other improvements outside the hospital precludes adequate assessment of why case-fatality rates fell. Results from this study emphasise the importance of effective national systems for data collection. Further work combining this with data on trends in the incidence of pneumonia in the community are needed to estimate trends in the overall risk of mortality from pneumonia in children in Malawi.

FUNDING: Bill \& Melinda Gates Foundation.

}, issn = {2214-109X}, doi = {10.1016/S2214-109X(15)00215-6}, author = {Lazzerini, Marzia and Seward, Nadine and Lufesi, Norman and Banda, Rosina and Sinyeka, Sophie and Masache, Gibson and Nambiar, Bejoy and Makwenda, Charles and Costello, Anthony and McCollum, Eric D and Colbourn, Tim} } @article {8485, title = {Oral zinc provision in acute diarrhea.}, journal = {Curr Opin Clin Nutr Metab Care}, volume = {19}, year = {2016}, month = {2016 May}, pages = {239-43}, abstract = {

PURPOSE OF REVIEW: The clinical management of acute diarrhea is based on the use of oral rehydration salts and appropriate nutrition. In addition, the WHO and The United Nations Children{\textquoteright}s Fund recommend zinc supplementation for diarrhea in children below 5 years. This article aims at reviewing recent literature on the effects of oral zinc for treating acute diarrhea in children.

RECENT FINDINGS: Recent studies confirm that zinc supplementation has a benefit in children below 5 years with acute diarrhea in countries at medium or high risk of zinc deficiency. A few small trials have reported a benefit of zinc in children at low risk of zinc deficiency, with heterogeneity in results. No recent study has explored the effects of zinc in children younger than 6 months, and in this age group previous research refuted any benefit from zinc.

SUMMARY: Current literature supports the use of oral zinc in treating diarrhea in children older than 6 months, especially if at risk of zinc deficiency, such as children with poor diets exposed to recurrent gastrointestinal infections. More research is needed to confirm findings in children at low risk of zinc deficiency. Currently there is no evidence that zinc benefits children younger than 6 months.

}, issn = {1473-6519}, doi = {10.1097/MCO.0000000000000276}, author = {Lazzerini, Marzia} } @article {8494, title = {Thalidomide for inflammatory bowel disease: Systematic review.}, journal = {Medicine (Baltimore)}, volume = {95}, year = {2016}, month = {2016 Jul}, pages = {e4239}, abstract = {

BACKGROUND: Thalidomide is an immunomodulatory drug used in the experimental treatment of refractory Crohn disease and ulcerative colitis. We aimed to review the existing evidence on the efficacy and safety of thalidomide in the treatment of inflammatory bowel diseases.

METHODS: CENTRAL, MEDLINE, LILACS, POPLINE, CINHAL, and Web of Science were searched in March 2016. Manual search included conference and reference lists. All types of studies, except single case reports, were included. Outcomes evaluated were: induction of remission; maintenance of remission; steroid reduction; effect on penetrating Crohn disease; endoscopic remission; adverse events.

RESULTS: The research strategies retrieved 722 papers. Two randomized controlled trials and 29 uncontrolled studies for a total of 489 patients matched the inclusion criteria. Thalidomide induced a clinical response in 296/427 (69.3\%) patients. Clinical remission was achieved in 220/427 (51.5\%) cases. Maintenance of remission was reported in 128/160 (80.0\%) patients at 6 months and in 96/133 (72.2\%) at 12 months. Reduction in steroid dosage was reported in 109/152 (71.7\%) patients. Fistulas improved in 49/81 (60.5\%) cases and closed in 28/81 (34.6\%). Endoscopic improvement was observed in 46/66 (69.7\%) and complete mucosal healing in 35/66 (53.0\%) patients. Cumulative incidence of total adverse events and of those leading to drug suspension was 75.6 and 19.7/1000 patient-months, respectively. Neurological disturbances accounted for 341/530 (64.3\%) adverse events and were the most frequent cause of drug withdrawal.

CONCLUSION: Existing evidence suggests that thalidomide may be a valid treatment option for patients with inflammatory bowel diseases refractory to other first- and second-line treatments.

