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Buonsenso D, Camporesi A, Morello R, De Rose C, Fracasso M, Valentini P. Paediatric long COVID studies should focus on clinical evaluations that examine the impact on daily life not just self-reported symptoms. Acta Paediatr 2024; 113:778-780. [PMID: 38287466 DOI: 10.1111/apa.17129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/26/2023] [Accepted: 01/17/2024] [Indexed: 01/31/2024]
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Center for Global Health Research Studies, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Camporesi
- Anesthesia and Intensive Care Unit, 'Vittore Buzzi' Children's Hospital, Milan, Italy
| | - Rosa Morello
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Matteo Fracasso
- Medicine and Surgery, Universityà Cattolica del Sacro Cuore, Roma, Italy
| | - Piero Valentini
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Camporesi A, Yock-Corrales A, Gomez-Vargas J, Roland D, Gonzalez M, Barreiro S, Morello R, Brizuela M, Buonsenso D. Management and outcomes of bronchiolitis in Italy and Latin America: a multi-center, prospective, observational study. Eur J Pediatr 2024:10.1007/s00431-024-05530-6. [PMID: 38554172 DOI: 10.1007/s00431-024-05530-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/01/2024]
Abstract
We aimed to describe differences in the epidemiology, management, and outcomes existing between centers located in countries which differ by geographical location and economic status during to post-pandemic bronchiolitis seasons. This was a prospective observational cohort study performed in two academic centers in Latin America (LA) and three in Italy. All consecutive children with a clinical diagnosis of bronchiolitis were included, following the same data collection form. Nine hundred forty-three patients have been enrolled: 275 from the two Latin American Centers (San Jose, 215; Buenos Aires, 60), and 668 from Italy (Rome, 178; Milano, 163; Bologna, 251; Catania, 76). Children in LA had more frequently comorbidities, and only rarely received palivizumab. A higher number of patients in LA had been hospitalized in a ward (64% versus 23.9%, p < 0.001) or in a PICU (16% versus 6.2%, p < 0.001), and children in LA required overall more often respiratory support, from low flow oxygen to invasive mechanical ventilation, except for CPAP which was more used in Italy. There was no significant difference in prescription rates for antibiotics, but a significantly higher number of patients treated with systemic steroids in Italy. CONCLUSIONS We found significant differences in the care for children with bronchiolitis in Italy and LA. Reasons behind such differences are unclear and would require further investigations to optimize and homogenize practice all over the world. WHAT IS KNOWN • Bronchiolitis is among the commest cause of morbidity and mortality in infants all over the world. WHAT IS NEW • There are significant differences on how clinicians care for bronchiolitis in different centers and continents. Differences in care can be principally due to different local practices than differences in patients severity/presentations. • Understanding these differences should be a priority to optime and standardize bronchiolitis care globally.
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Affiliation(s)
- Anna Camporesi
- Division of Pediatric Anesthesia and Intensive Care, Buzzi Children's Hospital, Milano, Italy
| | | | | | - Damian Roland
- SAPPHIRE Group, Department Population Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Magali Gonzalez
- Department Pediatrics Unit, Velez Sarsfield General Hospital, Buenos Aires, Argentina
| | - Sandra Barreiro
- Department Pediatrics Unit, Velez Sarsfield General Hospital, Buenos Aires, Argentina
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Martin Brizuela
- Department Pediatrics Unit, Velez Sarsfield General Hospital, Buenos Aires, Argentina
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
- Center for Global Health Research Studies, Università Cattolica del Sacro Cuore, Rome, Italy.
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Sanna G, Camporesi A, Diotto V, Abbiati G, Torri A, Gemma M. Virtual sedation as a substitute to pharmacological sedation during PICC placement in pediatric patients: A feasibility study. J Vasc Access 2024; 25:313-317. [PMID: 35773952 DOI: 10.1177/11297298221085424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In pediatric patients, PICC insertion is often performed under sedation to reduce pain and anxiety, which is associated with risks such as laryngospasm, apnea, and hypoxia. Furthermore, it requires a pediatric anesthesiologist. The aim of our study was to evaluate the VR as an alternative to pharmacological sedation to reduce those risks and the overall cost. METHODS We tested a VR immersive experience for ten children requiring a PICC. To achieve this, we ran a software, specifically designed for the pediatric healthcare setting, on a commercially available VR headset.In order to evaluate this new practice, we recorded the following data:Patient's anxiety before and after the procedure, recorded through a modified numeric rating scale from 0 (no anxiety) to 10 (worst anxiety imaginable).Patient's pain before (e.g., because of preexisting medical conditions) and after the procedure through a Wong-Baker scale.Caregiver's satisfaction.No active or passive restraint was enforced during the whole procedure, patients had to keep their arms still all by themselves. RESULT Out of the 10 patients only in a single case, we had to interrupt the attempt with the VR technique and let the anesthesiologist perform a sedation. From the immediate beginning said patient had trouble adapting to the virtual environment and tried to remove the headset.In all other cases, we noticed a drop in the anxiety level of the patient and the pain never increased. Globally, caregivers were pleased with the experience and reported an average satisfaction rate of 9.3 out of 10. CONCLUSION Virtual reality seems a valid alternative to traditional sedation in pediatric patients undergoing a PICC placement procedure. Additional studies, with adequate sample size, of patients are necessary to assess the benefit from this new approach, as well as its impact on the overall procedure length.
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Affiliation(s)
- Gianuario Sanna
- Anesthesia and Intensive Care Unit, Fatebenefratelli Hospital, Milan, Lombardy, Italy
| | - Anna Camporesi
- Pediatric Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children Hospital, Milan, Lombardy, Italy
| | - Veronica Diotto
- Pediatric Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children Hospital, Milan, Lombardy, Italy
| | - Giacomo Abbiati
- Anesthesia and Intensive Care Unit, Fatebenefratelli Hospital, Milan, Lombardy, Italy
| | - Adriano Torri
- Specialist on vascular access, Becton, Dickinson and Company, Milano, Lombardia, Italy
| | - Marco Gemma
- Department of Neuroanesthesia and Critical Care, "Carlo Besta" Neurological Institute, Milan, Italy
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Camporesi A, Pierucci UM, Paladini G, Gentile A, Buonsenso D, Pelizzo G. Lung ultrasound-guided best positive end-expiratory pressure in neonatal anesthesia: a proposed randomized, controlled study. Pediatr Res 2024; 95:393-396. [PMID: 37648746 DOI: 10.1038/s41390-023-02730-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Atelectasis is a common complication in neonatal anesthesia. Lung ultrasound (LUS) can be used intraoperatively to evaluate and recognize atelectatic lung areas. Hypotheses for the study are: (1) The use of LUS to guide choice of best positive end-expiratory pressure (PEEP) can lead to reduction of FiO2 to achieve same saturations of oxygen (SpO2). (2) In a less de-recruited lung, there will be less postoperative pulmonary complications. (3) Static respiratory system compliance could be different. (4) Hemodynamic parameters and amount of fluids infused or need for vasopressors intraoperatively could be different. METHODS We propose a randomized controlled trial that compares standard PEEP settings with LUS-guided PEEP choice in patients under 2 months of age undergoing general anesthesia. RESULTS The primary aim is to determine whether LUS-guided PEEP choice in neonatal anesthesia, compared to standard PEEP choice, can lead to reduction of FiO2 applied to the ventilatory setting in order to maintain same SpO2s. Secondary aims are to determine whether patients treated with LUS-guided PEEP will develop less postoperative pulmonary complications, will have a significant difference in hemodynamic parameters and amount of fluids or vasopressors infused, and in static respiratory system compliance. CONCLUSIONS We expect a significant reduction of FiO2 in LUS-guided ventilation. IMPACT Lung atelectasis is extremely common in neonatal anesthesia, because of the physiology of the neonatal lung and chest wall and leads to hypoxemia, being a lung area with a perfusion/ventilation mismatch. Raising inspired fraction of oxygen can overcome temporarily hypoxemia but oxygen is a toxic compound for newborns. Lung ultrasound (LUS) can detect atelectasis at bedside and be used to optimize ventilator settings including choice of positive end-expiratory pressure (PEEP). This randomized controlled trial (RCT) aims at demonstrating that LUS-guided choice of best PEEP during neonatal anesthesia can lead to reduction of inspired fractions of oxygen to keep same peripheral saturations SpO2.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Buzzi Children's Hospital, Milan, Italy.
| | | | - Giuseppe Paladini
- Department of Pediatric Anesthesia and Intensive Care, Buzzi Children's Hospital, Milan, Italy
| | - Andrea Gentile
- Department of Medical-Surgical Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli", Roma, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, Luigi Sacco University Hospital, Milan, Italy
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Buonsenso D, Sodero G, Camporesi A, Pierucci UM, Raffaelli F, Proli F, Valentini P, Rendeli C. Predictors of Urinary Abnormalities in Children Hospitalised for Their First Urinary Tract Infection. Children (Basel) 2023; 11:55. [PMID: 38255368 PMCID: PMC10814763 DOI: 10.3390/children11010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
We aimed to investigate if children with their first UTI and a concomitant positive blood culture have a higher risk of abnormalities. We performed a retrospective study of children younger than 18 years of age with their first UTI. Multivariate logistic regression and receiver operating characteristic (ROC) curves were used to evaluate if positive blood cultures are associated with urinary abnormalities. After the screening process, we considered the enrolled 161 children with UTIs. The median age was three months, and 83 were females (43.2%). In multivariate analysis, age (p = 0.001, 95% CI 1.005-1.020), the presence of Pseudomonas aeruginosa or unusual germs in urine cultures (p = 0.002, 95% CI 2.18-30.36) and the positivity of blood cultures (p = 0.001, 95% CI 2.23-18.98) were significantly associated with urinary abnormalities. A model based on these parameters has an AUC of 0.7168 to predict urinary malformations (p = 0.0315). Conclusions include how greater age, a positive blood culture and the presence of Pseudomonas aeruginosa or unusual germs in urine culture in children hospitalised for their first episode of a UTI are factors associated with a significantly higher risk of urinary abnormalities. These data can guide the implementation of more personalized strategies to screen for urinary abnormalities that may be included in future guidelines.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (P.V.); (C.R.)
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Giorgio Sodero
- Institute of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Buzzi Children’s Hospital, 20154 Milan, Italy;
| | - Ugo Maria Pierucci
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy;
| | - Francesca Raffaelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Francesco Proli
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (P.V.); (C.R.)
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (P.V.); (C.R.)
| | - Claudia Rendeli
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (P.V.); (C.R.)
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Camporesi A, Vetrugno L, Morello R, De Rose C, Ferrario S, Buonsenso D. Prognostic Value of the Area of Lung Involved in Severe and Non-Severe Bronchiolitis: An Observational, Ultrasound-Based Study. J Clin Med 2023; 13:84. [PMID: 38202091 PMCID: PMC10780043 DOI: 10.3390/jcm13010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Point of care lung ultrasound (LUS) has a definite role in viral bronchiolitis when combined with clinical data. Previous data showed a bigger involvement of the superior lung zones in more severe cases. The aim of the present study is to describe whether different lung areas are implicated to different degrees in patients admitted to a Pediatric Intensive Care Unit (PICU) and needing ventilation compared to those with less severe forms. METHODS observational, prospective study. LUS scores of single lung areas and clinical data were collected for all children aged 0-12 months presenting with bronchiolitis to the participating centers and used as covariates for logistic regression having "PICU admission" as outcome. A subsequent analysis was carried out to investigate factors concurring with different lung zones' involvement. RESULTS 173 patients were enrolled. Difficulty in feeding, presence of wheezing, SpO2 were all risk factors for PICU admission. Superior lung areas' LUS scores presented higher Odds Ratios for PICU admission and need for ventilation than inferior ones. Age and prematurity concurred in determining their higher LUS scores. CONCLUSIONS Superior lobes' greater involvement could be favored by the geometrical distribution of relative bronchi, exiting with an acute angle from mainstem bronchi in small children where airway caliber is small and only small volumes of secretions can be occlusive.
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Affiliation(s)
- Anna Camporesi
- Pediatric Anesthesia and Intensive Care, Buzzi Children’s Hospital, 20154 Milano, Italy;
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli”, 00168 Roma, Italy; (R.M.); (C.D.R.); (D.B.)
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli”, 00168 Roma, Italy; (R.M.); (C.D.R.); (D.B.)
| | - Stefania Ferrario
- Pediatric Anesthesia and Intensive Care, Buzzi Children’s Hospital, 20154 Milano, Italy;
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli”, 00168 Roma, Italy; (R.M.); (C.D.R.); (D.B.)
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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Camporesi A, Vetrugno L, Buonsenso D. COVID-19 and Children: Reflections after Three Years. Children (Basel) 2023; 11:10. [PMID: 38275431 PMCID: PMC10814962 DOI: 10.3390/children11010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
Three years after the beginning of the COVID-19 pandemic, enough experience has been gained to derive reflections on the impact of SARS-CoV-2 in children [...].
