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Bertone S, Denina M, Pagano M, Delmonaco AG, Castagno E, Bondone C. Red Code Management in a Pediatric Emergency Department: A Retrospective Study. Children (Basel) 2024; 11:462. [PMID: 38671679 PMCID: PMC11048913 DOI: 10.3390/children11040462] [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: 03/20/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
The "red code" (RC) represents the highest level of emergency in the emergency department (ED). This study retrospectively analyzed RCs in the Regina Margherita Children's Hospital ED, a regional referral center in north Italy, between 1 July 2020 and 30 June 2023. The aim was to describe RC characteristics and to identify significant correlations between presenting complaints and clinical management. The study includes 934 RCs (0.9% of overall ED admissions); 64% were assigned based on the Pediatric Assessment Triangle alteration. Most patients, 86.5%, followed the medical pathway, while 13.5% were surgical cases. Admission complaints were respiratory (46.9%), neuropsychiatric (26.7%), traumatic (11.8%), cardiologic (9.3%), metabolic (3.8%), and surgical (1.5%). Seventy-six percent of patients received vascular access, and intraosseous access was obtained in 2.2% of them. In one-third of RCs, an urgent critical care evaluation was necessary, and 19% of cases required admission to the intensive care unit. The overall mortality rate was 3.4% (0.4% in ED setting). The study identified six distinct diagnostic pathways, each associated with specific characteristics in clinical presentation, management, therapeutic interventions, and outcomes. Our findings underscore the need for a systematic approach in pediatric emergency settings, supported by international and national guidelines but also by clearly defined diagnostic pathways, aiming to enhance the quality of care and patient outcomes.
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Affiliation(s)
- Serena Bertone
- Paediatric Unit, Ospedale Regina Montis Regalis, 12084 Mondovì, Italy;
| | - Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Città della Salute e della Scienza, 10126 Turin, Italy
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
| | - Manuela Pagano
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
| | - Angelo Giovanni Delmonaco
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
| | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
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Denina M, Castagno E, Feyles F, Bruno I, Delmonaco AG, Peruzzi L, Bondone C. An unusual peak of febrile rhabdomyolysis. Minerva Pediatr (Torino) 2024; 76:294-295. [PMID: 37768644 DOI: 10.23736/s2724-5276.23.07346-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Marco Denina
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Francesca Feyles
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Ilaria Bruno
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Angelo G Delmonaco
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Licia Peruzzi
- Department of Pediatric Nephrology, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
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Balbo S, Pini CM, Raffaldi I, Delmonaco AG, Castagno E, Guanà R, Di Rosa G, Bondone C. Accuracy of point-of-care ultrasound in the diagnosis of acute appendicitis in a pediatric emergency department. J Clin Ultrasound 2024. [PMID: 38436504 DOI: 10.1002/jcu.23658] [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: 10/19/2023] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To investigate the accuracy of point-of-care ultrasound (PoCUS) in diagnosing acute appendicitis in children; to evaluate the concordance between PoCUS performed by a pediatric emergency physician (PedEm) and ultrasonography (US) performed by a radiologist; to draw a "learning curve." METHODS We prospectively enrolled children aged 0-14 years old led to the Emergency Department of Regina Margherita Children's Hospital, from January 2021 to June 2021, with suspected acute appendicitis. PoCUS was performed by a single trained PedEm, blindly to the radiologist's scan. A "self-assessment score" and the "time of duration of PoCUS" were recorded for each patient. Final diagnosis of appendicitis was made by a pediatric surgeon. RESULTS We enrolled 62 children (2-14 years). Overall sensitivity of PoCUS was 88%, specificity 90%; PPV 90.6%, and NPV 86.6%. Global concordance between the PedEm and the radiologist was good/excellent (k 0.74). The mean duration of PoCUS significantly decreased during the study period, while the self-assessment score increased. CONCLUSION This is a preliminary study that shows the effectiveness of PoCUS in diagnosing acute appendicitis; furthermore, it shows how the PedEm's performance may improve over time. The learning curve showed how the experience of the PedEm affects the accuracy of PoCUS.
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Affiliation(s)
- Stefano Balbo
- Emergency Department, Regina Margherita Children's Hospital, Turin, Italy
| | - Cecilia Maria Pini
- Emergency Department, Regina Margherita Children's Hospital, Turin, Italy
| | - Irene Raffaldi
- Emergency Department, Regina Margherita Children's Hospital, Turin, Italy
| | | | - Emanuele Castagno
- Emergency Department, Regina Margherita Children's Hospital, Turin, Italy
| | - Riccardo Guanà
- Pediatric Surgery Department, Regina Margherita Children's Hospital, Turin, Italy
| | - Gianpaolo Di Rosa
- Radiology Department, Regina Margherita Children's Hospital, Turin, Italy
| | - Claudia Bondone
- Emergency Department, Regina Margherita Children's Hospital, Turin, Italy
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Lupariello F, Lauria B, Mirri F, Aguzzi S, Castagno E, Bondone C, Di Vella G. Child Sexual Abuse: Comparison of Male and Female Victims. Am J Forensic Med Pathol 2024; 45:33-39. [PMID: 38064319 DOI: 10.1097/paf.0000000000000902] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
ABSTRACT In the scientific literature, few authors deal with child sexual abuse (CSA) in boys. In addition, these authors debate this phenomenon in most available articles without statistically evaluating the occurrence of different or similar distributions of variables under sex. In light of the above, the authors compared multiple variables between female and male samples. The aim was to explore the characteristics of boys' CSA, identifying the main differences existing compared with the same phenomenon occurring in girls. The authors selected 2 samples for sex: group A, females; group B, males. The authors statistically compared the main variables between the 2 groups. The study yielded the following main results: the population was characterized by 607 children (476 were females-group A; 131 were males-group B); the variables' source of the referral and the type of anogenital findings were statistically significant. These data gave new insights into the CSA phenomenon. Because this study pointed out that sexual abuse does not have the same characteristics in boys and girls, researchers and safeguarding agencies should consider the abovementioned differences when planning preventive strategies against CSA.
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Affiliation(s)
- Francesco Lupariello
- From the Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Sezione di Medicina Legale, "Università degli Studi di Torino," corso Galileo Galilei 22, 10126 Torino, Italy
| | - Barbara Lauria
- Dipartimento di Pediatria d'Urgenza, "A.O.U. Città della Salute e della Scienza" di Torino, Corso Bramante 88-89, 10126 Torino, Italy
| | - Federica Mirri
- From the Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Sezione di Medicina Legale, "Università degli Studi di Torino," corso Galileo Galilei 22, 10126 Torino, Italy
| | - Sonia Aguzzi
- Dipartimento di Pediatria d'Urgenza, "A.O.U. Città della Salute e della Scienza" di Torino, Corso Bramante 88-89, 10126 Torino, Italy
| | - Emanuele Castagno
- Dipartimento di Pediatria d'Urgenza, "A.O.U. Città della Salute e della Scienza" di Torino, Corso Bramante 88-89, 10126 Torino, Italy
| | - Claudia Bondone
- Dipartimento di Pediatria d'Urgenza, "A.O.U. Città della Salute e della Scienza" di Torino, Corso Bramante 88-89, 10126 Torino, Italy
| | - Giancarlo Di Vella
- From the Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Sezione di Medicina Legale, "Università degli Studi di Torino," corso Galileo Galilei 22, 10126 Torino, Italy
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Castagno E, Balbo M, Procacci A, Parisi A, Paglia F, Bergese I, Versace A, Bondone C. [Early warning scores of clinical deterioration in pediatric patients: a literature review]. Assist Inferm Ric 2023; 42:137-151. [PMID: 37721339 DOI: 10.1702/4095.40918] [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] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
. Early warning scores for clinical deterioration in pediatric patients: a literature review. INTRODUCTION An early recognition of clinical worsening (the manifestation of signs and symptoms resulting in physiological instability) in pediatric inpatients may prevent the evolution towards cardiorespiratory arrest. In recent decades, several tools known as PEWS (Pediatric Early Warning Scores), have been developed, aiming to reduce in-hospital morbidity and mortality. OBJECTIVE To describe efficacy, sensitivity and specificity of the available tools for early detection of clinical worsening in children, based on literature review. METHODS Systematic review through the consultation of PubMed and Google Scholar, cross-combining Mesh terms and free text words. RESULTS Out of 266 analysed papers, 34 were included in this review: 23 retrospective observational studies, 8 reviews, 1 reliability study, and 2 pilot studies. Overall, 23 main PEWS with sufficient evidence of efficacy were described (11 track and trigger and 12 aggregate). Ranges of sensibility and specificity were available only for 18 PEWS. It is not possible to recognize a gold standard, however, some PEWS are better in terms of validity and efficacy in different clinical settings. Internationally, the BPEWS (Brighton Pediatric Early Warning Score) is the most commonly adopted tool, able to identify clinical worsening of in-hospital children almost 11 hours before cardiac arrest. CONCLUSIONS Although with limited evidence, validated PEWS have shown good ability to prevent the risk of clinical worsening by reducing adverse events. Further studies and greater standardization according to the clinical context are still needed.
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Affiliation(s)
- Emanuele Castagno
- S.C. Pediatria d'Urgenza, Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienza di Torino, Italia
| | - Margherita Balbo
- Corso di Laurea Infermieristica, Università Cattolica del Sacro Cuore, Presidio Ospedale Cottolengo, Torino, Italia
| | - Arianna Procacci
- Corso di Laurea Infermieristica, Università Cattolica del Sacro Cuore, Presidio Ospedale Cottolengo, Torino, Italia
| | - Alessandro Parisi
- S.C. Pediatria d'Urgenza, Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienza di Torino, Italia
| | - Federica Paglia
- S.C. Pediatria d'Urgenza, Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienza di Torino, Italia
| | - Ilaria Bergese
- S.C. Rianimazione 5 Pediatrica, Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienza di Torino, Italia
| | - Antonia Versace
- S.C. Pediatria d'Urgenza, Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienza di Torino, Italia
| | - Claudia Bondone
- S.C. Pediatria d'Urgenza, Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienza di Torino, Italia
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Pellegrino F, Raffaldi I, Rossi R, De Vito B, Pagano M, Garelli D, Bondone C. Epidemiology, clinical aspects, and management of pediatric drowning. Ital J Pediatr 2023; 49:74. [PMID: 37316902 PMCID: PMC10268379 DOI: 10.1186/s13052-023-01464-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/28/2023] [Indexed: 06/16/2023] Open
Abstract
Drowning is the third leading cause of injury death in the pediatric population worldwide, with incidence peaking among those aged 1-4 years and again in adolescence.The purpose of this commentary is to review the basic pathophysiology of drowninginjury and factors that affect the outcome, such as submersion and hypothermia. We also discuss principles of prehospital and in-hospital management, comprising resuscitation and stabilization, administration of oxygen and intravenous liquids, and central reheating.Even though the mortality rate has decreased in recent years, further investments and safety measures are needed to prevent child drowning deaths.
