Clinical use of gastric antisecretory drugs in pediatric patients with gastroesophageal reflux disease: a narrative review.

Background And Objective: Gastroesophageal reflux (GER) is a common condition in infants. Usually, it resolves spontaneously in 95% of cases within 12-14 months of age, but gastroesophageal reflux disease (GERD) may develop in some children. Most authors do not recommend pharmacological treatment of GER, while the management of GERD is debated.

Clinical Use of Gastric Antisecretory Drugs in Hospitalized Pediatric Patients.

Antisecretory drugs are frequently used in the treatment of pediatric gastrointestinal disorders. This study was aimed to assess the prescribing patterns and the safety of ranitidine and proton pump inhibitors (PPIs) in a cohort of Italian pediatric patients. Children aged >1 month to <16 years that were admitted to our Pediatric Clinic between 2016 and 2018 were enrolled in this retrospective observational study.

Use of Azithromycin in Pregnancy: More Doubts than Certainties.

Macrolides such as azithromycin are commonly prescribed antibiotics during pregnancy. The good oral bioavailability and transplacental transfer of azithromycin make this drug suitable for the treatment of sexually transmitted diseases, toxoplasmosis, and malaria. Moreover, azithromycin is useful both in the management of preterm pre-labor rupture of membranes and in the adjunctive prophylaxis for cesarean delivery.

Paracetamol overdose in the newborn and infant: a life-threatening event.

Purpose: Paracetamol is the only drug recommended to treat fever in neonates. At recommended doses, paracetamol has not been associated with liver injury in neonates, while hepatotoxicity may occur after intake of a single high dose or multiple excessive doses. The aim of this narrative review is to critically analyze and summarize the available literature on newborns and infants exposed to supratherapeutic doses of paracetamol, with special focus on their clinical features, outcome, and management.

Ceftriaxone-associated biliary pseudolithiasis in children: do we know enough?

Ceftriaxone is an antibiotic agent frequently used in paediatric hospital practice for the treatment of severe bacterial infections. The use of this agent can result in cholelithiasis and/or biliary sludge, more commonly in children than in adults. This systematic review was aimed at analysing available literature concerning ceftriaxone-associated biliary pseudolithiasis in paediatric patients, with a special emphasis on the clinical aspects.

The dark side of ibuprofen in the treatment of patent ductus arteriosus: could paracetamol be the solution?

Patent ductus arteriosus (PDA) persistence is associated, in prematures, to several complications. The optimal PDA management is still under debate, especially regarding the best therapeutic approach and the time to treat. The available drugs are not exempt from contraindications and side effects; ibuprofen itself, although representing the first-choice therapy, can show nephrotoxicity and other complications.

Current Challenges in Neonatal Resuscitation: What is the Role of Adrenaline?

Adrenaline, also known as epinephrine, is a hormone, neurotransmitter, and medication. It is the best established drug in neonatal resuscitation, but only weak evidence supports current recommendations for its use. Furthermore, the available evidence is partly based on extrapolations from adult studies, and this introduces further uncertainty, especially when considering the unique physiological characteristics of newly born infants.

Maternal Carbamazepine Therapy and Unusual Adverse Effects in a Breastfed Infant.

Background: Usually, no adverse effects are observed in breastfed infants whose mothers are treated with the anti-epileptic carbamazepine. In this article, we described unusual short-term adverse effects observed in a young infant after exposure to carbamazepine during pregnancy and lactation.

Case Report: A 40-day-old female infant, born at term, was admitted to the Pediatric Clinic at University of Sassari, Italy, for recurrent regurgitations and vomiting.

Off-label and unlicensed drug treatments in Neonatal Intensive Care Units: an Italian multicentre study.

Purpose: The use of medicines among newborns admitted to intensive care units is characterized by a high prevalence of off-label/unlicensed use and a wide variability in the absence of international guidelines. A prospective cross-sectional study was organized with the aim to analyse drug prescriptions among all 107 Italian level III neonatal intensive care units.

Methods: An online questionnaire was used to collect detailed information for each newborn, and a classification was made about the license status of all prescriptions.

Paracetamol (acetaminophen) efficacy and safety in the newborn.

Neonates can perceive pain, therefore an adequate analgesic therapy is a major issue not only from an ethical perspective but also to improve short- and long-term outcome. Fever during the neonatal period requires hospitalization and needs a treatment with an antipyretic agent because of the high risk of severe complications. Paracetamol (acetaminophen), the most commonly prescribed drug in paediatric patients for its analgesic and antipyretic effects, is the only agent recommended for use as an antipyretic in the newborn and has been recently proposed as a supplement therapy to opioids for postoperative analgesia.

Drug metabolizing enzymes in the perinatal and neonatal period: differences in the expression and activity.

Physiological changes occurring perinatally and in the first month of life can affect the answer to a pharmacological treatment and the individual response to a drug in terms of efficacy and toxicity is highly variable in the neonatal population. Among potential causes for such variability, differences in drug metabolism may have a great impact. This article aims to review qualitative and quantitative differences in drug metabolizing enzymes in neonates, since both phase I and phase II metabolic pathways are immature at birth and subject to maturational changes in the first period of extrauterine life.