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Affiliation(s)
- Anna Camporesi
- Pediatric Anesthesia and Intensive Care, Vittore Buzzi Children’s Hospital, 20154 Milano, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, 20123 Roma, Italy
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Buonsenso D, Camporesi A, Morello R, De Rose C, Fracasso M, Chieffo DPR, Valentini P. Social Stigma in Children with Long COVID. Children (Basel) 2023; 10:1518. [PMID: 37761479 PMCID: PMC10529184 DOI: 10.3390/children10091518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
There is growing evidence that adults with Long COVID suffer from different sets of stigmata related to their condition. In children with Long COVID, this aspect has never been investigated. This study aims to investigate if children with Long COVID also experience stigma. METHODS Children with a previous SARS-CoV-2 infection evaluated at 3 month follow-ups in a pediatric post COVID unit were asked to fill in an online Long COVID Stigma Scale survey before they were assessed by a pediatrician. Doctors were unaware of children's responses when they performed a diagnosis of Long COVID or full recovery from previous infection, according to the World Health Organization definition of pediatric Long COVID. Responses to the Stigma scale were then compared in the two cohorts of children. RESULTS 224 patients responded to the questionnaire; 40 patients were diagnosed with Long COVID. Children with Long COVID significantly more frequently felt embarrassed about having Long COVID (p 0.035), felt embarrassed about having physical limitations (p < 0.001), felt they were valued less due to Long COVID (p 0.003), felt they were different from other peers due to Long COVID (p 0.033), felt significantly more frequently that people behaved differently towards them because they might be lying since the diagnosis of Long COVID (p 0.006), that they were less respected by others due to Long COVID (p 0.017), that other people thought that Long COVID is not a real disease (p 0.007), that other people thought that developing Long COVID is a sign of weakness (p 0.008), and that other people might judge them negatively due to their diagnosis of Long COVID (p < 0.001). CONCLUSIONS Children with Long COVID, similar to adults, are suffering from stigmata due to their condition,. These data may have implication and should be used by the public, policy makers, and healthcare professionals regarding pediatric Long COVID.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (C.D.R.); (P.V.)
- Center for Global Health Research Studies, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Anna Camporesi
- Pediatric Anesthesia and Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Rosa Morello
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (C.D.R.); (P.V.)
| | - Cristina De Rose
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (C.D.R.); (P.V.)
| | - Matteo Fracasso
- Medicine and Surgery, Universityà Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, 00168 Rome, Italy;
- Department of Woman, Children and Public Health, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (C.D.R.); (P.V.)
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Masnada S, Previtali R, Erba P, Beretta E, Camporesi A, Chiapparini L, Doneda C, Iascone M, Sartorio MUA, Spaccini L, Veggiotti P, Osio M, Tonduti D, Moroni I. FDXR-associated disease: a challenging differential diagnosis with inflammatory peripheral neuropathy. Neurol Sci 2023; 44:3037-3043. [PMID: 37046037 PMCID: PMC10096094 DOI: 10.1007/s10072-023-06790-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND AND AIMS Mutations in FDXR gene, involved in mitochondrial pathway, cause a rare recessive neurological disorder with variable severity of phenotypes. The most common presentation includes optic and/or auditory neuropathy, variably associated to developmental delay or regression, global hypotonia, pyramidal, cerebellar signs, and seizures. The review of clinical findings in previously described cases from literature reveals also a significant incidence of sensorimotor peripheral polyneuropathy (22.72%) and ataxia (43.18%). To date, 44 patients with FDXR mutations have been reported. We describe here on two new patients, siblings, who presented with a quite different phenotype compared to previously described patients. METHODS Clinical, neurophysiological, and genetic features of two siblings and a systematic literature review focused on the clinical spectrum of the disease are described. RESULTS Both patients presented with an acute-sub-acute onset of peripheral neuropathy and only in later stages of the disease developed the typical features of FDXR-associated disease. INTERPRETATION The peculiar clinical presentation at onset and the evolution of the disease in our patients and in some cases revised from the literature shed lights on a new possible phenotype of FDXR-associated disease: a peripheral neuropathy which can mimic an acute inflammatory disease.
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Affiliation(s)
- Silvia Masnada
- Pediatric Neurology Unit, Buzzi Children's Hospital, Milan, Italy.
| | - Roberto Previtali
- Pediatric Neurology Unit, Buzzi Children's Hospital, Milan, Italy
- University of Milan, Milan, Italy
| | - Paola Erba
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
| | - Elena Beretta
- Acquired Brain Injury Unit, Scientific Institute IRCCS Eugenio Medea, Lecco, Italy
| | - Anna Camporesi
- Division of Anesthesia and Intensive Care, Buzzi Children's Hospital, Milan, Italy
| | - Luisa Chiapparini
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Doneda
- Department of Pediatric Radiology and Neuroradiology, Buzzi Children's Hospital, Milan, Italy
| | - Maria Iascone
- Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Luigina Spaccini
- Clinical Genetics Unit, Department of Obstetrics and Gynecology, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Pierangelo Veggiotti
- Pediatric Neurology Unit, Buzzi Children's Hospital, Milan, Italy
- University of Milan, Milan, Italy
| | - Maurizio Osio
- Department of Neurology ASST Fatebenefratelli Sacco, Milan, Italy
| | - Davide Tonduti
- Pediatric Neurology Unit, Buzzi Children's Hospital, Milan, Italy
- University of Milan, Milan, Italy
| | - Isabella Moroni
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Camporesi A, Morello R, Pierucci UM, Proli F, Lazzareschi I, Bersani G, Valentini P, Roland D, Buonsenso D. 2021/22 and 2022/23 Post-Pandemic Bronchiolitis Seasons in Two Major Italian Cities: A Prospective Study. Children (Basel) 2023; 10:1081. [PMID: 37371312 DOI: 10.3390/children10061081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Abstract
Objectives: Bronchiolitis remains a major cause of morbidity and mortality in children under 24 months. During the first year of the pandemic, non-pharmacological interventions resulted in a significant reduction of bronchiolitis cases. Early in 2021, a rebound of bronchiolitis was reported with a description of out-of-season outbreaks. In this study, we prospectively evaluated the impact of bronchiolitis in two Italian University centers located in different geographical areas, aiming to compare two post-pandemic bronchiolitis seasons (2021/22 and 2022/23) in terms of severity, outcomes, microbiology and temporal distribution. Methods: This was a bicentric prospective observational cohort study. All consecutive children under 24 months of age assessed in the participating institutions during the specified seasons and receiving a clinical diagnosis of bronchiolitis were included. Results: A total of 900 patients were enrolled. Patients in the second season were globally younger and had comorbidities less often. Temporal distribution changed between the two seasons. Of the patients, 56% were tested for RSV; 60% of these was positive. Patients with RSV were globally younger (3.5 months vs. 4.9, p < 0.001), more often had a need for any kind of respiratory and fluid support and more often needed ward or PICU admission. At the end of the ED visit, 430 patients were discharged home, 372 (41.3%) were admitted to an inpatient ward and 46 (5.1%) to a pediatric intensive care unit. Conclusions: The 2022/23 post-COVID bronchiolitis was mostly similar to that of 2021/22, and was in line with pre-pandemic expectations.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Via Ludovico Castelvetro 32, 20154 Milano, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Ugo Maria Pierucci
- Department of Pediatric Surgery, Children's Hospital "Vittore Buzzi", 20154 Milano, Italy
| | - Francesco Proli
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Ilaria Lazzareschi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giulia Bersani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Hospital, Leicester LE1 5WW, UK
- Social Science APPlied to Healthcare Improvement Research, SAPPHIRE Group, Health Sciences, Leicester University, Leicester LE1 7RH, UK
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Center for Global Health Research Studies, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Bonfiglio R, Francavilla A, Gregori D, Lenares E, Kuppers B, Mondarini MC, Camporesi A, Sbaraglia F, Disma N. Morbidity and mortality after anesthesia in early life in Italy. A subgroup analysis of the NECTARINE Trial. Minerva Pediatr (Torino) 2023:S2724-5276.23.07139-2. [PMID: 37155203 DOI: 10.23736/s2724-5276.23.07139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Recent literature on neonatal anesthesia focuses on the importance of keeping physiology within the ranges of normality to improve the long-term neurological outcome. The Neonate and Children audit of Anesthesia pRactice IN Europe (NECTARINE) showed a derangement of one or more than one physiological parameters during anesthesia needing a medical intervention in 35.2% of 6592 anesthesia procedure performed in infants up to 60 weeks postmenstrual age. METHODS Subanalysis of the Italian NECTARINE cohort providing a snapshot of anesthesia management, incidence of clinical events requiring intervention during anesthesia, and morbidity and mortality at 30 and 90 days. Secondary aim was to compare outcomes between Italy and Europe. RESULTS Twenty-three Italian centers recruited 501 patients (63% male, 37% female) undergoing 611 procedures (441 surgical and 170 non-surgical) with a mean gestational age at birth of 38 weeks. Events requiring a medical intervention during anesthesia occurred in 177 cases (28.9%), lower than those reported in Europe (35.3%). The majority of events concerned episodes of cardiovascular instability, most commonly due to hypotension. The incidence of mortality at 30 days was 2.7%, consistent with the European incidence. CONCLUSIONS Anesthetizing neonates is challenging. It is crucial that neonatal anesthesia practice is performed in specialized centers to maximize the potential positive outcome. We recommend a certification of quality for Institutions providing care for very young patients.
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Affiliation(s)
- Rachele Bonfiglio
- Unit for Research in Anesthesia, Department of Pediatric Anesthesia, IRCCS Giannina Gaslini Institute, Genoa, Italy -
| | - Andrea Francavilla
- Unit of Biostatistics, Epidemiology and Public Health, University of Padua, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, University of Padua, Padua, Italy
| | | | - Beate Kuppers
- Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | | | | | - Fabio Sbaraglia
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Nicola Disma
- Unit for Research in Anesthesia, Department of Pediatric Anesthesia, IRCCS Giannina Gaslini Institute, Genoa, Italy
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12
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Buonsenso D, Mariani F, Morello R, Cammarota G, De Rose C, Valentini P, Camporesi A, Vetrugno L. Ultrasound Imaging for Diaphragm Function in a Population of Healthy Infants: A Short Observational Report. Diagnostics (Basel) 2023; 13:diagnostics13061095. [PMID: 36980403 PMCID: PMC10047558 DOI: 10.3390/diagnostics13061095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction: Diaphragm ultrasound is increasingly used in adults, and more recently in pediatric practice. However, normal diaphragm parameters in healthy infants are unknown. This was a prospective observational pilot study aiming to define the normal diaphragm ultrasound characteristics in healthy infants during the first 6 months of life. Methods: We recruited healthy neonates at 7 to 15 days of life, who were followed until the sixth month of life, undergoing five assessments in different time points. The measurements included diaphragm thickness at end expiration (TEE) and at end inspiration (TEI). The thickening fraction (TF) was calculated as (TEI-TEE)/TEE and expressed as a percentage, and as (TEI-TEE)/TEI. Results: A total of 37 toddlers, 16 of which were females (43.2%), were enrolled. Thirty-four children (91.9%) were of Caucasian ethnicity and the median gestational age was 38.4 (35.7–40) weeks. Normal TEE, TEI, and TF have been provided for each time point. Conclusion: We provided new insight regarding data about thickness and thickening function in healthy children to be used for future physiologic and pathologic pediatric studies.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630154390
| | - Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Gianmaria Cammarota
- Department of Anaesthesia and Intensive Care Medicine, University of Perugia, 06100 Perugia, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy
| | - Luigi Vetrugno
- Department of Anesthesia, “SS Annunziata” Hospital, Via dei Vestini, 66100 Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
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13
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Camporesi A, Soares Lanziotti V, Bulut Y, Behrens D, Buonsenso D. Editorial: Covid, Long Covid, Mental Health, Schools and Masks: how and why we failed child health communication during a pandemic. Front Pediatr 2023; 11:1104518. [PMID: 36846164 PMCID: PMC9946450 DOI: 10.3389/fped.2023.1104518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 02/11/2023] Open
Affiliation(s)
- Anna Camporesi
- Pediatric Anesthesia and Intensive Care, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Vanessa Soares Lanziotti
- Pediatric Intensive Care Unit, Institute of Pediatrics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yonca Bulut
- Pediatric Intensive Care, UCLA Mattel Children's Hospital, Los Angeles, CA, United States
| | - Deanna Behrens
- Pediatric Anesthesia and Intensive Care, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italy
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14
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Camporesi A, Diotto V, Pederiva F. A worldwide survey on the variability in checking the tip position of pediatric central venous catheter. Paediatr Anaesth 2022; 33:405-407. [PMID: 36583236 DOI: 10.1111/pan.14623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Anna Camporesi
- Pediatric Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Veronica Diotto
- Pediatric Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Federica Pederiva
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, Milan, Italy
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15
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Pelizzo G, Lanfranchi G, Pantaloni M, Camporesi A, Tommasi P, Durante E, Costanzo S, Canonica CMP, Zoia E, Zuccotti G, Ruotolopalmi V, Donzelli C, Tosi GL, Calcaterra V. Epidemiological and Clinical Profile of Pediatric Burns in the COVID-19 Era: The Experience of a Reference Center. Children (Basel) 2022; 9:1735. [PMID: 36421184 PMCID: PMC9688935 DOI: 10.3390/children9111735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 02/08/2024]
Abstract
Pediatric burns represent a significant public health problem. We analyzed the characteristics of pediatric burns in a reference center, in order to identify better strategies for prevention and care. Burn patients admitted to the pediatric departments of our hospital from January 2020 to June 2022 were retrospectively evaluated. Age, gender, the etiology of injuries, the total burn surface area (TBSA), the degree of burns, the length of hospital stay (LOS), concomitant SARS-CoV-2 infection, and burn surface microbial colonization were analyzed. Forty-seven patients were included in the analysis (M:F = 1:0.67). Most of the cases involved patients between 0 and 4 years of age (83%). Hot liquid burns accounted for 79% of cases, flame burns for 9%, thermal burns for 6%, scald burns for 4% and chemical burns for 2%. Mean TBSA was 14 ± 11%. A second-degree lesion was detected in 79% of patients and third-degree in 21%. Mean LOS was 17 days. No additional infection risks or major sequelae were reported in patients with SARS-CoV-2 infection. Fifteen different species of bacteria plus C. parapsilosis were isolated, while no anaerobic microorganisms were detected. In the light of our experience, we recommend a carefully planned and proactive management strategy, always multidisciplinary, to ensure the best care for the burned child.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
| | - Giulia Lanfranchi
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Marcello Pantaloni
- Plastic and Reconstructive Surgery Unit, Fatebenefratelli Sacco Hospital, 20154 Milan, Italy
| | - Anna Camporesi
- Pediatric Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Paola Tommasi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Eleonora Durante
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Sara Costanzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | | | - Elena Zoia
- Pediatric Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Valeria Ruotolopalmi
- Head Nurse Operating Room, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Claudia Donzelli
- Head Nurse Pediatric Surgery Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Giulia Lina Tosi
- Pharmacy Service Manager, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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16
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Gonzalez-Dambrauskas S, Vasquez-Hoyos P, Camporesi A, Cantillano EM, Dallefeld S, Dominguez-Rojas J, Francoeur C, Gurbanov A, Mazzillo-Vega L, Shein SL, Yock-Corrales A, Karsies T. Paediatric critical COVID-19 and mortality in a multinational prospective cohort. Lancet Reg Health Am 2022; 12:100272. [PMID: 35599855 PMCID: PMC9111167 DOI: 10.1016/j.lana.2022.100272] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries. METHODS Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe between April 1 and December 31, 2020. Associations with mortality were evaluated using logistic regression. FINDINGS 557 patients (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Invasive (41%) or non-invasive (20%) ventilation and vasopressors (56%) were the most common support modalities. Hospital mortality was 10% and higher in children <2 years old (15%; odds ratio 1·94, 95%CI 1·08-3·49). Most who died had pulmonary disease. When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2·89; 95%CI 1·2-6·94) or pulmonary comorbidities (aOR 4·43; 95%CI 1·70-11·5), admission hypoxemia (aOR 2·44; 95%CI 1·30-4·57), and lower respiratory symptoms (aOR 2·96; 95%CI 1·57-5·59). MIS-C (aOR 0·25; 95%CI 0·1-0·61) and receiving methylprednisolone (aOR 0·5; 95%CI 0·25-0·99), IVIG (aOR 0·32; 95%CI 0·16-0·62), or anticoagulation (aOR 0·49; 95%CI 0·25-0·95) were associated with lower mortality although these associations might be limited to children >2 years old. INTERPRETATION We identified factors associated with COVID-19 mortality in critically ill children from both high and low-middle income countries, including higher mortality with younger age and COVID-related pulmonary disease but lower mortality in MIS-C. Further research is needed on optimal treatments for younger children and respiratory failure in paediatric COVID-19. FUNDING None.
