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Schlapbach LJ, Watson RS, Sorce LR, Argent AC, Menon K, Hall MW, Akech S, Albers DJ, Alpern ER, Balamuth F, Bembea M, Biban P, Carrol ED, Chiotos K, Chisti MJ, DeWitt PE, Evans I, Flauzino de Oliveira C, Horvat CM, Inwald D, Ishimine P, Jaramillo-Bustamante JC, Levin M, Lodha R, Martin B, Nadel S, Nakagawa S, Peters MJ, Randolph AG, Ranjit S, Rebull MN, Russell S, Scott HF, de Souza DC, Tissieres P, Weiss SL, Wiens MO, Wynn JL, Kissoon N, Zimmerman JJ, Sanchez-Pinto LN, Bennett TD. International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA 2024; 331:665-674. [PMID: 38245889 PMCID: PMC10900966 DOI: 10.1001/jama.2024.0179] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
Importance Sepsis is a leading cause of death among children worldwide. Current pediatric-specific criteria for sepsis were published in 2005 based on expert opinion. In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, but it excluded children. Objective To update and evaluate criteria for sepsis and septic shock in children. Evidence Review The Society of Critical Care Medicine (SCCM) convened a task force of 35 pediatric experts in critical care, emergency medicine, infectious diseases, general pediatrics, nursing, public health, and neonatology from 6 continents. Using evidence from an international survey, systematic review and meta-analysis, and a new organ dysfunction score developed based on more than 3 million electronic health record encounters from 10 sites on 4 continents, a modified Delphi consensus process was employed to develop criteria. Findings Based on survey data, most pediatric clinicians used sepsis to refer to infection with life-threatening organ dysfunction, which differed from prior pediatric sepsis criteria that used systemic inflammatory response syndrome (SIRS) criteria, which have poor predictive properties, and included the redundant term, severe sepsis. The SCCM task force recommends that sepsis in children be identified by a Phoenix Sepsis Score of at least 2 points in children with suspected infection, which indicates potentially life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems. Children with a Phoenix Sepsis Score of at least 2 points had in-hospital mortality of 7.1% in higher-resource settings and 28.5% in lower-resource settings, more than 8 times that of children with suspected infection not meeting these criteria. Mortality was higher in children who had organ dysfunction in at least 1 of 4-respiratory, cardiovascular, coagulation, and/or neurological-organ systems that was not the primary site of infection. Septic shock was defined as children with sepsis who had cardiovascular dysfunction, indicated by at least 1 cardiovascular point in the Phoenix Sepsis Score, which included severe hypotension for age, blood lactate exceeding 5 mmol/L, or need for vasoactive medication. Children with septic shock had an in-hospital mortality rate of 10.8% and 33.5% in higher- and lower-resource settings, respectively. Conclusions and Relevance The Phoenix sepsis criteria for sepsis and septic shock in children were derived and validated by the international SCCM Pediatric Sepsis Definition Task Force using a large international database and survey, systematic review and meta-analysis, and modified Delphi consensus approach. A Phoenix Sepsis Score of at least 2 identified potentially life-threatening organ dysfunction in children younger than 18 years with infection, and its use has the potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock around the world.
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Affiliation(s)
- Luregn J. Schlapbach
- Department of Intensive Care and Neonatology, and Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - R. Scott Watson
- Department of Pediatrics, University of Washington, Seattle
- Seattle Children’s Research Institute and Pediatric Critical Care, Seattle Children’s, Seattle, Washington
| | - Lauren R. Sorce
- Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew C. Argent
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- University of Cape Town, Cape Town, South Africa
| | - Kusum Menon
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Canada
- University of Ottawa, Ontario, Canada
| | - Mark W. Hall
- Division of Critical Care Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Samuel Akech
- Kenya Medical Research Institute (KEMRI)–Wellcome Trust Research Programme, Nairobi, Kenya
| | - David J. Albers
- Departments of Biomedical Informatics, Bioengineering, Biostatistics and Informatics, University of Colorado School of Medicine, Aurora
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Elizabeth R. Alpern
- Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Department of Pediatrics, Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Fran Balamuth
- Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melania Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paolo Biban
- Pediatric Intensive Care Unit, Verona University Hospital, Verona, Italy
| | - Enitan D. Carrol
- University of Liverpool, Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom
| | - Kathleen Chiotos
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Divisions of Critical Care Medicine and Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mohammod Jobayer Chisti
- Intensive Care Unit, Dhaka Hospital, Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter E. DeWitt
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora
| | - Idris Evans
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, Pennsylvania
| | - Cláudio Flauzino de Oliveira
- AMIB–Associação de Medicina Intensiva Brasileira, São Paulo, Brazil
- LASI–Latin American Institute of Sepsis, São Paulo, Brazil
| | - Christopher M. Horvat
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, Pennsylvania
| | - David Inwald
- Paediatric Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Paul Ishimine
- Departments of Emergency Medicine and Pediatrics, University of California, San Diego School of Medicine, La Jolla
| | - Juan Camilo Jaramillo-Bustamante
- PICU Hospital General de Medellín “Luz Castro de Gutiérrez” and Hospital Pablo Tobón Uribe, Medellín, Colombia
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network)
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London, London, United Kingdom
- Department of Paediatrics, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Blake Martin
- Departments of Biomedical Informatics and Pediatrics (Division of Critical Care Medicine), University of Colorado School of Medicine and Pediatric Intensive Care Unit, Children’s Hospital Colorado, Aurora
- Pediatric Intensive Care Unit, Children’s Hospital Colorado, Aurora
| | - Simon Nadel
- Paediatric Intensive Care, St Mary’s Hospital, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Satoshi Nakagawa
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mark J. Peters
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR Biomedical Research Centre, London, United Kingdom
| | - Adrienne G. Randolph
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Suchitra Ranjit
- Pediatric Intensive Care Unit, Apollo Children’s Hospital, Chennai, India
| | - Margaret N. Rebull
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora
| | - Seth Russell
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora
| | - Halden F. Scott
- Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Emergency Department, Children’s Hospital Colorado, Aurora
| | - Daniela Carla de Souza
- LASI–Latin American Institute of Sepsis, São Paulo, Brazil
- Department of Pediatrics (PICU), Hospital Universitario of the University of São Paulo, São Paulo, Brazil
- Department of Pediatrics (PICU), Hospital Sírio Libanês, São Paulo, Brazil
| | - Pierre Tissieres
- Pediatric Intensive Care, AP-HP Paris Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Scott L. Weiss
- Division of Critical Care, Department of Pediatrics, Nemours Children’s Health, Wilmington, Delaware
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew O. Wiens
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Institute for Global Health, BC Children’s Hospital, Vancouver, Canada and Walimu, Uganda
| | - James L. Wynn
- Department of Pediatrics, University of Florida, Gainesville
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Jerry J. Zimmerman
- Department of Pediatrics, University of Washington, Seattle
- Seattle Children’s Research Institute and Pediatric Critical Care, Seattle Children’s, Seattle, Washington
| | - L. Nelson Sanchez-Pinto
- Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Department of Pediatrics, Division of Critical Care, and Department of Preventive Medicine, Division of Health & Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tellen D. Bennett
- Departments of Biomedical Informatics and Pediatrics (Division of Critical Care Medicine), University of Colorado School of Medicine and Pediatric Intensive Care Unit, Children’s Hospital Colorado, Aurora
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Martinato M, Comoretto RI, Biban P, Zanonato E, Simonini A, Montaguti A, Gitto E, Caramelli F, Ferrario S, Sagredini R, Alaimo N, Zito Marinosci G, Rossetti E, Cecchetti C, L'erario M, Vasile B, Ivani G, Bonanomi E, Astuto M, Gregori D, Mondardini MC, Amigoni A. Italian pediatric intensive care units admitting critically ill cancer children: results from a national survey. Minerva Anestesiol 2023; 89:850-858. [PMID: 37378625 DOI: 10.23736/s0375-9393.23.17329-9] [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: 06/29/2023]
Abstract
BACKGROUND Pediatric patients affected by oncologic disease have a significant risk of clinical deterioration that requires admission to the intensive care unit. This study reported the results of a national survey describing the characteristics of Italian onco-hematological units (OHUs) and pediatric intensive care units (PICUs) that admit pediatric patients, focusing on the high-complexity treatments available before PICU admission, and evaluating the approach to the end-of-life (EOL) when cared in a PICU setting. METHODS A web-based electronic survey has been performed in April 2021, involving all Italian PICUs admitting pediatric patients with cancer participating in the study. RESULTS Eighteen PICUs participated, with a median number of admissions per year of 350 (IQR 248-495). Availability of Extracorporeal Membrane Oxygenation therapy and the presence of intermediate care unit are the only statistically different characteristics between large or small PICUs. Different high-level treatments and protocols are performed in OHUs, non depending on the volume of PICU. Palliative sedation is mainly performed in the OHUs (78%), however, in 72% it is also performed in the PICU. In most centers protocols that address EOL comfort care and treatment algorithms are missing, non depending on PICU or OHU volume. CONCLUSIONS A non-homogeneous availability of high-level treatments and in OHUs is described. Moreover, protocols addressing EOL comfort care and treatment algorithms in palliative care are lacking in many centers.