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Affiliation(s)
- Francesco Pellegrino
- Department of Pediatric and Public Health Sciences, Postgraduate School of Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy.
| | - Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberta Rossi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Barbara De Vito
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Manuela Pagano
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Davide Garelli
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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Abrigo E, Munarin J, Bondone C, Tuli G, Castagno E, de Sanctis L, Matarazzo P. Adrenal insufficiency management in the pediatric emergency setting and risk factors for adrenal crisis development. Ital J Pediatr 2023; 49:63. [PMID: 37280667 PMCID: PMC10242818 DOI: 10.1186/s13052-023-01475-y] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/16/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND In patients with adrenal insufficiency (AI), adrenal crisis (AC) represents a clinical emergency. Early recognition and prompt management of AC or AC-risk conditions in the Emergency Department (ED) can reduce critical episodes and AC-related outcomes. The aim of the study is to report the clinical and biochemical characteristics of AC presentation to improve their timely recognition and proper management in a ED setting. METHODS Single-centre, retrospective, observational study on pediatric patients followed at the Department of Pediatric Endocrinology of Regina Margherita Children's Hospital of Turin for primary AI (PAI) and central AI (CAI). RESULTS Among the 89 children followed for AI (44 PAI, 45 CAI), 35 patients (21 PAI, 14 CAI) referred to the PED, for a total of 77 accesses (44 in patients with PAI and 33 with CAI). The main causes of admission to the PED were gastroenteritis (59.7%), fever, hyporexia or asthenia (45.5%), neurological signs and respiratory disorders (33.8%). The mean sodium value at PED admission was 137.2 ± 1.23 mmol/l and 133.3 ± 1.46 mmol/l in PAI and CAI, respectively (p = 0.05). Steroids administration in PED was faster in patients with CAI than in those with PAI (2.75 ± 0.61 and 3.09 ± 1.47 h from PED access, p = 0.83). Significant factors related to the development of AC were signs of dehydration at admission (p = 0.027) and lack of intake or increase of usual steroid therapy at home (p = 0.059). Endocrinological consulting was requested in 69.2% of patients with AC and 48.4% of subjects without AC (p = 0.032). CONCLUSION children with AI may refer to the PED with an acute life-threatening condition that needs prompt recognition and management. These preliminary data indicate how critical the education of children and families with AI is to improve the management at home, and how fundamental the collaboration of the pediatric endocrinologist with all PED personnel is in raising awareness of early symptoms and signs of AC to anticipate the proper treatment and prevent or reduce the correlated serious events.
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Affiliation(s)
- Enrica Abrigo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy
- Postgraduate School of Pediatrics, University of Turin, Turin, Italy
| | - Jessica Munarin
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy.
- Postgraduate School of Pediatrics, University of Turin, Turin, Italy.
| | - Claudia Bondone
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Gerdi Tuli
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy
| | - Emanuele Castagno
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Luisa de Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy
| | - Patrizia Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy
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Raucci U, Parisi P, Ferro V, Margani E, Vanacore N, Raieli V, Bondone C, Calistri L, Suppiej A, Palmieri A, Cordelli DM, Savasta S, Papa A, Verrotti A, Orsini A, D'Alonzo R, Pavone P, Falsaperla R, Velardita M, Nacca R, Papetti L, Rossi R, Gioè D, Malaventura C, Drago F, Morreale C, Rossi L, Foiadelli T, Monticone S, Mazzocchetti C, Bonuccelli A, Greco F, Marino S, Monte G, Versace A, Masi S, Di Nardo G, Reale A, Villani A, Valeriani M. Children under 6 years with acute headache in Pediatric Emergency Departments. A 2-year retrospective exploratory multicenter Italian study. Cephalalgia 2023; 43:3331024231164361. [PMID: 37345616 DOI: 10.1177/03331024231164361] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Preschool age (i.e. children under six years of age) represents a red flag for requiring neuroimaging to exclude secondary potentially urgent intracranial conditions (PUIC) in patients with acute headache. We investigated the clinical characteristics of preschoolers with headache to identify the features associated with a greater risk of secondary "dangerous" headache. METHODS We performed a multicenter exploratory retrospective study in Italy from January 2017 to December 2018. Preschoolers with new-onset non-traumatic headache admitted to emergency department were included and were subsequently divided into two groups: hospitalized and discharged. Among hospitalized patients, we investigated the characteristics linked to potentially urgent intracranial conditions. RESULTS We included 1455 preschoolers with acute headache. Vomiting, ocular motility disorders, ataxia, presence of neurological symptoms and signs, torticollis and nocturnal awakening were significantly associated to hospitalization. Among the 95 hospitalized patients, 34 (2.3%) had potentially urgent intracranial conditions and more frequently they had neurological symptoms and signs, papilledema, ataxia, cranial nerves paralysis, nocturnal awakening and vomiting. Nevertheless, on multivariable logistic regression analysis, we found that only ataxia and vomiting were associated with potentially urgent intracranial conditions. CONCLUSION Our study identified clinical features that should be carefully evaluated in the emergency department in order to obtain a prompt diagnosis and treatment of potentially urgent intracranial conditions. The prevalence of potentially urgent intracranial conditions was low in the emergency department, which may suggest that age under six should not be considered an important risk factor for malignant causes as previously thought.
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Affiliation(s)
- Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Chair of Pediatrics, Sapienza University, c/o Sant'Andrea Hospital, Rome, Italy
| | - Valentina Ferro
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Erika Margani
- NESMOS Department, Faculty of Medicine and Psychology, Chair of Pediatrics, Sapienza University, c/o Sant'Andrea Hospital, Rome, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance, and Health Promotion, National Institute of Health, Rome, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Unit, ISMEP- ARNAS CIVICO, Palermo, Italy
| | - Claudia Bondone
- AOU Città della Salute e della Scienza, Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Lucia Calistri
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Agnese Suppiej
- Department of Medical Sciences, Pediatric Section, University of Ferrara, Italy
| | - Antonella Palmieri
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, IRCCS, Genova, Italy
| | - Duccio Maria Cordelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età Pediatrica, Bologna, Italy
| | - Salvatore Savasta
- Clinica Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amanda Papa
- S.C.D.O. Neuropsichiatria Infantile AOU Maggiore della Carità, Novara, Italy
| | | | - Alessandro Orsini
- Paediatric Neurology, Paediatric Department, Pisa University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Renato D'Alonzo
- Pediatric and Neonatological Unit, Maternal and Child Department, Nuovo Ospedale San Giovanni Battista, Foligno, Perugia, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, AOU Policlinico, PO San Marco, University of Catania, Italy
| | - Mario Velardita
- Department of Pediatrics, Gravina Hospital, Caltagirone, Catania, Italy
| | - Raffaella Nacca
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Papetti
- Pediatric Headache Center, Neuroscience Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Roberta Rossi
- AOU Città della Salute e della Scienza, Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Daniela Gioè
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | | | - Flavia Drago
- Child Neuropsychiatry Unit, Department Pro.Mi.Se, G. D'Alessandro University of Palermo, Italy
| | - Cristina Morreale
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, IRCCS, Genova, Italy
| | - Lucia Rossi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età Pediatrica, Bologna, Italy
| | - Thomas Foiadelli
- Clinica Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Italy
| | - Sonia Monticone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Alice Bonuccelli
- Paediatric Neurology, Paediatric Department, Pisa University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Filippo Greco
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Silvia Marino
- Unit of Pediatrics and Pediatric Emergency, AOU Policlinico, PO San Marco, University of Catania, Italy
| | - Gabriele Monte
- Pediatric Headache Center, Neuroscience Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Antonella Versace
- AOU Città della Salute e della Scienza, Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Stefano Masi
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Chair of Pediatrics, Sapienza University, c/o Sant'Andrea Hospital, Rome, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Massimiliano Valeriani
- Pediatric Headache Center, Neuroscience Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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Castagno E, Aguzzi S, Rossi L, Gallo R, Carpino A, Ricceri F, Urbino AF, Bondone C. Clinical Predictors and Biomarkers in Children With Sepsis and Bacterial Meningitis. Pediatr Emerg Care 2023; 39:311-317. [PMID: 36715265 DOI: 10.1097/pec.0000000000002865] [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] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Sepsis and meningitis in children may present with different clinical features and a wide range of values of inflammatory markers. The aim of this study was to identify the prognostic value of clinical features and biomarkers in children with sepsis and bacterial meningitis in the emergency department (ED). METHODS We carried out a single-center, retrospective, observational study on 194 children aged 0 to 14 years with sepsis and bacterial meningitis admitted to the pediatric ED of a tertiary children's hospital through 12 years. RESULTS Among epidemiological and early clinical features, age older than 12 months, capillary refill time greater than 3 seconds, and oxygen blood saturation lower than 90% were significantly associated with unfavorable outcomes, along with neurological signs ( P < 0.05). Among laboratory tests, only procalcitonin was an accurate and early prognostic biomarker for sepsis and bacterial meningitis in the ED, both on admission and after 24 hours. Procalcitonin cut-off value on admission for short-term complications was 19.6 ng/mL, whereas the cut-off values for long-term sequelae were 19.6 ng/mL on admission and 41.9 ng/mL after 24 hours, respectively. The cut-off values for mortality were 18.9 ng/mL on admission and 62.4 ng/mL at 24 hours. CONCLUSIONS Procalcitonin, along with clinical evaluation, can guide the identification of children at higher risk of morbidity and mortality, allowing the most appropriate monitoring and treatment.
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Affiliation(s)
- Emanuele Castagno
- From the Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Sonia Aguzzi
- From the Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lorenza Rossi
- Division of Pediatrics and Neonatology, P.O. Ciriè, ASL-TO4, Ciriè (TO), Italy
| | - Rachele Gallo
- Pediatric Department, E. Agnelli Hospital, Pinerolo (TO), Italy
| | - Andrea Carpino
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Orbassano (TO), Italy
| | - Antonio F Urbino
- From the Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Claudia Bondone
- From the Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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10
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Rossi R, Benetti S, Lauria B, Grasso G, Castagno E, Ricceri F, Bondone C, Versace A. Cardiovascular Risk Factors and Family History of Major Thrombotic Events in Children with Migraine: A 12-Year Retrospective Single-Centre Study. J Clin Med 2023; 12:jcm12072582. [PMID: 37048668 PMCID: PMC10095463 DOI: 10.3390/jcm12072582] [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: 02/27/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Migraine is one of the most frequent primary headaches in childhood. The role of thrombotic predisposition in its pathogenesis is debated. Our aim was to analyse the cardiovascular risk factors and family history of major thrombotic events in children with migraine. METHODS A retrospective, single-centre study was performed over 12 years. Our headache centre record database was screened for migraine with aura (MA) and migraine without aura (MO) on the basis of the ICHD-II (until 2013) and III criteria. A control group of otherwise healthy children was recruited. Descriptive and multivariate analyses are provided; significance was set at p < 0.05. RESULTS Migraine was diagnosed in 930 children (24.7% MA); 73.3% were 9-14 years old. Children with MA were older (p < 0.001). A family history of cerebral ischemic events at ≤50 years old was more commonly reported by children with MA than those with MO (p < 0.001) and those in the control group (p = 0.001). Children with MA showed a higher risk of a family history of cerebral ischemic events at ≤50 years old than children with MO (OR: 2.6) and those in the control group (OR: 3.1). When comparing the family history of DVT, we observed a significantly increased risk for MA vs. MO (OR: 2.9). CONCLUSION A family history of cerebral ischemic events at ≤50 years old leads to an increased risk of MA. Further studies are needed to explore such an association.
