Three months of azithromycin in addition to standard therapy improves asthma control in the most difficult cases This Indian study carried out during the pandemic years, with some limitations related to the difficulty of reevaluating patients because of the restrictions in place, shows us that in uncontrolled asthma, the addition of azithromycin (10 mg/Kg 3 times a week for 3 months) leads to an improvement in disease control in children aged 5 to 15 years in whom adherence to basic therapy (with inhaled corticosteroids and/or long-acting ß-agonists) has already been reinforced and deemed adequate. This is a relatively simple and low-cost therapy that is feasible even in resource-limited countries. A total of 120 patients (60 per arm) were enrolled; treatment efficacy was assessed by questionnaires (ACT/CACT) showing that in treated patients there is a statistically significant improvement in symptoms and a marked increase in patients with well-controlled asthma according to GINA guidelines, which is not the case in the control arm taking baseline therapy alone. No adverse events were observed and no resistant germs appeared in the treated group.

Effects of smartphone use in the interaction of the mother-child dyad: results of an experimental study This study aimed to experimentally evaluate the effects of maternal smartphone use on mother-child interaction. 33 Israeli mothers with their 24–36-month-old children participated in 3 consecutive videotaped sessions, each with specific indications: use of the smartphone, reading a magazine, dyadic free play. The mother-child interaction was assessed in terms of maternal linguistic "input", maternal responsiveness and non-responsiveness, and conversational shifts, whose operational decoding were defined. Mothers engaged with smartphones or printed magazines produced fewer expressions and responses to baby's calls, missed baby's calls more often, and exchanged fewer conversational shifts compared to the free play setting. The quality of maternal responsiveness was also reduced. Smartphone are constantly used in current daily life and a negative effect on the development of the child is hypothesized. There is growing interest in the effects of parental use of smartphones on the relationship with the child, but data are still very limited, and the complexity of the aspects to be considered insufficiently studied.

Monosymptomatic primary nocturnal enuresis and daily urotherapy: an unnecessary intervention? Although evidence of their effectiveness is lacking, basic bladder function indications (urotherapy, BBA), according to old international guidelines have been the first step in treating nocturnal enuresis in children. Sixty-two children aged 6-11 were randomized into 3 groups (standard urotherapy, enuresis alarm, no treatment) and followed for 8 weeks; response to therapy was measured, defined as a reduction in the number of wet nights during the last 2 weeks of treatment (or no treatment), compared with 2 weeks before the intervention. The difference in reduction in frequency of enuresis between groups was highly significant (p=0.002) in favor of the alarm group, while no difference was found between BBA and controls. The small number of participants, the brevity of follow-up, and the lack of follow-up on compliance, do not allow the results to be generalized. It is reported that urotherapy is no longer planned in the treatment of monosymptomatic nocturnal enuresis according to the 2020 ICCS guideline update. Surprisingly, although the authors cited this update regarding the usefulness of the micturition chart in the initial evaluation of all children with enuresis, they made no mention of urotherapy being surpassed as the first level of treatment in monosymptomatic nocturnal enuresis.

Risk Factors for Severe SARS-CoV-2 Infection in Children: Data in the pre vaccinal era of one year of epidemic confirm that children who become seriously ill are few and comorbid The results of a population-based surveillance conducted in 250 pediatric acute-care U.S.A. hospitals, during March 2020–May 2021 are described. Rates and risk factors for severe COVID-19 among a group of 2,293 children primarily admitted for COVID-19 are defined. Approximately 30% of the hospitalized children had severe COVID-19 and 0.5% died during hospitalization. By means of a multivariate analysis the possible risks of severe COVID-19 were identified. Among children aged <2 years, chronic lung disease, neurologic disorders, cardiovascular disease, prematurity and airway abnormality were associated with severe COVID-19. Among children aged 2‒17 years, feeding tube dependence, diabetes mellitus and obesity were associated with severe COVID-19. These results are considered useful to identify children at risk of severe disease and who can benefit from COVID-19 prevention strategies, including vaccination.

How does oral cortisone work in acute bronchospasm in preschool age? ARCT with not reassuring results. The 2021 guide of the Global Initiatve for Asthma (GINA) states that the use of oral steroids in preschool children with acute bronchospasm is only recommended in cases of severe exacerbation, however the literature continues to present conflicting results. The Wheeze and Steroids in Preschoolers (WASP) Study, conducted in 3 New Zealand emergency rooms, randomized 477 children aged 24–59 months with acute bronchospasm to receive oral prednisolone for 3 days versus placebo. The respiratory outcomes measured were conflicting: the change in severity score (PRAM) at 24 hours was not different between the 2 groups, while the absolute value of the score at both 4 and 24 hours (secondary outcomes) was significantly lower in the prednisolone group. Hospitalization rate, need for further oral prednisolone treatment, and intravenous drug use were also lower in the prednisolone group. It is debated whether the equivalence design of the study and the margins chosen by the authors for the primary outcome have attenuated the difference between the treatments.