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Affiliation(s)
- Matteo Martinato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
- Giuseppe Parenti Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy
| | - Rosanna I Comoretto
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
- Department of Sciences of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Paolo Biban
- University Hospital of Verona, Verona, Italy
| | | | | | | | | | - Fabio Caramelli
- S. Orsola-Malpighi IRCCS University Hospital, Bologna, Italy
| | | | | | | | | | | | | | | | | | - Giorgio Ivani
- AOU Città della Salute e della Scienza, Turin, Italy
| | | | | | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Manti S, Staiano A, Orfeo L, Midulla F, Marseglia GL, Ghizzi C, Zampogna S, Carnielli VP, Favilli S, Ruggieri M, Perri D, Di Mauro G, Gattinara GC, D’Avino A, Becherucci P, Prete A, Zampino G, Lanari M, Biban P, Manzoni P, Esposito S, Corsello G, Baraldi E. UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants. Ital J Pediatr 2023; 49:19. [PMID: 36765418 PMCID: PMC9912214 DOI: 10.1186/s13052-022-01392-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/29/2022] [Indexed: 02/12/2023] Open
Abstract
Bronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children. This document aims to update the consensus document published in 2014 to provide guidance on the current best practices for managing bronchiolitis in infants. The document addresses care in both hospitals and primary care. The diagnosis of bronchiolitis is based on the clinical history and physical examination. The mainstays of management are largely supportive, consisting of fluid management and respiratory support. Evidence suggests no benefit with the use of salbutamol, glucocorticosteroids and antibiotics with potential risk of harm. Because of the lack of effective treatment, the reduction of morbidity must rely on preventive measures. De-implementation of non-evidence-based interventions is a major goal, and educational interventions for clinicians should be carried out to promote high-value care of infants with bronchiolitis. Well-prepared implementation strategies to standardize care and improve the quality of care are needed to promote adherence to guidelines and discourage non-evidence-based attitudes. In parallel, parents' education will help reduce patient pressure and contribute to inappropriate prescriptions. Infants with pre-existing risk factors (i.e., prematurity, bronchopulmonary dysplasia, congenital heart diseases, immunodeficiency, neuromuscular diseases, cystic fibrosis, Down syndrome) present a significant risk of severe bronchiolitis and should be carefully assessed. This revised document, based on international and national scientific evidence, reinforces the current recommendations and integrates the recent advances for optimal care and prevention of acute bronchiolitis.
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Affiliation(s)
- Sara Manti
- grid.10438.3e0000 0001 2178 8421University of Messina, Messina, Italy
| | - Annamaria Staiano
- grid.4691.a0000 0001 0790 385XSIP “Società Italiana di Pediatria”, University “Federico II”, Naples, Italy
| | - Luigi Orfeo
- grid.476687.c0000 0001 0944 2874SIN “Società Italiana di Neonatologia”, Hospital San Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Fabio Midulla
- grid.7841.aSIMRI ”Società Italiana per le Malattie Respiratorie Infantili”, University of Rome “La Sapienza”, Rome, Italy
| | - Gian Luigi Marseglia
- grid.419425.f0000 0004 1760 3027SIAIP “Società Italiana di Allergologia e Immunologia Pediatrica”, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Ghizzi
- AMIETIP ”Accademia Medica Infermieristica di Emergenza e Terapia Intensiva Pediatrica”, Major Hospital Polyclinic: Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Bologna, Italy
| | - Stefania Zampogna
- SIMEUP “Società Italiana di Medicina di Emergenza ed Urgenza Pediatrica”, Pugliese Ciaccio Hospital, Catanzaro, Italy
| | - Virgilio Paolo Carnielli
- SIMP “Società Italiana di Medicina Perinatale”, University Hospital of Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Silvia Favilli
- SICP “Società Italiana di Cardiologia Pediatrica”, University Hospital Meyer, Firenze, Italy
| | - Martino Ruggieri
- grid.8158.40000 0004 1757 1969SINP “Società Italiana di Neurologia Pediatrica”, University of Catania, Catania, Italy
| | - Domenico Perri
- grid.415069.f0000 0004 1808 170XSIPO “Società Italiana Pediatria Ospedaliera”, San Giuseppe Moscati Hospital, Aversa, Italy
| | - Giuseppe Di Mauro
- SIPPS “Società Italiana di Pediatria Preventiva e Sociale”, Local Health Authority Caserta, Caserta, Italy
| | - Guido Castelli Gattinara
- grid.414125.70000 0001 0727 6809SITIP “Società Italiana di Infettivologia Pediatrica”, Bambino Gesu Pediatric Hospital, Rome, Italy
| | - Antonio D’Avino
- FIMP “Federazione Italiana Medici Pediatri”, Local Health Authority Naples 1 Centre, Naples, Italy
| | - Paolo Becherucci
- SICuPP “Società Italiana delle Cure Primarie Pediatriche”, Florence City Council, Florence, Italy
| | - Arcangelo Prete
- grid.412311.4AIEOP “Società Italiana di Ematologia e Oncologia Pediatrica”, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Giuseppe Zampino
- grid.411075.60000 0004 1760 4193SIMGePeD “Società Italiana Malattie Genetiche Pediatriche e Disabilità Congenite”, University Hospital Agostino Gemelli, Rome, Italy
| | - Marcello Lanari
- grid.6292.f0000 0004 1757 1758Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Paolo Biban
- grid.411475.20000 0004 1756 948XUniversity Hospital of Verona, Verona, Italy
| | - Paolo Manzoni
- grid.417165.00000 0004 1759 6939Ospedale Degli Infermi, Biella, Italy ,grid.7605.40000 0001 2336 6580University of Turin, Turin, Italy
| | - Susanna Esposito
- grid.10383.390000 0004 1758 0937University of Parma, Parma, Italy
| | - Giovanni Corsello
- grid.10776.370000 0004 1762 5517University of Palermo, Palermo, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padova, Padova, Italy.
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Affiliation(s)
- Davide Silvagni
- Unit of Pediatric Emergency, Department of Neonatal and Pediatric Critical Care, Integrated University Hospital of Verona, Verona, Italy
| | - Pietro Soloni
- Unit of Pediatric Emergency, Department of Neonatal and Pediatric Critical Care, Integrated University Hospital of Verona, Verona, Italy
| | - Paolo Biban
- Unit of Pediatric Emergency, Department of Neonatal and Pediatric Critical Care, Integrated University Hospital of Verona, Verona, Italy -
| | - Laura Baggio
- Unit of Pediatric Emergency, Department of Neonatal and Pediatric Critical Care, Integrated University Hospital of Verona, Verona, Italy
| | - Francesca Darra
- Unit of Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Diani E, Silvagni D, Lotti V, Lagni A, Baggio L, Medaina N, Biban P, Gibellini D. Evaluation of saliva and nasopharyngeal swab sampling for genomic detection of SARS-CoV-2 in children accessing a pediatric emergency department during the second pandemic wave. Front Microbiol 2023; 14:1163438. [PMID: 37138621 PMCID: PMC10149871 DOI: 10.3389/fmicb.2023.1163438] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
SARS-CoV-2 infection is mainly detected by multiplex real-time RT-PCR from upper respiratory specimens, which is considered the gold-standard technique for SARS-CoV-2 infection diagnosis. A nasopharyngeal (NP) swab represents the clinical sample of choice, but NP swabbing can be uncomfortable to the patients, especially for pediatric-age participants, requires trained healthcare personnel, and may generate an aerosol, increasing the intrinsic exposure risk of healthcare workers. The objective of this study was to compare paired NP and saliva samples (SS) collected from pediatric patients to evaluate whether the saliva collection procedure may be considered a valuable alternative to the classical NP swab (NPS) sampling in children. In this study, we describe a SARS-CoV-2 multiplex real-time RT-PCR protocol for SS, comparing the results with the paired NPS specimens from 256 pediatric patients (mean age 4.24 ± 4.40 years) admitted to the hospital emergency room of Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, and randomly enrolled between September 2020 and December 2020. The saliva sampling demonstrated consistent results when compared to NPS use. The SARS-CoV-2 genome was detected in 16 out of 256 (6.25%) NP samples, among which 13 (5.07%) were positive even when paired SS were analyzed. Moreover, SARS-CoV-2-negative NPS and SS were consistent, and the overall concordances between NPS and SS were detected in 253 out of 256 samples (98.83%). Our results suggest that saliva samples may be considered a valuable alternative to NPS for SARS-CoV-2 direct diagnosis with multiplex real-time RT-PCR in pediatric patients.
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Affiliation(s)
- Erica Diani
- Microbiology Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Davide Silvagni
- Pediatric Emergency Room, Department of Neonatal and Pediatric Critical Care, University of Verona, Verona, Italy
| | - Virginia Lotti
- Microbiology Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
- *Correspondence: Virginia Lotti
| | - Anna Lagni
- Microbiology Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Laura Baggio
- Pediatric Emergency Room, Department of Neonatal and Pediatric Critical Care, University of Verona, Verona, Italy
| | | | - Paolo Biban
- Pediatric Emergency Room, Department of Neonatal and Pediatric Critical Care, University of Verona, Verona, Italy
| | - Davide Gibellini
- Microbiology Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
- Microbiology Unit, AOUI Verona, Verona, Italy
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6
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Silvagni D, Baggio L, Mazzi C, Cuffaro G, Carlassara S, Spada S, Biban P. The PAWPER tape as a tool for rapid weight assessment in a Paediatric Emergency Department: Validation study and comparison with parents’ estimation and Broselow tape. Resusc Plus 2022; 12:100301. [PMID: 36148444 PMCID: PMC9486114 DOI: 10.1016/j.resplu.2022.100301] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Davide Silvagni
- Pediatric Emergency Room – Department of Neonatal and Pediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Laura Baggio
- Pediatric Emergency Room – Department of Neonatal and Pediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Cristina Mazzi
- Clinical Research Unit, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy
- Centre for Clinical Research, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Giorgio Cuffaro
- Pediatrics Residency, Department of Surgical Sciences, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Silvia Carlassara
- Pediatrics Residency, Department of Surgical Sciences, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Simona Spada
- Pediatric Emergency Room – Department of Neonatal and Pediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Paolo Biban
- Pediatric Emergency Room – Department of Neonatal and Pediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy
- Corresponding author at: Department of Pediatric and Neonatal Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy.
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7
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Rosati A, L'Erario M, Bianchi R, Olivotto S, Battaglia DI, Darra F, Biban P, Biggeri A, Catelan D, Danieli G, Mondardini MC, Cordelli DM, Amigoni A, Cesaroni E, Conio A, Costa P, Lombardini M, Meleleo R, Pugi A, Tornaboni EE, Santarone ME, Vittorini R, Sartori S, Marini C, Vigevano F, Mastrangelo M, Pulitanò SM, Izzo F, Fusco L. KETASER01 protocol: What went right and what went wrong. Epilepsia Open 2022; 7:532-540. [PMID: 35833327 PMCID: PMC9436287 DOI: 10.1002/epi4.12627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
Abstract
Objective To discuss the results of the KETASER01 trial and the reasons for its failure, particularly in view of future studies. Methods KETASER01 is a multicenter, randomized, controlled, open‐label, sequentially designed, non‐profit Italian study that aimed to assess the efficacy of ketamine compared with conventional anesthetics in the treatment of refractory convulsive status epilepticus (RCSE) in children. Results During the 5‐year recruitment phase, a total of 76 RCSEs treated with third‐line therapy were observed in five of the 10 participating Centers; only 10 individuals (five for each study arm; five females, mean age 6.5 ± 6.3 years) were enrolled in the KETASER01 study. Two of the five patients (40%) in the experimental arm were successfully treated with ketamine and two of the five (40%) children in the control arm, where successfully treated with thiopental. In the remaining six (60%) enrolled patients, RCSE was not controlled by the randomized anesthetic(s). Significance The KETASER01 study was prematurely halted due to low eligibility of patients and no successful recruitment. No conclusions can be drawn regarding the objectives of the study. Here, we discuss the KETASER01 results and critically analyze the reasons for its failure in view of future trials.
