Mese: Ottobre 2020

ENCEFALOPATIA IPOSSICO-ISCHEMICA: LA SURVEY E LE RACCOMANDAZIONI DELLA SIN PER MIGLIORARE LE CURE A LIVELLO NAZIONALE

L’Encefalopatia Ipossico-Ischemica ha un’incidenza media di 1,5 ogni 1000 nati vivi, interessando 1,15 milioni di neonati all’anno nel mondo.
Ad oggi l’ipotermia terapeutica rimane l’unica possibilità di trattamento delle forme moderate/gravi di questa patologia, ma non è noto quanti trattamenti ipotermici vengano effettuati in Italia.
Per fare maggior chiarezza sulla situazione nel nostro Paese, la Società Italiana di Neonatologia (SIN) ha avviato una Survey retrospettiva, i cui dati preliminari sono stati presentati in occasione del XXVI Congresso Nazionale.

Medicoebambino.it

O’Boyle DS, Dunn WB, O’Neill D, Kirwan JA, Broadhurst DI, Hallberg B, Boylan GB, Murray DM. Improvement in the Prediction of Neonatal Hypoxicischemic Encephalopathy with the Integration of Umbilical Cord Metabolites and Current Clinical Makers. J Pediatr. 2020 Oct 8:S0022-3476(20)31257-9. doi: 10.1016/j.jpeds.2020.09.065. Epub ahead of print. PMID: 33039387.

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Rozé JC, Ancel PY, Marchand-Martin L, Rousseau C, Montassier E, Monot C, Le Roux K, Butin M, Resche-Rigon M, Aires J, Neu J, Lepage P, Butel MJ; EPIFLORE Study Group. Assessment of Neonatal Intensive Care Unit Practices and Preterm Newborn Gut Microbiota and 2-Year Neurodevelopmental Outcomes. JAMA Netw Open. 2020 Sep 1;3(9):e2018119. doi: 10.1001/jamanetworkopen.2020.18119. PMID: 32965499; PMCID: PMC7512059.

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El-Khuffash A, Bussmann N, Breatnach CR, Smith A, Tully E, Griffin J, McCallion N, Corcoran JD, Fernandez E, Looi C, Cleary B, Franklin O, McNamara PJ. A Pilot Randomized Controlled Trial of Early Targeted Patent Ductus Arteriosus Treatment Using a Risk Based Severity Score (The PDA RCT). J Pediatr. 2020 Oct 15:S0022-3476(20)31291-9. doi: 10.1016/j.jpeds.2020.10.024. Epub ahead of print. PMID: 33069668.

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WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne JAC, Murthy S, Diaz JV, Slutsky AS, Villar J, Angus DC, Annane D, Azevedo LCP, Berwanger O, Cavalcanti AB, Dequin PF, Du B, Emberson J, Fisher D, Giraudeau B, Gordon AC, Granholm A, Green C, Haynes R, Heming N, Higgins JPT, Horby P, Jüni P, Landray MJ, Le Gouge A, Leclerc M, Lim WS, Machado FR, McArthur C, Meziani F, Møller MH, Perner A, Petersen MW, Savovic J, Tomazini B, Veiga VC, Webb S, Marshall JC. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. JAMA. 2020 Sep 2;324(13):1–13. doi: 10.1001/jama.2020.17023. Epub ahead of print. PMID: 32876694; PMCID: PMC7489434.

Importance: Effective therapies for patients with coronavirus disease 2019 (COVID-19) are needed, and clinical trial data have demonstrated that low-dose dexamethasone reduced mortality in hospitalized patients with COVID-19 who required respiratory support.

Objective: To estimate the association between administration of corticosteroids compared with usual care or placebo and 28-day all-cause mortality.

Design, setting, and participants: Prospective meta-analysis that pooled data from 7 randomized clinical trials that evaluated the efficacy of corticosteroids in 1703 critically ill patients with COVID-19. The trials were conducted in 12 countries from February 26, 2020, to June 9, 2020, and the date of final follow-up was July 6, 2020. Pooled data were aggregated from the individual trials, overall, and in predefined subgroups. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I2 statistic. The primary analysis was an inverse variance-weighted fixed-effect meta-analysis of overall mortality, with the association between the intervention and mortality quantified using odds ratios (ORs). Random-effects meta-analyses also were conducted (with the Paule-Mandel estimate of heterogeneity and the Hartung-Knapp adjustment) and an inverse variance-weighted fixed-effect analysis using risk ratios.