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Affiliation(s)
- Roberta Rossi
- Department of Pediatric Emergency, Pediatric Headache Centre, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Stefania Benetti
- Department of Pediatrics, Ospedale degli Infermi, ASL TO3, Via Rivalta 29, 10098 Rivoli, Italy
| | - Barbara Lauria
- Department of Pediatric Emergency, Pediatric Headache Centre, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Giulia Grasso
- Department of Pediatric Emergency, Pediatric Headache Centre, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Emanuele Castagno
- Department of Pediatric Emergency, Pediatric Headache Centre, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Pediatric Headache Centre, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Antonia Versace
- Department of Pediatric Emergency, Pediatric Headache Centre, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
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11
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Bonino E, Matarazzo P, Buganza R, Tuli G, Munarin J, Bondone C, de Sanctis L. Pediatric Myxedema Due to Autoimmune Hypothyroidism: A Rare Complication of a Common Disorder. Children (Basel) 2023; 10:children10040614. [PMID: 37189863 DOI: 10.3390/children10040614] [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: 02/09/2023] [Revised: 03/03/2023] [Accepted: 03/23/2023] [Indexed: 05/17/2023]
Abstract
In children, hypothyroidism usually presents non-specific symptoms; symptoms can emerge gradually, compromising a timely diagnosis. We report the case of a 13-year-old male, who was admitted to the hospital due to swelling of the torso and neck. Besides these symptoms, the child was healthy, except for a significant growth delay. Ultrasound evaluation and blood tests led to the diagnosis of myxedema secondary to severe hypothyroidism, which was due to autoimmune thyroiditis. Further investigations revealed pericardial effusion and pituitary hyperplasia, with hyper-prolactinemia. Treatment with levothyroxine led to edema regression and clinical, hemato-chemical and radiological improvement. After 6 months, growth velocity increased, although the recovery of growth already lost was not guaranteed. Brain MRI showed regression of pituitary hyperplasia. The diagnostic delay in this case was probably due to the patient's apparent good health, and the underestimation of growth restriction. This report underlines the importance of growth monitoring in adolescence, a critical period for identifying endocrine conditions; if undiagnosed, these conditions can lead to serious complications, such as myxedema in hypothyroidism, with potential effects beyond growth on multiple organs.
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Affiliation(s)
- Elisa Bonino
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Città della Salute e della Scienza, 10126 Torino, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Torino, Italy
- Postgraduate School of Pediatrics, University of Turin, 10126 Torino, Italy
| | - Patrizia Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Città della Salute e della Scienza, 10126 Torino, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Torino, Italy
| | - Raffaele Buganza
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Città della Salute e della Scienza, 10126 Torino, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Torino, Italy
| | - Gerdi Tuli
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Città della Salute e della Scienza, 10126 Torino, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Torino, Italy
| | - Jessica Munarin
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Città della Salute e della Scienza, 10126 Torino, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Torino, Italy
- Postgraduate School of Pediatrics, University of Turin, 10126 Torino, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, 10126 Torino, Italy
| | - Luisa de Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Città della Salute e della Scienza, 10126 Torino, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Torino, Italy
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12
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Pruccoli G, Castagno E, Raffaldi I, Denina M, Barisone E, Baroero L, Timeus F, Rabbone I, Monzani A, Terragni GM, Lovera C, Brach del Prever A, Manzoni P, Barbaglia M, Roasio L, De Franco S, Calitri C, Lupica M, Felici E, Marciano C, Santovito S, Militerno G, Abrigo E, Curtoni A, Quarello P, Bondone C, Garazzino S. The Importance of RSV Epidemiological Surveillance: A Multicenter Observational Study of RSV Infection during the COVID-19 Pandemic. Viruses 2023; 15:v15020280. [PMID: 36851494 PMCID: PMC9963567 DOI: 10.3390/v15020280] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
The restrictive measures adopted worldwide against SARS-CoV-2 produced a drastic reduction in respiratory pathogens, including RSV, but a dramatic rebound was thereafter reported. In this multicenter retrospective observational study in 15 Pediatric Emergency Departments, all children <3 years old with RSV infection admitted between 1 September and 31 December 2021 were included and compared to those admitted in the same period of 2020 and 2019. The primary aim was to evaluate RSV epidemiology during and after the COVID-19 pandemic peak. The secondary aims were to evaluate the clinical features of children with RSV infection. Overall, 1015 children were enrolled: 100 in 2019, 3 in 2020 and 912 in 2021. In 2019, the peak was recorded in December, and in 2021, it was recorded in November. Comparing 2019 to 2021, in 2021 the median age was significantly higher and the age group 2-3 years was more affected. Admissions were significantly higher in 2021 than in 2020 and 2019, and the per-year hospitalization rate was lower in 2021 (84% vs. 93% in 2019), while the duration of admissions was similar. No difference was found in severity between 2019-2020-2021. In conclusion, after the COVID-19 pandemic, an increase in RSV cases in 2021 exceeding the median seasonal peak was detected, with the involvement of older children, while no difference was found in severity.
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Affiliation(s)
- Giulia Pruccoli
- Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Marco Denina
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Elisa Barisone
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-0113135396
| | - Luca Baroero
- Department of Pediatrics, Martini Hospital, 10141 Turin, Italy
| | - Fabio Timeus
- Pediatrics Department, Chivasso Hospital, 10034 Chivasso (TO), Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Alice Monzani
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | | | - Cristina Lovera
- Department of Pediatrics, A.O. S.Croce e Carle, 12100 Cuneo, Italy
| | | | - Paolo Manzoni
- Department of Pediatrics, Ospedale Degli Infermi di Ponderano, University of Turin, 13900 Biella, Italy
| | | | - Luca Roasio
- Department of Pediatrics, Edoardo Agnelli Hospital, 10064 Pinerolo (TO), Italy
| | - Simona De Franco
- Department of Pediatrics, Ospedale di Borgomanero, 28021 Borgomanero (NO), Italy
| | - Carmelina Calitri
- Department of Pediatrics, Ospedale di Rivoli, 10098 Rivoli (TO), Italy
| | - Maddalena Lupica
- Department of Pediatrics, Ospedale di Rivoli, 10098 Rivoli (TO), Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, Children’s Hospital, AO SS Antonio e Biagio e C. Arrigo, 15121 Alessandria, Italy
| | - Cinzia Marciano
- Pediatric and Pediatric Emergency Unit, Children’s Hospital, AO SS Antonio e Biagio e C. Arrigo, 15121 Alessandria, Italy
| | - Savino Santovito
- Department of Pediatrics, Ospedale Maria Vittoria, ASL Città di Torino, 10143 Turin, Italy
| | - Gaia Militerno
- Department of Pediatrics, Ospedale Cardinal Massaia, 14100 Asti, Italy
| | - Enrica Abrigo
- Department of Pediatrics, Ospedale Cardinal Massaia, 14100 Asti, Italy
| | - Antonio Curtoni
- Microbiology and Virology Unit, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Paola Quarello
- Department of Pediatric Onco-Hematology, University of Turin, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Silvia Garazzino
- Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
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13
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Giachetti E, Raffaldi I, Delmonaco AG, Tardivo I, Versace A, Bondone C, Urbino AF. Point-of-care ultrasound in the pediatric emergency department to diagnose lung abscess. Pediatr Neonatol 2023; 64:83-84. [PMID: 36089539 DOI: 10.1016/j.pedneo.2021.11.015] [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: 08/17/2021] [Revised: 10/31/2021] [Accepted: 11/12/2021] [Indexed: 01/18/2023] Open
Affiliation(s)
- Elena Giachetti
- Department of Pediatric and Neonatology, Santa Croce Hospital, Moncalieri, Turin, Italy
| | - Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy.
| | | | - Irene Tardivo
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Antonia Versace
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
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14
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Racca F, Sansone VA, Ricci F, Filosto M, Pedroni S, Mazzone E, Longhitano Y, Zanza C, Ardissone A, Adorisio R, Berardinelli A, Bondone C, Briani C, Cairello F, Carraro E, Comi GP, Crescimanno G, D’Amico A, Deiaco F, Fabiano A, Franceschi F, Mancuso M, Massè A, Messina S, Mongini T, Moroni I, Moscatelli A, Musumeci O, Navalesi P, Nigro G, Origo C, Panicucci C, Pane M, Pavone M, Pedemonte M, Pegoraro E, Piastra M, Pini A, Politano L, Previtali S, Rao F, Ricci G, Toscano A, Wolfler A, Zoccola K, Sancricca C, Nigro V, Trabacca A, Vianello A, Bruno C. Emergencies cards for neuromuscular disorders 1 st Consensus Meeting from UILDM - Italian Muscular Dystrophy Association Workshop report. Acta Myol 2022; 41:135-177. [PMID: 36793651 PMCID: PMC9896597 DOI: 10.36185/2532-1900-081] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/20/2022] [Indexed: 02/17/2023]
Abstract
Acute hospitalisation may be required to support patients with Neuromuscular disorders (NMDs) mainly experiencing respiratory complications, swallowing difficulties, heart failure, urgent surgical procedures. As NMDs may need specific treatments, they should be ideally managed in specialized hospitals. Nevertheless, if urgent treatment is required, patients with NMD should be managed at the closest hospital site, which may not be a specialized centre where local emergency physicians have the adequate experience to manage these patients. Although NMDs are a group of conditions that can differ in terms of disease onset, progression, severity and involvement of other systems, many recommendations are transversal and apply to the most frequent NMDs. Emergency Cards (EC), which report the most common recommendations on respiratory and cardiac issues and provide indications for drugs/treatments to be used with caution, are actively used in some countries by patients with NMDs. In Italy, there is no consensus on the use of any EC, and a minority of patients adopt it regularly in case of emergency. In April 2022, 50 participants from different centres in Italy met in Milan, Italy, to agree on a minimum set of recommendations for urgent care management which can be extended to the vast majority of NMDs. The aim of the workshop was to agree on the most relevant information and recommendations regarding the main topics related to emergency care of patients with NMD in order to produce specific ECs for the 13 most frequent NMDs.