Use of non-steroidal anti-inflammatory drugs in pregnancy: impact on the fetus and newborn.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed in pregnancy to treat fever, pain and inflammation. Indications for chronic use of these agents during pregnancy are inflammatory bowel or chronic rheumatic diseases. Since the seventies, NSAIDs have been used as effective tocolytic agents: indomethacin has been the reference drug, delaying delivery for at least 48 hours and up to 7-10 days.

Use of herbal products among 392 Italian pregnant women: focus on pregnancy outcome.

Purpose: The present study aimed to explore the use of herbal products among a sample of Italian pregnant women and the possible influence of herbal consumption on pregnancy outcome.

Methods: The study was conducted over a 10-month period (2 days a week, from January to October 2009) at the Maternity wards of Padua and Rovereto Hospital. Data were collected through a face-to-face interview on the basis of a prestructured questionnaire including socio-demographic characteristics of the enrolled subjects, specific questions on herbal use, information about pregnancy and newborn.

Drug treatments in a neonatal setting: focus on the off-label use in the first month of life.

Objective: The purpose of this work was to analyse drugs prescribed in the first month of life among a group of newborns admitted to the Neonatal Intensive Care Unit and Neonatal Pathology of Cagliari University Hospital.

Method: This pilot study was prospectively conducted during a 1-month period and involved all newborns admitted to our hospital that received a pharmacotherapy. After obtaining written parental consent, data collected from each newborn included date of birth, sex, gestational age and weight.

Safety of non-prescription medicines: knowledge and attitudes of Italian pharmacy customers.

Objective: A survey was designed to investigate customers attitudes and knowledge toward non-prescription medicines taken on a self-medication basis but not devoid of risks.

Setting: Community pharmacies in Italy.

Method: Forty-four pharmacies participated in the project.

Early diagnosis of acute kidney injury with urinary biomarkers in the newborn.

Biomarkers are biological parameters that can be objectively measured and evaluated, which act as indicators of normal or pathological processes, or of the response to intervention. Acute Kidney Injury (AKI) biomarkers must be easy to detect and measure, must correlate with severity (offering accurate prognosis), quantitatively describing the level of injury even in the absence of clinical signs. Finally, they must be adequate to indicate treatment initiation.

Acute non-oliguric kidney failure and cholestatic hepatitis induced by ibuprofen and acetaminophen: a case report.

Unlabelled: The combined use of acetaminophen with ibuprofen has long been in clinical use because the target of action of each drug is different and they do not interfere with each other. Appropriate dosing and managing of these drugs do not likely lead to organ toxicity. However, both acetaminophen and ibuprofen can induce liver problems and acute kidney failure, respectively, if administered at high doses.

Attitudes and knowledge toward natural products safety in the pharmacy setting: an Italian study.

The lack of a professional supervision may expose consumers of natural products to risks; pharmacists play an important role in giving information about these substances. A survey was designed to investigate the attitudes and knowledge of consumers and pharmacists toward the safety of natural products. Twenty-three pharmacies participated in the project.

Phytotherapic compounds: the consumer-pharmacist relationship.

Pharmacists play an important role in providing information about natural products and in preventing risks related to these substances, particularly with respect to interactions with conventional drugs. For these reasons, a survey was specifically designed to investigate the quality of self-care counselling by pharmacists on phytotherapy. Twenty-three pharmacy stores took part in the project.

Urinary prostaglandin E2 in the newborn and infant.

Prostaglandin E(2) (PGE(2)) belongs to a family of biologically active lipids derived from the 20-carbon essential fatty acids. Renal PGE(2) is involved in the development of the kidney; it also contributes to regulate renal perfusion and glomerular filtration rate, and controls water and electrolyte balance. Furthermore, this mediator protects the kidney against excessive functional changes during the transition from fetal to extrauterine life, when it counteracts the vasoconstrictive effects of high levels of angiotensin II and other mediators.

Knowledges about herbal products among subjects on warfarin therapy and patient-physician relationship: a pilot study.

Purpose: The purpose of our study was to analyse behaviours and patient-physician relationship about phytotherapy among a sample of Italian patients on warfarin therapy for atrial fibrillation.

Methods: During a 4-month study period, interviews of patients on warfarin therapy, followed regularly in the medical laboratories to monitor INR values, were conducted on the basis of a pre-structured 25-item questionnaire.

Results: Among a study population of 294 patients, 69 subjects reported to have been taking one or more phytotherapic products in the last year in combination with warfarin.

Patologie delle alte vie respiratorie del bambino in ambulatorio: un'esperienza italiana. Diseases of the upper respiratory tract in children in ambulatory care: an Italian experience.

Background: Overuse of antibiotics for children is widespread and contributes to the emergence of antibiotic-resistant bacteria. Moreover, non steroidal antiinflammatory drugs (NSAIDs) are often overprescribed despite of their renal and gastrointestinal side-effects.

Objectives: To assess the behaviour and the factors influencing the prescribing practice of family pediatricians for the common upper respiratory diseases of pre-school children in an outpatient setting.

Off-label and unlicensed prescribing for newborns and children in different settings: a review of the literature and a consideration about drug safety.

This review aims to give an updated overview of the worldwide situation of off-label and unlicensed drug use in the paediatric field, also taking into account the safety of this kind of treatment. A Medline and Embase search was performed between 1990 and 2006 and a total of 52 studies were identified and included in the systematic review. From the authors' analysis of the literature, the extent of paediatric unlicensed/off label use is higher in neonatal and paediatric intensive care units and oncology wards, compared with primary care.