}, issn = {1536-5964}, doi = {10.1097/MD.0000000000004239}, author = {Bramuzzo, Matteo and Ventura, Alessandro and Martelossi, Stefano and Lazzerini, Marzia} } @article {7708, title = {Effect of Thalidomide on Clinical Remission in Children and Adolescents with Ulcerative Colitis Refractory to Other Immunosuppressives: Pilot Randomized Clinical Trial.}, journal = {Inflamm Bowel Dis}, volume = {21}, year = {2015}, month = {2015 Aug}, pages = {1739-49}, abstract = {

BACKGROUND: In a randomized controlled trial, thalidomide has shown to be effective in refractory Crohn{\textquoteright}s disease in children. This pilot study aimed at evaluating thalidomide in refractory pediatric ulcerative colitis (UC).

METHODS: Double-blind, placebo-controlled randomized clinical trial on thalidomide 1.5 to 2.5 mg/kg/day in children with active UC despite multiple immunosuppressive treatments. In an open-label extension, nonresponders to placebo received thalidomide for an additional 8 weeks; all responders were followed up for a minimum of 52 weeks.

RESULTS: Twenty-six children with refractory UC were randomized to thalidomide or placebo. Clinical remission at week 8 was achieved by significantly more children treated with thalidomide {10/12 (83.3\%) versus 2/11 (18.8\%); risk ratio, 4.5 (95\% confidence interval [CI], 1.2-16.4); P = 0.005; number needed to treat, 1.5}. Of the nonresponders to placebo who were switched to thalidomide, 8 of 11 (72.7\%) subsequently reached remission at week 8 (risk ratio, 4.0 [95\% CI, 1.1-14.7]; number needed to treat, 2.45; P = 0.01). Clinical remission in the thalidomide group was 135.0 weeks (95\% CI, 32-238), compared with 8.0 weeks (95\% CI, 2.4-13.6) in the placebo group (P < 0.0001). Cumulative incidence of severe adverse events was 3.1 per 1000 patient-weeks. Peripheral neuropathy and amenorrhea were the most frequent adverse events.

CONCLUSIONS: In this pilot randomized controlled trial on cases of UC refractory to immunosuppressive therapy, thalidomide compared with placebo resulted in improved clinical remission at 8 weeks of treatment and in longer term maintenance of remission. These findings require replication in larger clinical studies evaluating both thalidomide efficacy and safety.

}, issn = {1536-4844}, doi = {10.1097/MIB.0000000000000437}, author = {Lazzerini, Marzia and Martelossi, Stefano and Magazz{\`u}, Giuseppe and Pellegrino, Salvatore and Lucanto, Maria Cristina and Barabino, Arrigo and Calvi, Angela and Arrigo, Serena and Lionetti, Paolo and Lorusso, Monica and Mangiantini, Francesca and Fontana, Massimo and Zuin, Giovanna and Palla, Gabriella and Maggiore, Giuseppe and Bramuzzo, Matteo and Pellegrin, Maria Chiara and Maschio, Massimo and Villanacci, Vincenzo and Manenti, Stefania and Decorti, Giuliana and De Iudicibus, Sara and Paparazzo, Rossella and Montico, Marcella and Ventura, Alessandro} } @article {8037, title = {Hypoxaemia as a Mortality Risk Factor in Acute Lower Respiratory Infections in Children in Low and Middle-Income Countries: Systematic Review and Meta-Analysis.}, journal = {PLoS One}, volume = {10}, year = {2015}, month = {2015}, pages = {e0136166}, abstract = {

OBJECTIVE: To evaluate the association between hypoxaemia and mortality from acute lower respiratory infections (ALRI) in children in low- and middle-income countries (LMIC).

DESIGN: Systematic review and meta-analysis.

STUDY SELECTION: Observational studies reporting on the association between hypoxaemia and death from ALRI in children below five years in LMIC.

DATA SOURCES: Medline, Embase, Global Health Library, Lilacs, and Web of Science to February 2015.

RISK OF BIAS ASSESSMENT: Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger{\textquoteright}s test to evaluate publication bias.

