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Zanetto L, Cavallin F, Doglioni N, Bua B, Savino S, Bernardo GD, Pratesi S, Villani PE, Weiner GM, Trevisanuto D. A Simulation Competition on Neonatal Resuscitation as a New Educational Tool for Pediatric Residents. Children (Basel) 2023; 10:1621. [PMID: 37892284 PMCID: PMC10605553 DOI: 10.3390/children10101621] [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: 08/23/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Training programs on resuscitation have been developed using simulation-based learning to build skills, strengthen cognitive strategies, and improve team performance. This is especially important for residency programs where reduced working hours and high numbers of residents can reduce the educational opportunities during the residency, with lower exposure to practical procedures and prolonged length of training. Within this context, gamification has gained popularity in teaching and learning activities. This report describes the implementation of a competition format in the context of newborn resuscitation and participants' perceptions of the educational experience. METHODS Thirty-one teams of three Italian pediatric residents participated in a 3-day simulation competition on neonatal resuscitation. The event included an introductory lecture, familiarization time, and competition time in a tournament-like structure using high-fidelity simulation stations. Each match was evaluated by experts in neonatal resuscitation and followed by a debriefing. The scenarios and debriefings of simulation station #1 were live broadcasted in the central auditorium where teams not currently competing could observe. At the end of the event, participants received an online survey regarding their perceptions of the educational experience. RESULTS 81/93 (87%) participants completed the survey. Training before the event mostly included reviewing protocols and textbooks. Low-fidelity manikins were the most available simulation tools at the residency programs. Overall, the participants were satisfied with the event and appreciated the live broadcast of scenarios and debriefings in the auditorium. Most participants felt that the event improved their knowledge and self-confidence and stimulated them to be more involved in high-fidelity simulations. Suggested areas of improvement included more time for familiarization and improved communication between judges and participants during the debriefing. CONCLUSIONS Participants appreciated the simulation competition. They self-perceived the educational impact of the event and felt that it improved their knowledge and self-confidence. Our findings suggest areas of improvements for further editions and may serve as an educational model for other institutions.
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Affiliation(s)
- Lorenzo Zanetto
- Department of Women’s and Children’s Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy; (L.Z.); (N.D.); (B.B.)
| | | | - Nicoletta Doglioni
- Department of Women’s and Children’s Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy; (L.Z.); (N.D.); (B.B.)
| | - Benedetta Bua
- Department of Women’s and Children’s Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy; (L.Z.); (N.D.); (B.B.)
| | - Sandro Savino
- Department of Medicine–DIMED, University of Padua, 35121 Padua, Italy;
| | - Giuseppe De Bernardo
- Department of Woman and Child, Ospedale Buon Consiglio Fatebenefratelli, 80122 Naples, Italy;
| | - Simone Pratesi
- Division of Neonatology, Careggi University Hospital of Florence, 50141 Florence, Italy;
| | | | - Gary M. Weiner
- Department of Pediatrics-Neonatology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Daniele Trevisanuto
- Department of Women’s and Children’s Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy; (L.Z.); (N.D.); (B.B.)
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Paolin C, Zanetto L, Frison S, Boscolo Mela F, Tessari A, Amigoni A, Daverio M, Bonardi CM. Apneas requiring respiratory support in young infants with COVID-19: a case series and literature review. Eur J Pediatr 2023; 182:2089-2094. [PMID: 36912961 PMCID: PMC10009862 DOI: 10.1007/s00431-023-04856-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 03/14/2023]
Abstract
The objective of this study is to describe the clinical features of young infants with apneas as a clinical sign of COVID-19. We reported the cases of 4 infants who needed respiratory support in our PICU for a severe course of COVID-19 complicated with recurrent apneas. Moreover, we conducted a review of the literature about COVID-19 and apneas in infants ≤ 2 months of corrected age. A total of 17 young infants were included. Overall, in most of the cases (88%), apnea was an initial symptom of COVID-19, and in two cases, it recurred after 3-4 weeks. Regarding neurological workup, most children underwent a cranial ultrasound, while a minority underwent electroencephalography registration, neuroimaging, and lumbar punctures. One child showed signs of encephalopathy on electroencephalogram, with further neurological workup resulting normal. SARS-CoV-2 was never found in the cerebrospinal fluid. Ten children required intensive care unit admission, with five of them needing intubation and three non-invasive ventilation. A less invasive respiratory support was sufficient for the remaining children. Eight children were treated with caffeine. All patients had a complete recovery. Conclusion: Young infants with recurrent apneas during COVID-19 usually need respiratory support and undergo a wide clinical work-up. They usually show complete recovery even when admitted to the intensive care unit. Further studies are needed to better define diagnostic and therapeutic strategies for these patients. What is Known: • Although the course of COVID-19 in infants is usually mild, some of them may develop a more severe disease needing intensive care support. Apneas may be a clinical sign in COVID-19. What is New: • Infants with apneas during COVID-19 may require intensive care support, but they usually show a benign course of the disease and full recovery.