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Affiliation(s)
- Sebastian Gonzalez-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network) and Cuidados Intensivos Pediátricos Especializados (CIPe) Casa de Galicia, Montevideo, Uruguay
| | - Pablo Vasquez-Hoyos
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Universidad Nacional de Colombia and Sociedad de Cirugía Hospital de San José, FUCS, Bogota, Colombia
| | - Anna Camporesi
- Division of Pediatric Anesthesia and ICU, Department of Pediatrics. Children's Hospital Vittore Buzzi, Milan, Italy
| | - Edwin Mauricio Cantillano
- UCIP. Hospital Regional del Norte, Instituto Hondureño de Seguridad Social, San Pedro Sula, Honduras
| | - Samantha Dallefeld
- Pediatric Critical Care Medicine, Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - Jesus Dominguez-Rojas
- Departamento Pediatría Universidad Nacional Federico Villarreal. UCIP Hospital de Emergencia Villa El Salvador, Lima, Perú
| | - Conall Francoeur
- Department of Pediatrics, Division of Pediatric Critical Care, CHU de Québec – Université Laval Research Center, Québec, Québec, Canada
| | - Anar Gurbanov
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Steven L. Shein
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Adriana Yock-Corrales
- Emergency Department. Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, CCSS. San José, Costa Rica
| | - Todd Karsies
- Division of Pediatric Critical Care, Nationwide Children's Hospital, Columbus, Ohio, USA
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Sümpelmann R, Camporesi A, Gálvez I, Pechilkov D, Eich C, Kretz FJ, Perera Sarri R, Tancheva D, Serrano-Casabon S, Murphy P, Astuto M, Zanaboni C, Becke K, Dennhardt N. Modified fluid gelatin 4% for perioperative volume replacement in pediatric patients (GPS): Results of a European prospective noninterventional multicenter study. Paediatr Anaesth 2022; 32:825-833. [PMID: 35426196 DOI: 10.1111/pan.14459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/01/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Modified fluid gelatin 4% is approved for use in children, but there is still a surprising lack of clinical studies including large numbers of pediatric patients. Therefore, we performed a European prospective noninterventional multicenter study to evaluate the use of a modified fluid gelatin 4% in saline (sal-GEL) or an acetate-containing balanced electrolyte solution (bal-GEL) in children undergoing major pediatric surgery. AIMS The primary aim was to assess the indications and dosing of modified fluid gelatin, and the secondary aim was to assess the safety and efficacy, focusing, in particular, on routinely collected clinical parameters. METHODS Children aged up to 12 years with ASA risk scores of I-III receiving sal-GEL or bal-GEL were followed perioperatively. Demographic data, surgical procedures performed, anesthesia, hemodynamic and laboratory data, adverse events, and adverse drug reactions were documented using a standardized case report form. RESULTS 601 children that were investigated at 13 European pediatric centers from May 2015 to March 2020 (sal-GEL 20.1%, bal-GEL 79.9%; mean age 29.1 ± 38.6 (range 0-144) months; body weight 12.1 ± 10.5 (1.4-70) kg) were included in the analysis. The most frequent indications for GEL infusion were hemodynamic instability without bleeding (76.0%), crystalloids alone not being sufficient for hemodynamic stabilization (55.7%), replacement of preoperative deficit (26.0%), and significant bleeding (13.0%). Mean infused GEL volume was 13.0 ± 5.3 (2.4-37.5) ml kg-1 . The total dose was affected by age, with higher doses in younger patients. After gelatin infusion, mean arterial pressure increased (mean change 8.5 ± 7.3 [95% CI: 8 to 9.1] mmHg), and the hemoglobin concentrations decreased significantly (mean change -1.1 ± 1.8 [95% CI: -1.2 to -0.9] g·dL-1 ). Acid-base parameters were more stable with bal-GEL. No serious adverse drug reactions directly related to gelatin (i.e., anaphylactoid reaction, clotting disorders, and renal failure) were observed. CONCLUSION Moderate doses up to 20 ml kg-1 of modified fluid gelatin were infused most frequently to improve hemodynamic stability in children undergoing major pediatric surgery. The acid-base balance was more stable when gelatin in a balanced electrolyte solution was used instead of saline. No serious adverse drug reactions associated with gelatin were observed.
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Affiliation(s)
- Robert Sümpelmann
- Clinic of Anaesthesiology, Hannover Medical School, Hannover, Germany
| | - Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, "V. Buzzi" Children's Hospital, University of Milan, Milan, Italy
| | - Ignacio Gálvez
- Department of Pediatric Anesthesia, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Dimitar Pechilkov
- Pediatric Cardiac Intensive Care Unit, Department of Pediatric Cardiology, National Cardiology Hospital, Sofia, Bulgaria
| | - Christoph Eich
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Franz-Josef Kretz
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Remei Perera Sarri
- Department of Paediatric Anaesthesia, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Dora Tancheva
- Intensive Care Unit, Burn Injury Clinic, University Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov", Sofia, Bulgaria
| | | | - Peter Murphy
- Department of Paediatric Anaesthesia, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Marinella Astuto
- Department of Anesthesiology and Intensive Care, AOU Policlinico- San Marco Catania, Catania, Italy
| | - Clelia Zanaboni
- Department of Anaesthesia, Critical Care and Perinatal Medicine, Istituto Giannina Gaslini, Genoa, Italy
| | - Karin Becke
- Department of Anaesthesia and Intensive Care, Cnopfsche Kinderklinik/Klinik Hallerwiese, Nürnberg, Germany
| | - Nils Dennhardt
- Clinic of Anaesthesiology, Hannover Medical School, Hannover, Germany
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Camporesi A, Gemma M, Buonsenso D, Ferrario S, Mandelli A, Pessina M, Diotto V, Rota E, Raso I, Fiori L, Campari A, Izzo F. Lung Ultrasound Patterns in Multisystem Inflammatory Syndrome in Children (MIS-C)-Characteristics and Prognostic Value. Children (Basel) 2022; 9:children9070931. [PMID: 35883915 PMCID: PMC9322869 DOI: 10.3390/children9070931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 12/11/2022]
Abstract
Objective and design: Following COVID-19 infection, children can develop an hyperinflammatory state termed Multisystem Inflammatory Syndrome in Children (MIS-C). Lung Ultrasound (LUS) features of COVID-19 in children have been described, but data describing the LUS findings of MIS-C are limited. The aim of this retrospective observational study conducted between 1 March and 31 December 2020, at a tertiary pediatric hospital in Milano, is to describe LUS patterns in patients with MIS-C and to verify correlation with illness severity. The secondary objective is to evaluate concordance of LUS with Chest X-ray (CXR). Methodology: Clinical and laboratory data were collected for all patients (age 0−18 years) admitted with MIS-C, as well as LUS and CXR patterns at admission. PICU admission, needed for respiratory support and inotrope administration, hospital, and PICU length of stay, were considered as outcomes and evaluated in the different LUS patterns. An agreement between LUS and CXR evaluation was assessed with Cohen’ k. Results: 24 children, who had a LUS examination upon admission, were enrolled. LUS pattern of subpleural consolidations < or > 1 cm with or without pleural effusion were associated with worse Left Ventricular Ejection Fraction at admission and need for inotropes. Subpleural consolidations < 1 cm were also associated with PICU length of stay. Agreement of CXR with LUS for consolidations and effusion was slight. Conclusion: LUS pattern of subpleural consolidations and consolidations with or without pleural effusion are predictors of disease severity; under this aspect, LUS can be used at admission to stratify risk of severe disease.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
- Correspondence:
| | - Marco Gemma
- Department of NeuroAnesthesia and NeuroIntensive Care, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20154 Milano, Italy;
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli”, 00168 Roma, Italy;
| | - Stefania Ferrario
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
| | - Anna Mandelli
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
| | - Matteo Pessina
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
| | - Veronica Diotto
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
| | - Elena Rota
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
| | - Irene Raso
- Department of Pediatric Cardiology, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy;
| | - Laura Fiori
- Department of Pediatrics, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy;
| | - Alessandro Campari
- Department of Pediatric Radiology, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy;
| | - Francesca Izzo
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
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Camporesi A, Diotto V, Zoia E, Rotta S, Tarantino F, Eccher LMG, Calcaterra V, Pelizzo G, Gemma M. Postoperative apnea after pyloromyotomy for infantile hypertrophic pyloric stenosis. World Jnl Ped Surgery 2022; 5:e000391. [DOI: 10.1136/wjps-2021-000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/20/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveInfantile hypertrophic pyloric stenosis (IHPS), which causes gastric outlet obstruction and hypochloremic hypokalemic metabolic alkalosis, could pose a risk of postoperative apnea in patients. The aim of this study is to evaluate the incidence of postoperative apnea in babies admitted to a tertiary-level pediatric surgical center in Milano, Italy with diagnosis of IHPS in 2010–2019. The secondary objective is to evaluate the risk factors for postoperative apnea.MethodsThis is a single-center, retrospective, observational cohort study. All patients admitted to our institution with diagnosis of IHPS during the study period were enrolled. Demographic and surgical variables, along with blood gas parameters, were obtained from the population. Postoperative apnea was defined as a respiratory pause longer than 15 s or a respiratory pause lasting less than 15 s, but associated with either bradycardia (heart rate <120 per minute), desaturation (SatO2 <90%), cyanosis, or hypotonia. Occurrence was obtained from nursing charts and was recorded as a no/yes dichotomous variable.ResultsOf 122 patients, 12 (9.84%) experienced apnea and 110 (90.16%) did not. Using univariate analysis, we found that only postoperative hemoglobin was significantly different between the groups (p=0.03). No significant multivariable model was better than this univariate model for prediction of apnea.ConclusionsPostoperative anemia, possibly due to hemodilution, increased the risk of postoperative apnea. It could be hypothesized that anemia can be added as another apnea-contributing factor in a population at risk due to metabolic changes.