RESULTS: Out of 11,627 papers retrieved, 18 studies from 13 countries on 20,224 children met the inclusion criteria. Twelve (66.6\%) studies had either low or moderate risk of bias. Hypoxaemia defined as oxygen saturation rate (SpO2) <90\% associated with significantly increased odds of death from ALRI (OR 5.47, 95\% CI 3.93 to 7.63) in 12 studies on 13,936 children. An Sp02 <92\% associated with a similar increased risk of mortality (OR 3.66, 95\% CI 1.42 to 9.47) in 3 studies on 673 children. Sensitivity analyses (excluding studies with high risk of bias and using adjusted OR) and subgroup analyses (by: altitude, definition of ALRI, country income, HIV prevalence) did not affect results. Only one study was performed on children living at high altitude.

CONCLUSIONS: The results of this review support the routine evaluation of SpO2 for identifying children with ALRI at increased risk of death. Both a Sp02 value of 92\% and 90\% equally identify children at increased risk of mortality. More research is needed on children living at high altitude. Policy makers in LMIC should aim at improving the regular use of pulse oximetry and the availability of oxygen in order to decrease mortality from ALRI.

}, issn = {1932-6203}, doi = {10.1371/journal.pone.0136166}, author = {Lazzerini, Marzia and Sonego, Michela and Pellegrin, Maria Chiara} } @article {7745, title = {Orofacial granulomatosis in children: think about Crohn{\textquoteright}s disease.}, journal = {Dig Liver Dis}, volume = {47}, year = {2015}, month = {2015 Apr}, pages = {338-41}, abstract = {

BACKGROUND: The term orofacial granulomatosis is conventionally used to describe patients with granulomatous lesions affecting the orofacial tissues, in absence of intestinal lesions. Lip swelling and facial swelling are the most common clinical signs. Despite the fact that histologically it is not distinguishable from Crohn{\textquoteright}s disease, and that both diseases have a chronic/recurrent course, the relationship between orofacial granulomatosis and Crohn{\textquoteright}s disease is still debated.

METHODS: Herein we present five cases of orofacial granulomatosis.

RESULTS: All patients presented concomitant Crohn{\textquoteright}s disease, supporting the hypothesis that orofacial granulomatosis and Crohn{\textquoteright}s disease may be one single disease. Thalidomide was effective in inducing remission of oral and intestinal symptoms in all five cases and could be considered a valid treatment opportunity for these patients.

CONCLUSIONS: Orofacial granulomatosis and Crohn{\textquoteright}s disease may be part of the same disease; both may respond to thalidomide.

}, keywords = {Adolescent, Biopsy, Child, Colonoscopy, Crohn Disease, Diagnosis, Differential, Female, Granulomatosis, Orofacial, Humans, Immunosuppressive Agents, Male, Thalidomide}, issn = {1878-3562}, doi = {10.1016/j.dld.2014.12.012}, author = {Lazzerini, Marzia and Martelossi, Stefano and Cont, Gabriele and Bersanini, Chiara and Ventura, Giovanna and Fontana, Massimo and Zuin, Giovanna and Ventura, Alessandro and Taddio, Andrea} } @article {7687, title = {Reply to Thalidomide Treatment of Pediatric Ulcerative Colitis: A New Use for an Old Drug.}, journal = {Inflamm Bowel Dis}, volume = {21}, year = {2015}, month = {2015 Aug}, pages = {1752-3}, keywords = {Crohn Disease, Female, Humans, Immunosuppressive Agents, Male, Thalidomide}, issn = {1536-4844}, doi = {10.1097/MIB.0000000000000451}, author = {Lazzerini, Marzia and Martelossi, Stefano and Ventura, Alessandro} } @article {8054, title = {Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies.}, journal = {PLoS One}, volume = {10}, year = {2015}, month = {2015}, pages = {e0116380}, abstract = {

OBJECTIVE: To evaluate risk factors for death from acute lower respiratory infections (ALRI) in children in low- and middle-income countries.

DESIGN: Systematic review and meta-analysis.

STUDY SELECTION: Observational studies reporting on risk factors for death from ALRI in children below five years in low- and middle income countries.

DATA SOURCES: Medline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014.

RISK OF BIAS ASSESSMENT: Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger{\textquoteright}s test to evaluate publication bias.