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Affiliation(s)
- Fabrizio Racca
- Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy,Correspondence Fabrizio Racca Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, via Venezia 16, 15121 Alessandria, Italy E-mail:
| | - Valeria A. Sansone
- Neurorehabilitation Unit, the NeMO Clinical Center in Milan, University of Milan, Milan, Italy
| | - Federica Ricci
- Division of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Stefania Pedroni
- Neuromuscular Omnicentre (NeMO), Fondazione Serena Onlus, Milan, Italy
| | - Elena Mazzone
- Paediatric Neurology and NeMO Center, Catholic University and Policlinico Gemelli, Rome, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Christian Zanza
- Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Anna Ardissone
- Child Neurology Unit, Department of Pediatric Neuroscience Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rachele Adorisio
- Bambino Gesù Hospital and Research Institute- ERN GUARD Heart, Rome, Italy
| | | | - Claudia Bondone
- Pediatric Emergency Department, University Hospital “Città della Salute e della Scienza di Torino”, Turin, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Francesca Cairello
- Pediatric and Pediatric Emergency Unit, Pediatric Cardiology Service AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Elena Carraro
- Neuromuscular Omnicentre (NeMO), Fondazione Serena Onlus, Milan, Italy
| | - Giacomo P. Comi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy; Dino Ferrari Center, University of Milan, Milan, Italy
| | - Grazia Crescimanno
- Italian National Research Council, Institute for Biomedical Research and Innovation, Palermo, Italy; Regional Center for prevention and treatment of respiratory complications of rare genetic neuromuscular diseases, Villa Sofia-Cervello Hospital Palermo, Italy
| | - Adele D’Amico
- Neuromuscular and Neurodegenerative Unit, Department of Neurosciences. Bambino Gesù Paediatric Hospital, Rome, Italy
| | - Fabio Deiaco
- Paediatric Emergency Department, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessia Fabiano
- Pneumology Unit Azienda USL Romagna Infermi Hospital, Rimini, Italy
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine Neurological Institute, University of Pisa, Pisa, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, Turin, Italy
| | - Sonia Messina
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Tiziana Mongini
- Neuromuscular Unit, Department of Neurosciences RLM, University of Turin, Turin, Italy
| | - Isabella Moroni
- Child Neurology Unit, Department of Pediatric Neuroscience Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Olimpia Musumeci
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Gerardo Nigro
- Department of Medical Translational Sciences, Division of Cardiology, Monaldi Hospital, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Carlo Origo
- Pediatric Orthopedic and Traumatology Unit Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Chiara Panicucci
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marika Pane
- Paediatric Neurology and NeMO Center, Catholic University and Policlinico Gemelli, Rome, Italy
| | - Martino Pavone
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Pediatric Hospital Bambino Gesù Research Institute, Rome, Italy
| | - Marina Pedemonte
- Pediatric Neurology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Marco Piastra
- Pediatric Anesthesiology and Intensive Care Unit, Università Cattolica, Rome, Italy
| | - Antonella Pini
- Pediatric Neuromuscular Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Luisa Politano
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy and Gaetano Torre for Muscular Dystrophy Association, Naples, Italy
| | | | - Fabrizio Rao
- Neuromuscular Omnicentre (NeMO), Fondazione Serena Onlus La Colletta Hospital, Arenzano (GE), Italy
| | - Giulia Ricci
- Department of Clinical and Experimental Medicine Neurological Institute, University of Pisa, Pisa, Italy
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Andrea Wolfler
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Khristian Zoccola
- Pediatric Orthopedic and Traumatology Unit Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonio Trabacca
- Scientific Institute IRCCS “E. Medea”, Unit for Severe disabilities in developmental age and young adults. (Developmental Neurology and Neurorehabilitation), Brindisi, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Claudio Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - DINOGMI, University of Genoa, Genoa, Italy
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15
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Castagno E, Raffaldi I, Del Monte F, Garazzino S, Bondone C. New epidemiological trends of respiratory syncytial virus bronchiolitis during COVID-19 pandemic. World J Pediatr 2022; 19:502-504. [PMID: 36163542 PMCID: PMC9512956 DOI: 10.1007/s12519-022-00623-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/15/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città Della Salute e della Scienza di Torino, Piazza Polonia 94, 10126, Turin, Italy.
| | - Irene Raffaldi
- Present Address: Department of Pediatric Emergency, Regina Margherita Children’s Hospital - A.O.U. Città Della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Francesco Del Monte
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Silvia Garazzino
- Pediatric Infectious Disease Unit, Regina Margherita Children’s Hospital - A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Claudia Bondone
- Present Address: Department of Pediatric Emergency, Regina Margherita Children’s Hospital - A.O.U. Città Della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
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16
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Barbero A, Pagano M, Tuli G, Buganza R, de Sanctis L, Bondone C. Menorrhagia as main presentation sign of severe hypothyroidism in a pediatric patient: a case report. Ital J Pediatr 2022; 48:171. [PMID: 36089580 PMCID: PMC9465942 DOI: 10.1186/s13052-022-01363-x] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The relative high frequency of menstrual irregularities in the first two–three years after menarche may lead to the risk of underestimation of associated pathological conditions, which are always to be accurately researched with careful examination and anamnesis. The association between menstrual irregularities and hypothyroidism is described in literature but the available data are scarce and mainly based on adult case series. It is described that low plasma levels of thyroid hormone can shift the hemostatic system towards a hypocoagulable and hyperfibrinolytic state and seem to lead to an increased bleeding risk.
Case presentation
This case report describes the case of a thirteen years old girl who presented to our Emergency Department complaining of menorrhagia for the last fifteen days, leading to severe anemia. The objective examination revealed clinical signs of hypothyroidism and a severe short stature, lower than mid-parental height, with stunting of growth and a significant bone age delay. Blood exams and thyroid ultrasound were consistent with the diagnosis of severe hypothyroidism in autoimmune thyroiditis with acquired von Willebrand syndrome, growth hormone deficiency. Magnetic resonance showed pituitary functional hyperplasia.
The substitutive therapy with levothyroxine led to the resolution of heavy bleeding after five days and following normalization of coagulative parameters and pituitary hyperplasia.
Conclusions
Hypothyroidism usually presents with unspecific symptoms, with consequent risk of diagnostic delay. It can influence the coagulation system and it seems to be associated to increased risk of menstrual irregularities.
We underline the importance of a regular follow up of the pubertal development, including height measurements, thyroid palpation and menstrual anamnesis to intercept red flags findings for hypothyroidism.
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Denina M, Trada M, Tinti D, Funiciello E, Novara C, Moretto M, Rosati S, Garazzino S, Bondone C, De Sanctis L. Increase in newly diagnosed type 1 diabetes and serological evidence of recent SARS-CoV-2 infection: Is there a connection? Front Med (Lausanne) 2022; 9:927099. [PMID: 35966867 PMCID: PMC9371320 DOI: 10.3389/fmed.2022.927099] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
Several studies have investigated the correlation between the COVID-19 pandemic and the onset of type 1 diabetes (T1D) in children, reporting an increased incidence of T1D and severe diabetic ketoacidosis (DKA). This study aimed to investigate the infection by SARS-CoV-2 in children with newly-diagnosed T1D to explore a possible link between SARS-CoV-2 infection, T1D and DKA. Thirty-nine children with a T1D new onset between October 15, 2020, and April 15, 2021, were enrolled. SARS-CoV-2 infection was investigated through a polymerase chain reaction on the nasal swab, dosage of specific antibodies, and an anamnestic question form. Nine (23%) of them had antibodies directed toward SARS-CoV-2, and five (12%) had a history of recent SARS-CoV-2 infection in themselves or in their family. No molecular swabs were positive. Compared to the general pediatric population, the overall incidence of COVID-19 was 5.6 times higher in the T1D patients' group (p < 0.00001). Referring only to the cases in the metropolitan area, we find a net increase in the incidence of T1D compared to the 5 years preceding our study, by 50% compared to the same months in 2016/2017 and 2017/2018, by 69% compared to 2018/2019 and by 77% compared to 2019/2020. The same trend was observed regarding DKA cases. The attributable risk of the pandemic cohort compared to the previous year is 44%. The abnormal disproportion of SARS-CoV-2 infection between children with T1D and the pediatric reference population, with a ratio of 5.6, appears to support the causative role of SARS-CoV-2 in triggering the immune response underlying diabetes, as often described for other viral infections. The difficulty accessing care services during the pandemic, with a consequent diagnosis delay, does not justify the increase in observed T1D cases, which could to be directly linked to the pandemic. The acceleration of the immune process provoked by SARS-CoV-2 may play a suggestive role in the development of T1D with DKA. Multicenter studies are needed to deepen and fully understand the pathophysiological link between SARS-CoV-2 and the onset of T1D in children.
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Affiliation(s)
- Marco Denina
- Department of Pediatric Emergency, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
- Infectious Diseases Unit, Department of Pediatrics, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
- *Correspondence: Marco Denina
| | - Michela Trada
- Department of Pediatrics, Center of Pediatric Diabetology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Davide Tinti
- Department of Pediatrics, Center of Pediatric Diabetology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Elisa Funiciello
- Department of Pediatrics and Public Health, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Chiara Novara
- Department of Pediatrics and Public Health, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Martina Moretto
- Department of Pediatrics and Public Health, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Sergio Rosati
- Department of Veterinary Science, University of Turin, Turin, Italy
| | - Silvia Garazzino
- Infectious Diseases Unit, Department of Pediatrics, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa De Sanctis
- Department of Pediatrics, Center of Pediatric Diabetology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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18
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Rossi R, Castagno E, Matarazzo P, Tuli G, Saracco P, Urbino AF, Bondone C. Severe hyponatremia due to water intoxication in a child with sickle cell disease: A case report. Emer Care J 2022. [DOI: 10.4081/ecj.2022.10364] [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] [Indexed: 11/22/2022] Open
Abstract
Water intoxication is a potentially fatal hypo-osmolar syndrome with brain function impairment. Isolated symptomatic excessive ingestion of free water is very rare in childhood. We report a case of acute hyponatremia due to water intoxication without Antidiuretic Hormone (ADH) excess in a child with sickle cell disease. The boy was admitted to our Emergency Department because of new-onset prolonged generalized seizures. Blood test showed hyponatremia, and elevated creatine kinase value; neuroimaging was negative. His recent medical history revealed that on the day before he had drunk about 4 liters of water in 2 hours to prevent sickling, because of back pain. He was treated with mild i.v. hydration with normal saline solution and showed progressive clinical improvement and normalization of laboratory test. Rhabdomyolysis is a rare complication of hyponatremia whose underlying mechanism is still unclear.