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Affiliation(s)
- Anna Rosati
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Italy
| | - Manuela L'Erario
- Intensive Care Unit, Meyer Children's Hospital-University of Florence, Florence, Italy
| | - Roberto Bianchi
- Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Olivotto
- Pediatric Neurology Unit, Children's Hospital Vittore Buzzi, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Francesca Darra
- Child Neuropsychiatry Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - Paolo Biban
- Department of Neonatal and Pediatric Intensive Care, University Hospital, Verona, Italy
| | - Annibale Biggeri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Dolores Catelan
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giacomo Danieli
- Department of Statistics, Computer Science, Applications G. Parenti, University of Florence, Italy
| | - Maria Cristina Mondardini
- Department of Pediatric Anesthesia and Intensive Care, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Duccio Maria Cordelli
- IRCCS Institute of Neurological Sciences of Bologna, UOC Neuropsychiatry of the Pediatric Age, Bologna, Italy
| | - Angela Amigoni
- Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Italy
| | - Elisabetta Cesaroni
- Child Neuropsychiatry Unit, Polytechnic University of the Marche, Ancona, Italy
| | - Alessandra Conio
- Pediatric Intensive Care Unit, Health and Science City Hospital-University of Turin, Italy
| | - Paola Costa
- Department of Neuropsychiatry Ward, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Martina Lombardini
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Italy
| | - Rosanna Meleleo
- Intensive Care Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alessandra Pugi
- Clinical Trial Office Meyer Children's Hospital-University of Florence, Italy
| | - Elena Eve Tornaboni
- Clinical Trial Office Meyer Children's Hospital-University of Florence, Italy
| | | | - Roberta Vittorini
- Child and Adolescence Neuropsychiatry Unit, Health and Science City Hospital-University of Turin, Italy
| | - Stefano Sartori
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Italy
| | - Carla Marini
- Child Neuropsychiatry Unit, Polytechnic University of the Marche, Ancona, Italy
| | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Mastrangelo
- Pediatric Neurology Unit, Children's Hospital Vittore Buzzi, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Francesca Izzo
- Pediatric Intensive Care Unit, Children's Hospital Vittore Buzzi, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Lucia Fusco
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Biban P. Chest compressions in children before ECPR cannulation: Do we have time for pauses? Resuscitation 2022; 177:16-18. [PMID: 35750285 DOI: 10.1016/j.resuscitation.2022.06.012] [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] [Received: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Paolo Biban
- Pediatric Intensive Care Unit - Department of Neonatal and Pediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy.
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Ficial B, Bonafiglia E, Gangemi A, Clemente M, Cappelleri A, Corsini I, Biban P. Impact of Aortic Diameter Measurements at Three Anatomical Landmarks on Left Ventricular Output Calculation in Neonates. J Ultrasound Med 2022; 41:1187-1194. [PMID: 34423855 DOI: 10.1002/jum.15808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/04/2021] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To assess reproducibility and accuracy of left ventricular output (LVO) quantifications in neonates, when left ventricular outflow tract diameter (LVOTD) was measured at the hinges of the aortic valve (AV), at the aortic sinus (AS), and at the sinotubular junction (STJ). METHODS This was an observational study. In the first cohort of very preterm neonates, we assessed intraobserver and interobserver repeatability of LVOTD measured at the AV, AS, and STJ and of the corresponding LVO. In the second cohort of older neonates, we compared paired LVO measurements by echo and magnetic resonance imaging (MRI). RESULTS In the first cohort of 48 neonates, mean (standard deviation) weight and age at scan were 1046 (302) g and 28.1 (2.7) weeks. Interobserver bias (95% limits of agreement [LOA]) for LVOTD at the AV, AS, and STJ was 0 (-0.3 to 0.3) mm, 0 (-0.7 to 0.7) mm, and 0 (-0.8 to 0.7) mm, respectively. Interobserver bias (95% LOA) for the corresponding LVO was -1.3 (-31 to 33) ml/kg/min, -0.5 (-88 to 87) ml/kg/min, and -7.2 (-83 to 69) ml/kg/min, respectively. In the second cohort of 10 neonates, median (range) weight and age at scan were 1942 (970-3640) g and 37.2 (31.7-39.8) weeks. LVO measured at the AV showed stronger agreement with MRI: bias (LOA) -10.6 (-74 to 52) ml/kg/min, compared to LVO measured at AS and STJ: 194 (-0.5 to 388) ml/kg/min and 43 (-72 to 159) ml/kg/min respectively. CONCLUSIONS Reproducibility and accuracy of LVO quantification by echo were better when aortic diameter was measured at AV.
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Affiliation(s)
- Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Elena Bonafiglia
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Antonella Gangemi
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Maria Clemente
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessia Cappelleri
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Paolo Biban
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Pozzi N, Cogo P, Moretti C, Biban P, Fedeli T, Orfeo L, Gitto E, Mosca F. The care of critically ill infants and toddlers in neonatal intensive care units across Italy and Europe: our proposal for healthcare organization. Eur J Pediatr 2022; 181:1385-1393. [PMID: 35088115 PMCID: PMC8794634 DOI: 10.1007/s00431-021-04349-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/02/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED Numerous studies have shown that critically ill infants and toddlers admitted to paediatric intensive care units (PICUs) have a lower mortality than those admitted to adult ICUs. In 2014, there were only 23 registered PICUs in Italy, most of which were located in the north. For this reason, in Italy and elsewhere in Europe, some neonatal ICUs (NICUs) have begun managing critically ill infants and toddlers. Our proposal for healthcare organization is to establish "extended NICUs" in areas where paediatric intensive care beds are lacking. While some countries have opted for a strict division between neonatal and paediatric intensive care units, the model of "extended NICUs" has already been set up in Italy and in Europe. In this instance, the management of critically ill infants and toddlers undoubtedly falls upon neonatologists, who, however, must gain specific knowledge and technical skills in paediatric critical care medicine (PCCM). Postgraduate residencies in paediatrics need to include periods of specific training in neonatology and PCCM. The Italian Society of Neonatology's Early Childhood Intensive Care Study Group is supporting certified training courses for its members involving both theory and practice. CONCLUSION Scientific societies should promote awareness of the issues involved in the intensive management of infants and toddlers in NICUs and the training of all health workers involved. These societies include the Italian Society of Neonatology, the European Society of Paediatric and Neonatal Intensive Care, and the Union of European Neonatal and Perinatal Societies. They should also act in concert with the governmental institutional bodies to establish the standards for the "extended NICUs." WHAT IS KNOWN • The mortality of critically ill infants and toddlers admitted to PICUs is lower than that for those admitted to adult ICUs. • In Italy, there are only a handful of PICUs, located mainly in the north. WHAT IS NEW • Critically ill infants and small toddlers can be managed in "extended NICUs" in areas with a lack of paediatric intensive care beds. • "Extended NICUs" is our proposal for healthcare organization to compensate for the paucity of paediatric intensive care beds, but neonatologists must be trained to provide them with specific knowledge and technical skills in PCCM.
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Affiliation(s)
- Nicola Pozzi
- Neonatal Intensive Care Unit, Department of Maternal and Child Health, San Pio Hospital, Via dell'Angelo 1, Benevento, 83013, Italy.
| | - Paola Cogo
- Department of Medicine (DAME), Division of Pediatrics, S. Maria della Misericordia University Hospital, University of Udine, P.zzale S. Maria della Misericordia, 15, Udine, 33100 Italy
| | - Corrado Moretti
- Emeritus Consultant in Paediatrics, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Paolo Biban
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
| | - Tiziana Fedeli
- Neonatal Intensive Care Unit, Fondazione Monza e Brianza per il Bambino e la sua Mamma and Azienda Socio Sanitaria Territoriale-Monza, Monza, Italy
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Eloisa Gitto
- Neonatal and Paediatric Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi, ” University of Messina, Via Consolare Valeria, 1, Messina, 98125 Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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11
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Menon K, Schlapbach LJ, Akech S, Argent A, Biban P, Carrol ED, Chiotos K, Jobayer Chisti M, Evans IVR, Inwald DP, Ishimine P, Kissoon N, Lodha R, Nadel S, Oliveira CF, Peters M, Sadeghirad B, Scott HF, de Souza DC, Tissieres P, Watson RS, Wiens MO, Wynn JL, Zimmerman JJ, Sorce LR. Criteria for Pediatric Sepsis-A Systematic Review and Meta-Analysis by the Pediatric Sepsis Definition Taskforce. Crit Care Med 2022; 50:21-36. [PMID: 34612847 PMCID: PMC8670345 DOI: 10.1097/ccm.0000000000005294] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine the associations of demographic, clinical, laboratory, organ dysfunction, and illness severity variable values with: 1) sepsis, severe sepsis, or septic shock in children with infection and 2) multiple organ dysfunction or death in children with sepsis, severe sepsis, or septic shock. DATA SOURCES MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2004, and November 16, 2020. STUDY SELECTION Case-control studies, cohort studies, and randomized controlled trials in children greater than or equal to 37-week-old postconception to 18 years with suspected or confirmed infection, which included the terms "sepsis," "septicemia," or "septic shock" in the title or abstract. DATA EXTRACTION Study characteristics, patient demographics, clinical signs or interventions, laboratory values, organ dysfunction measures, and illness severity scores were extracted from eligible articles. Random-effects meta-analysis was performed. DATA SYNTHESIS One hundred and six studies met eligibility criteria of which 81 were included in the meta-analysis. Sixteen studies (9,629 patients) provided data for the sepsis, severe sepsis, or septic shock outcome and 71 studies (154,674 patients) for the mortality outcome. In children with infection, decreased level of consciousness and higher Pediatric Risk of Mortality scores were associated with sepsis/severe sepsis. In children with sepsis/severe sepsis/septic shock, chronic conditions, oncologic diagnosis, use of vasoactive/inotropic agents, mechanical ventilation, serum lactate, platelet count, fibrinogen, procalcitonin, multi-organ dysfunction syndrome, Pediatric Logistic Organ Dysfunction score, Pediatric Index of Mortality-3, and Pediatric Risk of Mortality score each demonstrated significant and consistent associations with mortality. Pooled mortality rates varied among high-, upper middle-, and lower middle-income countries for patients with sepsis, severe sepsis, and septic shock (p < 0.0001). CONCLUSIONS Strong associations of several markers of organ dysfunction with the outcomes of interest among infected and septic children support their inclusion in the data validation phase of the Pediatric Sepsis Definition Taskforce.