RESULTS: Out of 10,655 papers retrieved, 77 studies from 39 countries (198,359 children) met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95\% confidence interval 6.37-13.92); age below two months (5.22, 1.70-16.03); diagnosis of Pneumocystis Carinii (4.79, 2.67-8.61), chronic underlying diseases (4.76, 3.27-6.93); HIV/AIDS (4.68, 3.72-5.90); and severe malnutrition (OR 4.27, 3.47-5.25). Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03-3.31); low maternal education (1.43, 1.13-1.82); low socio-economic status (1.62, 1.32-2.00); second-hand smoke exposure (1.52, 1.20 to 1.93); indoor air pollution (3.02, 2.11-4.31). Immunisation (0.46, 0.36-0.58) and good antenatal practices (0.50, 0.31-0.81) were associated with decreased odds of death.

CONCLUSIONS: Host and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to reduce ALRI mortality in children in low- and middle-income countries.

}, keywords = {Child, Preschool, Developing Countries, Environmental Exposure, Humans, Infant, Infant, Newborn, Observational Studies as Topic, Poverty, Respiratory Tract Infections, Risk Factors, Survival Analysis}, issn = {1932-6203}, doi = {10.1371/journal.pone.0116380}, author = {Sonego, Michela and Pellegrin, Maria Chiara and Becker, Genevieve and Lazzerini, Marzia} } @article {3556, title = {Association between orofacial granulomatosis and Crohn{\textquoteright}s disease in children: systematic review.}, journal = {World J Gastroenterol}, volume = {20}, year = {2014}, month = {2014 Jun 21}, pages = {7497-504}, abstract = {

AIM: To review pediatric cases of orofacial granulomatosis (OFG), report disease characteristics, and explore the association between OFG and Crohn{\textquoteright}s disease.

METHODS: We conducted a systematic review according to the PRISMA guidelines. We searched Medline, LILACS, Virtual Health Library, and Web of Knowledge in September 2013 for cases of OFG in the pediatric age range (< 18 years), with no language limitations. All relevant articles were accessed in full text. The manual search included references of retrieved articles. We extracted data on patients{\textquoteright} characteristics, disease characteristics, association with other diseases, and treatment. We analyzed the data and reported the results in tables and text.

RESULTS: We retrieved 173 reports of OFG in children. Mean age at onset was 11.1 {\textpm} 3.8 years (range: 2.0-18 years). Prevalence in males was significant higher than in females (P < 0.001), with a male:female ratio of 2:1. Gastrointestinal signs or symptoms were present in 26.0\% of children at the time of OFG diagnosis. Overall, 70/173 (40.4\%) children received a concomitant diagnosis of Crohn{\textquoteright}s disease. In about half (51.4\%) of the cases the onset of OFG anticipated the diagnosis of Crohn{\textquoteright}s disease, with a mean time between the two diagnoses of 13.1 {\textpm} 11.6 mo (range: 3-36 mo). Overall, 21/173 (12.1\%) of the children with OFG had perianal disease, while 11/173 (6.4\%) had a family history of Crohn{\textquoteright}s disease. Both perianal disease and a family history of Crohn{\textquoteright}s disease were significantly associated with a higher risk of Crohn{\textquoteright}s disease diagnosis in children with OFG [relative risk (RR) = 3.10, 95\% confidence interval (CI): 2.46-3.90; RR = 2.74, 95\%CI: 2.24-3.36, P < 0.0001 for both). Treatment of OFG included steroids (70.8\% of children) and other immunosuppressive drugs (42.7\%), such as azathioprine, thalidomide and infliximab.

CONCLUSION: High prevalence of Crohn{\textquoteright}s disease in children with OFG suggests that OFG may be a subtype of Crohn{\textquoteright}s disease.

}, keywords = {Adolescent, Age of Onset, Child, Child, Preschool, Crohn Disease, Female, Granulomatosis, Orofacial, Humans, Immunosuppressive Agents, Male, Prevalence, Risk Factors, Steroids, Treatment Outcome}, issn = {2219-2840}, doi = {10.3748/wjg.v20.i23.7497}, author = {Lazzerini, Marzia and Bramuzzo, Matteo and Ventura, Alessandro} } @article {3583, title = {Teleradiology for remote consultation using iPad improves the use of health system human resources for paediatric fractures: prospective controlled study in a tertiary care hospital in Italy.}, journal = {BMC Health Serv Res}, volume = {14}, year = {2014}, month = {2014}, pages = {327}, abstract = {

BACKGROUND: The growing cost of health care and lack of specialised staff have set e-Health high on the European political agenda. In a prospective study we evaluated the effect of providing images for remote consultation through an iPad on the number of in-hospital orthopaedic consultations for children with bone fractures.