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Dominguez-Rojas JÁ, Vásquez-Hoyos P, Pérez-Morales R, Monsalve-Quintero AM, Mora-Robles L, Diaz-Diaz A, Torres SF, Castro-Dajer Á, Cabanillas-Burgos LY, Aguilera-Avendaño V, Cantillano-Quintero EM, Camporesi A, Agulnik A, Mukkada S, Alvarado-Gamarra G, Rojas-Soto N, Mendieta-Zevallos AL, Tello-Pezo MV, Vásquez-Ponce L, Lasso-Palomino RE, Pérez-Arroyave MC, Trujillo-Honeysberg M, Mesa-Monsalve JG, Pardo González CA, López Cubillos JF, Gonzalez-Dambrauskas S, Coronado-Munoz A. Association of Cancer Diagnosis and Therapeutic Stage With Mortality in Pediatric Patients With COVID-19, Prospective Multicenter Cohort Study From Latin America. Front Pediatr 2022; 10:885633. [PMID: 35592840 PMCID: PMC9110860 DOI: 10.3389/fped.2022.885633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Children with cancer are at risk of critical disease and mortality from COVID-19 infection. In this study, we describe the clinical characteristics of pediatric patients with cancer and COVID-19 from multiple Latin American centers and risk factors associated with mortality in this population. Methods This study is a multicenter, prospective cohort study conducted at 12 hospitals from 6 Latin American countries (Argentina, Bolivia, Colombia, Ecuador, Honduras and Peru) from April to November 2021. Patients younger than 14 years of age that had an oncological diagnosis and COVID-19 or multisystemic inflammatory syndrome in children (MIS-C) who were treated in the inpatient setting were included. The primary exposure was the diagnosis and treatment status, and the primary outcome was mortality. We defined "new diagnosis" as patients with no previous diagnosis of cancer, "established diagnosis" as patients with cancer and ongoing treatment and "relapse" as patients with cancer and ongoing treatment that had a prior cancer-free period. A frequentist analysis was performed including a multivariate logistic regression for mortality. Results Two hundred and ten patients were included in the study; 30 (14%) died during the study period and 67% of patients who died were admitted to critical care. Demographics were similar in survivors and non-survivors. Patients with low weight for age (<-2SD) had higher mortality (28 vs. 3%, p = 0.019). There was statistically significant difference of mortality between patients with new diagnosis (36.7%), established diagnosis (1.4%) and relapse (60%), (p <0.001). Most patients had hematological cancers (69%) and they had higher mortality (18%) compared to solid tumors (6%, p= 0.032). Patients with concomitant bacterial infections had higher mortality (40%, p = 0.001). MIS-C, respiratory distress, cardiovascular symptoms, altered mental status and acute kidney injury on admission were associated with higher mortality. Acidosis, hypoxemia, lymphocytosis, severe neutropenia, anemia and thrombocytopenia on admission were also associated with mortality. A multivariate logistic regression showed risk factors associated with mortality: concomitant bacterial infection OR 3 95%CI (1.1-8.5), respiratory symptoms OR 5.7 95%CI (1.7-19.4), cardiovascular OR 5.2 95%CI (1.2-14.2), new cancer diagnosis OR 12 95%CI (1.3-102) and relapse OR 25 95%CI (2.9-214). Conclusion Our study shows that pediatric patients with new onset diagnosis of cancer and patients with relapse have higher odds of all-cause mortality in the setting of COVID-19. This information would help develop an early identification of patients with cancer and COVID-19 with higher risk of mortality.
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Affiliation(s)
- Jesus Ángel Dominguez-Rojas
- Pediatric Critical Care, Hospital Edgardo Rebagliati Martins, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Lima, Peru
| | - Pablo Vásquez-Hoyos
- Pediatric Critical Care, Hospital de San Jose, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Bogota, Colombia
- Research Division, Department of Pediatrics, Fundacion Universitatia de Ciencias de la Salud–FUCS, Bogota, Colombia
| | - Rodrigo Pérez-Morales
- Pediatric Critical Care, HOMI Fundacion Hospital Pediatrico La Misericordia, Bogota, Colombia
| | | | | | - Alejandro Diaz-Diaz
- Pediatric Infectious Diseases, Hospital Pablo Tobon Uribe y Hospital General de Medellin, Medellin, Colombia
| | - Silvio Fabio Torres
- Pediatric Critical Care, Hospital Universitario Austral Pilar, Buenos Aires, Argentina
| | | | | | | | | | - Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sheena Mukkada
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Giancarlo Alvarado-Gamarra
- Pediatrics, Hospital Edgardo Rebagliati Martins, Lima, Peru
- Instituto de Investigación Nutricional, Lima, Perú
| | | | | | | | - Liliana Vásquez-Ponce
- Research Center “Medicina de Precisión, ” Facultad de Medicina, Universidad de San Martín de Porres, Lima, Perú
| | | | | | | | | | | | | | - Sebastián Gonzalez-Dambrauskas
- Specialized Pediatric Critical Care (CIPe), Casa de Galicia, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Medical School, Pediatric Critical Care, Pereira Rossell Medical Center (UCIN-CHPR), Universidad de la República, Montevideo, Uruguay
| | - Alvaro Coronado-Munoz
- Pediatric Critical Care Division, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, United States
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21
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Camporesi A, Morello R, Ferro V, Pierantoni L, Rocca A, Lanari M, Trobia GL, Sciacca T, Bellinvia AG, De Ferrari A, Valentini P, Roland D, Buonsenso D. Epidemiology, Microbiology and Severity of Bronchiolitis in the First Post-Lockdown Cold Season in Three Different Geographical Areas in Italy: A Prospective, Observational Study. Children (Basel) 2022; 9:children9040491. [PMID: 35455535 PMCID: PMC9024462 DOI: 10.3390/children9040491] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022]
Abstract
The aim of this study was to understand the epidemiology, disease severity, and microbiology of bronchiolitis in Italy during the 2021–2022 cold season, outside of lockdowns. Before COVID-19, the usual bronchiolitis season in Italy would begin in November and end in April, peaking in February. We performed a prospective observational study in four referral pediatric centers located in different geographical areas in Italy (two in the north, one in the center and one in the south). From 1 July 2021 to 31 January 2022, we collected all new clinical diagnoses of bronchiolitis in children younger than two years of age recording demographic, clinical and microbiological data. A total of 657 children with a clinical diagnosis of bronchiolitis were enrolled; 56% children were admitted and 5.9% required PICU admission. The first cases were detected during the summer, peaking in November 2021 and declining into December 2021 with only a few cases detected in January 2022. RSV was the commonest etiological agent, while SARS-CoV-2 was rarely detected and only since the end of December 2021. Disease severity was similar in children with RSV vs. non-RSV bronchiolitis, and in those with a single infectious agent detected compared with children with co-infections. The 2021–2022 bronchiolitis season in Italy started and peaked earlier than the usual pre-pandemic seasons, but had a shorter duration. Importantly, the current bronchiolitis season was not more severe when data were compared with Italian published data, and SARS-CoV-2 was rarely a cause of bronchiolitis in children younger than 24 months of age.
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Affiliation(s)
- Anna Camporesi
- Anesthesia and Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (A.C.); (A.D.F.)
| | - Rosa Morello
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (P.V.)
| | - Valentina Ferro
- Department of Pediatric Emergency, Bambin Gesù Children’s Hospital IRCCS, 00168 Rome, Italy;
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.P.); (A.R.); (M.L.)
| | - Alessandro Rocca
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.P.); (A.R.); (M.L.)
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.P.); (A.R.); (M.L.)
| | - Gian Luca Trobia
- Pediatric and Pediatric Emergency Room Unit, Cannizzaro Emergency Hospital-Catania, 95126 Catania, Italy; (G.L.T.); (T.S.); (A.G.B.)
| | - Tiziana Sciacca
- Pediatric and Pediatric Emergency Room Unit, Cannizzaro Emergency Hospital-Catania, 95126 Catania, Italy; (G.L.T.); (T.S.); (A.G.B.)
| | - Agata Giuseppina Bellinvia
- Pediatric and Pediatric Emergency Room Unit, Cannizzaro Emergency Hospital-Catania, 95126 Catania, Italy; (G.L.T.); (T.S.); (A.G.B.)
| | - Alessandra De Ferrari
- Anesthesia and Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (A.C.); (A.D.F.)
| | - Piero Valentini
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (P.V.)
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Hospital, Leicester LE1 5WW, UK;
- Social science APPlied to Healthcare Improvement REsearch, SAPPHIRE Group, Health Sciences, Leicester University, Leicester LE1 7RH, UK
| | - Danilo Buonsenso
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (P.V.)
- Center for Global Health Research Studies, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-30154390
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22
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Mannarino S, Raso I, Garbin M, Ghidoni E, Corti C, Goletto S, Nespoli L, Santacesaria S, Zoia E, Camporesi A, Izzo F, Dilillo D, Fiori L, D'Auria E, Silvestri AD, Dolci A, Calcaterra V, Zuccotti G. Cardiac dysfunction in Multisystem Inflammatory Syndrome in Children: An Italian single-center study. Ital J Pediatr 2022; 48:25. [PMID: 35135600 PMCID: PMC8822778 DOI: 10.1186/s13052-021-01189-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/30/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a novel condition temporally associated with SARS-CoV2 infection. Cardiovascular involvement is mainly evident as acute myocardial dysfunction in MIS-C. The aim of this study was to describe the cardiac dysfunction in patients with MIS-C, defining the role of severity in the clinical presentations and outcomes in a single cohort of pediatric patients. METHODS A single-center retrospective study on patients diagnosed with MIS-C, according to the Center for Disease Control and Prevention (CDC) definition, and referred to Vittore Buzzi Children's Hospital in Milan from November 2020 to February 2021. Patients were managed according to a local approved protocol. According to the admission cardiac left ventricular ejection fraction (LVEF), the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥45%). Pre-existing, clinical, and laboratory factors were assessed for evaluating outcomes at discharge. RESULTS Thirty-two patients were considered. Cardiac manifestations of MIS-C were reported in 26 patients (81%). Group A included 10 patients (9 M/1F, aged 13 years [IQR 5-15]), and group B included 22 patients (15 M/7 M, aged 9 years [IQR 7-13]). Significant differences were noted among clinical presentations (shock, diarrhea, intensive care unit admission), laboratory markers (leucocytes, neutrophils, and protein C-reactive), and cardiac markers (troponin T and N-terminal pro B-type Natriuretic Peptide) between the groups, with higher compromission in Group A. We found electrocardiogram anomalies in 14 patients (44%) and rhythm alterations in 3 patients (9%), without differences between groups. Mitral regurgitation and coronary involvement were more prevalent in group A. Total length of hospital stay and cardiac recovery time were not statistically different between groups. A recovery of cardiac functioning was reached in all patients. CONCLUSION Despite significant differences in clinical presentations and need for intensive care, all of the MIS-C patients with significant cardiac involvement in this study completely recovered. This suggests that the heart is an involved organ and did not influence prognosis if properly treated and supported in the acute phase.
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Affiliation(s)
- Savina Mannarino
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.
| | - Irene Raso
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Massimo Garbin
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Elena Ghidoni
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Carla Corti
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Sara Goletto
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Luisa Nespoli
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Sara Santacesaria
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Elena Zoia
- Anesthesia and Intensive Care Unit, ``Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Anna Camporesi
- Anesthesia and Intensive Care Unit, ``Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Francesca Izzo
- Anesthesia and Intensive Care Unit, ``Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Dario Dilillo
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Laura Fiori
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Enza D'Auria
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Annalisa De Silvestri
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Alberto Dolci
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy.,Pediatric and Adolescent Unit, Clinical Pathology Laboratory , "Luigi Sacco" Hospital, 27100, Pavia, Italy
| | - Valeria Calcaterra
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.,Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100, Pavia, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.,Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy
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23
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Costanzo S, Pansini A, Colombo L, Caretti V, Popovic P, Lanfranchi G, Camporesi A, Pelizzo G. Video-Assisted Thoracoscopy for Vertebral Body Tethering of Juvenile and Adolescent Idiopathic Scoliosis: Tips and Tricks of Surgical Multidisciplinary Management. Children (Basel) 2022; 9:children9010074. [PMID: 35053697 PMCID: PMC8774437 DOI: 10.3390/children9010074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 12/15/2022]
Abstract
VATS (video assisted thoracoscopic surgery) is routinely and successfully performed in minor and major complex thoracic procedures. This technique has been recently introduced for the treatment of severe forms of idiopathic scoliosis (IS) with the aim to repair the deformity, reduce morbidity and to prevent its progression in patients with skeletal immaturity. This study aims to present VATS in anterior vertebral body tethering (AVBT) approach to support the pediatric orthopedic surgeons during vertebral body fixation. Surgical and anesthesiologic tips and tricks are reported to assure a safe procedure. The study includes preadolescents with IS and a grade of scoliosis >40° that had a high probability of deterioration due to remaining growth (December 2018 to April 2021). Skeletal immaturity of enrolled patients was assessed by Sanders classification and Risser sign. Patients had a Risser score between 0 and 1 and a Sanders score >2 and <5. AVBT technique using VATS was performed by a senior pediatric surgeon assisting the pediatric orthopedic surgeon. Twenty-three patients have been submitted to VATS AVBT in the period of study (age range 9–14 years). The patients had a classified deformity Lenke 1A or B convex right and all types of curves were treated. In all patients, the vertebrae submitted to tethering surgery ranged from D5 to D12; mean curve correction was 43%. Three postoperative complications occurred: one late postoperative bleeding requiring a chest tube positioning on 12th postoperative day; one screw dislodged and needed to be removed; one child showed worsening of the scoliosis and needed a posterior arthrodesis. Initial results of VATS AVBT in growing patients with spinal deformities are encouraging. An appropriate selection of patients and a pediatric dedicated multidisciplinary surgical approach decrease intraoperative complications, time of operation and postoperative sequelae and guarantee an optimal outcome.
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Affiliation(s)
- Sara Costanzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy; (A.P.); (P.P.); (G.L.); (G.P.)
- Correspondence:
| | - Andrea Pansini
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy; (A.P.); (P.P.); (G.L.); (G.P.)
| | - Luca Colombo
- Pediatric Orthopedics and Traumatology, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy; (L.C.); (V.C.)
| | - Valentina Caretti
- Pediatric Orthopedics and Traumatology, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy; (L.C.); (V.C.)
| | - Petar Popovic
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy; (A.P.); (P.P.); (G.L.); (G.P.)
| | - Giulia Lanfranchi
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy; (A.P.); (P.P.); (G.L.); (G.P.)
| | - Anna Camporesi
- Pediatric Anesthesia and Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy; (A.P.); (P.P.); (G.L.); (G.P.)