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19
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Raucci U, Stanco M, Roversi M, Ponticiello E, Pisani M, Rosa M, Falsaperla R, Pavone P, Bondone C, Raffaldi I, Calistri L, Masi S, Reale A, Villani A, Marano M. Acquired methemoglobinemia in children presenting to Italian pediatric emergency departments: a multicenter report. Clin Toxicol (Phila) 2022; 60:920-925. [PMID: 35416740 DOI: 10.1080/15563650.2022.2061986] [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] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Methemoglobinemia (MetHb) is a rare inherited or acquired cause of cyanosis in children. Owing to its rarity, case reports and case series are mostly available in the current literature. This study reports data on a large sample of children with acquired MetHb. METHODS Data on patients admitted for acquired MetHb between January 2007 to December 2020 was extracted from the databases of five Italian pediatric emergency departments (EDs). Demographical and clinical characteristics was reported and discussed. RESULTS Nineteen cases of acquired MetHb were evaluated. Ten patients (52.6%) were male and 9 (47.4%) were female. The median age was 8.23 months. The median time from trigger to symptom onset was 6 hours. Mostly, the intoxication presumptively occurred by home ingestion of contaminated food, mainly badly preserved vegetable broth. All patients were cyanotic at admission, most patients also presented tachycardia and/or tachypnea, and two patients were comatose. Antidotal therapy with methylene blue was given in 14 patients (73.7%). The median hospital stay was 2 days. All patients survived. DISCUSSION As MetHb leads to the pathognomonic brown blood discoloration, blood gas analysis is mandatory immediately upon hospital arrival of a cyanotic patient. A correct medical history is crucial to identify the trigger and remove it. In our sample, the age onset was much lower than in the previous literature, and MetHb mainly due to ingestion of contaminated vegetable broth. Methylene blue led to a rapid recovery in all patients. Oxygen therapy may well lead to complete recovery when methemoglobin levels do not exceed 30% in asymptomatic and 20% in mildly symptomatic patients. CONCLUSIONS The diagnosis and management of acquired MetHb in the emergency setting requires acknowledgment of this condition as a cause of cyanosis in the weaning child. Indeed, when promptly recognized and treated, this severe condition rapidly resolves with no significant acute sequelae.
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Affiliation(s)
- Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michela Stanco
- Department of Women, Children And General and Specialist Surgery, University of the Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Roversi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, University of Rome Tor Vergata, Residency School of Pediatrics, Rome, Italy
| | | | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Margherita Rosa
- Dipartimento di Area Critica, AORN Santobono Pausilipon, Naples, Italy
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit [NICU], AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy.,Unit of Pediatrics and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Piero Pavone
- Division of Pediatrics and Pediatric Emergency, University Hospital Policlinico "Rodolico-San Marco," Catania, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lucia Calistri
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Stefano Masi
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Marano
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Paediatric Clinical Toxicology Centre, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
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20
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Castagno E, Fabiano G, Carmellino V, Cerchio R, De Vito B, Lauria B, Mercurio G, Coscia A, Ponte G, Bondone C. Neonatal pain assessment scales: review of the literature. Prof Inferm 2022; 75:17-28. [PMID: 36962062 DOI: 10.7429/pi.2022.751017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
INTRODUCTION The measurement of pain is the fundamental prerequisite for its proper management. Since newborns are unable to communicate verbally, neonatal algometric scales have been developed. However, no gold standard has been identified yet. OBJECTIVE To identify and classify the most suitable and effective scales for different kinds of pain for term and preterm newborns in different clinical settings. METHOD The review was carried out between December 2019 and November 2020 by consulting the PubMed and CINAHL Database, combining Mesh terms and free text with appropriate inclusion and exclusion filters. The references reported in the articles found in the first part of the research were also analyzed, in order to identify further relevant studies. RESULTS :Out of 2442 papers initially identified, we included 45 articles, describing 50 pain assessment scales (34 for acute pain, 12 for procedural pain, 24 for prolonged/chronic pain and 19 for pain after surgery). Scales with higher evidence are N-PASS, NFCS, BIIP and PIPP for acute and procedural pain, N-PASS, ALPS-Neo, EDIN and EDIN6 for prolonged/chronic pain, and PIPP, CRIES and COMFORT for pain after surgery. DISCUSSION There is no unanimously accepted gold standard scale for neonatal pain. However, some are more suitable and effective: PIPP, NFCS, N-PASS and BIIP for acute pain; N-PASS, ALPS-Neo and EDIN/EDIN6 for chronic and prolonged pain; PIPP, CRIES and COMFORT for postoperative pain. Among all, N-PASS scale is the most complete and fits to different settings.
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Affiliation(s)
- Emanuele Castagno
- S.C. Pediatria d'Urgenza, Gruppo di Lavoro sul Dolore, Ospedale Infantile Regina Margherita A.O.U. Città della Salute e della Scienza di Torino
| | - Giada Fabiano
- Corso di Laurea in Infermieristica, Università degli Studi di Torino
| | - Virna Carmellino
- S.C. Pediatria d'Urgenza, Gruppo di Lavoro sul Dolore, Ospedale Infantile Regina Margherita A.O.U. Città della Salute e della Scienza di Torino
| | - Roberto Cerchio
- S.C. Pediatria d'Urgenza, Gruppo di Lavoro sul Dolore, Ospedale Infantile Regina Margherita A.O.U. Città della Salute e della Scienza di Torino
| | - Barbara De Vito
- S.C. Pediatria d'Urgenza, Gruppo di Lavoro sul Dolore, Ospedale Infantile Regina Margherita A.O.U. Città della Salute e della Scienza di Torino
| | - Barbara Lauria
- S.C. Pediatria d'Urgenza, Gruppo di Lavoro sul Dolore, Ospedale Infantile Regina Margherita A.O.U. Città della Salute e della Scienza di Torino
| | - Giancarlo Mercurio
- Corso di Laurea in Infermieristica, Università degli Studi di Torino, Dipartimento di Scienze della Sanità Pubblica e Pediatriche A.O.U. Città della Salute e della Scienza di Torino
| | - Alessandra Coscia
- S.C. Neonatologia U, S.S. Terapia Intensiva Neonatale, Gruppo di Lavoro sul Dolore, Ospedale Ostetrico ginecologico Sant'Anna A.O.U. Città della Salute e della Scienza di Torino
| | - Giulia Ponte
- S.C. Neonatologia U, S.S. Terapia Intensiva Neonatale, Gruppo di Lavoro sul Dolore, Ospedale Ostetrico ginecologico Sant'Anna A.O.U. Città della Salute e della Scienza di Torino
| | - Claudia Bondone
- S.C. Pediatria d'Urgenza, Gruppo di Lavoro sul Dolore, Ospedale Infantile Regina Margherita A.O.U. Città della Salute e della Scienza di Torino
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21
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Denina M, Giannone V, Curtoni A, Zanotto E, Garazzino S, Urbino AF, Bondone C. Can we trust in Sars-CoV-2 rapid antigen testing? Preliminary results from a paediatric cohort in the emergency department. Ir J Med Sci 2021; 191:1767-1770. [PMID: 34519927 PMCID: PMC8438652 DOI: 10.1007/s11845-021-02776-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
Background Rapid identification of Covid-19 in the paediatric emergency department is critical; Antigen tests are fast but poorly investigated in children. Aims To investigate Sars-CoV-2 antigen rapid test in children. Methods We compare the performance of LumiraDx with molecular tests in a paediatric emergency department. Results A retrospective cohort of 191 patients with AT and PCR tests performed in the same episode was analysed; 16% resulted positive for Sars-CoV-2. Using the PCR test as the gold standard, we calculated antigen testing overall sensitivity of 94.1%, specificity of 91.9%, and NPV of 99.4%. Only one false-negative test was found. Conclusions AT may be helpful in the initial screening of patients at PED.
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Affiliation(s)
- Marco Denina
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy. .,Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy.
| | - Virginia Giannone
- Department of Pediatrics and Public Health, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Antonio Curtoni
- Department of Public Health and Pediatrics, Microbiology and Virology Unit, Molinette Hospital, University of Turin, Città della salute e della Scienza, Turin, Italy
| | - Elisa Zanotto
- Department of Public Health and Pediatrics, Microbiology and Virology Unit, Molinette Hospital, University of Turin, Città della salute e della Scienza, Turin, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | | | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
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22
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Davico C, Marcotulli D, Lux C, Calderoni D, Cammisa L, Bondone C, Rosa-Brusin M, Secci I, Porro M, Campanile R, Bosia C, Di Santo F, Terrinoni A, Ricci F, Amianto F, Urbino A, Ferrara M, Vitiello B. Impact of the COVID-19 Pandemic on Child and Adolescent Psychiatric Emergencies. J Clin Psychiatry 2021; 82. [PMID: 33989466 DOI: 10.4088/jcp.20m13467] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE By forcing closure of schools, curtailing outpatient services, and imposing strict social distancing, the COVID-19 pandemic has abruptly affected the daily life of millions worldwide, with still unclear consequences for mental health. This study aimed to evaluate if and how child and adolescent psychiatric visits to hospital emergency departments (EDs) changed during the pandemic lockdown, which started in Italy on February 24, 2020. METHODS We examined all ED visits by patients under 18 years of age in the 7 weeks prior to February 24, 2020, and in the subsequent 8 weeks of COVID-19 lockdown at two urban university hospitals, in Turin and Rome, Italy. ED visits during the corresponding periods of 2019 served as a comparison using Poisson regression modeling. The clinician's decision to hospitalize or discharge home the patient after the ED visit was examined as an index of clinical severity. RESULTS During the COVID-19 lockdown, there was a 72.0% decrease in the number of all pediatric ED visits (3,395) compared with the corresponding period in 2019 (12,128), with a 46.2% decrease in psychiatric visits (50 vs 93). The mean age of psychiatric patients was higher in the COVID-19 period (15.7 vs 14.1 years). No significant changes were found in hospitalization rate or in the prevalence distribution of the primary reason for the psychiatric ED visit (suicidality, anxiety/mood disorders, agitation). CONCLUSIONS In the first 8 weeks of the COVID-19-induced social lockdown, the number of child and adolescent psychiatric ED visits significantly decreased, with an increase in patient age. This decrease does not appear to be explained by severity-driven self-selection and might be due to a reduction in psychiatric emergencies or to the implementation of alternative ways of managing acute psychopathology.
