A multicenter, randomized, controlled trial of osteopathic manipulative treatment on preterms.

BACKGROUND: Despite some preliminary evidence, it is still largely unknown whether osteopathic manipulative treatment improves preterm clinical outcomes. MATERIALS AND METHODS: The present multi-center randomized single blind parallel group clinical trial enrolled newborns who met the criteria for gestational age between 29 and 37 weeks, without any congenital complication from 3 different public neonatal intensive care units. Preterm infants were randomly assigned to usual prenatal care (control group) or osteopathic manipulative treatment (study group). The primary outcome was the mean difference in length of hospital stay between groups. RESULTS: A total of 695 newborns were randomly assigned to either the study group (n= 352) or the control group (n=343). A statistical significant difference was observed between the two groups for the primary outcome (13.8 and 17.5 days for the study and control group respectively, p<0.001, effect size: 0.31). Multivariate analysis showed a reduction of the length of stay of 3.9 days (95% CI -5.5 to -2.3, p<0.001). Furthermore, there were significant reductions with treatment as compared to usual care in cost (difference between study and control group: 1,586.01€; 95% CI 1,087.18 to 6,277.28; p<0.001) but not in daily weight gain. There were no complications associated to the intervention. CONCLUSIONS: Osteopathic treatment reduced significantly the number of days of hospitalization and is cost-effective on a large cohort of preterm infants.

Epidemiological and clinical features of rotavirus among children younger than 5 years of age hospitalized with acute gastroenteritis in Northern Italy.

BACKGROUND: Rotavirus is the major cause of acute gastroenteritis and severe dehydrating diarrhea in young children. METHODS: To estimate the proportion of hospital admissions for rotavirus acute gastroenteritis and identify the circulating G and P genotypes among children under five years of age, we conducted a prospective observational study from January to December 2008, recruiting children consecutively admitted to six hospitals in Milan and nearby towns in northern Italy. Typing was done on stool samples by reverse transcriptase polymerase chain reaction amplification. RESULTS: Of the 521 stool samples from children with acute gastroenteritis, 34.9% (95%CI, 30.8 to 39.2%) were rotavirus-positive. Two thirds (67.6%) were under two years of age, and 13.2% were under six months. The predominant G type was G1 (40.7%), followed by G9 (22.5%), G2 (13.2%), G3 (5.5%), G4 (3.8%) and G10 (1.6%). Twenty-one (11.7%) mixed-G infections were identified: G1+G10 (8.8%); G1+G9 (1.6%); and G2+G10 (1.2%). Only P[8] (67.6%) and P[4] (12.6%) types were P genotyped. The predominant single G/P combination was G1P[8] (39.7%), followed by G9P[8] (25.3%), G2P[4] (14.3%), and G3P[8] (4.1%). All G-mixed types combined with P[8]. CONCLUSIONS: These findings show an high prevalence of rotavirus infections among children admitted to hospital for acute gastroenteritis caused by different rotavirus strains circulating in the area studied.

Docosahexaenoic acid supplementation and time at achievement of gross motor milestones in healthy infants: a randomized, prospective, double-blind, placebo-controlled trial.

BACKGROUND: Docosahexaenoic acid (DHA) intake throughout the first year of life is associated with neurodevelopmental and neuropsychological benefits. Few studies have evaluated the role of DHA intakes on age at achievement of gross motor milestones. OBJECTIVE: The objective was to assess the effects of DHA supplementation throughout the first year of life on the achievement of four gross motor milestones in healthy infants. DESIGN: In this multicenter prospective, randomized, double-blind, placebo-controlled trial, 1160 healthy neonates were assigned to receive supplementation with either 20 mg liquid DHA (n = 580) or placebo (n = 580) orally once daily throughout the first year of life. The primary endpoint was the time at achievement of 4 gross motor milestones (sitting without support, hands-and-knees crawling, standing alone, and walking alone). All analyses were performed on an intention-to-treat basis. RESULTS: The time to achievement of sitting without support was shorter (P < 0.001) in infants who received DHA [median: 26 wk; interquartile range (IQR): 24-29 wk] than in those who received placebo (27 wk; 26-31 wk). No significant difference between infants who received DHA or placebo was found for hands-and-knees crawling [39 wk (34-44 wk) compared with 40 wk (35-44 wk), respectively], standing alone [49 wk (43-55 wk) compared with 49 wk (44-57 wk), respectively], and walking alone [55 wk (50-60 wk) compared with 56 wk (52-61 wk), respectively]. CONCLUSIONS: Despite the 1-wk advance in sitting without support associated with DHA supplementation, no demonstrable persistent effects of DHA supplementation on later motor development milestones were found. Thus, the long-term clinical significance of the 1-wk change in sitting without support, if any, remains unknown. This trial is registered at (clinicaltrials.gov) as NCT00610922.

[Nonne-Milroy's syndrome (hereditary lymphedema type I). Report of a clinical case]. / Sindrome di Nonne-Milroy (linfedema ereditario di tipo I). Descrizione di un caso clinico.

The authors report on a case of a 7-days old girls, with Nonne-Milroy syndrome (type I hereditary lynphedema). The clinical picture of this disease is severe but the outcome is usually good. Its etiology, differential diagnosis, therapy and follow-up are discussed.

Differential diagnosis of IgE-mediated allergy in young children with wheezing or eczema symptoms using a single blood test.

BACKGROUND: Allergy-like symptoms are common in young children, but the case history and physical examination cannot identify the underlying origins of overlapping symptom profiles. OBJECTIVE: To evaluate a blood test, Phadiatop Infant (Pharmacia Diagnostics AB, Uppsala, Sweden), for differentiating the capability of IgE-mediated disease in young children with recurrent wheezing, eczema, or both. METHODS: One hundred forty-seven children (mean age, 2.0 years) were consecutively referred to 2 allergy centers by their primary care physician for recurrent wheezing, eczema, or both. The allergist's clinical evaluation included medical history, physical examination, skin prick testing with inhalant and food allergens, and specific IgE determinations in blood. The accuracy of Phadiatop Infant was evaluated in a masked manner against the allergist's final diagnosis. RESULTS: Sixty-nine children had wheezing, 69 had eczema, and 9 had both symptoms. Sixty-one children were clinically diagnosed as having IgE-mediated allergy, 78 as having non-IgE-associated disease, and 8 as having an inconclusive diagnosis. Fifty-six of the 61 children with IgE-mediated allergy had positive Phadiatop Infant test results, and 64 of 78 without the condition had negative results. Sensitivity was 92% and specificity was 82%, with positive and negative predictive values of 80% and 93%, respectively. Thirteen children with a positive Phadiatop Infant test result and a negative final diagnosis were retested after 2 years; 12 of them were diagnosed as having IgE-mediated allergy using a masked evaluation. CONCLUSIONS: The Phadiatop Infant blood test discriminates between IgE- and non-IgE-mediated symptoms in children younger than 4 years.