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milano, 20157 Milano, Italy
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24
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Pelizzo G, Costanzo S, Roveri M, Lanfranchi G, Vertemati M, Milani P, Zuccotti G, Cassin S, Panfili S, Rizzetto F, Campari A, Camporesi A, Calcaterra V. Developing Virtual Reality Head Mounted Display (HMD) Set-Up for Thoracoscopic Surgery of Complex Congenital Lung MalFormations in Children. Children (Basel) 2022; 9:50. [PMID: 35053675 PMCID: PMC8774663 DOI: 10.3390/children9010050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/19/2022]
Abstract
Video assisted thoracoscopic surgery (VATS) has been adopted in pediatric age for the treatment of congenital lung malformations (CLM). The success of VATS in pediatrics largely depends on the surgeon's skill ability to understand the airways, vascular system and lung parenchyma anatomy in CLM. In the last years, virtual reality (VR) and 3-dimensional (3D) printing of organ models and VR head mounted display (HMD) technologies have been introduced for completion of preoperative planning in adult patients. To date no reports about the use of VR HMD technologies in a pediatric setting are available. The aim of this report is to introduce a VR HMD model in VATS procedure to improve the quality of care in children with CLM. VR HMD set-up for planning thoracoscopic surgery was performed in a series of pediatric patients with diagnosis of CLM. The preoperative VR HMD evaluation allowed a navigation into the malformation with the aim to explore, interact, and make the surgeon more confident and skilled to answer to the traps. A development of surgical simulations models and teaching program dedicated to education and training in pediatric VATS is suitable among the pediatric surgery community. Further studies should demonstrate all the benefits of such technology in pediatric patients submitted to VATS procedure.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (S.C.); (M.R.); (G.L.)
- Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, 20157 Milan, Italy; (M.V.); (G.Z.); (S.C.); (S.P.)
| | - Sara Costanzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (S.C.); (M.R.); (G.L.)
| | - Margherita Roveri
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (S.C.); (M.R.); (G.L.)
| | - Giulia Lanfranchi
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (S.C.); (M.R.); (G.L.)
| | - Maurizio Vertemati
- Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, 20157 Milan, Italy; (M.V.); (G.Z.); (S.C.); (S.P.)
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy;
| | - Paolo Milani
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy;
- Department of Physics “Aldo Pontremoli”, University of Milano, 20157 Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, 20157 Milan, Italy; (M.V.); (G.Z.); (S.C.); (S.P.)
- Pediatric Department, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy;
| | - Simone Cassin
- Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, 20157 Milan, Italy; (M.V.); (G.Z.); (S.C.); (S.P.)
| | - Sebastiano Panfili
- Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, 20157 Milan, Italy; (M.V.); (G.Z.); (S.C.); (S.P.)
| | - Francesco Rizzetto
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy;
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milano, 20157 Milan, Italy
| | - Alessandro Campari
- Pediatric Radiology and Neuroradiology Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Anna Camporesi
- Division of Pediatric Anesthesia and Intensive Care Unit, Department of Pediatrics, Children’s Hospital Vittore Buzzi, 20154 Milan, Italy;
| | - Valeria Calcaterra
- Pediatric Department, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy;
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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25
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Calcaterra V, Biganzoli G, Dilillo D, Mannarino S, Fiori L, Pelizzo G, Zoia E, Fabiano V, Carlucci P, Camporesi A, Corti C, Mercurio G, Izzo F, Biganzoli E, Zuccotti G. Non-thyroidal illness syndrome and SARS-CoV-2-associated multisystem inflammatory syndrome in children. J Endocrinol Invest 2022; 45:199-208. [PMID: 34312809 PMCID: PMC8312710 DOI: 10.1007/s40618-021-01647-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE COVID-19 disease may result in a severe multisystem inflammatory syndrome in children (MIS-C), which in turn may alter thyroid function (TF). We assessed TF in MIS-C, evaluating its impact on disease severity. METHODS We retrospectively considered children admitted with MIS-C to a single pediatric hospital in Milan (November 2019-January 2021). Non-thyroidal illness syndrome (NTIS) was defined as any abnormality in TF tests (FT3, FT4, TSH) in the presence of critical illness and absence of a pre-existing hormonal abnormality. We devised a disease severity score by combining severity scores for each organ involved. Glucose and lipid profiles were also considered. A principal component analysis (PCA) was performed, to characterize the mutual association patterns between TF and disease severity. RESULTS Of 26 (19 M/7F) patients, median age 10.7 (IQR 5.8-13.3) years, 23 (88.4%) presented with NTIS. A low FT3 level was noted in 15/23 (65.3%), while the other subjects had varying combinations of hormone abnormalities (8/23, 34.7%). Mutually correlated variables related to organ damage and inflammation were represented in the first dimension (PC1) of the PCA. FT3, FT4 and total cholesterol were positively correlated and characterized the second axis (PC2). The third axis (PC3) was characterized by the association of triglycerides, TyG index and HDL cholesterol. TF appeared to be related to lipemic and peripheral insulin resistance profiles. A possible association between catabolic components and severity score was also noted. CONCLUSIONS A low FT3 level is common among MIS-C. TF may be useful to define the impact of MIS-C on children's health and help delineate long term follow-up management and prognosis.
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Affiliation(s)
- V Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Via Aselli 2, 27100, Pavia, Italy.
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.
| | - G Biganzoli
- Pharmacogenomics and Precision Therapeutics Master Degree, University of Milan, 20142, Milan, Italy
| | - D Dilillo
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - S Mannarino
- Pediatric Cardiology Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - L Fiori
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - G Pelizzo
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, University of Milan, 20154, Milan, Italy
| | - E Zoia
- Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - V Fabiano
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy
| | - P Carlucci
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - A Camporesi
- Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - C Corti
- Pediatric Cardiology Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - G Mercurio
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - F Izzo
- Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - E Biganzoli
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, 20122, Milan, Italy
| | - G Zuccotti
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy
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Camporesi A, Abecasis F, Torres EM, Zoia E, Izzo F, Ferrario S, Melloni EMT. The parental psychological distress caused by separation from their critically ill child during the COVID-19 pandemic: A tale of two cities. Front Pediatr 2022; 10:909210. [PMID: 36186626 PMCID: PMC9520916 DOI: 10.3389/fped.2022.909210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/12/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION A child's critical illness is a stressful event for the entire family, causing significant emotional distress among parents and changes to family functioning. The Severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-CoV-2) pandemic has abruptly caused modifications in visitation policies of Pediatric Intensive Care Units (PICUs) in many countries. We hypothesized that caregivers with no or severely restricted access to PICUs would demonstrate increased psychological distress as compared to those who had limitless access (LA) to PICUs. METHODS Sociodemographic variables, levels of psychological distress, ratings of family functioning, and ability to cope with stressful events were collected with an online survey in a group of caregivers after their child's hospitalization. Ratings of psychological distress were compared between caregivers with no/severely restricted (NA) and with LA to PICUs. RESULTS Measures of depression, anxiety, and global severity index (GSI) of psychological distress were significantly higher in NA caregivers as compared to LA. Among demographic characteristics of the sample, only gender influenced the severity of psychological symptoms: women showed an increased score on levels of somatization, depression, anxiety, and GSI. Avoidant coping style positively correlated with measures of depression. Univariate General Linear Model (GLM) analyses of the effects of sex, age, visitation policies of PICUs, and score of avoidant coping strategies on measures of psychological distress confirmed a significant univariate effect of no access to PICUs on parents' psychopathological scores. CONCLUSION Restrictions imposed on visitation policies in PICU during the pandemic negatively impacted families' psychological wellbeing. A balance between the safety of patients, families, and health care professionals and meeting the needs of families is of utmost importance.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Milan, Italy
| | - Francisco Abecasis
- Pediatric Intensive Care Unit, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Erica M Torres
- Pediatric Intensive Care Unit, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Elena Zoia
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Milan, Italy
| | - Francesca Izzo
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Milan, Italy
| | - Stefania Ferrario
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Milan, Italy
| | - Elisa Maria Teresa Melloni
- Psychiatry & Clinical Psychobiology Unit, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
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Camporesi A, De Silvestri A, Diotto V, Ferrario S, Eccher L, De Ferrari A, Messina F, Pelizzo G, Mileto D, Calcaterra V, Buonsenso D. Very High Negative Concordance Rate of RT-PCR for SARS-CoV-2 in Nasopharyngeal Swab and Tracheo-Bronchial Aspirate in Children. Front Pediatr 2022; 10:866111. [PMID: 35692973 PMCID: PMC9174601 DOI: 10.3389/fped.2022.866111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Reliable testing methods for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are essential to allow normal activities. Diagnosis of SARS-CoV-2 infection is currently based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) performed on nasopharyngeal (NP) swabs; concerns have been raised regarding NP swab accuracy in children to detect the virus because of potential lack of cooperation of the patients or due to general uncertainties about concordance between high and low respiratory tract specimens in children. The aim of the study (IRB approval: ST/2020/405) is to prospectively compare RT-PCR results on NP and tracheo-bronchial aspirate (TA) in children admitted to the hospital for surgery or admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary children hospital in Milano, Italy, during a peak of COVID-19 infections in the city. A total of 385 patients were enrolled in the study: 364 from surgical theater and 21 from PICU. Two patients (0.5%) tested positive on TA and were negative on NP; both cases occurred in November 2020, during a peak of infection in the city. Specificity of NP swab was.995 (95% CI: 0.980-0.999). Two patients with positive NP swabs tested negative on TA. CONCLUSION Our study shows that the specificity of SARS-CoV-2 RT-PCR on TA swab, compared to results of SARS-CoV-2 RT-PCR on NP, was very high for negative cases in our pediatric cohort during a period of high epidemiological pressure.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Veronica Diotto
- Department of Pediatric Anesthesia and Intensive Care, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Stefania Ferrario
- Department of Pediatric Anesthesia and Intensive Care, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Laura Eccher
- Department of Pediatric Anesthesia and Intensive Care, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Alessandra De Ferrari
- Department of Pediatric Anesthesia and Intensive Care, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Francesco Messina
- Pediatric Ear, Nose and Throat Unit, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Gloria Pelizzo
- Department of Pediatric Surgery, "V. Buzzi" Children's Hospital, University of Milan, Milan, Italy.,Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Milan, Italy
| | - Davide Mileto
- Clinical Microbiology, Virology, and Bio-Emergence Diagnosis, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
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Camporesi A, Zanin A, Kanaris C, Gemma M, Soares Lanziotti V. Impact of COVID-19 Pandemic on Pediatric Intensive Care Unit (PICU) Visiting Policies: A Worldwide Survey. J Pediatr Intensive Care 2021. [DOI: 10.1055/s-0041-1739263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractThe purpose of this study was to evaluate pediatric intensive care unit (PICU) visiting policies around the world and how the coronavirus disease 2019 (COVID-19) pandemic has affected these policies, due to concerns relating to a viral transmission. A web-based international survey was designed and disseminated through social networks, emails, or direct messages. Two hundred forty-one answers were received. From these, 26 were excluded (13 due to missing location and 13 duplicated answers), resulting in a final number of 215 answers. Europe accounted for 35% of responses (n = 77), South America 22.4% (n = 49), North America 19% (n = 41), Asia 16.5% (n = 36), Central America 2.7% (n = 6), Oceania, and Africa 2.2% each (n = 5 each). Before the pandemic, reported admission/visiting policies already varied between continents. Family time schedules remained similar to the pre-pandemic period in half of European, Central, and South American units and have changed in 60% of Asian, African, North American, and Oceanian units. Access to PICUs has been granted for patients and caregivers tested negative for severe acute respiratory syndrome coronavirus 2 (SARS COV-2) in only part of studied PICUs. Isolation precautions for the visitors were intensified at the onset of the pandemic. Changes in visiting policies were observed in most PICUs worldwide during the COVID-19 pandemic, with some PICUs prohibiting any visitation by families. These changes can decrease possibilities of parental participation in emotional support and reduction of sedation needs, early mobility, and shared decision-making process and impact negatively both children and parental well-being and even patients' outcomes.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital Vittore Buzzi, Milano, Italy