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Affiliation(s)
- Kusum Menon
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Luregn J. Schlapbach
- Pediatric and Neonatal ICU, University Children`s Hospital Zurich, Zurich, Switzerland, and Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Samuel Akech
- KEMRI Wellcome Trust Research Program, Nairobi, Kenya
| | - Andrew Argent
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
| | - Paolo Biban
- Department of Paediatrics, Verona University Hospital, Verona, Italy
| | - Enitan D. Carrol
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom
| | | | | | - Idris V. R. Evans
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, and The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA
| | - David P. Inwald
- Paediatric Intensive Care Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Paul Ishimine
- Departments of Emergency Medicine and Pediatrics, University of California San Diego School of Medicine, La Jolla, CA
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia and British Columbia Children’s Hospital, Vancouver, BC, Canada
| | - Rakesh Lodha
- All India Institute of Medical Sciences, Delhi, India
| | - Simon Nadel
- St. Mary’s Hospital, Imperial College Healthcare NHS Trust, and Imperial College London, London, United Kingdom
| | | | - Mark Peters
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Benham Sadeghirad
- Departments of Anesthesia and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Halden F. Scott
- Departments of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Daniela C. de Souza
- Departments of Pediatrics, Hospital Sírio-Libanês and Hospital Universitário da Universidade de São Paulo, São Paolo, Brazil
| | - Pierre Tissieres
- Pediatric Intensive Care, AP-HP Paris Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - R. Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Matthew O. Wiens
- University of British Columbia, Vancouver, BC, Canada
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - James L. Wynn
- Department of Pediatrics, University of Florida, Gainesville, FL
| | - Jerry J. Zimmerman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Lauren R. Sorce
- Ann & Robert H. Lurie Children’s Hospital and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Lurie Children’s Pediatric Research & Evidence Synthesis Center (PRECIISE): A JBI Affiliated Group, Chicago, IL
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12
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Stefana A, Biban P, Padovani EM, Lavelli M. Fathers' experiences of supporting their partners during their preterm infant's stay in the neonatal intensive care unit: a multi-method study. J Perinatol 2022; 42:714-722. [PMID: 34471215 PMCID: PMC8409081 DOI: 10.1038/s41372-021-01195-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/07/2021] [Accepted: 08/20/2021] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To explore how the fathers experience their role as a support for their partner and the relationship with them during their preterm infant's stay in the NICU. STUDY DESIGN Multi-method longitudinal study involving ethnographic observation, semi-structured interviews, self-report questionnaires, and clinical information. Twenty fathers of preterm infants hospitalized in a level-III-NICU were included. Data were analyzed using thematic continent analysis. RESULTS Three main themes were identified: support for mother (subthemes: putting mother's and infant's needs first; hiding worries and negative emotions; counteracting the sense of guilt; fear that the mother would reject the child), mother's care for the infant (subthemes: observing mother engaged in caregiving; mother has "something extra"), and couple relationship (subthemes: collaboration; bond). CONCLUSION Fathers supporting their partners during the stay in the NICU experience emotional distress and the need for being supported that often are hidden. This demands a great deal of emotional and physical energy.
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Affiliation(s)
| | - Paolo Biban
- grid.411475.20000 0004 1756 948XNeonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Ezio Maria Padovani
- grid.411475.20000 0004 1756 948XNeonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Manuela Lavelli
- grid.5611.30000 0004 1763 1124Department of Human Sciences, University of Verona, Verona, Italy
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Cavallin F, Doglioni N, Allodi A, Battajon N, Vedovato S, Capasso L, Gitto E, Laforgia N, Paviotti G, Capretti MG, Gizzi C, Villani PE, Biban P, Pratesi S, Lista G, Ciralli F, Soffiati M, Staffler A, Baraldi E, Trevisanuto D. Thermal management with and without servo-controlled system in preterm infants immediately after birth: a multicentre, randomised controlled study. Arch Dis Child Fetal Neonatal Ed 2021; 106:572-577. [PMID: 33597230 DOI: 10.1136/archdischild-2020-320567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/28/2020] [Revised: 12/29/2020] [Accepted: 01/31/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The thermal servo-controlled systems are routinely used in neonatal intensive care units (NICUs) to accurately manage patient temperature, but their role during the immediate postnatal phase has not been previously assessed. OBJECTIVE To compare two modalities of thermal management (with and without the use of a servo-controlled system) immediately after birth. STUDY DESIGN AND SETTING Multicentre, unblinded, randomised trial conducted 15 Italian tertiary hospitals. PARTICIPANTS Infants with estimated birth weight <1500 g and/or gestational age <30+6 weeks. INTERVENTION Thermal management with or without a thermal servo-controlled system during stabilisation in the delivery room. PRIMARY OUTCOME Proportion of normothermia at NICU admission (axillary temperature 36.5°C-37.5°C). RESULTS At NICU admission, normothermia was achieved in 89/225 neonates (39.6%) with the thermal servo-controlled system and 95/225 neonates (42.2%) without the thermal servo-controlled system (risk ratio 0.94, 95% CI 0.75 to 1.17). Thermal servo-controlled system was associated with increased mild hypothermia (36°C-36.4°C) (risk ratio 1.48, 95% CI 1.09 to 2.01). CONCLUSIONS In very low birthweight infants, thermal management with the servo-controlled system conferred no advantage in maintaining normothermia at NICU admission, while it was associated with increased mild hypothermia. Thermal management of preterm infants immediately after birth remains a challenge. TRIAL REGISTRATION NUMBER NCT03844204.
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Affiliation(s)
| | - Nicoletta Doglioni
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | | | - Nadia Battajon
- Pediatric Department, Ospedale Regionale Ca Foncello Treviso, Treviso, Veneto, Italy
| | - Stefania Vedovato
- Pediatric Department, Ospedale San Bortolo di Vicenza, Vicenza, Veneto, Italy
| | - Letizia Capasso
- Translational Medical Sciences, University "Federico II", Napoli, Italy
| | - Eloisa Gitto
- Department of Pediatrics, University of Messina, Neonatal Intensive Care Unit, Messina, Italy
| | | | - Giulia Paviotti
- Department of Neonatology, Azienda Ospedaliera Universitaria Integrata di Udine, Udine, Italy
| | - Maria Grazia Capretti
- Department of Medical and Surgical Sciences, Operative Unit of Neonatology, University of Bologna, Bologna, Italy
| | - Camilla Gizzi
- NICU, "S. Giovanni Calibita" Hospital - Fatebenefratelli Isola Tiberina, Rome, Italy
| | | | - Paolo Biban
- Department of Pediatrics, PICU-NICU, University Hospital of Verona, Verona, Italy
| | - Simone Pratesi
- Division of Neonatology, Careggi University Hospital, Florence, Italy
| | - Gianluca Lista
- Department of Pediatrics, Ospedale dei Bambini "V.Buzzi", Milano, Italy
| | - Fabrizio Ciralli
- Dipartimento Donna-Bambino-Neonato, Ospedale Maggiore Policlinico, Milano, Lombardia, Italy
| | - Massimo Soffiati
- Division of Pediatrics, S. Chiara General Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Trentino-Alto Adige, Italy
| | - Alex Staffler
- Division of Neonatology, Azienda Sanitaria dell'Alto Adige di Bolzano, Bolzano, Italy
| | - Eugenio Baraldi
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Daniele Trevisanuto
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
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14
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Carnevale FA, Giannini A, Bonaldi A, Bravi E, Cecchi C, Pettenazzo A, Amigoni A, Pulitanò SMM, Tosin C, Biban P. Life-sustaining treatment decisions in pediatric intensive care: an Italian survey on ethical concerns. Ital J Pediatr 2021; 47:153. [PMID: 34233717 PMCID: PMC8261393 DOI: 10.1186/s13052-021-01054-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives To investigate how life-sustaining treatment (LST) decisions are made and identify problematic ethical concerns confronted by physicians and nurses in pediatric intensive care within Italy. Methods An 88-question online survey was created, based on a previous qualitative study conducted by this team. The survey was designed to identify how LST decisions were managed; contrasting actual practices with what participants think practices should be. Replies from physicians and nurses were compared, to identify potential inter-professional ethical tensions. The study also identified participants’ principal ethical concerns. Moreover, open-ended questions elicited qualitative perspectives on participants’ views. The survey was pilot-tested and refined before initiation of the study. Results 31 physicians and 65 nurses participated in the study. Participants were recruited from pediatric intensive care units across five Italian cities; i.e., Florence, Milan, Padua, Rome, Verona. Statistically significant differences were identified for (a) virtually all questions contrasting actual practices with what participants think practices should be and (b) 14 questions contrasting physician replies with those of nurses. Physicians and nurses identified the absence of legislative standards for LST withdrawal as a highly problematic ethical concern. Physicians also identified bearing responsibility for LST decisions as a major concern. Qualitative descriptions further demonstrated that these Italian pediatric intensive care clinicians encounter significantly distressing ethical problems in their practice. Conclusions The results of this study highlight a need for the development of (a) strategies for improving team processes regarding LST decisions, so they can be better aligned with how clinicians think decisions should be made, and (b) Italian LST decision-making standards that can help ensure optimal ethical practices.