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Affiliation(s)
- Chiara Paolin
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Lorenzo Zanetto
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Sara Frison
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Federica Boscolo Mela
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Anna Tessari
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy.
| | - Claudia Maria Bonardi
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
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Zanetto L, van de Maat J, Nieboer D, Moll H, Gervaix A, Da Dalt L, Mintegi S, Bressan S, Oostenbrink R. Diagnostic variation for febrile children in European emergency departments. Eur J Pediatr 2022; 181:2481-2490. [PMID: 35314869 PMCID: PMC9110537 DOI: 10.1007/s00431-022-04417-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/21/2021] [Accepted: 02/10/2022] [Indexed: 02/02/2023]
Abstract
UNLABELLED The study aimed to explore the use of diagnostics for febrile children presenting to European emergency departments (EDs), the determinants of inter-hospital variation, and the association between test use and hospitalization. We performed a secondary analysis of a cross-sectional observational study involving 28 paediatric EDs from 11 countries. A total of 4560 children < 16 years were included, with fever as reason for consultation. We excluded neonates and children with relevant comorbidities. Our primary outcome was the proportion of children receiving testing after primary evaluation, by country and by focus of infection. Variability between hospitals and effects of blood testing on patient disposition were explored by multilevel regression analyses, adjusting for patient characteristics (age group, triage level, appearance, fever duration, focus of infection) and hospital type (academic, teaching, other). The use of routine diagnostics varied widely, mostly in the use of blood tests, ranging from 3 to 75% overall across hospitals. Age < 3 months, high-acuity triage level, ill appearance, and suspicion of urinary tract infection displayed the strongest association with blood testing (odds ratios (OR) of 8.71 (95% CI 5.23-14.53), 19.46 (3.66-103.60), 3.13 (2.29-4.26), 10.84 (6.35-18.50), respectively). Blood testing remained highly variable across hospitals (median OR of the final model 2.36, 1.98-3.54). A positive association was observed between blood testing and hospitalization (OR 13.62, 9.00-20.61). CONCLUSION the use of diagnostics for febrile children was highly variable across European EDs, yet patient and hospital characteristics could only partly explain inter-hospital variability. Focus groups of participating sites should help define reasons for unexpected variation. WHAT IS KNOWN • Although previous research has shown variation in the emergency department (ED) management of febrile children, there is limited information on the use of diagnostics in European EDs. • A deeper knowledge of variability and its determinants can steer optimization of care. WHAT IS NEW • The use of diagnostics for febrile children was highly variable across European EDs, yet patient and hospital characteristics could only partly explain inter-hospital variability. • Data on between-centre comparison offer opportunities to further explore factors influencing unwarranted variation.
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Affiliation(s)
- Lorenzo Zanetto
- Department of Women’s and Children’s Health, University of Padova, Padua, 35128 Italy
| | - Josephine van de Maat
- Department of General Pediatrics, Erasmus Medical Center Sophia Children’s Hospital, Rotterdam, 3015 CN Netherlands
| | - Daan Nieboer
- Department of General Pediatrics, Erasmus Medical Center Sophia Children’s Hospital, Rotterdam, 3015 CN Netherlands
| | - Henriette Moll
- Department of General Pediatrics, Erasmus Medical Center Sophia Children’s Hospital, Rotterdam, 3015 CN Netherlands
| | - Alain Gervaix
- Department of Pediatrics, Gynaecology and Obstetrics, University Hospital of Geneva, Geneva, 1205 Switzerland
| | - Liviana Da Dalt
- Department of Women’s and Children’s Health, University of Padova, Padua, 35128 Italy
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Silvia Bressan
- Department of Women's and Children's Health, University of Padova, Padua, 35128, Italy.