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Affiliation(s)
- Chiara Davico
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy.,Drs Davico and Marcotulli are co-first authors of this article.,Corresponding author: Chiara Davico, MD, Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Piazza Polonia 94, 10100, Turin, Italy
| | - Daniele Marcotulli
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy.,Drs Davico and Marcotulli are co-first authors of this article
| | - Caterina Lux
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Dario Calderoni
- Department of Human Neuroscience, Section of Child and Adolescent Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Luca Cammisa
- Department of Human Neuroscience, Section of Child and Adolescent Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Claudia Bondone
- Emergency Pediatrics, Department of Child Care, Regina Margherita Hospital, Turin, Italy
| | - Martina Rosa-Brusin
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Ilaria Secci
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Marzia Porro
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Roberta Campanile
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy
| | - Chiara Bosia
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Federica Di Santo
- Department of Human Neuroscience, Section of Child and Adolescent Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Arianna Terrinoni
- Department of Human Neuroscience, Section of Child and Adolescent Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Federica Ricci
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | | | - Antonio Urbino
- Emergency Pediatrics, Department of Child Care, Regina Margherita Hospital, Turin, Italy
| | - Mauro Ferrara
- Department of Human Neuroscience, Section of Child and Adolescent Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
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23
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Raffaldi I, Castagno E, Fumi I, Bondone C, Ricceri F, Besenzon L, Brach Del Prever A, Capalbo P, Cosi G, Felici E, Fusco P, Gallina MR, Garofalo F, Gianino P, Guala A, Haitink O, Manzoni P, Marra A, Rabbone I, Roasio L, Santovito S, Serra A, Tappi E, Terragni GM, Timeus FS, Torielli F, Vigo A, Urbino AF. Pediatric admissions to emergency departments of North-Western Italy during COVID-19 pandemic: A retrospective observational study. Lancet Reg Health Eur 2021; 5:100081. [PMID: 34104902 PMCID: PMC7969147 DOI: 10.1016/j.lanepe.2021.100081] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background COVID-19 pandemic caused huge decrease of pediatric admissions to Emergency Department (ED), arising concerns about possible delays in diagnosis and treatment of severe disorders. Methods Impact of COVID-19 on Pediatric Emergency Room (ICOPER) was a retrospective multicentre observational study including 23 Italian EDs. All the children <18 years admitted, between March 9th and May 3rd 2020 stratified by age, priority code, cause of admission and outcome have been included and compared to those admitted in the same period of 2019. Our objectives were to assess the characteristics of pediatric admissions to EDs since COVID-19 outbreak until the end of lockdown, and to describe the features of critical children. Findings 16,426 children were admitted in 2020, compared to 55,643 in 2019 (-70·48%). Higher reduction was reported in hospitals without Pediatric Intensive Care Unit (PICU) (-73·38%) than in those with PICU (-64·08%) (P<0·0001). Admissions with low priority decreased more than critical ones (-82·77% vs. 44·17% respectively; P<0·0001). Reduction of discharged patients was observed both in hospitals with (-66·50%) and without PICU (-74·65%) (P<0·0001). No difference in the duration of symptoms before admission was reported between 2019 and 2020, with the majority of children accessing within 24 h (55·08% vs. 57·28% respectively; P = 0·2344). Interpretation Admissions with low priority decreased significantly more than those with high priority; we suppose that the fear of being infected in hospital maybe overcame the concerns of caregivers. Compared to 2019, no significant referral delay by caregivers was reported. Our data suggest the need of adaptation of EDs and primary care services to different needs of children during COVID-9 pandemic.
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Affiliation(s)
- Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Ilaria Fumi
- Department of Public Health and Pediatrics, University of Turin, Piazza Polonia 94, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, Orbassano, TO, Italy.,Unit of Epidemiology, Regional Health Service, ASL TO3, Via Sabaudia 164, Grugliasco, TO, Italy
| | - Luigi Besenzon
- Division of Pediatrics and Neonatology, P.O. Savigliano, ASL CN1, Via Ospedali 9, Savigliano, CN, Italy
| | | | - Pina Capalbo
- Division of Pediatrics and Neonatology 3, P.O Martini, ASL Città di Torino, Via Tofane 71, Turin, Italy
| | - Gianluca Cosi
- Pediatric Unit, Sant'Andrea Hospital, ASL VC, Corso Mario Abbiate 21, Vercelli, Italy
| | - Enrico Felici
- Pediatrics and Pediatric Emergency Unit, The Children's Hospital, AO SS Antonio e Biagio e C. Arrigo, Via Spalto Marengo 46, Alessandria, Italy
| | - Patrizia Fusco
- Pediatric Unit, Montis Regalis Hospital, ASL CN1, Via San Rocchetto 99, Mondovì, CN, Italy
| | - Maria Rita Gallina
- Division of Pediatrics and Neonatology, Beauregard Hospital, Via L. Vaccari 5, Aosta, Italy
| | - Franco Garofalo
- Pediatric Unit, P.O. Rivoli, ASL TO3, Via Rivalta 29, Rivoli, TO, Italy
| | - Paola Gianino
- Division of Pediatrics, P.O. Cardinal Massaia, ASL AT, Corso Dante Alighieri 202, Asti, Italy
| | - Andrea Guala
- Division of Pediatrics, Ospedale Castelli, Via Fiume 18, Pallanza, Verbania, Italy
| | - Oscar Haitink
- Pediatric Department, SS Trinità Hospital, Viale Zoppis 10, Borgomanero, NO, Italy
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal-Infantile Medicine, Nuovo Ospedale Degli Infermi, Via dei Ponderanesi 2, Ponderano, BI, Italy
| | - Antonio Marra
- Pediatric Unit - NICU, S. Croce Hospital, ASLT TO5, Piazza Amedeo Ferdinando 3, Moncalieri, TO, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Science, University of Piemonte Orientale, Corso G. Mazzini 18, Novara, Italy
| | - Luca Roasio
- Pediatric Department, E. Agnelli Hospital, Via Brigata Cagliari 39, Pinerolo, TO, Italy
| | - Savino Santovito
- Division of Pediatrics 1, Maria Vittoria Hospital, Via L. Cibrario 72, Turin, Italy
| | - Alberto Serra
- Division of Pediatrics, Ospedale Michele e Pietro Ferrero, P.O. Alba-Bra ASL CN2, Verduno, CN, Italy
| | - Eleonora Tappi
- Pediatric Unit, A.S.O. S. Croce e Carle, Via M. Coppino 26, Cuneo, Italy
| | - Gian Maria Terragni
- Division of Pediatrics, P.O. Chieri, ASL TO5, Via de Maria 1, Chieri, TO, Italy
| | - Fabio S Timeus
- Division of Pediatrics and Neonatology, P.O. Chivasso, ASL TO4, Corso G. Ferraris 3, Chivasso, TO, Italy
| | - Flaminia Torielli
- Division of Pediatrics, P.O. Novi Ligure, ASL AL, Via E. Raggio 12, Novi Ligure, AL, Italy
| | - Alessandro Vigo
- Division of Pediatrics and Neonatology, P.O. Ivrea, ASL TO4, Piazza Credenza 2, Ivrea, TO, Italy
| | - Antonio F Urbino
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
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Denina M, Aguzzi S, Versace A, Rossi R, Pruccoli G, Mignone F, Bondone C, Garazzino S. Testing strategy for SARS-CoV-2 in the paediatric emergency department. Arch Dis Child 2021; 106:e11. [PMID: 32586931 DOI: 10.1136/archdischild-2020-319806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Marco Denina
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Sonia Aguzzi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Antonia Versace
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Roberta Rossi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Giulia Pruccoli
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Federica Mignone
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
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Del Borrello G, Giraudo I, Bondone C, Denina M, Garazzino S, Linari C, Mignone F, Pruccoli G, Scolfaro C, Spadea M, Pollio B, Saracco P. SARS-COV-2-associated coagulopathy and thromboembolism prophylaxis in children: A single-center observational study. J Thromb Haemost 2021; 19:522-530. [PMID: 33305475 PMCID: PMC9906296 DOI: 10.1111/jth.15216] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Multiple investigators have described an increased incidence of thromboembolic events in SARS-CoV-2-infected individuals. Data concerning hemostatic complications in children hospitalized for COVID-19/multisystem inflammatory syndrome in children (MIS-C) are scant. OBJECTIVES To share our experience in managing SARS-CoV-2-associated pro-coagulant state in hospitalized children. METHODS D-dimer values were recorded at diagnosis in children hospitalized for SARS-CoV-2-related manifestations. In moderately to critically ill patients and MIS-C cases, coagulation and inflammatory markers were checked at multiple time points and median results were compared. Pro-thrombotic risk factors were appraised for each child and thromboprophylaxis was started in selected cases. RESULTS Thirty-five patients were prospectively enrolled. D-dimer values did not discriminate COVID-19 of differing severity, whereas were markedly different between the COVID-19 and the MIS-C cohorts. In both cohorts, D-dimer and C-reactive protein levels increased upon clinical worsening but were not accompanied by decreased fibrinogen or platelet values, with all parameters returning to normal upon disease resolution. Six patients had multiple thrombotic risk factors and were started on pharmacological thromboprophylaxis. No deaths or thrombotic or bleeding complications occurred. CONCLUSIONS COVID-19 pediatric patients show mildly altered coagulation and inflammatory parameters; on the other hand, MIS-C cases showed laboratory signs of an inflammatory driven pro-coagulant status. Universal anticoagulant prophylaxis in hospitalized children with SARS-CoV-2-related manifestations is not warranted, but may be offered to patients with other pro-thrombotic risk factors in the context of a multi-modal therapeutic approach.
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Affiliation(s)
| | - Isaac Giraudo
- Sciences of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Claudia Bondone
- Paediatric Emergency Department, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Marco Denina
- Paediatric Infectious Disease Unit, Department of Paediatrics, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Silvia Garazzino
- Paediatric Infectious Disease Unit, Department of Paediatrics, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Claudia Linari
- Laboratory Medicine, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Federica Mignone
- Paediatric Infectious Disease Unit, Department of Paediatrics, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Giulia Pruccoli
- Sciences of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Carlo Scolfaro
- Paediatric Infectious Disease Unit, Department of Paediatrics, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Manuela Spadea
- Sciences of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Berardino Pollio
- Immune-Haematology and Transfusion Medicine, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Paola Saracco
- Paediatric Haematology Unit, Department of Paediatrics, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
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Lovera C, Castagno E, Bondone C, Ricceri F, Urbino AF. Caustic ingestion in children: A 6-year retrospective study. Emerg Care J 2020. [DOI: 10.4081/ecj.2020.9044] [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] [Indexed: 11/22/2022] Open
Abstract
Some aspects of the management of caustic ingestion in children are still debated. We aimed to determine the predictive value of epidemiological and clinical features of caustic ingestion, and to define guidelines adherence. This is a retrospective study on children ≤18 years referred to our Emergency Department over 6 years because of caustic ingestion. Statistical significance at p<0.05. Overall, 107 caustic ingestions were identified, mainly accidental <5 years (87.85%). Bleach was the most common caustic (46.73%). Forty-six patients underwent endoscopy; 57.38% children who should have endoscopy on guidelines, actually did not (p<0.0001), but no complications were reported. No or minimal lesions were reported in asymptomatic children; ≥2 symptoms correlated with the severity of lesions (p<0.0002). Therapy of severe cases was correct; overtreatment was observed for minor injuries (p<0.0001). Asymptomatic children after caustic ingestion have a very low-probability of moderate-severe endoscopic lesions, and the risk of severe damage increases proportionally with ≥2 symptoms. Prospective studies are needed to evaluate the efficacy of intensive clinical observation versus EGD on low-risk children to identify those with clinically relevant esophageal lesions.
