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Kantar A.,Pediatric Asthma and Cough Center | Bernardini R.,Pediatric Unit | Paravati F.,Pediatric and Neonatology Unit | Minasi D.,Pediatric Unit | Sacco O.,Pediatric Pulmonology and Allergy Unit
Early Human Development | Year: 2013

Cough may be the first overt sign of disease of the airways or lungs when it represents more than a defense mechanism, and may by its persistence become a helpful pointer of potential disease for both patient and physician. On the other hand, impairment or absence of the coughing mechanism can be harmful and even fatal; this is why cough suppression is rarely indicated in childhood. Pediatricians are concerned more with the etiology of the cough and making the right diagnosis. Whereas chronic cough in adults has been universally defined as a cough that lasts more than 8. weeks, in childhood, different timing has been reported. Many reasons support defining a cough that lasts more than 4. weeks in preschool children as chronic, however; and this is particularly true when the cough is wet. During childhood, the respiratory tract and nervous system undergo a series of anatomical and physiological maturation processes that influence the cough reflex. In addition, immunological response undergoes developmental and memorial processes that make infection and congenital abnormalities the overwhelming causes of cough in preschool children. Cough in children should be treated on the basis of etiology, and there is no evidence in support of the use of medication for symptomatic cough relief or adopting empirical approaches. Most cases of chronic cough in preschool age are caused by protracted bacterial bronchitis, tracheobronchomalacia, foreign body aspiration, post-infectious cough or some combination of these. Other causes of chronic cough, such as bronchiectasis, asthma, gastroesophageal reflux, and upper respiratory syndrome appear to be less frequent in this age group. The prevalence of each depends on the population in consideration, the epidemiology of infectious diseases, socioeconomic aspects, and the local health system. © 2013 Elsevier Ltd. Source


Lanari M.,Pediatrics and Neonatology Unit | Prinelli F.,National Research Council Italy | Prinelli F.,University of Milan | Adorni F.,National Research Council Italy | And 4 more authors.
Early Human Development | Year: 2013

Objective: Bronchiolitis is one of the primary causes of hospitalization in infancy. We evaluated the effect of breastfeeding on the occurrence of hospitalization for bronchiolitis in the first year of life. Methods: In a prospective cohort study, 1,814 newborns of =33 weeks of gestational age (wGA) were enrolled in 30 Italian Neonatology Units and followed-up for 1 year to assess hospitalizations for bronchiolitis. Children were grouped as 'never breastfed' and 'ever breastfed'; these latter were further divided into those 'exclusively breastfed' and 'breastfed associated with milk formula'. The risk of hospitalization for bronchiolitis was evaluated with survival analysis, and hazard ratios (HR) with 95% confidence interval [95% CI] were calculated. Results: Among enrolled newborns 22.9% were 'never breastfed'; in the breastfed group, 65% were 'exclusively breastfed' and 35% were 'breastfed with associated milk formula'. At 12 months of age, the risk of hospitalization for bronchiolitis was significantly higher in the 'never breastfed' group (HR: 1.57; 95% CI: 1.00-2.48). 'Breastfed associated with formula milk' and 'exclusively breastfed' groups were at similar risk of hospitalization for bronchiolitis. This observed protective effect of maternal milk was not explained by the higher prevalence of conditions able to increase the risk of bronchiolitis among 'never breastfed newborns'. Conclusions: Breastfeeding, even in association with formula milk, reduces the risk of hospitalization for bronchiolitis during the first year of life. Encouraging breastfeeding might be an effective/inexpensive measure of prevention of lower respiratory tract infections in infancy. © 2013 Elsevier Ireland Ltd. Source


Ciprandi G.,IRCCS AOU San Martino | Sivestri M.,Pediatric Pulmonology and Allergy Unit
Journal of Investigational Allergology and Clinical Immunology | Year: 2014