METHODS: Children from 0 to 18 years diagnosed with a bone fracture by the radiologist during the hours when an orthopaedic service is provided only on-call were eligible for enrollment. Cases were enrolled prospectively during September and October 2013. A standard approach (verbal information only, no X-Ray provided remotely) was compared to an experimental approach (standard approach plus the provision of X-ray for remote consultation through an iPad). The primary outcome was the number of orthopaedic in-hospital consultations that occurred. Other outcomes included: immediate activation of other services; time needed for decision-making; technical difficulties; quality of images and diagnostic confidence (on a likert scale of 1 to 10).

RESULTS: Forty-two children were enrolled in the study. Number of in-hospital consultancies dropped from 32/42 (76.1\%) when no X-ray was provided to 16/42 (38\%) when the X-rays was provided (p < 0.001). With remote X-ray consultation in 14/42 (33.3\%) cases services such as surgery and plaster room could be immediately activated, compared to no service activated without teleradiology (p < 0.001). Average time for decision making was 23.4 {\textpm} 21.8 minutes with remote X-ray consultation, compared to 56.2 {\textpm} 16.1 when the X-ray was not provided (p < 0.001). The comparison between images on the iPad and on the standard system for X- Ray visualisation resulted in a non statistically significant difference in the quality of images (average score 9.89 {\textpm} 0.37 vs 9.91 {\textpm} 0.30; p = 0.79), and in non statistically significant difference in diagnostic confidence (average score 9.91 {\textpm} 0.32 vs 9.92 {\textpm} 0.31; p = 0.88).

CONCLUSIONS: Remote X-ray consultation through Aycan OsiriX PRO and iPad should be considered as a means for reducing the need of in-hospital orthopaedic consultation during on-call times, and potentially decrease the cost of care for the health system. In the future, alternative systems less expensive than Aycan OsiriX PRO should be further developed and tested.

}, keywords = {Adolescent, Child, Child, Preschool, Computers, Handheld, Decision Making, Fractures, Bone, Humans, Infant, Infant, Newborn, Italy, Prospective Studies, Remote Consultation, Teleradiology, Time Factors}, issn = {1472-6963}, doi = {10.1186/1472-6963-14-327}, author = {Zennaro, Floriana and Grosso, Daniele and Fascetta, Riccardo and Marini, Marta and Odoni, Luca and Di Carlo, Valentina and Dibello, Daniela and Vittoria, Francesca and Lazzerini, Marzia} } @article {3511, title = {Use of placebo in a trial of thalidomide for pediatric Crohn disease--reply.}, journal = {JAMA}, volume = {311}, year = {2014}, month = {2014 Mar 26}, pages = {1251-2}, keywords = {Crohn Disease, Female, Humans, Immunosuppressive Agents, Male, Thalidomide}, issn = {1538-3598}, doi = {10.1001/jama.2014.1278}, author = {Lazzerini, Marzia and Martelossi, Stefano and Ventura, Alessandro} } @article {1796, title = {Amenorrhea in women treated with thalidomide: report of two cases and literature review.}, journal = {Inflamm Bowel Dis}, volume = {19}, year = {2013}, month = {2013 Jan}, pages = {E10-1}, keywords = {Adolescent, Amenorrhea, Colitis, Ulcerative, Crohn Disease, Female, Humans, Review Literature as Topic, Thalidomide}, issn = {1536-4844}, doi = {10.1002/ibd.22845}, author = {Lazzerini, Marzia and Bramuzzo, Matteo and Martelossi, Stefano and Magazz{\`u}, Giuseppe and Pellegrino, Salvatore and Ventura, Alessandro} } @article {1925, title = {Oral zinc for treating diarrhoea in children.}, journal = {Cochrane Database Syst Rev}, volume = {6}, year = {2012}, month = {2012}, pages = {CD005436}, abstract = {

BACKGROUND: In developing countries, diarrhoea causes around two million child deaths annually. Zinc supplementation during acute diarrhoea is currently recommended by the World Health Organization and UNICEF.