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Berta GN, Di Scipio F, Bosetti FM, Mognetti B, Romano F, Carere ME, Del Giudice AC, Castagno E, Bondone C, Urbino AF. Childhood acute poisoning in the Italian North-West area: a six-year retrospective study. Ital J Pediatr 2020; 46:83. [PMID: 32527281 PMCID: PMC7291716 DOI: 10.1186/s13052-020-00845-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/01/2020] [Indexed: 03/30/2024] Open
Abstract
BACKGROUND Data about acute poisoning in Italian pediatric patients are obsolete or absent. This study would partially fill this exiting gap and compare the scene with others around the world. METHODS A retrospective evaluation was performed on a 2012-2017 data registry of the Children's Emergency Department at the Regina Margherita Hospital of Turin, where 1030 children under age 14 were accepted with a diagnosis of acute intoxication. RESULTS The median age of the patients was 2.2 years (IQR 2.3) and 55% were male. Events occurred mostly in children aged 1-4 years (n = 751, 72.9%). Six hundred and eight patients (59%) were exposed to Nonpharmaceutical agents, the household cleaning products being the more frequent (n = 298, 49%). Exposure to Pharmaceuticals were 422 (41%); the most common Pharmaceuticals were analgesics (n = 88, 20.8%), psychotropics (n = 77, 18.2%) and cardiovascular (n = 53, 12.6%) drugs. The 85% of the intoxications occurred accidentally, the 10.6% as therapeutic error, the 2.3% as suicide attempts and the 1.5% for recreational purposes. No patient died. CONCLUSIONS Despite acute poisoning being a relevant problem in pediatric emergency, our results would seem to paint a less worrying picture if compared to other countries, mainly when considering the children hospitalized in the pediatric intensive care unit and the number of deaths. Nevertheless, our study might represent a tool for public health authorities to program incisive interventions.
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Affiliation(s)
- Giovanni N Berta
- Department of Clinical and Biological Sciences, Pharmacology Unit, University of Turin, Turin, Italy
| | - Federica Di Scipio
- Department of Clinical and Biological Sciences, Pharmacology Unit, University of Turin, Turin, Italy
| | | | - Barbara Mognetti
- Department of Clinical and Biological Sciences, Pharmacology Unit, University of Turin, Turin, Italy.
- Department of Life Science and Systems Biology, University of Turin, Turin, Italy.
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Maria E Carere
- Department of Clinical and Biological Sciences, Pharmacology Unit, University of Turin, Turin, Italy
| | | | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio F Urbino
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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Garone G, Reale A, Vanacore N, Parisi P, Bondone C, Suppiej A, Brisca G, Calistri L, Cordelli DM, Savasta S, Grosso S, Midulla F, Falsaperla R, Verrotti A, Bozzola E, Vassia C, Da Dalt L, Maggiore R, Masi S, Maltoni L, Foiadelli T, Rossetti A, Greco C, Marino S, Di Paolantonio C, Papetti L, Urbino AF, Rossi R, Raucci U. Acute ataxia in paediatric emergency departments: a multicentre Italian study. Arch Dis Child 2019; 104:768-774. [PMID: 30948362 DOI: 10.1136/archdischild-2018-315487] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 05/08/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the causes and management of acute ataxia (AA) in the paediatric emergency setting and to identify clinical features predictive of an underlying clinically urgent neurological pathology (CUNP). STUDY DESIGN This is a retrospective medical chart analysis of children (1-18 years) attending to 11 paediatric emergency departments (EDs) for AA in an 8-year period. A logistic regression model was applied to identify clinical risk factors for CUNP. RESULTS 509 patients (mean age 5.8 years) were included (0.021% of all ED attendances). The most common cause of AA was acute postinfectious cerebellar ataxia (APCA, 33.6%). Brain tumours were the second most common cause (11.2%), followed by migraine-related disorders (9%). Nine out of the 14 variables tested showed an OR >1. Among them, meningeal and focal neurological signs, hyporeflexia and ophthalmoplegia were significantly associated with a higher risk of CUNP (OR=3-7.7, p<0.05). Similarly, the odds of an underlying CUNP were increased by 51% by each day from onset of ataxia (OR=1.5, CI 1.1 to 1.2). Conversely, a history of varicella-zoster virus infection and vertigo resulted in a significantly lower risk of CUNP (OR=0.1 and OR=0.5, respectively; p<0.05). CONCLUSIONS The most frequent cause of AA is APCA, but CUNPs account for over a third of cases. Focal and meningeal signs, hyporeflexia and ophthalmoplegia, as well as longer duration of symptoms, are the most consistent 'red flags' of a severe underlying pathology. Other features with less robust association with CUNP, such as seizures or consciousness impairment, should be seriously taken into account during AA evaluation.
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Affiliation(s)
- Giacomo Garone
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital IRCCS, University of Rome Tor Vergata, Rome, Italy
| | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Agnese Suppiej
- Child Neurology and Clinical Neurophysiology, Department of Woman and Child Health, University of Padua, Padova, Italy.,Department of Medical Sciences, Pediatric Section, University of Ferrara, Ferrara, Italy
| | - Giacomo Brisca
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Lucia Calistri
- Pediatric Emergency Unit, Anna Meyer Children's Hospital, Florence, Italy
| | | | - Salvatore Savasta
- Department of Pediatrics, Fondazione Policlinico San Matteo IRCCS, University of Pavia, Pavia, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Fabio Midulla
- Pediatric Emergency Unit, Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Emergency Pediatrics, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Elena Bozzola
- Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cristina Vassia
- Department of Pediatric Emergency, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Liviana Da Dalt
- Pediatric Emergency Department, Department of Woman's and Child Health, University of Padova, Padova, Italy
| | - Rosario Maggiore
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Stefano Masi
- Pediatric Emergency Unit, Anna Meyer Children's Hospital, Florence, Italy
| | - Lucia Maltoni
- Child Neurology Unit, University of Bologna, Bologna, Italy
| | - Thomas Foiadelli
- Department of Pediatrics, Fondazione Policlinico San Matteo IRCCS, University of Pavia, Pavia, Italy
| | - Annalisa Rossetti
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Carla Greco
- Pediatric Emergency Unit, Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Silvia Marino
- Unit of Pediatrics and Emergency Pediatrics, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Laura Papetti
- Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Rossella Rossi
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Raucci U, Parisi P, Vanacore N, Garone G, Bondone C, Palmieri A, Calistri L, Suppiej A, Falsaperla R, Capuano A, Ferro V, Urbino AF, Tallone R, Montemaggi A, Sartori S, Pavone P, Mancardi M, Melani F, Ilvento L, Pelizza MF, Reale A. Acute hyperkinetic movement disorders in Italian paediatric emergency departments. Arch Dis Child 2018. [PMID: 29519947 DOI: 10.1136/archdischild-2017-314464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Limited data exist on epidemiology, clinical presentation and management of acute hyperkinetic movement disorders (AHMD) in paediatric emergency departments (pED). METHODS We retrospectively analysed a case series of 256 children (aged 2 months to 17 years) presenting with AHMD to the pEDs of six Italian tertiary care hospitals over a 2-year period (January 2012 to December 2013). RESULTS The most common type of AHMD was tics (44.5%), followed by tremors (21.1%), chorea (13.7%), dystonia (10.2%), myoclonus (6.3%) and stereotypies (4.3%). Neuropsychiatric disorders (including tic disorders, psychogenic movement disorders and idiopathic stereotypies) were the most represented cause (51.2%). Inflammatory conditions (infectious and immune-mediated neurological disorders) accounted for 17.6% of the cases whereas non-inflammatory disorders (including drug-induced AHMDs, genetic/metabolic diseases, paroxysmal non-epileptic movements and idiopathic AHMDs) accounted for 31.2%. Neuropsychiatric disorders prevailed among preschoolers and schoolers (51.9% and 25.2%, respectively), non-inflammatory disorders were more frequent in infants and toddlers (63.8%), whereas inflammatory conditions were more often encountered among schoolers (73.3%). In 5 out of 36 Sydenham's chorea (SC) cases, tics were the presentation symptom on admission to emergency department (ED), highlighting the difficulties in early diagnosis of SC. Inflammatory disorders were associated with a longer hospital stay and a greater need of neuroimaging test compared with other disorders. CONCLUSIONS This study provides the first large sample of paediatric patients presenting to the ED for AHMDs, helping to elucidate the epidemiology, aetiology and clinical presentation of these disorders.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital of Rome, Sapienza University, Rome, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance, and Health Promotion, National Institute of Health, Rome, Italy
| | - Giacomo Garone
- University Department of Pediatrics (DPUO), University of Rome Tor Vergata, Bambino Gesù Children's Hospital, Rome, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital-AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonella Palmieri
- Department of Pediatric Emergency, IRCCS Giannina Gaslini, Genova, Italy
| | - Lucia Calistri
- Department of Pediatric Emergency, Anna Meyer Children's Hospital, Florence, Italy
| | - Agnese Suppiej
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University of Padua, Padova, Italy
| | - Raffaele Falsaperla
- General Paediatrics Operative Unit, University Hospital Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Valentina Ferro
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Francesco Urbino
- Department of Pediatric Emergency, Regina Margherita Children's Hospital-AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ramona Tallone
- Department of Pediatric Emergency, IRCCS Giannina Gaslini, Genova, Italy
| | | | - Stefano Sartori
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University of Padua, Padova, Italy
| | - Piero Pavone
- General Paediatrics Operative Unit, University Hospital Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - Margherita Mancardi
- Unit of Child Neuropsychiatry, Head-Neck and Neuroscience Department, Giannina Gaslini Institute, Genoa, Italy
| | - Federico Melani
- Pediatric Neurology and Neurogenetics Unit and Laboratories, Neuroscience Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Lucrezia Ilvento
- Pediatric Neurology and Neurogenetics Unit and Laboratories, Neuroscience Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Maria Federica Pelizza
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University of Padua, Padova, Italy
| | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Raucci U, Parisi P, Vanacore N, La Penna F, Ferro V, Calistri L, Bondone C, Midulla F, Suppiej A, Falsaperla R, Cordelli DM, Palmieri A, Verrotti A, Becciani S, Aguzzi S, Mastrangelo M, Pelizza F, Greco F, Carbonari G, Tallone R, Bottone G, Trenta I, Masi S, Villa MP, Reale A. Acute diplopia in the pediatric Emergency Department. A cohort multicenter Italian study. Eur J Paediatr Neurol 2017. [PMID: 28625338 DOI: 10.1016/j.ejpn.2017.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND Acute diplopia (AD) is an uncommon and distressing symptom of numerous ocular and neurological conditions, with potentially serious sequelaes. No data are present in pediatrics on the presentation and management of AD. AIM This study investigated characteristics, etiology and health care utilization of the pediatric population with AD accessed to pediatric Emergency Departments (ED), trying to identify "red flags" associated with potentially life-threatening (LT) conditions. METHODS We conducted a cohort multicenter study on children with AD in ten Italian hospitals. Patients were classified into diagnostic categories, comparing children with and without LT disease. RESULTS 621 children presented AD at a rate of 3.6 per 10.000. The most frequent diagnosis among no-LT conditions (81.2%) were headache, ocular disorders and minor post-traumatic disease, while LT conditions (18.8%) were represented by brain tumors, demyelinating conditions, idiopathic intracranial hypertension and major post-traumatic diseases. The LT group showed a significantly higher age, with the odds increased by 1% for each month of age. Monocular diplopia occurred in 16.1%, but unlike adult one-fifth presented LT conditions. Binocular diplopia, associated ocular manifestations or extraocular neurological signs were significantly more common in the LT group. At regression logistic analysis strabismus and ptosis were associated with LT conditions. CONCLUSION The majority of children presented no-LT conditions and more than one-fourth of patients had headache. Monocular diplopia in the LT group was never isolated but associated with other signs or symptoms. Our study was able to identify some specific ocular disturbances or neurologic signs potentially useful for ED physician to recognize patients with serious pathologies.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, C/O Sant'Andrea Hospital, Rome, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance, and Health Promotion, National Institute of Health, Rome, Italy