| | - Rianne Oostenbrink
- Department of General Pediatrics, Erasmus Medical Center Sophia Children’s Hospital, Rotterdam, 3015 CN Netherlands
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Zanetto L, Da Dalt L, Daverio M, Dunning J, Frigo AC, Nigrovic LE, Bressan S. Systematic review and meta-analysis found significant risk of brain injury and neurosurgery in alert children after a post-traumatic seizure. Acta Paediatr 2019; 108:1841-1849. [PMID: 30951221 DOI: 10.1111/apa.14810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/19/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
AIM This study aimed to determine the frequency of traumatic brain injury (TBI) on neuroimaging and the need for emergency neurosurgery in children with normal mental status following a post-traumatic seizure (PTS). METHODS We searched six electronic databases from inception to October 15, 2018, to identify studies including children under 18 years with head injury and a Glasgow Coma Score of 15 after an immediate PTS. Relevant non-English articles were translated to determine eligibility. RESULTS We performed random effect meta-analyses and assessed heterogeneity with I2 . The pooled estimate of the frequency of TBI, from seven studies, was 13.0% (95% CI: 4.0-26.1; I2 = 81%). Data on the need of emergency neurosurgery were reported in four studies and the pooled estimate of its frequency was 2.3% (95% CI: 0.0-9.9; I2 = 86%). Two studies reported on children with isolated PTS without any other signs of head injury, representing 0.1% of patients in both studies, for a total of 76 children. Of these, only three had TBI and one underwent neurosurgery. CONCLUSION Children with immediate PTS and normal mental status frequently have TBI with a substantial need for neurosurgery. Clinicians should strongly consider neuroimaging for these children, although prolonged observation may be considered for those with isolated PTS.
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Affiliation(s)
- Lorenzo Zanetto
- Division of Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
| | - Liviana Da Dalt
- Division of Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
| | - Marco Daverio
- Division of Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery James Cook University Hospital Middlesbrough UK
| | - Anna Chiara Frigo
- Unit of Biostatistics, Epidemiology and Public Health Department of Cardiac, Thoracic and Vascular Sciences University of Padova Padova Italy
| | - Lise E. Nigrovic
- Division of Emergency Medicine Harvard Medical School Boston Children's Hospital Boston MA USA
| | - Silvia Bressan
- Division of Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
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Poletto E, Zanetto L, Velasco R, Da Dalt L, Bressan S. Bacterial meningitis in febrile young infants acutely assessed for presumed urinary tract infection: a systematic review. Eur J Pediatr 2019; 178:1577-1587. [PMID: 31473824 DOI: 10.1007/s00431-019-03442-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/11/2019] [Accepted: 08/06/2019] [Indexed: 12/26/2022]
Abstract
Urinary tract infections, the most common severe bacterial infections in young infants, may be associated with co-existing meningitis. There is no consensus on when to perform a lumbar puncture in these infants. Our aim was to quantify the frequency of co-existing bacterial meningitis in febrile young infants acutely assessed for presumed urinary tract infections. We systematically reviewed PubMed, EMBASE, and the Cochrane Library for studies including infants ≤ 3 months with suspected/confirmed urinary tract infections, who underwent a lumbar puncture. Two investigators independently reviewed articles for inclusion and extracted relevant data. Our outcomes were culture-confirmed meningitis and identification of low-/high-risk criteria of meningitis. Overall 20/2079 studies, including 4191 infants, met inclusion criteria. A total of 11 infants had bacterial meningitis (frequency between 0 and 2.1% across studies) and were mostly neonates. Of 253 infants meeting the low-risk criteria (well-appearing, age > 21 days, procalcitonin ≤ 0.5 ng/ml, and C reactive protein ≤ 20 mg/L) none developed meningitis, but only 15 underwent lumbar puncture.Conclusion: Co-existing bacterial meningitis in febrile young infants with urinary tract infection is rare. In those meeting low-risk criteria, a lumbar puncture may not be indicated. A case by case assessment should be made in infants not meeting low-risk criteria.Trial registration: CRD42018105339 What is known: • When caring for febrile infants ≤ 3 months with urinary tract infections, clinicians may have uncertainty on whether to perform a lumbar puncture (LP) for possible co-existing meningitis What is new: • An up-to-date systematic review of 20 studies found the frequency of co-existing meningitis in this population to be between 0 and 2.1% • Despite limited data, an LP may not be indicated in infants meeting low-risk criteria (being well-appearing, age > 21 days, procalcitonin ≤ 0.5 ng/ml, C reactive protein ≤ 20 mg/L). Ill-appearance and neonatal age appear to be significant risk factors of co-existing meningitis.
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Affiliation(s)
- Elisa Poletto
- Division of Emergency Medicine, Department of Women's and Children's Health, University of Padova, via Giustiniani, 3, 35128, Padova, Italy
| | - Lorenzo Zanetto
- Division of Emergency Medicine, Department of Women's and Children's Health, University of Padova, via Giustiniani, 3, 35128, Padova, Italy
| | - Roberto Velasco
- Pediatric Emergency Unit, Department of Pediatrics, Rio Hortega Universitary Hospital, Valladolid, Spain
| | - Liviana Da Dalt
- Division of Emergency Medicine, Department of Women's and Children's Health, University of Padova, via Giustiniani, 3, 35128, Padova, Italy
| | - Silvia Bressan
- Division of Emergency Medicine, Department of Women's and Children's Health, University of Padova, via Giustiniani, 3, 35128, Padova, Italy.
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