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AIM: The aim of this study was to give a support to the parents of the patients with apparent life threatening event (ALTE), to learn a correct management outside the protective environment of the hospital and a prevention such events. METHODS: This was the 33rd edition of a training course called "Course of first aid and prevention of the accidents in infants", in which the recommendations of the Italian cardiopulmonary resuscitation's guidelines are treated. The course comprehended a short frontal lesson, a practice training and the compilation of a test to express one's satisfaction about the received training, using a points assessment from 1 to 10. RESULTS: The course included 385 participants (including any kind of person who may be in contact with infants) and 361 questionnaires were returned. Critical parameters were the scheme of teaching, the adequacy of contents, the teachers' technical and behavioral abilities, the adequacy of time and the communicative capacity. The learners demonstrated pleasure in variable percentages from 98% to 100%. The 79% of the learners felt the necessity to have some training again later on. CONCLUSION: Our positive experience allowed us to reflect about three concepts that we considered essential: communication, training and prevention. In fact, we think that prevention is infinitely potentiated from training and communication is its inalienable instrument.

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The chronically ill patient admitted to an Emergency Department or to a Pediatric Emergency Unit for an intercurrent acute episode is rare but requires adequate management. Aim of this study is to evaluate the health care needs of these patients vs patients with exclusively acute disease and to underline the need of identifying criteria for health care taking into account basic clinical conditions. This study can be carried out most suitably at the Gaslini Institute, since it is a children's hospital with a Pediatric Emergency Department admitting children from the Liguria region presenting almost the whole range of chronic pediatric diseases.

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In recent years pediatric guidelines have increasingly become part of clinical practice, in Italy too. Aim of the present work is, on the basis of a review of national and international literature, to focus on the Italian situation about the use of guidelines in pediatric emergency, with particular respect to methodology, correct use, and related risks and benefits. The developing of efficient guidelines is achieved in different steps: 1) identifying and refining the topic for guidelines, in order to obtain an improvement of healthcare; 2) correct developing strategies, based on scientific evidence, leading to production of recommendations validated by external review; 3) adequate implementation and diffusion in local settings; 4) application with sensible and appropriate clinical discretion. Benefits obtained with the correct use of efficient pediatric guidelines, can be identified at different levels: patients' care (outcome improvement, increased patients' consciousness, influence on public healthcare policy); healthcare professionals (improving quality of clinical decisions, agreement on clinical and therapeutic strategies; medicolegal protection, representing a reference for prospective and retrospective audits); healthcare systems (standardising care, improving efficacy of care; optimising costs). Personal experience in systematic development of emergency pediatric guidelines, applied in a second level Emergency Department is also presented.

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The child's discomfort and the cost of overnight hospitalization are clear disadvantages of prolonged esophageal pH monitoring. The aim of this study was to verify the reliability of short recording versus 24-h testing in a pediatric series with symptoms suggestive of gastroesophageal reflux (GER) disease. A 24-h pH monitoring performed on 160 patients with either gastroenterological symptoms (n = 61), respiratory problems (n = 58), or emesis plus respiratory problems (n = 41) was reviewed. Regardless of clinical presentation, children were also classified according to age: < 12 months (n = 39), 12-71 months (n = 81), and 72-168 months (n = 40). A diurnal fraction of 6 h, including at least 2 h after a meal, was compared to the entire 24-h recording in all groups with respect to the reflux index (RI) (sum of the periods with pH < 3.9 expressed as percentage of time) and reflux/h. RIs of > 10% were considered positive in patients < 1 year of age, whereas RIs of > 5% were considered positive in other age groups. Negative predictive values of the short recording RI ranged from 71 to 90%. Positive predictive values ranged from 50 to 83%; it was unreliable for children < 12 mos (50%) and patients with emesis plus respiratory problems (64%), who were, significantly, the youngest. Reflux/h values were not in agreement for the same groups. Absence of agreement was found if the absolute value of RI was considered.(ABSTRACT TRUNCATED AT 250 WORDS)

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A 2-year-old girl had a de novo duplication in the long arm of one chromosome 7 and an increased level of the enzyme beta-glucuronidase in cultured fibroblasts. The phenotype of the girl partly overlaps those of two presumptive syndromes due to secondary partial trisomies 7q. The ratio of the enzyme activity was 1.43 to the controls, and 1.37 to her parent's values. We could not define the abnormality but suggest two alternatives: either the patient is trisomic for region q112 to q22 or for the region q22 to q34. If the second alternative is correct the locus for beta-glucuronidase is possibly assigned to band 7q22.

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