| | - Francesco La Penna
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Ferro
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lucia Calistri
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | | | - Fabio Midulla
- Pediatric Emergency Unit, Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Italy
| | - Agnese Suppiej
- Child Neurology and Clinical Neurophysiology, Paediatric University Hospital, Padova, Italy
| | - Raffaele Falsaperla
- General and Emergency Paediatrics Operative Unit, AOU "Policlinico-Vittorio Emanuele", University of Catania, Italy
| | | | - Antonella Palmieri
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Sabrina Becciani
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Sonia Aguzzi
- Regina Margherita Paediatric Hospital, Torino, Italy
| | - Mario Mastrangelo
- Pediatric Emergency Unit, Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Italy
| | - Federica Pelizza
- Child Neurology and Clinical Neurophysiology, Paediatric University Hospital, Padova, Italy
| | - Filippo Greco
- Clinical Pediatrics, AOU "Policlinico-Vittorio Emanuele", University of Catania, Italy
| | | | - Ramona Tallone
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, Genova, Italy
| | | | - Italo Trenta
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Masi
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, C/O Sant'Andrea Hospital, Rome, Italy
| | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Bellone S, Einaudi S, Caputo M, Prodam F, Busti A, Belcastro S, Parlamento S, Zavattaro M, Verna F, Bondone C, Tessaris D, Gasco V, Bona G, Aimaretti G. Measurement of height velocity is an useful marker for monitoring pituitary function in patients who had traumatic brain injury. Pituitary 2013. [PMID: 23179963 DOI: 10.1007/s11102-012-0446-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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] [Indexed: 10/27/2022]
Abstract
To assess the incidence of abnormal neuroendocrine function post-traumatic brain injuriy (TBI) in a large group of paediatric patients and its correlations with clinical parameters (Glasgow coma scale-GCS, Glasgow outcome scale-GOS, TC marshall scale, height velocity). We evaluated 70 patients [58 M, 12 F; age at the time of TBI (mean ± SEM) 8.12 ± 4.23 years] previously hospitalized for TBI at the "Regina Margherita" Hospital, in Turin and "Maggiore della Carità Hospital" in Novara, Italy, between 1998 and 2008. All patients included underwent: auxological, clinical, hormonal and biochemical assessments at recall (after at least 1 year from TBI to T0); auxological visit after 6 months (T6) and hormonal assessments at 12 months (T12) in patients with height velocity (HV) below the 25th centile. At T0, 4 cases of hypothalamus-pituitary dysfunction had been diagnosed; At T6 20/70 patients had an HV <25th centile, but no one had HV < the 3rd centile limit. At T12, among the 20 patients with HV <25th centile, in 13 patients the HV was below the 25th centile and GHRH + Arginine test has been performed. Four subjects demonstrated an impaired GH peak and were classified as GH deficiency (GHD). Of these 4 subjects, 3 subjects showed isolated GHD, while one patient showed multiple hypopituitarism presenting also secondary hypocortisolism and hypothyroidism. The GCS at admission and GOS do not correlate with the onset of hypopituitarism. A simple measurement of the height velocity at least 1 year after the TBI, is enough to recognize patients with a pituitary impairment related to GH deficiency. We suggest to follow-up paediatric population who had TBI with auxological evaluations every 6 months, limiting hormonal evaluation in patients with a reduction of height velocity below the 25th centile limit.
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Affiliation(s)
- S Bellone
- Pediatrics, Department of Health Science, A. Avogadro, University, Novara, Italy
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Abstract
PURPOSE OF REVIEW Endocrine dysfunctions have been increasingly recognized following traumatic brain injury. Ever more numerous studies on acute head-injured adults have also raised concern about this risk in children and adolescents who have experienced head injury. The current review of the pediatric literature summarizes recent findings on acute-phase dysfunction and traumatic brain injury-associated hypopituitarism. RECENT FINDINGS The pathophysiologic mechanisms underlying acute-phase hyponatremic and hypernatremic disorders have been elucidated. Prospective studies on traumatic brain injury-associated hypopituitarism in pediatric patients are ongoing and preliminary data are available. SUMMARY Traumatic brain injury, a 'silent epidemic' that carries a considerable burden of disabilities, leads to a variety of endocrine dysfunctions in 28-69% of adult acute head-injured patients. In the acute posttraumatic phase, adrenal insufficiency and electrolyte disorders are critical conditions. Neurosurgical patients, particularly those prone to neurological damage, require prompt diagnosis. Hypopituitarism may be diagnosed months or years after a traumatic brain injury event. Since growth hormone and gonadotropin secretion are most frequently compromised, careful follow-up of growth and pubertal development is mandatory in children hospitalized for traumatic brain injury.
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Affiliation(s)
- Silvia Einaudi
- Department of Pediatric Endocrinology, Regina Margherita Hospital, Turin, Italy.
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Einaudi S, Matarazzo P, Peretta P, Grossetti R, Giordano F, Altare F, Bondone C, Andreo M, Ivani G, Genitori L, de Sanctis C. Hypothalamo-hypophysial dysfunction after traumatic brain injury in children and adolescents: a preliminary retrospective and prospective study. J Pediatr Endocrinol Metab 2006; 19:691-703. [PMID: 16789636 DOI: 10.1515/jpem.2006.19.5.691] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [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] [Indexed: 11/15/2022]
Abstract
With two study protocols, one retrospective and the other prospective, we evaluated hypothalamo-hypophysial dysfunction (HHD) in paediatric patients treated for traumatic brain injury (TBI) in the neurosurgical or intensive care department at our hospital. The retrospective group comprised 22 patients who had experienced TBI 0.7-7.25 years before the study. The prospective group included 30 patients assessed at TBI (T0), 26 of 30 after 6 months (T6), and 20 of 26 after 12 months (T12). Auxological and hormonal basal parameters of hypothalamo-hypophysial function were evaluated at recall in the retrospective group, and at T0, T6 and T12 in the prospective group. Basal data and standard dynamic tests in selected patients revealed one with precocious puberty, one with total anterior hypopituitarism, one with central hypogonadism, and one with growth hormone (GH) deficiency in the retrospective group; three patients with cerebral salt-wasting syndrome, one with diabetes insipidus and seven with low T3 syndrome at T0 (all transient), one with hypocorticism at T6 confirmed at T12, and one with GH deficiency at T12 in the prospective group. The results of our study show that post-TBI HHD in our paediatric cohort is not uncommon. Of the 48 patients who underwent a complete evaluation (22 retrospective study patients and 26 prospective study patients evaluated at T6) five (10.4%) developed HHD 6 months or more after TBI. HHD was newly diagnosed in one previously normal patient from the prospective group at 12 months after TBI. GH deficiency was the most frequent disorder in our paediatric cohort.
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Affiliation(s)
- S Einaudi
- Department of Paediatric Endocrinology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy.
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Guardamagna O, Bondone C, Allora C, Sacchetti C, Rabbone I. [Familial combined hyperlipemia in childhood]. Pediatr Med Chir 2002; 24:257-66. [PMID: 12197082] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Affiliation(s)
- O Guardamagna
- Dipartimento di Scienze Pediatriche e dell'Adolescenza, Università degli Studi di Torino.
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Bondone C, Rutto E, Giaccone M, Avagnina A, Bo C, Allora C, Guardamagna O. [Influence of diet on lipoprotein profile in familial combined hyperlipidemia affected children]. Minerva Pediatr 2002; 54:227-36. [PMID: 12070482] [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
BACKGROUND Familial Combined Hyperlipidemia is an inherited disorder affecting cholesterol and triglycerides metabolism, well known myocardial infarction risk factors. The FCHL clinical presentation is usually silent until the third decade although children can be affected, and the more recent opinion is that precocious diagnosis is mandatory in preventing complications. Aim of this study is to examine the effectiveness of the diet therapy (Step-One-Diet) in a group of 13 children affected by Familial Combined Hyperlipidemia. METHODS The patients have been submitted to a normocaloric diet, 30% fat of the total caloric daily intake according with the Dietary Intervention Study in Children (Step-One-Diet). The patients then have been submitted to a two year-follow-up and lipoprotein levels (total cholesterol, LDL-cholesterol, triglycerides and apolipoprotein B), nutritional status (macro- and micro-nutrients) as well as anthropometric data (height, weight, BMI) have been monitored. RESULTS Results showed a 10% total cholesterol and 30% triglycerides decrease, Iron and Calcium intake show increased levels approaching to the normal ones after controlled diet, while cholesterol intake was correct on both regimen. The growth parameters show a decrease in weight only in two obese and two overweight patients. CONCLUSIONS The present study confirmed the effectiveness and safety of the Step-One-Diet in children patients, allowing triglycerides normalization in 60% of the patients, and a 10% cholesterol decrease, in agreement with the complex genetic inheritance of the disease.
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Affiliation(s)
- C Bondone
- Dipartimento di Scienze Pediatriche e dell'Adolescenza, Università degli Studi, Turin, Italy
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Boglione L, Bondone C, Corno E, Gastaldo L, Borghi F, Gattolin A, Levi AC. The development of the suprarenal gland: surgical and anatomical considerations. Panminerva Med 2001; 43:33-7. [PMID: 11319516] [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: 02/19/2023]
Abstract
BACKGROUND Aim of this research is to study the situation and relationships of the adrenal gland in the first stage of development in order to give some contributes for the application of laparoscopic adrenalectomy; in the meantime we describe the series of the debate changes occurring in the constitution of the cortex and medulla. METHODS Analysis of histologic slices of thoraco-abdominal and abdominal regions of human embryos and fetuses ranging from the fifth (12 mm CR) to the twentieth week (170 mm CR). RESULTS At 12 mm CR an unique type of cells is present in the cortex; at 16 mm CR there are two different groups of cells. Sympathogonia enter into the cortex at 16 mm CR. The right adrenal gland seems enclosed into the liver and a ligament containing the middle adrenal vein reaches the vena cava inferior sulcus. The left adrenal gland, through the coelomic cavity, is in relationship with the stomach, the medial border of the spleen and the pancreatic body contained in the primitive dorsal mesogastrium. CONCLUSIONS The timing of penetration of the ganglion cells into the cortex is defined as well as the hypothesis that the matrix of the fetal and definitive cortex is the same: moreover the study of the early development allows to understand the main characteristics of both the adrenal glands which are significant for a rational and differential laparoscopic approach.
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Affiliation(s)
- L Boglione
- Department of Anatomy, Pharmacology and Forensic Medecine, University of Turin, Turin, Italy
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