The main objective of the Laboratory for Mother and Child Health is to ensure a better mother and child well-being by undertaking interdisciplinary and collaborative work in the field of public health.
In particular, the laboratory is involved:
- in the monitoring and epidemiological evaluation of the use and effects of drugs and vaccines
- in the evaluation of diagnostic and therapeutic pathways carried out in the paediatric population for neuropsychiatric disorders
- in the research methodology related to general hospital and paediatric community practices
- in studying the public health determinants of children’s well-being
- in the transfer of health information to the community.
Pharmacoepidemiology in the Lombardy Region
The Laboratory for Mother and Child Health is involved in the analysis of the drug prescription profile in children and adolescents in the EPIFARM (Epidemiologia del Farmaco) project funded by the Lombardy Region. During 2018, the activities regarded mainly: a) the analysis of drug prescriptions to children and adolescents during 2016, b) the evaluation of the perinatal outcomes of antiepileptic exposure during pregnancy, and c) the qualitative evaluation of antibiotic prescriptions in the emergency room and in primary care. A) Analysis of drug prescriptions to children and adolescents during 2016 During 2016, 840,244 children and adolescents (47% of residents less than 18 years old) received at least one prescription for drugs reimbursed by the national health service. The prescription prevalence was slightly higher in males than females (ratio M / F = 1.04), reached the highest value in the 1-5 year old group (67%), and subsequently decreased with increasing age, reaching 35% in adolescents. Antibiotics (subgroup J01 of the ATC classification) were the most commonly prescribed class of drugs, with a prevalence of 37.5%, followed by anti-asthmatics (R03, 17.1%) and antihistamines (R06 , 5.3%). The most prescribed drugs were amoxicillin + clavulanic acid (21.5%), amoxicillin (9.8%), beclometasone (9.6%) and salbutamol (6.4%). In the 2000-2016 period, the drug prescription prevalence for children and adolescents decreased from 52.9 to 47.0%. B) Evaluation of perinatal outcomes of antiepileptic exposure during pregnancy The prescriptions of drugs dispensed to women who gave birth between 2005 and 2011 were analyzed. The newborns were classified as cases if exposed in utero to antiepileptic drugs and each was paired with 7 controls (newborns not exposed to antiepileptics). The main outcomes of the analyses were: congenital malformations, birth weight, gestational age, preterm birth, hospitalization, specialist visits and drug prescriptions during the first year of life. No significant differences in the risk of congenital malformations were observed between 526 cases and 3,682 controls (OR 2.29, 95% CI 1.24-4.22), but cases had a greater likelihood of being small for gestational age (χ2 = 7.66 P = 0.006). The cases exposed to antiepileptic drugs in utero received slightly more drug prescriptions during the first year of life and were more likely to be visited by a child neuropsychiatrist (in particular those exposed to valproic acid) [OR 1.74; IC 95% 1.22-2.49]. C) Qualitative evaluation of antibiotic prescriptions in the emergency departments (ED) and in primary care A total of 23,216 children aged 1-13 years were visited at least once in an emergency department for an upper respiratory tract infection, and 56% of them were prescribed an antibiotic. The prevalence of antibiotic prescriptions was 68% in children with otitis, 56% for pharyngitis and 48% for infections of the upper airways not otherwise specified. Amoxicillin, the first choice antibiotic, was prescribed as an index prescription (treatment for a new infection episode) in only 22% of the cases, with minimal differences between infections (24% pharyngitis, 21% in other cases). Regarding the visits for pharyngotonsillitis, amoxicillin was prescribed to more than half of the children treated with antibiotics in only 5 of 56 monitored emergency departments, while in 5 other emergency departments it was never prescribed. The qualitative profile of antibiotic prescriptions was similar in the ED and in primary care. Primary care physicians prescribed cephalosporins/macrolides, which are second-line treatments, more frequently: 31% of new courses of therapy versus 23% in the emergency department.
The Lombardy Region’s ADHD Register
The Lombardy Region’s ADHD Register was launched in June 2011 within the project called “Sharing diagnostic-therapeutic approaches for ADHD in Lombardy” with the funding of the Lombardy Region. The project involves 18 referral centres and the coordinator is the UONPIA (Child and Adolescent Neuropsychiatric Unit) of Brescia’s A.O. Spedali Civili hospital. The project includes training initiatives for health care workers who provide assistance to ADHD patients and their families, initiatives to increase information on ADHD, and a regional register of ADHD cases. The register was designed as a disease register and therefore collects information not only on the patients diagnosed with ADHD under pharmacological treatment (as foreseen by the national register), but also on all patients who visit the referral Centres for a suspected ADHD. The register allows for the: • monitoring of diagnostic paths; • defining of the prevalence of the disorder; • monitoring of non pharmacological treatment programs; • continuation of pharmacovigilance activity by extending the monitoring on the use of drugs to those other than atomoxetine and methylphenidate; • quantification of the workload for the referral centres. At the end of 2018, 5,509 patients were included in the register, 6,662 of whom had a confirmed ADHD diagnosis, 1,517 of whom were not diagnosed for ADHD, and 330 of whom were still under diagnostic evaluation. In most cases patients were referred to the centers by the school (31%) or the parents (16%). 3,662 of the 3,568 ADHD patients were assigned a treatment: 117 only pharmacological therapy, 2,748 a non-pharmacological prescriptions, and 703 no specific treatment. The most frequent comorbidities were learning disabilities (39%), oppositional/defiant disorder (15%) and sleep disorders (14%).
Since the early 1960s, home delivery has become increasingly rare throughout the country. Today, about a thousand children are born every year in Italy outside of the hospital. This is a phenomenon that affects only a few regions and few parents who are very determined to counter the sometimes excessive medicalization of the birth pathway. In a country such as Italy, where 35% of deliveries (between 60% in Campania and 21% in Tuscany) are cesarean compared to the 15% indicated by the World Health Organization, home delivery does not represent an alternative. The interest in home delivery arises from the need expressed by women to have more intimate, personalized assistance. In 2018 the laboratory continued its collaboration with The National Obstetricians for Home Births and Maternity Home Association to support a study in which assistance during labour and physiological birth was assessed in agreement with national and international guidelines. The ideal condition is the presence of an obstetrician throughout the pregnancy and during labour, so that the future mother (and the couple) receive non-invasive, appropriate assistance and are supported during the entire period. In this manner the obstetrician can also readily identify any possible contraindications to home birth.
Co-operation with Countries with Limited Resources
As an expression, test, and original method of manifesting the choice to make the laboratory’s research transferable and accessible to all populations, the laboratory has promoted and provided assistance to projects in, and for, the South of the world, in collaboration with non-governmental organizations (NGOs) and the World Health Organization. The technical and organisational support for carrying out socio-sanitary projects in countries with limited resources continues today.
International Consensus on Cardiopulmonary Resuscitation.