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PP-037 Pharmacological treatment of children with enuresis in general pediatrics
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  1. Paola Nigri1,
  2. Luigi Nigri2,
  3. Lucia Peccarisi2
  1. 1Division of Nephrology and Dialysis, Department of Medicine, University of Verona, 37126 Verona, Italy
  2. 2Italian Federation of Pediatricians (FIMP), 00185 Rome, Italy

Abstract

Aim Give operational indications to family care pediatricians

Material and Method In children with enuresis (EN) (1 nocturnal episode, normal bladder capacity), the elective therapy is desmopressin (1-deamino-8-D-arginine vasopressin). The efficacy and safety of desmopressin in the treatment of monosymptomatic enuresis (MNE) have been extensively documented, placing this therapy in the ranking of recommendations as Grade A, Level 1. The recent sublingual formulation (Melt) has further reduced dosages and eliminated side effects from incorrect evening fluid intake. Oral desmopressin reaches its peak concentration within 1 hour, with a bioavailability of 1%. Its antidiuretic effect begins 30 minutes after administration, reaching peak efficacy in a minimum of 2–3 hours up to a maximum of 10 hours. The drug should be administered one hour before bedtime, always remembering to empty the bladder thoroughly. Fluid intake must be suspended 2 hours before administration. If taken correctly, the drug has excellent tolerance. Rare side effects are mild headache (2%) and abdominal pain (1%). Prescription of the drug is contraindicated in patients with polydipsia, hypertension, or heart diseases. For patients aged 6–7 years, it is recommended to take 1 sublingual desmopressin tablet of 120µg. For older children, the dose is 2 sublingual desmopressin tablets of 120µg. Based on body surface area and therapeutic response, the pediatrician may consider adjusting the dosage.

Results Patients must be reassessed after 2 months and before increasing the dosage. Treatment should be continued until achieving 8 consecutive dry weeks, gradually reducing a dose of 60 µg every 4 consecutive dry weeks. However, if patients wets >1 night/month, the treatment should be resumed at the immediately preceding dosage and continued until reaching 4 consecutive dry weeks before considering a new reduction

Conclusions If after 2 months of therapy the patient has not halved the number of wet nights, it is recommended to refer them to a second-level center.

  • Nocturnal enuresis treatment

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