Exposures: Patients had been randomized to receive systemic dexamethasone, hydrocortisone, or methylprednisolone (678 patients) or to receive usual care or placebo (1025 patients).

Main outcomes and measures: The primary outcome measure was all-cause mortality at 28 days after randomization. A secondary outcome was investigator-defined serious adverse events.

Results: A total of 1703 patients (median age, 60 years [interquartile range, 52-68 years]; 488 [29%] women) were included in the analysis. Risk of bias was assessed as “low” for 6 of the 7 mortality results and as “some concerns” in 1 trial because of the randomization method. Five trials reported mortality at 28 days, 1 trial at 21 days, and 1 trial at 30 days. There were 222 deaths among the 678 patients randomized to corticosteroids and 425 deaths among the 1025 patients randomized to usual care or placebo (summary OR, 0.66 [95% CI, 0.53-0.82]; P < .001 based on a fixed-effect meta-analysis). There was little inconsistency between the trial results (I2 = 15.6%; P = .31 for heterogeneity) and the summary OR was 0.70 (95% CI, 0.48-1.01; P = .053) based on the random-effects meta-analysis. The fixed-effect summary OR for the association with mortality was 0.64 (95% CI, 0.50-0.82; P < .001) for dexamethasone compared with usual care or placebo (3 trials, 1282 patients, and 527 deaths), the OR was 0.69 (95% CI, 0.43-1.12; P = .13) for hydrocortisone (3 trials, 374 patients, and 94 deaths), and the OR was 0.91 (95% CI, 0.29-2.87; P = .87) for methylprednisolone (1 trial, 47 patients, and 26 deaths). Among the 6 trials that reported serious adverse events, 64 events occurred among 354 patients randomized to corticosteroids and 80 events occurred among 342 patients randomized to usual care or placebo.

Conclusions and relevance: In this prospective meta-analysis of clinical trials of critically ill patients with COVID-19, administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality.

Walsh KA, Spillane S, Comber L, Cardwell K, Harrington P, Connell J, Teljeur C, Broderick N, de Gascun CF, Smith SM, Ryan M, O’Neill M. The duration of infectiousness of individuals infected with SARS-CoV-2. J Infect. 2020 Oct 10:S0163-4453(20)30651-4. doi: 10.1016/j.jinf.2020.10.009. Epub ahead of print. PMID: 33049331; PMCID: PMC7547320.

Objectives: To summarise the evidence on the duration of infectiousness of individuals in whom SARS-CoV-2 ribonucleic acid is detected.

Methods: A rapid review was undertaken in PubMed, Europe PubMed Central and EMBASE from 1 January 2020 to 26 August 2020.

Results: We identified 15 relevant studies, including 13 virus culture and 2 contact tracing studies. For 5 virus culture studies, the last day on which SARS-CoV-2 was isolated occurred within 10 days of symptom onset. For another 5 studies, SARS-CoV-2 was isolated beyond day 10 for approximately 3% of included patients. The remaining 3 virus culture studies included patients with severe or critical disease; SARS-CoV-2 was isolated up to day 32 in one study. Two studies identified immunocompromised patients from whom SARS-CoV-2 was isolated for up to 20 days. Both contact tracing studies, when close contacts were first exposed greater than 5 days after symptom onset in the index case, found no evidence of laboratory-confirmed onward transmission of SARS-CoV-2.

Conclusion: COVID-19 patients with mild-to-moderate illness are highly unlikely to be infectious beyond 10 days of symptoms. However, evidence from a limited number of studies indicates that patients with severe-to-critical illness or who are immunocompromised, may shed infectious virus for longer.

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La SIN è una società, non a fini di lucro, che persegue e allarga gli scopi ed obiettivi del Gruppo di Lavoro di Neonatologia della Società Italiana di Pediatria (SIP).