Background: Allergen immunotherapy (AIT) has proven to be effective. However, no biomarkers capable of predicting the clinical response to AIT have been detected. The aim of the present study was to determine a cutoff value for serum specific IgE that could be associated with effective AIT. Methods: We evaluated 174 allergic patients (83 males) with ages ranging between 6 and 77 years. All patients were monsensitized and received sublingual immunotherapy (SLIT) for at least 3 years with a single allergen extract. Symptom severity was assessed using the visual analog scale (VAS). Drug use was also evaluated. A responder was defined as a patient whose VAS score fell by at least 30% over baseline. Results: The response to SLIT was considered effective in 145 patients (83.3%). The use of allergen-specific IgE levels >9.74 kUA/L as a biomarker of effective SLIT yielded a sensitivity value of 96.4%, specificity of 100%, and an area under the receiver operator characteristic curve of 0.987. Conclusions: Assessment of serum specific-IgE before AIT could be a useful biomarker for predicting response to AIT. © 2014 Esmon Publicidad. Source


Lanari M.,Pediatrics and Neonatology Unit | Silvestri M.,Pediatric Pulmonology and Allergy Unit | Rossi G.A.,Pediatric Pulmonology and Allergy Unit
Current Drug Metabolism | Year: 2013

Respiratory syncytial virus (RSV) is the leading cause of respiratory tract infection in infants and young children throughout the world. Although preterm birth has been considered for years the major risk factor for severe disease and hospitalization, recent findings indicate that prematurity is not a necessary condition, but one of the independent risk factors for severe RSV infection, together with chronic lung diseases, congenital heart disease and immunodeficiency. Furthermore, over 50% of infants hospitalized for RSV infections during the first year of life are healthy, full-term newborns, suggesting that other environmental and individual factors may be involved. Unfortunately, there is still no specific therapy against RSV infection and therefore prophylactic measures seem to be the only intervention to avoid disease complications. No safe and effective RSV vaccine is available for the prevention of serious RSV infection. Therefore, in addition to hygienic measures, the only approach is passive immunoprophylaxis with humanized monoclonal anti-RSV antibodies, such as palivizumab that have been developed for clinical use. Because of the high cost of these antibodies, a better definition of the individual risk profile for severe RSV infection and timing of administration is needed for optimal effectiveness and careful use of limited health care resources. In this article, we have reviewed the clinical and pharmacological aspects of immunoprophylaxis with monoclonal antibodies for preventing RSV infection in high-risk infants. © 2013 Bentham Science Publishers. Source


Silvestri M.,Pediatric Pulmonology and Allergy Unit | Franchi S.,University of Florence | Pistorio A.,Clinical Epidemiology and Biostatistic Unit | Petecchia L.,Pediatric Pulmonology and Allergy Unit | Rusconi F.,University of Florence
Pediatric Pulmonology | Year: 2015

Summary Background The understanding of the role of smoking exposure in the induction of wheezing and asthma in children is important for prevention. Methods A systematic review of literature and a meta-analysis were conducted to identify studies on unselected prospective birth cohorts. The effect of exposure to maternal/parental smoking on the induction of current wheezing or asthma was evaluated in children aged 6 months, <6 years, and ≥6 years. Pooled odds ratios (OR) with 95% confidence intervals (CI) were estimated. Results We identified 43 papers. Exposure to maternal prenatal smoking was associated with an increased risk of wheezing in <6-year-olds (OR 1.36; 95% CI: 1.19-1.55) and of wheezing or asthma in ≥6-year-olds (OR: 1.22, 95% CI: 1.03-1.44). A positive association (OR: 1.24, 95% CI: 1.11-1.38) was also found in the only three studies that evaluated exposure to maternal prenatal smoking alone. Postnatal exposures to maternal/parental smoking were associated with wheezing in <6-year-olds (OR: 1.21; 95% CI: 1.13-1.31 and OR: 1.30; 95% CI: 1.13-1.51), although it was often impossible to separate the role of postnatal from that of prenatal exposure; data in schoolchildren are limited and this precluded a meta-analysis. No clear association was found between exclusive postnatal exposure and wheezing or asthma. Conclusions We confirmed an important role of prenatal exposure to maternal smoking on the induction of wheezing and asthma in offspring, particularly in the first years of life. More studies with a consistent number of subjects only exposed to smoke postnatally are needed to better investigate the harmful effects on the induction of wheezing or asthma, particularly in schoolchildren. © 2014 Wiley Periodicals, Inc. Source

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