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Affiliation(s)
- Franco A Carnevale
- McGill University/Montreal Children's Hospital, Montreal, 680 Sherbrooke St. West, Suite 1836, Montréal, Quebec, H3A 2M7, Canada.
| | - Alberto Giannini
- S.C. Anestesia e Rianimazione Pediatrica, Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Amabile Bonaldi
- Department of Neonatal and Pediatric Critical Care, Verona University Hospital, Verona, Italy
| | - Elena Bravi
- U.O. Psicologia, Azienda Provinciale Servizi Sanitari, Trento, Italy
| | - Costanza Cecchi
- Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Andrea Pettenazzo
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy
| | - Silvia Maria Modesta Pulitanò
- Pediatric Intensive Care Unit Trauma Center Pediatric, F. Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Chiara Tosin
- Department of Neonatal and Pediatric Critical Care, Verona University Hospital, Verona, Italy
| | - Paolo Biban
- Department of Neonatal and Pediatric Critical Care, Verona University Hospital, Verona, Italy
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Massolo AC, Clemente M, Patel N, Cantone GV, Toscano A, Ficial B, Landolfo F, Calzolari F, Capolupo I, Biban P, Dotta A. Could myocardial function be predictive of successful extubation in newborns and infants? Pediatr Pulmonol 2021; 56:1733-1738. [PMID: 33580748 DOI: 10.1002/ppul.25316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the relationship between cardiac function and extubation readiness in infants using speckle tracking echocardiography. WORKING HYPOTHESIS Cardiac function combined with established clinical parameters may better identify readiness for extubation. STUDY DESIGN Pilot prospective observational study. PATIENT SELECTION Mechanically ventilated infants were included. METHODOLOGY Cardiac function was assessed by echocardiography immediately before extubation. Systolic and diastolic function in the left (LV) and right ventricles (RV) were assessed by measurement of longitudinal strain (LS), and circumferential strain (CS) in the LV only. Pulmonary artery pressures were assessed using the velocity of tricuspid regurgitation jet (TR), septal position, and end-systolic eccentricity index (EI ES). Cases who extubated successfully (Group 1) were compared to cases who required reintubation (Group 2). RESULTS Twenty-five cases were included. LV CS and RV LS were significantly lower in those who required reintubation (Group 2) compared to those who were successfully extubated (Group 1) (LV CS, -21 (12)% vs. -33 (3)%, p = .001; RV LS -19 (2.7)% vs. -20 (2.5)%, p = .04). TR was absent in all cases. The septal shape was normal in 18 cases (72%), displaced to the left in 7 (28%) cases. No significant differences were found in LV EI ES between groups.
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Affiliation(s)
- Anna C Massolo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Clemente
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, UK
| | - Giulia V Cantone
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Toscano
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesca Landolfo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Flaminia Calzolari
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Irma Capolupo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Biban
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Dotta
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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16
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Mercolini F, Donà D, Girtler Y, Mussner KA, Biban P, Bordugo A, Molinaro G. First paediatric COVID-19 associated death in Italy. J Paediatr Child Health 2021; 57:736-737. [PMID: 32592522 PMCID: PMC7361632 DOI: 10.1111/jpc.14994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department of Woman's and Child's HealthPadua University HospitalPaduaItaly
| | | | | | - Paolo Biban
- Department of Neonatal and Pediatric Critical and Emergency CareAzienda Ospedaliera Universitaria Integrata Verona Sede di Borgo TrentoVeronaItaly
| | - Andrea Bordugo
- Inherited Metabolic Disease Unit, Department of PediatricsAzienda Ospedaliera Universitaria Integrata Verona Sede di Borgo TrentoVeronaItaly
| | - Grazia Molinaro
- Pediatric Palliative Care, Pain ServiceBolzano HospitalBolzanoItaly
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17
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Sangaletti M, Garzon S, Raffaelli R, D'Alessandro R, Bosco M, Casarin J, Laganà AS, Sibona I, Biban P, Franchi M. The Ex utero intrapartum treatment (EXIT) procedure: case report of a multidisciplinary team approach. Acta Biomed 2021; 92:e2021142. [PMID: 33944827 PMCID: PMC8142784 DOI: 10.23750/abm.v92is1.9964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK The EXIT-to-airway procedure is aimed to provide the time required to secure airways when an extrinsic or intrinsic fetal mass raise concerns about airways control at delivery. Due to the rarity of the procedure, we aim to provide a summary of the appropriate prenatal planning by a multidisciplinary team. METHODS Report of a case of EXIT-to-airway procedure. RESULTS A 30 years-old woman, G2P1 with previous cesarean section, was referred to our Unit at 34 gestational weeks due to a fetal cervical mass of 7cm. An EXIT-to-airways procedure was performed by a multidisciplinary team after accurate preoperative planning and the practice simulations. The partial fetal extraction and the amnioinfusion of pre-heated saline were used to prevent fetal complications. The use of supplemental intravenous anesthesia with remifentanil and better control of uterine tone with nitroglycerin allowed to reduce the exposure to volatile halogen for both the mother and the fetus. The accurate preoperative planning and the practice simulations allowed us to perform the treatment safely in urgency due to the onset of spontaneous labor at 37 weeks and 6 days. CONCLUSIONS The strong cooperation among specialists, accurate prenatal planning, and adopting all the required procedures and precautions are of paramount importance to successfully perform the EXIT-to-airway procedure.
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Affiliation(s)
- Marina Sangaletti
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy..
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy.
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy..
| | - Roberto D'Alessandro
- Department of Anesthesia and Intensive Care, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy..
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy..
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100 Varese (VA), Italy..
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100 Varese (VA), Italy.
| | - Irene Sibona
- Department of Neonatal and Pediatric Intensive Care, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy.
| | - Paolo Biban
- Department of Neonatal and Pediatric Intensive Care, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy. .
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy.
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18
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Silvagni D, Baggio L, Lo Tartaro Meragliotta P, Soloni P, La Fauci G, Bovo C, Ielo S, Biban P. Neonatal and Pediatric Emergency Room Visits in a Tertiary Center during the COVID-19 Pandemic in Italy. Pediatr Rep 2021; 13:168-176. [PMID: 33916938 PMCID: PMC8167637 DOI: 10.3390/pediatric13020023] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/18/2021] [Accepted: 03/23/2021] [Indexed: 12/11/2022] Open
Abstract
The COVID-19 pandemic is affecting healthcare services worldwide. We investigated the impact of a strict lockdown policy on the characteristics of neonatal and pediatric attendances to our pediatric emergency department (PED). The clinical features of PED visits in March-April 2020 (COVID-19) and March-April 2019 (non-COVID-19) were analyzed. During the COVID-19 lockdown period, visits reduced by 67%, from 3159 to 1039. Neonatal access decreased from 78 to 59, mainly due to fewer pathological conditions, with a complete disappearance of respiratory infections. On the other hand, minor neonatal clinical conditions rose from 44 (56.4%) to 48 (81.4%), mostly due to feeding-related issues. Communicable diseases, particularly respiratory infections and gastroenteritis, dropped from 1552 (49.1%) to 288 (27.7%). Accident-related visits also decreased during COVID-19, from 535 (16.9%) to 309 (29.7%), becoming the most common cause of PED access. Hospital admissions reduced from 266 to 109, while PICU (pediatric intensive care unit) admissions decreased from 27 to 11, with a comparable rate of 10.1% in both periods. The lockdown due to COVID-19 had a substantial impact on our PED visits, which markedly decreased, mainly due to fewer respiratory infections. Unexpectedly, neonatal visits for minor conditions did not decline, but rather slightly increased. Among the children admitted to the PICU, none had respiratory disease.
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Affiliation(s)
- Davide Silvagni
- Paediatric Emergency Room, Department of Neonatal and Paediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy; (D.S.); (L.B.); (P.L.T.M.); (P.S.); (G.L.F.); (S.I.)
| | - Laura Baggio
- Paediatric Emergency Room, Department of Neonatal and Paediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy; (D.S.); (L.B.); (P.L.T.M.); (P.S.); (G.L.F.); (S.I.)
| | - Patrizia Lo Tartaro Meragliotta
- Paediatric Emergency Room, Department of Neonatal and Paediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy; (D.S.); (L.B.); (P.L.T.M.); (P.S.); (G.L.F.); (S.I.)
| | - Pietro Soloni
- Paediatric Emergency Room, Department of Neonatal and Paediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy; (D.S.); (L.B.); (P.L.T.M.); (P.S.); (G.L.F.); (S.I.)
| | - Giovanna La Fauci
- Paediatric Emergency Room, Department of Neonatal and Paediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy; (D.S.); (L.B.); (P.L.T.M.); (P.S.); (G.L.F.); (S.I.)
| | - Chiara Bovo
- Medical Direction, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy;
| | - Stefania Ielo
- Paediatric Emergency Room, Department of Neonatal and Paediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy; (D.S.); (L.B.); (P.L.T.M.); (P.S.); (G.L.F.); (S.I.)
| | - Paolo Biban
- Paediatric Emergency Room, Department of Neonatal and Paediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy; (D.S.); (L.B.); (P.L.T.M.); (P.S.); (G.L.F.); (S.I.)
- Correspondence: ; Tel.: +39-045-8122365; Fax: +39-045-8123373
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Lazzerini M, Sforzi I, Trapani S, Biban P, Silvagni D, Villa G, Tibaldi J, Bertacca L, Felici E, Perricone G, Parrino R, Gioè C, Lega S, Conte M, Marchetti F, Magista A, Berlese P, Martelossi S, Vaienti F, Valletta E, Mauro M, Dall'Amico R, Fasoli S, Gatto A, Chiaretti A, Dragovic D, Pascolo P, Pilotto C, Liguoro I, Miorin E, Saretta F, Trobia GL, Di Stefano A, Orlandi A, Cardinale F, Lubrano R, Testa A, Binotti M, Moressa V, Barbi E, Armocida B, Mariani I. Characteristics and risk factors for SARS-CoV-2 in children tested in the early phase of the pandemic: a cross-sectional study, Italy, 23 February to 24 May 2020. Euro Surveill 2021; 26:2001248. [PMID: 33834960 PMCID: PMC8034058 DOI: 10.2807/1560-7917.es.2021.26.14.2001248] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/19/2020] [Indexed: 12/14/2022] Open
Abstract
BackgroundVery few studies describe factors associated with COVID-19 diagnosis in children.AimWe here describe characteristics and risk factors for COVID-19 diagnosis in children tested in 20 paediatric centres across Italy.MethodsWe included cases aged 0-18 years tested between 23 February and 24 May 2020. Our primary analysis focused on children tested because of symptoms/signs suggestive of COVID-19.ResultsAmong 2,494 children tested, 2,148 (86.1%) had symptoms suggestive of COVID-19. Clinical presentation of confirmed COVID-19 cases included besides fever (82.4%) and respiratory signs or symptoms (60.4%) also gastrointestinal (18.2%), neurological (18.9%), cutaneous (3.8%) and other unspecific influenza-like presentations (17.8%). In multivariate analysis, factors significantly associated with SARS-CoV-2 positivity were: exposure history (adjusted odds ratio (AOR): 39.83; 95% confidence interval (CI): 17.52-90.55; p < 0.0001), cardiac disease (AOR: 3.10; 95% CI: 1.19-5.02; p < 0.0001), fever (AOR: 3.05%; 95% CI: 1.67-5.58; p = 0.0003) and anosmia/ageusia (AOR: 4.08; 95% CI: 1.69-9.84; p = 0.002). Among 190 (7.6%) children positive for SARS-CoV-2, only four (2.1%) required respiratory support and two (1.1%) were admitted to intensive care; all recovered.ConclusionRecommendations for SARS-CoV-2 testing in children should consider the evidence of broader clinical features. Exposure history, fever and anosmia/ageusia are strong risk factors in children for positive SARS-CoV-2 testing, while other symptoms did not help discriminate positive from negative individuals. This study confirms that COVID-19 was a mild disease in the general paediatric population in Italy. Further studies are needed to understand risk, clinical spectrum and outcomes of COVID-19 in children with pre-existing conditions.