OBJECTIVES: To evaluate oral zinc supplementation for treating children with acute or persistent diarrhoea.

SEARCH METHODS: In February 2012, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2011, Issue 11), MEDLINE, EMBASE, LILACS, CINAHL, mRCT, and reference lists. We also contacted researchers.

SELECTION CRITERIA: Randomized controlled trials comparing oral zinc supplementation with placebo in children aged one month to five years with acute or persistent diarrhoea, including dysentery.

DATA COLLECTION AND ANALYSIS: Both authors assessed trial eligibility and risk of bias, extracted and analysed data, and drafted the review. Diarrhoea duration and severity were the primary outcomes. We summarized dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD) with 95\% confidence intervals (CI). Where appropriate, we combined data in meta-analyses (using the fixed- or random-effects model) and assessed heterogeneity.The quality of evidence has been assessed using the GRADE methods

MAIN RESULTS: Twenty-four trials, enrolling 9128 children, met our inclusion criteria. The majority of the data is from Asia, from countries at high risk of zinc deficiency, and may not be applicable elsewhere.Acute diarrhoeaThere is currently not enough evidence from well conducted randomized controlled trials to be able to say whether zinc supplementation during acute diarrhoea reduces death or hospitalization (very low quality evidence).In children aged greater than six months with acute diarrhoea, zinc supplementation may shorten the duration of diarrhoea by around 10 hours (MD -10.44 hours, 95\% CI -21.13 to 0.25; 2091 children, five trials, low quality evidence), and probably reduces the number of children whose diarrhoea persists until day seven (RR 0.73, 95\% CI 0.61 to 0.88; 3865 children, six trials, moderate quality evidence). In children with signs of moderate malnutrition the effect appears greater, reducing the duration of diarrhoea by around 27 hours (MD -26.98 hours, 95\% CI -14.62 to -39.34; 336 children, three trials, high quality evidence).Conversely, In children aged less than six months, the available evidence suggests zinc supplementation may have no effect on mean diarrhoea duration (MD 5.23 hours, 95\% CI -4.00 to 14.45; 1334 children, two trials, low quality evidence), and may even increase the proportion of children whose diarrhoea persists until day seven (RR 1.24, 95\% CI 0.99 to 1.54; 1074 children, one trial, moderate quality evidence).No trials reported serious adverse events, but zinc supplementation during acute diarrhoea causes vomiting in both age groups (RR 1.59, 95\% 1.27 to 1.99; 5189 children, 10 trials, high quality evidence).Persistent diarrhoeaIn children with persistent diarrhoea, zinc supplementation probably shortens the duration of diarrhoea by around 16 hours (MD -15.84 hours, 95\% CI -25.43 to -6.24; 529 children, five trials, moderate quality evidence).

AUTHORS{\textquoteright} CONCLUSIONS: In areas where the prevalence of zinc deficiency or the prevalence of moderate malnutrition is high, zinc may be of benefit in children aged six months or more.The current evidence does not support the use of zinc supplementation in children below six months of age.

}, keywords = {Acute Disease, Age Factors, Child, Child, Preschool, Diarrhea, Humans, Infant, Randomized Controlled Trials as Topic, Time Factors, Trace Elements, Zinc}, issn = {1469-493X}, doi = {10.1002/14651858.CD005436.pub3}, author = {Lazzerini, Marzia and Ronfani, Luca} } @article {1771, title = {Antibiotics in severely malnourished children: systematic review of efficacy, safety and pharmacokinetics.}, journal = {Bull World Health Organ}, volume = {89}, year = {2011}, month = {2011 Aug 1}, pages = {594-607}, abstract = {

OBJECTIVE: To systemically review the evidence in support of World Health Organization guidelines recommending broad-spectrum antibiotics for children with severe acute malnutrition (SAM).