| | - Anna Zanin
- Department of Women's and Children's Health, Azienda Ospedaliera University of Padua, Padua, Italy
| | - Constantinos Kanaris
- Pediatric Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Pediatric and Neonatal Decision Support and Retrieval Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Blizard Institute Queen Mary University of London, London, United Kingdom
| | - Marco Gemma
- Department of Anesthesia and Intensive Care, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Vanessa Soares Lanziotti
- Pediatric Intensive Care Unit, Maternal and Child Health, Institute of Pediatrics (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Camporesi A, Melloni GEM, Diotto V, Bertani P, La Pergola E, Pelizzo G. Organizational aspects of pediatric anesthesia and surgery between two waves of Covid-19. Acta Anaesthesiol Scand 2021; 65:755-760. [PMID: 33619727 PMCID: PMC8013590 DOI: 10.1111/aas.13802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 12/11/2022]
Abstract
Background The initial wave of the Covid‐19 pandemic has hit Italy, and Lombardy in particular, with violence, forcing to reshape all hospitals' activities; this happened even in pediatric hospitals, although the young population seemed initially spared from the disease. “Vittore Buzzi” Children's Hospital, which is a pediatric/maternal hospital located in Milan (Lombardy Region), had to stop elective procedures—with the exception of urgent/emergent ones—between February and May 2020 to leave space and resources to adults' care. We describe the challenges of reshaping the hospital's identity and structure, and restarting pediatric surgery and anesthesia, from May on, in the most hit area of the world, with the purpose to avoid and contain infections. Both patients and caregivers admitted to hospital have been tested for Sars‐CoV‐2 in every case. Methods Observational cohort study via review of clinical charts of patients undergoing surgery between 16th May and 30th September 2020, together with SARS‐CoV ‐2 RT‐PCR testing outcomes, and comparison to same period surgeries in 2019. Results An increase of approximately 70% in pediatric surgeries (OR 1.68 [1.33‐2.13], P < .001) and a higher increase in the number of surgeries were reported (OR 1.75 (1.43‐2.15), P < .001). Considering only urgent procedures, a significant difference in the distribution of the type of surgery was observed (Chi‐squared P‐value < .001). Sars‐CoV‐2‐positive patients have been 0.8% of total number; 14% of these was discovered through caregiver's positivity. Conclusion We describe our pathway for safe pediatric surgery and anesthesia and the importance of testing both patient and caregiver.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care “V. Buzzi” Children's Hospital University of Milan Milan Italy
| | - Giorgio E. M. Melloni
- TIMI Study Group Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA USA
| | - Veronica Diotto
- Department of Pediatric Anesthesia and Intensive Care “V. Buzzi” Children's Hospital University of Milan Milan Italy
| | - Patrizia Bertani
- Operation Theatre Nurse Pediatric Surgery Department Children's Hospital “V. Buzzi” Milan Italy
| | - Enrico La Pergola
- Department of Pediatric Surgery “V. Buzzi” Children's Hospital University of Milan Milan Italy
| | - Gloria Pelizzo
- Department of Pediatric Surgery “V. Buzzi” Children's Hospital University of Milan Milan Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco” University Hospital Milan Italy
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30
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Zanin A, García-Salido A, Rodríguez-Rubio M, Camporesi A, Ulloa-Gutierrez R, Villar ME, González-Dambrauskas S, Kudchadkar SR, Carroll CL. Live Tweeting the Discovery of a New Coronavirus Disease 2019-Related Syndrome in Children. Pediatr Crit Care Med 2021; 22:e373-e375. [PMID: 33606475 PMCID: PMC8168931 DOI: 10.1097/pcc.0000000000002713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Anna Zanin
- Pediatric Intensive Care Unit, San Bortolo Hospital, Vicenza, Italy
| | - Alberto García-Salido
- Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Anna Camporesi
- Pediatric Intensive Care, Children's Hospital V Buzzi, Milano, Italy
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, Costa Rica. Red de Enfermedad de Kawasaki en América Latina (REKAMLATINA)
| | - Maria Elena Villar
- Department of Communication, Steven Cruz Institute for Science, Media & Technology, Miami, FL
| | - Sebastián González-Dambrauskas
- Cuidados Intensivos Pediátricos Especializados (CIPe), Casa de Galicia, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher L Carroll
- Pediatric Intensive Care Unit, Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT
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31
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Pelizzo G, Vestri E, Del Re G, Filisetti C, Osti M, Camporesi A, Rizzo D, De Angelis A, Zoia E, Tommasi P, Zuccotti G, Calcaterra V. Supporting the Regional Network for Children with Burn Injuries in a Pediatric Referral Hospital for COVID-19. Healthcare (Basel) 2021. [PMID: 34066726 DOI: 10.339/healthcare9050551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Considerable reorganization of the regional network for pediatric burn treatment during the pandemic was required to cope with severe burn injuries in small children. In support of the emergency network for burns during the COVID-19 pandemic, we referred to regional indications for centralization in our hospital for all children aged less than 5 years who presented with severe burns, >15% of total body surface area (TBSA), or who necessitated admittance to the pediatric intensive care unit (PICU). A new service with a dedicated management protocol was set up to treat pediatric burns in our SARS-CoV-2 pediatric hospital during the lockdown period. A multidisciplinary burn treatment team was set up to offer compassionate and comprehensive burn care. Patient's clinical data, burn features, treatment and follow up were recorded. A higher number of admissions was recorded from February to December 2020 compared with the same period in 2019 (52 vs. 32 admissions). Eighteen patients were admitted to the COVID-19 Service (10 M/8 F; 3.10 ± 2.6 yrs); ten children (55.5%) were hospitalized in the ward and eight in the ICU (44.5%). Fifty percent of the cases presented with lesions extending over >15% TBSA; in one case, TBSA was 35%. All patients suffered 2nd-degree burns; while five patients also had 3rd degree lesions covering more than 15% TBSA. All of the injuries occurred at home. No major secondary infections were recorded. Successful treatment was achieved in 94.4% of cases. The average length of stay was 15.2 ± 12.6 days. A proactive, carefully planned service, involving a multidisciplinary team, was created to ensure appropriate care in a pediatric hospital during the COVID-19 period, despite the effective pandemic associated challenges. Better health promotion in pediatric burn cases should also include dedicated TBSA assessment and a database of children's burn characteristics.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy.,Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20122 Milan, Italy
| | - Elettra Vestri
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Giulia Del Re
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Claudia Filisetti
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Monica Osti
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy.,Department of Surgery, Policlinico San Donato, 20097 Milan, Italy
| | - Anna Camporesi
- Pediatric Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Dario Rizzo
- Outpatients Unit, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | | | - Elena Zoia
- Pediatric Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Paola Tommasi
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20122 Milan, Italy.,Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy.,Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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Camporesi A, Mandelli A, Melloni E. Intrathecal nusinersen administration: Is anesthesia really needed? Paediatr Anaesth 2021; 31:249-250. [PMID: 33539675 DOI: 10.1111/pan.14048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/18/2020] [Accepted: 10/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Camporesi
- Division of Pediatric Anesthesia and Intensive Care Unit, Department of Pediatrics, Children's Hospital Vittore Buzzi, Milan, Italy
| | - Anna Mandelli
- Division of Pediatric Anesthesia and Intensive Care Unit, Department of Pediatrics, Children's Hospital Vittore Buzzi, Milan, Italy
| | - Elisa Melloni
- Psychiatry and Psychobiology Unit, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy
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Zanin A, Garcia-Salido A, Gonzalez-Dambrauskas S, Camporesi A. There is no SARS-WAR. Minerva Anestesiol 2020; 87:488-489. [PMID: 33331752 DOI: 10.23736/s0375-9393.20.15214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Zanin
- Pediatric Intensive Care Unit, San Bortolo Hospital, Vicenza, Italy -
| | - Alberto Garcia-Salido
- Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Sebastiàn Gonzalez-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Unidad de Cuidados Intensivos Pediátricos Especializados (CIPe), Casa de Galicia, Montevideo, Uruguay
| | - Anna Camporesi
- Division of Pediatric Anesthesiology and Intensive Care, Department of Pediatrics, Children's Hospital Vittore Buzzi, ASST Fatebenefratelli-Sacco, Milan, Italy
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González-Dambrauskas S, Vásquez-Hoyos P, Camporesi A, Díaz-Rubio F, Piñeres-Olave BE, Fernández-Sarmiento J, Gertz S, Harwayne-Gidansky I, Pietroboni P, Shein SL, Urbano J, Wegner A, Zemanate E, Karsies T. Pediatric Critical Care and COVID-19. Pediatrics 2020; 146:peds.2020-1766. [PMID: 32518171 DOI: 10.1542/peds.2020-1766] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sebastián González-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica, Montevideo, Uruguay; .,Cuidados Intensivos Pediátricos Especializados, Casa de Galicia, Montevideo, Uruguay
| | - Pablo Vásquez-Hoyos
- Red Colaborativa Pediátrica de Latinoamérica, Montevideo, Uruguay.,Division of Emergency and Critical Care, Department of Pediatrics, Universidad Nacional de Colombia, Bogotá, Colombia.,Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Anna Camporesi
- Division of Pediatric Anesthesia and ICU, Department of Pediatrics, Children's Hospital Vittore Buzzi, Milan, Italy
| | - Franco Díaz-Rubio
- Instituto de Ciencias e Innovación en Medicina, Universidad del Desarrollo and Hospital El Carmen de Maipú, Santiago, Chile
| | | | - Jaime Fernández-Sarmiento
- Department of Pediatrics and Critical Care Medicine, Universidad de la Sabana and Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia
| | - Shira Gertz
- Department of Pediatrics, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Ilana Harwayne-Gidansky
- Division of Pediatric Critical Care Medicine, Stony Brook Children's Hospital and Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Pietro Pietroboni
- Unidad de Paciente Crítico Pediátrico, Hospital Regional de Antofagasta, Antofagasta, Chile
| | - Steven L Shein
- Division of Pediatric Critical Care, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Javier Urbano
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón and Universidad Complutense de Madrid, Madrid, Spain
| | | | - Eliana Zemanate
- Hospital Susana López de Valencia and Universidad del Cauca, Popayan, Colombia; and
| | - Todd Karsies
- Division of Pediatric Critical Care, Nationwide Children's Hospital, Columbus, Ohio
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Camporesi A, Díaz‐Rubio F, Carroll CL, González‐Dambrauskas S. Protecting children from iatrogenic harm during COVID19 pandemic. J Paediatr Child Health 2020; 56:1010-1012. [PMID: 32568444 PMCID: PMC7361910 DOI: 10.1111/jpc.14989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 01/16/2023]
Abstract
Critical care management of patients with COVID-19 has been influenced by a mixture of public, media and societal pressure, as well as clinical and anecdotal observations from many prominent researchers and key opinion leaders. These factors may have affected the principles of evidence-based medicine and encouraged the widespread use of non-tested pharmacological and aggressive respiratory support therapies, even in intensive care units (ICUs). The COVID-19 pandemic has predominantly affected adult populations, while children appear to be relatively spared of severe disease. Notwithstanding, paediatric intensive care (PICU) clinicians may already have been influenced by changes in practices of adult ICUs, and these changes may pose unintended consequences to the vulnerable population in the PICU. In this article, we analyse several potential iatrogenic causes of the detrimental effects of the current pandemic to children and highlight the risks underlying a sudden change of clinical practice.
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Affiliation(s)
- Anna Camporesi
- Division of Pediatric Anesthesia and Intensive Care Unit, Department of PediatricsChildren's Hospital Vittore BuzziMilanItaly
| | - Franco Díaz‐Rubio
- Instituto de Ciencias e Innovación en MedicinaUniversidad del DesarrolloSantiagoChile,Unidad de paciente crítico pediátricoHospital El Carmen de MaipúSantiagoChile
| | | | - Sebastián González‐Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network)MontevideoUruguay,Cuidados Intensivos Pediátricos Especializados (CIPe) Casa de GaliciaMontevideoUruguay
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36
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Wolfler A, Mannarino S, Giacomet V, Camporesi A, Zuccotti G. Acute myocardial injury: a novel clinical pattern in children with COVID-19. Lancet Child Adolesc Health 2020; 4:e26-e27. [PMID: 32497521 PMCID: PMC7263818 DOI: 10.1016/s2352-4642(20)30168-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/16/2020] [Accepted: 05/20/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Andrea Wolfler
- Division of Anesthesia and Intensive Care, Children's Hospital V Buzzi, ASST FBF Sacco, Milan, Italy.