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Affiliation(s)
- Marzia Lazzerini
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Idanna Sforzi
- Department of Pediatric Emergency Medicine and Trauma Center, Meyer Children's University Hospital, Florence, Italy
| | - Sandra Trapani
- Department of Health Sciences and Meyer Children's University Hospital, Florence, Italy
| | - Paolo Biban
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona Italy
| | - Davide Silvagni
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona Italy
| | - Giovanna Villa
- Pediatric Emergency Unit, IRCCS Gaslini Children's Hospital, Genoa, Italy
| | - Jessica Tibaldi
- Pediatric Emergency Unit, IRCCS Gaslini Children's Hospital, Genoa, Italy
| | - Luca Bertacca
- Pediatric Emergency Unit and Department of Pediatric and Neonatology, Misericordia Hospital, Grosseto, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giuseppina Perricone
- Pediatric and Pediatric Emergency Unit, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Roberta Parrino
- Pediatria d'Urgenza e Pronto Soccorso P.O.G. Di Cristina, Palermo, Italy
| | - Claudia Gioè
- Pediatric Infectious diseases, P.O.G. Di Cristina, Palermo, Italy
| | - Sara Lega
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Mariasole Conte
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | - Paola Berlese
- Department of Pediatrics, Treviso Hospital, Treviso, Italy
| | | | - Francesca Vaienti
- Department of Pediatrics, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Enrico Valletta
- Department of Pediatrics, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Margherita Mauro
- Department of Pediatrics and Neonatology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Roberto Dall'Amico
- Department of Pediatrics and Neonatology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | | | - Antonio Gatto
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danica Dragovic
- Department of Pediatrics, San Polo Hospital, ASUGI, Monfalcone (GO), Italy
| | - Paola Pascolo
- Department of Pediatrics, San Polo Hospital, ASUGI, Monfalcone (GO), Italy
| | - Chiara Pilotto
- Division of Paediatrics, Department of Medicine DAME, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
| | - Ilaria Liguoro
- Division of Paediatrics, Department of Medicine DAME, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
| | | | | | - Gian Luca Trobia
- Pediatric and Pediatric Emergency Room Unit Cannizzaro Emergency Hospital, Catania, Italy
| | - Antonella Di Stefano
- Pediatric and Pediatric Emergency Room Unit Cannizzaro Emergency Hospital, Catania, Italy
| | - Azzurra Orlandi
- Giovanni XXIII Pediatric Hospital, Department of Pediatrics, University of Bari, Bari, Italy
| | - Fabio Cardinale
- Giovanni XXIII Pediatric Hospital, Department of Pediatrics, University of Bari, Bari, Italy
| | - Riccardo Lubrano
- Department of Pediatrics Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Alessia Testa
- Department of Pediatrics Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Marco Binotti
- Neonatal and Pediatric Intensive Care Unit, Maggiore della Carità University Hospital, Novara, Italy
| | - Valentina Moressa
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
- University of Trieste, Trieste, Italy
| | - Benedetta Armocida
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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20
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Cena L, Biban P, Janos J, Lavelli M, Langfus J, Tsai A, Youngstrom EA, Stefana A. The Collateral Impact of COVID-19 Emergency on Neonatal Intensive Care Units and Family-Centered Care: Challenges and Opportunities. Front Psychol 2021; 12:630594. [PMID: 33716895 PMCID: PMC7943863 DOI: 10.3389/fpsyg.2021.630594] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/25/2021] [Indexed: 12/28/2022] Open
Abstract
The ongoing Coronavirus disease 2019 (COVID-19) pandemic is disrupting most specialized healthcare services worldwide, including those for high-risk newborns and their families. Due to the risk of contagion, critically ill infants, relatives and professionals attending neonatal intensive care units (NICUs) are undergoing a profound remodeling of the organization and quality of care. In particular, mitigation strategies adopted to combat the COVID-19 pandemic may hinder the implementation of family-centered care within the NICU. This may put newborns at risk for several adverse effects, e.g., less weight gain, more nosocomial infections, increased length of NICU stay as well as long-term worse cognitive, emotional, and social development. This article aims to contribute to deepening the knowledge on the psychological impact of COVID-19 on parents and NICU staff members based on empirical data from the literature. We also provided evidence-based indications on how to safely empower families and support NICU staff facing such a threatening emergency, while preserving the crucial role of family-centered developmental care practices.
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Affiliation(s)
- Loredana Cena
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Biban
- Department of Neonatal and Pediatric Critical Care, Verona University Hospital, Verona, Italy
| | - Jessica Janos
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Manuela Lavelli
- Department of Human Sciences, University of Verona, Verona, Italy
| | - Joshua Langfus
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Angelina Tsai
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Eric A. Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alberto Stefana
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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21
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De Luca D, Cogo P, Kneyber MC, Biban P, Semple MG, Perez-Gil J, Conti G, Tissieres P, Rimensberger PC. Surfactant therapies for pediatric and neonatal ARDS: ESPNIC expert consensus opinion for future research steps. Crit Care 2021; 25:75. [PMID: 33618742 PMCID: PMC7898495 DOI: 10.1186/s13054-021-03489-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/04/2021] [Indexed: 12/14/2022] Open
Abstract
Pediatric (PARDS) and neonatal (NARDS) acute respiratory distress syndrome have different age-specific characteristics and definitions. Trials on surfactant for ARDS in children and neonates have been performed well before the PARDS and NARDS definitions and yielded conflicting results. This is mainly due to heterogeneity in study design reflecting historic lack of pathobiology knowledge. We reviewed the available clinical and preclinical data to create an expert consensus aiming to inform future research steps and advance the knowledge in this area. Eight trials investigated the use of surfactant for ARDS in children and ten in neonates, respectively. There were improvements in oxygenation (7/8 trials in children, 7/10 in neonates) and mortality (3/8 trials in children, 1/10 in neonates) improved. Trials were heterogeneous for patients' characteristics, surfactant type and administration strategy. Key pathobiological concepts were missed in study design. Consensus with strong agreement was reached on four statements: 1. There are sufficient preclinical and clinical data to support targeted research on surfactant therapies for PARDS and NARDS. Studies should be performed according to the currently available definitions and considering recent pathobiology knowledge. 2. PARDS and NARDS should be considered as syndromes and should be pre-clinically studied according to key characteristics, such as direct or indirect (primary or secondary) nature, clinical severity, infectious or non-infectious origin or patients' age. 3. Explanatory should be preferred over pragmatic design for future trials on PARDS and NARDS. 4. Different clinical outcomes need to be chosen for PARDS and NARDS, according to the trial phase and design, trigger type, severity class and/or surfactant treatment policy. We advocate for further well-designed preclinical and clinical studies to investigate the use of surfactant for PARDS and NARDS following these principles.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, 157 Rue de la Porte de Trivaux, 92140, Clamart (Paris-IDF), France.
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France.
| | - Paola Cogo
- Department of Pediatrics, University of Udine, Udine, Italy
| | - Martin C Kneyber
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Beatrix Children's Hospital Groningen, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Critical Care, Anesthesiology, Peri-Operative and Emergency Medicine (CAPE), University of Groningen, Groningen, The Netherlands
| | - Paolo Biban
- Department of Neonatal and Pediatric Critical Care, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Malcolm Grace Semple
- Health Protection Research Unit in Emerging and Zoonotic Infections, Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Jesus Perez-Gil
- Department of Biochemistry and Molecular Biology and Research Institute "Hospital 12 de Octubre", Complutense University, Madrid, Spain
| | - Giorgio Conti
- Department of Anesthesiology and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Pierre Tissieres
- Division of Pediatric Critical Care and Neonatal Medicine, "Kremlin-Bicetre" Medical Center, Paris Saclay University Hospitals, APHP, Paris, France
- Integrative Cellular Biology Institute-UMR 9198, Host-Pathogen Interactions Team, Paris Saclay University, Paris, France
| | - Peter C Rimensberger
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
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22
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Biban P, Teggi M, Gaffuri M, Santuz P, Onorato D, Carpenè G, Gregori D, Lippi G. Cell Population Data (CPD) for Early Recognition of Sepsis and Septic Shock in Children: A Pilot Study. Front Pediatr 2021; 9:642377. [PMID: 33777867 PMCID: PMC7989813 DOI: 10.3389/fped.2021.642377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/11/2021] [Indexed: 01/30/2023] Open
Abstract
Objectives: Innovative Cell Population Data (CPD) have been used as early biomarkers for diagnosing sepsis in adults. We assessed the usefulness of CPD in pediatric patients with sepsis/septic shock, in terms of early recognition and outcome prediction. We revised 54 patients (0-15 y) admitted to our Pediatric Intensive Care Unit (PICU) for sepsis/septic shock during a 4-year period. Twenty-eight patients were excluded, 26 septic patients were enrolled (G1). Forty children admitted for elective surgery served as controls (G2). Data on five selected CPD parameters, namely neutrophils fluorescence intensity (NE-SFL), monocytes cells complexity (MO-X), monocytes fluorescence intensity (MO-Y), monocytes complexity and width of dispersion of events measured (MO-WX), and monocytes cells size and width dispersion (MO-WZ), were obtained at time of PICU admission (t0) by a hematological analyzer (Sysmex XN 9000®). As the primary outcome we evaluated the relevance of CPD for diagnosing sepsis/septic shock on PICU admission. Furthermore, we investigated if CPD at t0 were correlated with C-reactive protein (CRP), patient survival, or complicated sepsis course. Results: On PICU admission (t0), NE-SFL, MO-WX, and MO-Y were higher in sepsis/septic shock patients compared to controls. NE-SFL values were correlated with CRP values in G1 patients (r = 0.83). None of the five CPD parameters was correlated with survival or complicated sepsis course. Conclusion: We found higher values of NE-SFL, MO-WX, and MO-Y in children with sepsis/septic shock upon PICU admission. These parameters may be a promising adjunct for early sepsis diagnosis in pediatric populations. Larger, prospective studies are needed to confirm our preliminary observations.