METHODS: CENTRAL, MEDLINE, EMBASE, LILACS, POPLINE, CAB Abstracts and ongoing trials registers were searched. Experts were contacted. Conference proceedings and reference lists were manually searched. All study types, except single case reports, were included.

FINDINGS: Two randomized controlled trials (RCTs), one before-and-after study and two retrospective reports on clinical efficacy and safety were retrieved, together with 18 pharmacokinetic studies. Trial quality was generally poor and results could not be pooled due to heterogeneity. Oral amoxicillin for 5~days was as effective as intramuscular ceftriaxone for 2~days (1 RCT). For uncomplicated SAM, amoxicillin showed no benefit over placebo (1 retrospective study). The introduction of a standardized regimen using ampicillin and gentamicin significantly reduced mortality in hospitalized children (odds ratio, OR: 4.0; 95\% confidence interval, CI: 1.7-9.8; 1~before-and-after study). Oral chloramphenicol was as effective as trimethoprim-sulfamethoxazole in children with pneumonia (1 RCT). Pharmacokinetic data suggest that normal doses of penicillins, cotrimoxazole and gentamicin are safe in malnourished children, while the dose or frequency of chloramphenicol requires adjustment. Existing evidence is not strong enough to further clarify recommendations for antibiotic treatment in children with SAM.

CONCLUSION: Large RCTs are needed to define optimal antibiotic treatment in children with SAM with and without complications. Further research into gentamicin and chloramphenicol toxicity and into the pharmacokinetics of ceftriaxone and ciprofloxacin is also required.

}, keywords = {Anti-Bacterial Agents, Child, Child Nutrition Disorders, Child, Preschool, Humans, Severity of Illness Index, Treatment Outcome}, issn = {1564-0604}, doi = {10.2471/BLT.10.084715}, author = {Lazzerini, Marzia and Tickell, David} } @article {1727, title = {Prevalence of anaemia in children with thromboembolism in IBD.}, journal = {Arch Dis Child}, volume = {96}, year = {2011}, month = {2011 Aug}, pages = {783}, keywords = {Anemia, Iron-Deficiency, Female, Humans, Male, Stroke}, issn = {1468-2044}, doi = {10.1136/adc.2011.211409}, author = {Bramuzzo, Matteo and Lazzerini, Marzia} } @article {1816, title = {Thromboembolism in pediatric inflammatory bowel disease: systematic review.}, journal = {Inflamm Bowel Dis}, volume = {17}, year = {2011}, month = {2011 Oct}, pages = {2174-83}, abstract = {

BACKGROUND: Several studies suggest an increased risk of venous and arterial thromboembolism (TE) in adults with inflammatory bowel disease (IBD) compared to the general population. We performed a systematic review of studies on incidence and characteristic of TE in children with IBD.

METHODS: We searched Medline, LILACS, EMBASE, POPLINE, CINHAL, and reference lists of identified articles, without language restrictions, in August 2010.

RESULTS: Population studies suggest that there is an increased risk of TE in children with IBD compared to controls. TE occurred in children with IBD in all age ranges, mostly (82.8\%) during active disease, and more frequently in children with ulcerative colitis (odds ratio [OR] 3.7, 95\% confidence interval [CI] 1.8-7.6). At least one specific risk factor for TE was recognized in 50\% of cases; two risk factors were present in 24\%. Out of 92 published cases of TE in children with IBD, 54.3\% occurred in cerebral site, 26\% in the limbs, 13\% in the abdominal vessels, and the remaining in the retina and lungs. After a first episode of TE, an early recurrence was observed in 11.4\% of children, a late recurrence in 10\%. A number of different therapeutic schemes were used. Overall mortality was 5.7\% and was mostly associated with cerebral TE.

CONCLUSIONS: Population studies are needed to clarify the risk of TE in children with IBD, the relative weight of other risk factors, the characteristics of the events, and to define guidelines of therapy and prophylaxis.

}, keywords = {Adult, Child, Humans, Inflammatory Bowel Diseases, Risk Factors, Thromboembolism}, issn = {1536-4844}, doi = {10.1002/ibd.21563}, author = {Lazzerini, Marzia and Bramuzzo, Matteo and Maschio, Massimo and Martelossi, Stefano and Ventura, Alessandro} }