| | - Savina Mannarino
- Division of Cardiology, Children's Hospital V Buzzi, ASST FBF Sacco, Milan, Italy
| | - Vania Giacomet
- Department of Pediatrics, Children's Hospital V Buzzi, ASST FBF Sacco, Milan, Italy
| | - Anna Camporesi
- Division of Anesthesia and Intensive Care, Children's Hospital V Buzzi, ASST FBF Sacco, Milan, Italy
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37
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Wolfler A, De Silvestri A, Camporesi A, Ivani G, Vittori A, Zadra N, Pasini L, Astuto M, Locatelli B, Cortegiani A, Disma N. Pediatric anesthesia practice in Italy: a multicenter national prospective observational study derived from the APRICOT Trial. Minerva Anestesiol 2020; 86:295-303. [DOI: 10.23736/s0375-9393.19.14126-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Habre W, Disma N, Virag K, Becke K, Hansen TG, Jöhr M, Leva B, Morton NS, Vermeulen PM, Zielinska M, Boda K, Veyckemans F, Klimscha W, Konecny R, Luntzer R, Morawk-Wintersperger U, Neiger F, Rustemeyer L, Breschan C, Frey D, Platzer M, Germann R, Oeding J, Stoegermüller B, Ziegler B, Brotatsch P, Gutmann A, Mausser G, Messerer B, Toller W, Vittinghoff M, Zangl G, Seidel-Ahyai N, Hochhold C, Kroess R, Paal P, Cnudde S, Coucke P, Loveniers B, Mitchell J, Kahn D, Pirotte T, Pregardien C, Veyckemans F, Coppens M, De Hert S, Heyse B, Neckebroek M, Parashchanka A, Van Limmen J, Van Den Eynde N, Vanpeteghem C, Wyffels P, Lalot M, Lechat JP, Stevens F, Casaer S, De Groote F, De Pooter F, De Villé A, Gerin M, Magasich N, Sanchez Torres C, Van Deenen D, Berghmans J, Himpe D, Roofthooft E, Joukes E, Smitz C, Van Reeth V, Huygens C, Lauweryns J, De Smet K, Najafi N, Poelaert J, Van de Velde A, Van Mossevelde V, Bekavac I, Butkovic D, Heli Litvic D, Kerovec Soric I, Maretic H, Moscatello D, Popovic L, Micici S, Stuck Tus I, Kalagac Fabris L, Simurina T, Sulen N, Kesic-Valpotic G, Djapic D, Žurek J, Jureckova L, Mackova I, Skacel M, Weinlichova S, Divák J, Frelich M, Urbanec R, Biskupova V, Mifsud M, Strachan D, Leva B, Plichon B, Harlet P, Mixa V, Pavlickova J, Afshari A, Bøttger M, Ellekvist MB, Johansen M, Ingeborg Madsen B, Christian Nilsson J, Schousboe BMB, Clausen NG, Hansen TG, Phaff Steen N, Ilmoja ML, Tonise V, Karjagin J, Kikas R, Isohanni M, Lyly A, Takala A, Happo J, Kiviluoma K, Martikainen K, Aantaa R, Manner T, Vilo S, Amory C, Ludot H, Lambotte P, Busche R, Jacqmarcq O, Lejus C, Corouge J, Erb C, Garrigue D, Gillet P, Laffargue A, Lambelin V, Le Freche H, Peresbota D, Richart P, Berton J, Chapotte C, Colbus L, Lehousse T, Monrigal J, Baujard C, Roulleau P, Staiti G, Batoz H, Bordes M, Didier A, Hamonic Y, Lagarde S, Nouette-Gaulain K, Semjen F, Zaghet B, Dekens J, Delcuze A, Dupont H, Legrand A, Raffoflandreur C, Audren N, Camus B, Cartal M, Chazelet C, Davin I, Guillier M, Desjeux L, Larcher C, Grein E, Leclercq M, Levitchi R, Rosu L, Simon D, Zang A, Migeon A, Gagey AC, Bourdaud N, Carre AC, Duflo F, Riche JC, Robert P, Druot E, Maupain O, Orliaguet G, Sabau L, Taright H, Uhrig L, Verchere-Montmayeur J, Debrabant L, Pilla C, Podvin A, Roth B, Dahmani S, Julien-Marsollier F, Sabourdin N, Alexandri B, Brezac G, de la Brière F, Hayem C, Lhubat E, Paul Mission J, Rémond C, Dadure C, Maniora M, Marie A, Pirat P, Saour AC, Sola C, Ecoffey C, Wodey E, Adam C, Standl T, Schindler E, Yamamoto T, Brackhahn M, Eich CB, Guericke H, Kindermann P, Laschat M, Schink C, Wappler F, Hoehne C, Skordou N, Ulrici J, Jetzek-Zader M, Kienbaum P, Meyer-Treschan T, Picker O, Schaefer MS, Mielke G, Baethge S, Ramminger A, Bauer M, Bollinger M, Hinz J, Quintel M, Russo SG, Bauer M, Geil D, Kortgen A, Preussler NP, Hofmann U, Raber M, Reindl D, Becke K, Oppenrieder K, Schierlinger B, Roth J, Funk W, Fischer T, Gernoth C, Wiefelspütz C, Volger H, Zederer N, Diers A, Huber M, Schorer C, Weyland A, Schwarzkopf K, Grau C, Roth W, Holy R, Mader T, Peter L, Supthut H, Kuehhirt T, Milde A, Fiedler F, Isselhorst C, Grundmann U, Pattar A, Reinert J, Ehm B, Fritzsche K, Gaebler R, Meybohm P, Hein M, Guzman I, Jokinen J, Kranke P, Goebel U, Harris S, Eisner C, Ochsenreiter M, Schoeler M, Thil E, Ellerkmann R, Hoeft A, Neumann C, Weber S, Keilhauer J, Kloessing J, Schramm M, Trieschmann U, Knauss K, Sinner B, Steinmann J, Koessler H, Kalliardou E, Malisiova A, Tsiotou A, Chloropoulou P, Chrysi M, Iordanidou D, Ntavlis M, Boda KB, Guerin C, Irwin J, Magner C, Nakhjavani S, O'Hare B, Galvin D, Jamil Y, Lesmes C, Barak Y, Fisher H, Kachko L, Katz J, Kirilov D, Levinzon M, Manevich Y, Nekrasov K, Peled E, Sanko E, Schmain D, Sheinkin O, Simhi E, Tarabikin A, Trabkin E, Yagudaev I, Zeitlin Y, Zunser I, Cerutti E, Maddalena Schellino M, Valzan S, Lucia Pinciroli R, Bortone L, Cerati G, Salici F, Bussolin L, Rizzo G, Rossetti F, Marchesini L, Tesoro S, De Lorenzo B, Guarracino F, Kuppers B, Astuto M, Pitino S, Scalisi R, Scordo L, D'Alessandro S, Dei Giudici L, Farinelli I, Lofino G, Marchetti G, Giuseppe Picardo S, Reali S, Vittori A, Antonio Idone F, Sammartino M, Sbaraglia F, Barbera C, Bevilacqua M, Cento V, Disma N, Kotzeva S, Mameli L, Montobbio G, Passariello L, Punzo C, Sileo R, Viacava R, Volpe C, Zanaboni C, Calderini E, Genco D, Neri S, Ottolina D, Camporesi A, Izzo F, Salvo I, Wolfler A, Sanna A, Sciascia A, Stoia P, Guddo A, Lapi M, Ivani G, Longobardo A, Mossetti V, Pedrotti D, Grazzini M, Meneghini L, Metrangolo S, Michelon S, Minardi C, Tognon C, Zadra N, Busi I, Khotcholava M, Guido Locatelli B, Sonzogni V, Starita G, Almenrader N, Aurilio C, Sansone P, Albarello R, Bracci P, Cecini M, Cristina Mondardini M, Pasini L, Vason M, Zani G, Zoppellari R, Pistidda L, Cortegiani A, Maurizio Raineri S, Hasani A, Hashimi M, Ancupans A, Barzdina A, Straume Z, Zundane A, Chlopin M, Gestautaite D, Lukosiene L, Paliokaite E, Razlevice I, Armoniene I, Bernotiene A, Daugelavicius V, Dockiene I, Gaidelyte L, Saviciene N, Krikstaponiene J, Sidlovskaite-Baltake D, Stasevski V, Vaitoskaite A, Gatt D, Mifsud S, Zammit S, Allison C, Aslami H, Eberl S, van Stijn MFM, Stevens MF, Punt K, van Osch R, Bauwman A, Scholten H, Svircevic V, Adriaens V, Dirckx M, Dogger J, Dons-Sinke I, Machotta A, Moors X, Rad M, Staals L, van der Knijff - van Dortmont A, van der Marel C, Sieben A, van der Zwan T, Veldhuizen M, Alders D, Buhre W, Vermeulen PM, Engel N, Vossen C, Mahadewsing R, Meijer P, Gerling V, van der Schatte Olivier R, van Doorn T, Vons Mark Hendriks K, Lako S, jan Scheffer G, Tielens L, Voet M, Absalom A, Bergsma M, Spanjer V, Spanjersberg R, van de Riet Y, Volkers M, de Graaff JC, Hopman GA, Kappen TH, Hannie J, Megens A, Numan SC, Schouten AN, Turner NM, Van Der Werff DB, Wensing RT, Ephraim E, Nolte C, Reikvam T, Fredrik Lund O, Skaaden L, Marthe Ballovarre K, Bakken Boerke W, Grindheim G, Lindenskov PHH, Beate Solas A, Sponheim S, Ullensvang K, Viken O, Marie Drage I, Gymoese Berthelsen K, Anders Kroken B, Bergland U, Pryzmont M, Talalaj M, Wasiluk M, Zalewska D, Damps M, Siemek-Mitela J, Wieczorek P, Juzwa M, Rosada-Kurasinska J, Bartkowska-Sniatkowska A, Cettler M, Kopycinska R, Rudewicz I, Sobczyk J, Wojciechowski D, Baranowski A, Basiewicz E, Mierzewska-Schmidt M, Retka W, Sawicki P, Checinska M, Zielinska M, Zurawska M, Leal T, Mascarenhas C, Pedro Pina A, Joao Susano M, Moniz A, Teresa Rocha M, Calvao Santos C, Domingas Patuleia M, Pereira R, Roxo H, Amaral R, Guedes I, Gomes C, Gonçalves M, Salgado H, Santos M, Rodrigues S, Sa A, Machado E, Pé d'Arca S, Seabra M, Mihaela Gheorghe L, Ivascu C, Moraru-Draghici L, Suvejan M, Babici R, Eniko K, Hogea C, Mihaela D, Nicoleta D, Barbunc D, Maria Nistor A, Stefan V, Catalina Ionescu G, Davidescu I, Teodora Nastase A, Dumitru Rusu F, Badarau V, Cindea I, Moscaliuc M, Olteanu D, Petrescu L, Ceuca D, Galinescu I, Badeti R, Capusan A, Cucui-Cozma C, Popescu B, Cimpeanu L, Birliba MP, Miulescu M, Balamat S, Gurita A, Ilie L, Mocioiu G, Pick D, Sirghie R, Tabacaru R, Trante I, Gurita A, Horhota L, Bandrabur D, Ciobanu T, Cuciuc V, Munteanu V, Olaru V, Paiu C, Savu A, Trifan O, Elena Malos A, Glazunov A, Ivanov A, Poduskov E, Popov A, Guskov I, Lugovoy A, Nechaev V, Ovezov A, Basov M, Kochkin V, Lazarev V, Chizhov D, Ostreikov I, Tolasov K, Budic I, Marjanovic V, Draskovic B, Pandurov M, Simin J, Dolinaj V, Janjevic D, Mandras A, Mircetic M, Petrovic S, Rebac V, Slavkovic B, Stevanovic V, Velcev A, Knezevic M, Milojevic I, Puric S, Simic I, Stevic M, Stranjanac V, Simic D, Cabanova B, Hanula M, Grynyuk A, Berger J, Cerne U, Nastran A, Pirc D, Popic R, Stupnik S, Rubio P, del Río C, Benito P, Pino G, Gutierrez I, Gutierrez Valcarcel A, León Carsi I, Perez Garcia A, López Galera S, Marco Valls J, Ricol Lainez L, Vallejo Tarrat A, Artes D, Banus E, Chirichiello L, De Abreu L, De Josemaria B, Helena Gaitan M, Garces A, Lazaro JJ, Manen Berga F, Molies D, Monclus E, Navaro M, Pamies C, Perelló M, Prat M, Ribo L, Angeles Sanz M, Serrano S, Sola Ruiz E, Anuncia Escontrela Rodríguez B, Maria Gago Martinez A, Martínez Ruiz A, De La Cruz Benito F, Gabilondo Garcia G, Martinez Maldonado E, Noriega B, Oller Duque L, Olmos Mendez A, Perez- Ferrer A, Reinoso Barbero F, Acevedo Bambaren I, Domínguez F, Franco T, Jiménez A, Melero A, Feliu M, García I, Montferrer N, Munar F, Muro C, Nuño R, Perera R, Schmucker E, Börjesson G, Gillberg L, Castellheim A, Sandström K, Bauer A, Roos T, Hedlund L, Boegli Y, Dolci M, Marcucci C, Spahr-Schopfer I, Habre W, Pellegrini M, Book M, Errass L, Riggenbach C, Casutt M, Hölzle M, Hurni T, Jöhr M, Mauch J, Anselmi L, Anselmi I, Jacomet A, Oberhauser M, Wossner S, Zettl A, Erb T, Mackiewicz T, Simitzes H, Ozer Y, Takil A, Alanoglu Z, Bermede O, Cakar Turhan K, Alkis N, Yildirim Guclu C, Ceyda Meco B, Hatipoglu Z, Ozcengiz D, Begec Z, Ilksen Toprak H, Kendigelen P, Cigdem Tütüncü A, Karadeniz MS, Seyhan Ozkan T, Sivrikoz N, Kemal Arslantas M, Hizal A, Tore Altun G, Umuroglu T, Baris S, Kazak Bengisun Z, Goncharenko G, Khrapak M, Klymenko T, Pavlenko V, Prysiazhniuk D, Rudio O, Varyvoda M, Vodianytskyi S, Boryshkevych I, Kyselova I, Trikash N, Albokrinov A, Perova-Sharonova V, Sklyar V, Surkov D, Abdelaal A, Barber N, Checuti S, Godsiff L, Johanne L, Simpson J, Underhill H, Diwan R, Kelgeri N, Masip N, Ravi R, Roberts S, Cillis A, Marcus R, Merella F, Love D, Baraggia P, Bird V, Hussey J, Alderson P, Bartholomew K, Moncreiff M, Davidson S, Hare A, Kotecha A, Lee C, Liyanage G, Patel S, Samani A, Abou-Samra M, Boyd M, Hullatt L, Levy D, Pauling M, Sharman SJ, Smith N, Rutherford J, Cavalier A, Locke C, Sage F, Bapat S, Hammerschlag J, Ioannou I, King S, Pegg R, Salota V, Sketcher J, Thadsad M, Zeitlin D, Jack E, Lang C, Ahmed S, Ayyash R, Bari F, Bell SJ, Elizabeth Biercamp C, Briggs S, Gabriella Elena Clement M, Dalton M, Ali Eissa Eid M, Gandhi M, Harmen Herrema I, Khaffaf R, Jeng Min Law S, McClintock J, Ireland N, Majid Saleem M, Smith F, Cohen M, Lee CA, O'Donahue L, Powell A, Rawlinson E, Snoek A, Weiss K, Wellesley H, Crawford M, Abdel-Hafiz M, Day A, Rajamani B, Saha R, Wright D, Chee LC, Bew S, Homer R, Malarkkan N, Wolfe Barry J, Angadi P, Cagney B, De Melo E, Dekker E, Helm E, Jones G, Peiris K, Russell W, Slater P, Sodhi P, Browning M, Phillips T, Van Hecke R, Muir V, Singh P, Soskova T, Cumming C, Farquharson P, Pearson K, Shaw N, Whiteside J, Whyte E, Byers G, Davies K, Engelhardt T, Faliszewski I, Johnston G, Kaufmann N, Kusnirikova Z, Wilson G, Carachi P, Makin A, Foster B, Lipczynski D, Mawer R, Rutherford W, Rogerson D, Rushman S, Taylor C, Tomlinson W, Dix P, Woodward T, Bell G, Boyle D, Cloherty M, Cullen J, Cullen P, Fairgrieve R, Ghent R, Glasgow R, Gordeeva E, Harden A, Hivey S, Jerome K, McKee L, Morton N, Pribul V, Sinclair J, Steiner M, Steward H, Sweeney L, Thomson W, Whiteside J, Dalton A, Ross M, Smith C, Allen C, Anders N, Barlow V, Bassett M, Darwin L, Davison R, Diacono J, Hobbs A, Hutchinson A, Lomas B, Lonsdale H, Nasser L, Oshan V, Patel P, Raistrick C, Scott-Warren V, Talbot L, Wai C, Childs S, Dickinson M, Bloomfield T, Garrioch S, Watson K, Gaynor J, Harrison R, Lee J, Blythe E, Dorman T, Eissa A, Ellwood J, Gooch I, Hearn R, Hodgetts V, John R, Kirton C, Ladak N, Morgan J, Plant N, Shepherd E, Short J, Stack C, Steel S, Taylor M, Thomas D, Wilson C, Wilson-Smith E, Bradbury CL, Hussain N, Mayell A, Mesbah A, Qureshi A, Vaidyanath C, Geary T, Hawksworth C, Parasuraman T, Perry N, Banerjee I, Barr K, Butler P, Davies J, Flewin L, Gande R, Montague J, Plumb J, Pratt T, Sutherland P, Taylor M, Vail H, Wilkins A, Hunter C, Russell S, Thomas A. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. The Lancet Respiratory Medicine 2017; 5:412-425. [DOI: 10.1016/s2213-2600(17)30116-9] [Citation(s) in RCA: 355] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 11/24/2022]
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Migliavacca M, Assanelli A, Ferrua F, Cicalese MP, Biffi A, Frittoli M, Silvani P, Chidini G, Calderini E, Mandelli A, Camporesi A, Milani R, Farinelli G, Nicoletti R, Ciceri F, Aiuti A, Bernardo ME. Pioglitazone as a novel therapeutic approach in chronic granulomatous disease. J Allergy Clin Immunol 2016; 137:1913-1915.e2. [PMID: 27056268 PMCID: PMC4889778 DOI: 10.1016/j.jaci.2016.01.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/28/2015] [Accepted: 01/20/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Maddalena Migliavacca
- San Raffaele Telethon Institute for Gene Therapy (TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Assanelli
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Ferrua
- San Raffaele Telethon Institute for Gene Therapy (TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Cicalese
- San Raffaele Telethon Institute for Gene Therapy (TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Biffi
- San Raffaele Telethon Institute for Gene Therapy (TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marta Frittoli
- San Raffaele Telethon Institute for Gene Therapy (TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Silvani
- Department of Anesthesia and Critical Care, San Raffaele Hospital, Milan, Italy
| | - Giovanna Chidini
- Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Calderini
- Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Mandelli
- Pediatric Anesthesia and Intensive Care, Children Hospital "V.Buzzi", Milan, Italy
| | - Anna Camporesi
- Pediatric Anesthesia and Intensive Care, Children Hospital "V.Buzzi", Milan, Italy
| | - Raffaella Milani
- Cytometry Laboratory, San Raffaele Scientific Institute, Milan, Italy
| | - Giada Farinelli
- San Raffaele Telethon Institute for Gene Therapy (TIGET), San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Nicoletti
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy.