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Affiliation(s)
- Paolo Biban
- Pediatric Intensive Care Unit, Division of Pediatric Critical and Emergency Care, Verona University Hospital, Verona, Italy
| | - Martina Teggi
- Pediatric Intensive Care Unit, Division of Pediatric Critical and Emergency Care, Verona University Hospital, Verona, Italy
| | - Marcella Gaffuri
- Pediatric Intensive Care Unit, Division of Pediatric Critical and Emergency Care, Verona University Hospital, Verona, Italy
| | - Pierantonio Santuz
- Pediatric Intensive Care Unit, Division of Pediatric Critical and Emergency Care, Verona University Hospital, Verona, Italy
| | - Diletta Onorato
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Giovanni Carpenè
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padua, Padova, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Caroselli C, Raffaldi I, Norbedo S, Parri N, Poma F, Blaivas M, Zaccaria E, Dib G, Fiorentino R, Longo D, Biban P, Urbino AF. Accuracy of Point-of-Care Ultrasound in Detecting Fractures in Children: A Validation Study. Ultrasound Med Biol 2021; 47:68-75. [PMID: 33097313 DOI: 10.1016/j.ultrasmedbio.2020.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
This study sought to compare point-of-care ultrasound (POCUS) and conventional X-rays for detecting fractures in children. This was a prospective, non-randomized, convenience-sample study conducted in five medical centers. It evaluated pediatric patients with trauma. POCUS and X-ray examination results were treated as dichotomous variables with fracture either present or absent. Descriptive statistics were calculated in addition to prevalence, sensitivity, specificity, positive predictive value and negative predictive value, including 95% confidence intervals (CIs). The Cohen κ coefficient was determined as a measurement of the level of agreement. A total of 554 examinations were performed with POCUS and X-ray. On physical examination, swelling, localized hematoma and functional limitation were found in 66.73%, 33.78% and 53.74% of participants, respectively. The most-studied areas were limbs and hands/feet (58.19% and 38.27%), whereas the thorax was less represented (3.54%). Sensitivity of POCUS was 91.67% (95% CI, 76.41-97.82%) for high-skill providers and 71.50 % (95% CI, 64.75-77.43%) for standard-skill providers. Specificity was 88.89% (95% CI, 73.00-96.34%) and 82.91% (95% CI, 77.82-87.06%) for high- and standard-skill providers, respectively. Positive predictive value was 89.19% (95% CI, 73.64-96.48%) and 75.90% (95% CI, 69.16-81.59%) for high- and standard-skill providers, respectively. Negative predictive value was 91.43% (95% CI, 75.81-97.76%) and 79.44% (95% CI, 74.21-83.87%) for high- and standard-skill providers, respectively. The Cohen κ coefficient showed very good agreement (0.81) for high-skill providers, but moderate agreement (0.54) for standard-skill providers. We noted good diagnostic accuracy of POCUS in evaluating fracture, with excellent sensitivity, specificity, and positive and negative predictive value for high-skill providers.
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Affiliation(s)
- Costantino Caroselli
- Acute Geriatric Unit, Geriatric Emergency Room and Aging Research Centre INRCA-IRCCS, Ancona, Italy.
| | - Irene Raffaldi
- Emergency Department, Regina Margherita Children Hospital, Turin, Italy
| | - Stefania Norbedo
- Emergency Department, Pediatric Hospital IRCCS Burlo Garofolo, Trieste, Italy
| | - Niccolò Parri
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Francesca Poma
- Emergency Department, Regina Margherita Children Hospital, Turin, Italy
| | - Michael Blaivas
- Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA; Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | | | - Giovanni Dib
- Department of Orthopedics and Trauma Surgery, Borgo Trento Hospital, Verona, Italy
| | - Romano Fiorentino
- Emergency Department, Asola Hospital, ASST Carlo Poma, Mantua, Italy
| | | | - Paolo Biban
- Department of Pediatrics and Pediatric Intensive Care Unit, Borgo Trento, Verona, Italy
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Cossu A, Lo Barco T, Darra F, Fontana E, Fiorini E, Marangone M, Biban P, Dalla Bernardina B, Cantalupo G. Remote Teamwork Management of NORSE During the COVID-19 Lockdown. Neurol Clin Pract 2020; 11:e170-e173. [PMID: 33842087 DOI: 10.1212/cpj.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/30/2020] [Indexed: 11/15/2022]
Abstract
New-onset refractory status epilepticus (NORSE) is rare condition, and sharing knowledge is vital in its management, based on strict collaboration between multiple specialists, continuous EEG (c-EEG) monitoring, and prompt therapy modification. The coronavirus disease 2019 (COVID-19) pandemic challenged many of these established practices because of "social distancing" measures, making it necessary to work around physical restrictions. We report a case of a 10-year-old with NORSE admitted in a pediatric intensive-care unit and monitored with c-EEG and amplitude-integrated EEG. The monitoring interface was livestreamed using videoconference web-based platforms allowing remote viewing. Multiple daily web meetings took place between team members, where real-time therapy response was evaluated and confronted with medium-term trends in the epileptic activity, dictating further treatment and diagnostic steps. In addition to the known use of telemedicine in chronic conditions, we report how its use can be exploited to treat urgent conditions such as NORSE. By taking advantage of new tools and virtual environments, we were able to share treatment and diagnostic decisions and guarantee real-time therapy adjustments and a coherent course in treatment despite restrictions necessary for the COVID-19 pandemic. The constant specialist monitoring and the coherent and on-time communication of the patient's condition relieved the family stress, usually complained in these situations.
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Affiliation(s)
- Alberto Cossu
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Tommaso Lo Barco
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Francesca Darra
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Elena Fontana
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Elena Fiorini
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Martina Marangone
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Paolo Biban
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Bernardo Dalla Bernardina
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry (FD, TLB, FD, GC), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona; Clinical and Experimental Medicine PhD Program (TLB), University of Modena and Reggio Emilia; Child Neuropsychiatry Unit (FD, E. Fontana, E. Fiorini, MM, GC), and Pediatric Intensive Care Unit (PB), University-Hospital of Verona; and Center for Research on Epilepsies in Pediatric Age (CREP) (BDB), Verona, Italy
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25
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Parri N, Lenge M, Cantoni B, Arrighini A, Romanengo M, Urbino A, Da Dalt L, Verdoni L, Giacchero R, Lanari M, Musolino AM, Biban P, La Fauci G, Pilotto C, Buonsenso D, Chiossi M, Agostiniani R, Plebani A, Zampogna S, Barbieri MA, De Masi S, Agostoni C, Masi S. COVID-19 in 17 Italian Pediatric Emergency Departments. Pediatrics 2020; 146:peds.2020-1235. [PMID: 32968031 DOI: 10.1542/peds.2020-1235] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [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] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Variability in presentation of children with coronavirus disease 2019 (COVID-19) is a challenge in emergency departments (EDs) in terms of early recognition, which has an effect on disease control and prevention. We describe a cohort of 170 children with COVID-19 and differences with the published cohorts. METHODS Retrospective chart reviews on children (0-18 years) evaluated in 17 Italian pediatric EDs. RESULTS In our cohort (median age of 45 months; interquartile range of 4 months-10.7 years), we found a high number of patients <1 year with COVID-19 disease. The exposure happened mainly (59%) outside family clusters; 22% had comorbidities. Children were more frequently asymptomatic (17%) or with mild diseases (63%). Common symptoms were cough (43%) and difficulty feeding (35%). Chest computed tomography, chest radiograph, and point-of-care lung ultrasound were used in 2%, 36%, and 8% of cases, respectively. Forty-three percent of patients were admitted because of their clinical conditions. The minimal use of computed tomography and chest radiograph may have led to a reduced identification of moderate cases, which may have been clinically classified as mild cases. CONCLUSIONS Italian children evaluated in the ED infrequently have notable disease symptoms. For pediatrics, COVID-19 may have rare but serious and life-threatening presentations but, in the majority of cases, represents an organizational burden for the ED. These data should not lower the attention to and preparedness for COVID-19 disease because children may represent a source of viral transmission. A clinically driven classification, instead of a radiologic, could be more valuable in predicting patient needs and better allocating resources.