| | - Maria Ester Bernardo
- San Raffaele Telethon Institute for Gene Therapy (TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
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Affiliation(s)
- Anna Camporesi
- Department of Anesthesia and Intensive Care, Children Hospital "V. Buzzi", Milano, Italy.
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Camporesi A. balloon dilatational tracheostomy. Any place for pediatric patients ? Br J Anaesth 2010. [DOI: 10.1093/bja/el_6757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Persistent pulmonary hypertension (PPHN) is a disease characterised by the disruption of the transition from fetal to neonatal circulation with the persistence of high pulmonary vascular resistances and right-to left shunting. This condition, occurring in about 1-2 newborns per 1000 live births, causes severe hypoxemia. Despite significant improvements in treatment, the mortality of PPHN varies from 10 to 20 % of affected newborns. Pulmonary hypertension is frequently observed in some cardiac malformation and in congenital diaphragmatic hernia, in meconium aspiration syndrome, neonatal sepsis, podalic presentation and male sex. Maternal risk factors are tobacco smoking, cesarean section, low socio-economic conditions, diabetes and urinary infections. Another predisposing condition is antenatal or postnatal exposure to some drugs. The medications involved in drug-induced pulmonary hypertension and the mechanisms involved are reviewed.
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Affiliation(s)
- Paolo Silvani
- Department of Anesthesiology and Intensive Care, Pediatric Intensive Care Unit, Children Hospital "V. Buzzi", Via Castelvetro 32, 20154 Milano, Italy.
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Camporesi A, Silvani P. An unusual position of central venous catheter. Please, not so deep! Paediatr Anaesth 2006; 16:901-2; author reply 902. [PMID: 16884483 DOI: 10.1111/j.1460-9592.2006.01940.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Silvani P, Camporesi A, Agostino MR, Salvo I. Caudal anesthesia in pediatrics: an update. Minerva Anestesiol 2006; 72:453-9. [PMID: 16682915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
AIM Caudal anesthesia is one of the most used-popular regional blocks in children. This technique is a useful adjunct during general anesthesia and for providing postoperative analgesia after infraumbilical operations. The quality and level of the caudal blockade is dependent on the dose, volume, and concentration of the injected drug. Although it is a versatile block, one of the major limitations of the single-injection technique is the relatively short duration of postoperative analgesia. The most frequently used method to further prolong postoperative analgesia following caudal block is to add different adjunct drugs to the local anesthetics solution. Only few studies evaluated quality and duration of caudal block against the volume of the local anaesthetic applied. After reviewing recent scientific literature, the authors compare the duration of postoperative analgesia in children scheduled for hypospadia repair when 2two different volumes and concentrations of a fixed dose of ropivacaine are used. METHODS After informed parental consent, 30 children (ASA I, 1-5 years old) were enrolled in a multicentre, perspective, not randomized, observational study conducted in two 2 children hospitals. After premedication with midazolam, anesthesia was induced with thiopental and maintained with sevoflurane in oxygen/air. After induction, patients received a caudal blockade either with ropivacaine 0.375% at 0.5 mL/kg (Low Volume High Concentration Group, LVHC; n = 15), or ropivacaine 0.1% at 1.8 mLl/kg (High Volume Low Concentration Group, HVLC; n = 15). Surgery was allowed to begin 10ten minutes after performing the block. MAC-hour was calculated. In the recovery room, pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). In addition, the motor block was scored. After transferral to the ward, the patients were observed for 24 hours for signs of postoperative pain. The time period to first supplemental analgesic demand, i.e., from establishment of the block until the first registration of a CHEOPS score = or > 9, was considered the primary endpoint of the study. The time periods were compared using analysis of variance adjusted for age, weight and duration of surgical procedure as covariates. RESULTS All patients were judged to have sufficient intraoperative analgesia, and none of them received additional analgesics intraoperatively. Patients' characteristics were similar, besides the age (32+/-10 vs 24 +/- 9 months; P < 0.05) and weigh (15.13 +/- 3.92 vs 11.93 +/- 1.83; P = 0.08). Analgesics were needed after 520 +/- 480 min in the LVHC and 952 +/- 506 min in the HVLC group (P < 0.05). Motor block was less in the HVLC group. CONCLUSIONS In children undergoing hypospadia repair, caudal block with a ''high volume, low concentration'' regimen produces prolonged analgesia and less motor block, compared to a ''low volume, high concentration'' regimen.
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Affiliation(s)
- P Silvani
- Department of Anesthesia and Intensive Care, V. Buzzi Children Hospital, Milan, Italy.
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Silvani P, Camporesi A, Licari E, Wolfler A. Use of protein C concentrate in pediatric patients with sepsis. Minerva Anestesiol 2005; 71:373-8. [PMID: 15886604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
AIM Protein C (PC) is a plasma glycoprotein implicated in modulating coagulation and inflammation. Its levels decrease in sepsis and related diseases, where it has also proved to be a prognostic indicator of outcome. Infusion of exogenous PC, although not able to decrease mortality in severe sepsis and septic shock, can safely resolve the coagulation imbalances related to these pathological states. METHODS A retrospective study was performed about utilisation of PC in severe sepsis and septic shock patients in three italian PICUs during a one-year period. Data from 29 patients were analysed. Age, PIM 2, mortality and length of stay were compared between treated and non treated patients. Treated patients were also analysed for PC dosage received, length of treatment, and modification of hemocoagulation parameters, before PC infusion and every 24 hours. RESULTS In treated patients, the activity of PC, PT and PTT activity and fibrinogen improved significantly from basal to day 5 (p<0.05). Diminution of d-dimer was not quite significant (p=0.0514). Rise in platelets count and antithrombin III activity was not significant. No adverse reactions related to Protein C concentrate were observed. No difference in mortality was observed between the two groups. CONCLUSIONS Although PC is included in guidelines for management of severe sepsis and septic shock, only 38%, of observed patients received PC treatment. Even in the treated group, patients received a lower dosage of PC, and for a shorter period, than recommended. In accordance to previous studies, we did not observe differences in mortality between treated and untreated patients. Our results showed a significant increase in plasma PC activity, following infusion of PC concentrate. This increase in PC appeared sufficient to restore some, but not all, of the abnormalities in the coagulation system. A large randomized, phase 3, placebo-controlled trial in children with severe sepsis and septic shock is advisable to establish effective role of therapy with PC in reducing mortality of these patients.
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Affiliation(s)
- P Silvani
- Intensive Care Unit, V. Buzzi Children's Hospital, Milan, Italy.
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Silvani P, Camporesi A. Difficult weaning: failure of conventional ventilation or inadequacy of PEEP. Paediatr Anaesth 2005; 15:352; author reply 352. [PMID: 15787934 DOI: 10.1111/j.1460-9592.2005.01603.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Hyperinsulism is a rare cause of persistent hypoglycemia in the neonatal period. Therapy can be accomplished either surgically or pharmacologically. Diazoxide treatment remains the mainstay of medical therapy. Tolerance of diazoxide is usually excellent, but several adverse effects of this drug have been described. A case of severe diazoxide intoxication with fluid retention, congestive heart failure, and respiratory failure is reported. The patient was a 43-day-old infant, affected by persistent and severe hypoglycemia. After the diagnosis, hyperinsulinism was established he was treated with diazoxide (17 mg x kg(-1) daily) and octreotide (12 microg x kg(-1) daily). A few days later he presented with hepatomegaly, severe fluid retention, diffuse edema, congestive heart failure, and respiratory failure requiring mechanical ventilation. After introduction of ACE inhibitors he developed acute renal failure. The clinical condition worsened and he developed pulmonary hypertension requiring high-frequency oscillatory ventilation. Diazoxide was stopped on the 12th day in spite of poor control of blood sugar. During the next 5 days his hemodynamic status dramatically improved and he was weaned from catecholamines: he lost weight, had a negative fluid balance, and the edema disappeared, a normal diuresis resumed and renal function improved. Improvement of respiratory patterns and gas exchange made it possible to switch back to conventional ventilation and then to extubate the patient. Echocardiography demonstrated reduction of the PA pressure to normal and resolution of atrial enlargement. The patient was scheduled for elective subtotal pancreatectomy. Diagnosis and management of diazoxide intoxication are discussed.
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Affiliation(s)
- Paolo Silvani
- Department of Anesthesiology and Intensive Care, Paediatric Intensive Care Unit Children Hospital 'Vittore Buzzi', Milano, Italy.
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Salvo I, Cucchi C, Camporesi A, Borghi B, Grasso F, Silvani P. [Sedation with magnetic resonance imaging in pediatric patients]. Minerva Anestesiol 2002; 68:414-9. [PMID: 12029256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
219 children (ASA I-II, age 30 days-12 yrs), underwent deep sedation with intravenous thiopental for magnetic resonance imaging in a hospital setting. Sedation strategies and monitoring are described. The procedure showed to be safe for the patients and cause low artefacts by movements.
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Affiliation(s)
- I Salvo
- Dipartimento di Anestesia e Rianimazione, Ospedale dei Bambini V. Buzzi, Istituti Clinici di Perfezionamento, Milan, Italy.
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Abstract
After some notions on the mechanisms of action of radio-waves on solid tumours, the treatise illustrates the results achieved in the first 125 cases of malignant tumours treated with this method, its results are definitely encouraging, even in cases apparently with no hope. It also describes briefly the histologic modifications induced by this therapeutic method on neoplastic masses and discusses the criteria of the directions of thermotherapy, alone or combined, which is obviously the fifth weapon against tumours.
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Affiliation(s)
- G Bazzocchi
- Clinic Micro-Radio Frequency Hyperthermia, Italian Association Forli
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