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Affiliation(s)
| | - Matteo Lenge
- Clinical Trial Office.,Child Neurology Unit and Laboratories, Neuroscience Department, and.,Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Barbara Cantoni
- Healthcare Professional Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Arrighini
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | - Marta Romanengo
- Istituto di Ricovero e Cura a Carattere Scientifico Istituto Gaslini, Genova, Italy
| | - Antonio Urbino
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Liviana Da Dalt
- Department for Woman and Child Health, Pediatric Emergency Department, University of Padua, Padua, Italy
| | - Lucio Verdoni
- Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Marcello Lanari
- Pediatric Emergency Unit, Sant'Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy
| | - Anna Maria Musolino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital and
| | - Paolo Biban
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
| | - Giovanna La Fauci
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
| | - Chiara Pilotto
- Division of Paediatrics, Department of Medicine, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Massimo Chiossi
- Department of Pediatrics, Azienda Sanitaria Locale 4 Liguria, Lavagna, Italy
| | | | - Anna Plebani
- Pediatric Emergency Unit, Filippo Del Ponte Hospital, Azienda Socio Sanitaria Territoriale Settelaghi, Varese, Italy
| | | | | | | | - Carlo Agostoni
- University of Milan, Milan, Italy; and.,Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefano Masi
- Department of Emergency Medicine and Trauma Center
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26
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Biban P, Conti G, Wolfler AM, Carlassara S, Gitto E, Rulli I, Moscatelli A, Micalizzi C, Savron F, Sagredini R, Genoni G, Binotti M, Caramelli F, Fae M, Pettenazzo A, Stritoni V, D'Amato L, Zito Marinosci G, Calderini E, Scalia Catenacci S, Berardi A, Torcetta F, Bonanomi E, Bonacina D, Ivani G, Santuz P. Efficacy and safety of exogenous surfactant therapy in patients under 12 months of age invasively ventilated for severe bronchiolitis (SURFABRON): protocol for a multicentre, randomised, double-blind, controlled, non-profit trial. BMJ Open 2020; 10:e038780. [PMID: 33077567 PMCID: PMC7574934 DOI: 10.1136/bmjopen-2020-038780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Some evidence indicates that exogenous surfactant therapy may be effective in infants with acute viral bronchiolitis, even though more confirmatory data are needed. To date, no large multicentre trials have evaluated the effectiveness and safety of exogenous surfactant in severe cases of bronchiolitis requiring invasive mechanical ventilation (IMV). METHODS AND ANALYSIS This is a multicentre randomised, placebo-controlled, double-blind study, performed in 19 Italian paediatric intensive care units (PICUs). Eligible participants are infants under the age of 12 months hospitalised in a PICU, suffering from severe acute hypoxaemic bronchiolitis, requiring IMV. We adopted a more restrictive definition of bronchiolitis, including only infants below 12 months of age, to maintain the population as much homogeneous as possible. The primary outcome is to evaluate whether exogenous surfactant therapy (Curosurf, Chiesi Pharmaceuticals, Italy) is effective compared with placebo (air) in reducing the duration of IMV in the first 14 days of hospitalisation, in infants suffering from acute hypoxaemic viral bronchiolitis. Secondary outcomes are duration of non-invasive mechanical ventilation in the post-extubation phase, number of cases requiring new intubation after previous extubation within 14 days from randomisation, PICU and hospital length of stay (LOS), duration of oxygen dependency, effects on oxygenation and ventilatory parameters during invasive mechanical respiratory support, need for repeating treatment within 24 hours of first treatment, use of other interventions (eg, high-frequency oscillatory ventilation, nitric oxide, extracorporeal membrane oxygenation), mortality within the first 14 days of PICU stay and before hospital discharge, side effects and serious adverse events. ETHICS AND DISSEMINATION The trial design and protocol have received approval by the Italian National Agency for Drugs (AIFA) and by the Regional Ethical Committee of Verona University Hospital (1494CESC). Findings will be disseminated through publication in peer-reviewed journals, conference/meeting presentations and media. TRIAL REGISTRATION NUMBER Clinicaltrials.gov, issue date 22 May 2019. NCT03959384.
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Affiliation(s)
- Paolo Biban
- Department of Neonatal and Paediatric Critical Care, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giorgio Conti
- Paediatric Anesthesia and Intensive Care, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Andrea Michele Wolfler
- Paediatric Anesthesia and Intensive Care, Ospedale dei Bambini Vittore Buzzi, Milano, Italy
| | - Silvia Carlassara
- Department of Neonatal and Paediatric Critical Care, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Eloisa Gitto
- Neonatal and Paediatric Intensive Care, Azienda Ospedaliera Universitaria G. Martino, Messina, Italy
| | - Immacolata Rulli
- Neonatal and Paediatric Intensive Care, Azienda Ospedaliera Universitaria G. Martino, Messina, Italy
| | - Andrea Moscatelli
- Paediatric Anesthesia and Intensive Care, Ospedale Giannina Gaslini, Genova, Italy
| | - Camilla Micalizzi
- Paediatric Anesthesia and Intensive Care, Ospedale Giannina Gaslini, Genova, Italy
| | - Fabio Savron
- Paediatric Anesthesia and Intensive Care, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Raffaella Sagredini
- Paediatric Anesthesia and Intensive Care, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Giulia Genoni
- Neonatal and Paediatric Intensive Care, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Marco Binotti
- Neonatal and Paediatric Intensive Care, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Fabio Caramelli
- Paediatric Anesthesia and Intensive Care, Azienda Ospedaliera-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Monica Fae
- Paediatric Anesthesia and Intensive Care, Azienda Ospedaliera-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Andrea Pettenazzo
- Paediatric Intensive Care, Azienda Ospedaliera Universitaria Padova, Padua, Italy
| | - Valentina Stritoni
- Paediatric Intensive Care, Azienda Ospedaliera Universitaria Padova, Padua, Italy
| | - Luigia D'Amato
- Paediatric Anesthesia and Intensive Care, Ospedale Pediatrico Santobbono, Napoli, Italy
| | | | - Edoardo Calderini
- Paediatric Anesthesia and Intensive Care, Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Alberto Berardi
- Neonatal Intensive Care, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Francesco Torcetta
- Neonatal Intensive Care, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Ezio Bonanomi
- Paediatric Anesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Daniele Bonacina
- Paediatric Anesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giorgio Ivani
- Paediatric Anesthesia and Intensive Care, Ospedale Infantile Regina Margherita Sant'Anna, Torino, Italy
| | - Pierantonio Santuz
- Department of Neonatal and Paediatric Critical Care, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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27
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Parri N, Magistà AM, Marchetti F, Cantoni B, Arrighini A, Romanengo M, Felici E, Urbino A, Da Dalt L, Verdoni L, Armocida B, Covi B, Mariani I, Giacchero R, Musolino AM, Binotti M, Biban P, Fasoli S, Pilotto C, Nicoloso F, Raggi M, Miorin E, Buonsenso D, Chiossi M, Agostiniani R, Plebani A, Barbieri MA, Lanari M, Arrigo S, Zoia E, Lenge M, Masi S, Barbi E, Lazzerini M. Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks. Eur J Pediatr 2020; 179:1315-1323. [PMID: 32495147 PMCID: PMC7269687 DOI: 10.1007/s00431-020-03683-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [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: 04/14/2020] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 02/07/2023]
Abstract
Detailed data on clinical presentations and outcomes of children with COVID-19 in Europe are still lacking. In this descriptive study, we report on 130 children with confirmed COVID-19 diagnosed by 28 centers (mostly hospitals), in 10 regions in Italy, during the first months of the pandemic. Among these, 67 (51.5%) had a relative with COVID-19 while 34 (26.2%) had comorbidities, with the most frequent being respiratory, cardiac, or neuromuscular chronic diseases. Overall, 98 (75.4%) had an asymptomatic or mild disease, 11 (8.5%) had moderate disease, 11 (8.5%) had a severe disease, and 9 (6.9%) had a critical presentation with infants below 6 months having significantly increased risk of critical disease severity (OR 5.6, 95% CI 1.3 to 29.1). Seventy-five (57.7%) children were hospitalized, 15 (11.5%) needed some respiratory support, and nine (6.9%) were treated in an intensive care unit. All recovered.Conclusion:This descriptive case series of children with COVID-19, mostly encompassing of cases enrolled at hospital level, suggest that COVID-19 may have a non-negligible rate of severe presentations in selected pediatric populations with a relatively high rates of comorbidities. More studies are needed to further understand the presentation and outcomes of children with COVID-19 in children with special needs. What is Known: • There is limited evidence on the clinical presentation and outcomes of children with COVID-19 in Europe, and almost no evidence on characteristics and risk factors of severe cases. What is New: • Among a case series of 130 children, mostly diagnosed at hospital level, and with a relatively high rate (26.2%) of comorbidities, about three-quarter had an asymptomatic or mild disease. • However, 57.7% were hospitalized, 11.5% needed some respiratory support, and 6.9% were treated in an intensive care unit.
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Affiliation(s)
- Niccolò Parri
- Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy
| | | | | | - Barbara Cantoni
- Healthcare Professional Department Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Arrighini
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | | | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Urbino
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Liviana Da Dalt
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua, Italy
| | - Lucio Verdoni
- Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Benedetta Armocida
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Benedetta Covi
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | | | - Anna Maria Musolino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Binotti
- Neonatal and Pediatric Intensive Care Unit, Maggiore della Carità University Hospital, Novara, Italy
| | - Paolo Biban
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
| | | | - Chiara Pilotto
- Division of Paediatrics, Department of Medicine DAME, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
| | | | | | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Anna Plebani
- Pediatric Emergency Unit, Filippo Del Ponte Hospital, ASST-Settelaghi, Varese, Italy
| | | | - Marcello Lanari
- Pediatric Emergency Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Serena Arrigo
- Department of Pediatrics, Hospital Filippo Del Ponte, Varese, Italy
| | - Elena Zoia
- Department of Pediatrics, Hospital V. Buzzi, Milan, Italy
| | - Matteo Lenge
- Clinical Trial Office, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Child Neurology Unit and Laboratories, Neuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
| | - Stefano Masi
- Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Department of Medicine, Surgery and Health Science, Department of Pediatrics, University of Trieste, Trieste, Italy
| | - Marzia Lazzerini
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - on behalf of the CONFIDENCE and COVID-19 Italian Pediatric Study Networks
- Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy
- Department of Pediatrics, Community Pediatrics, Ravenna, Italy
- Department of Pediatrics, Ravenna Hospital, Ravenna, Italy
- Healthcare Professional Department Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
- IRCCS Istituto Gaslini, Genoa, Italy
- Pediatric and Pediatric Emergency Unit, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua, Italy
- Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Department of Pediatrics, Lodi Hospital, Lodi, Italy
- Department of Pediatric Emergency Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Neonatal and Pediatric Intensive Care Unit, Maggiore della Carità University Hospital, Novara, Italy
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
- Paediatric Unit, Carlo Poma Hospital, Mantua, Italy
- Division of Paediatrics, Department of Medicine DAME, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
- Family Pediatrician, Udine, Italy
- ICU, Pain Therapy Unit, Rovereto Hospital, Trento, Italy
- Department of Pediatrics, Latisana-Palmanova, ASUFC, Udine, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Pediatrics, ASL 4 Liguria, Lavagna, Italy
- Department of Pediatrics, Ospedale San Jacopo, Pistoia, Italy
- Pediatric Emergency Unit, Filippo Del Ponte Hospital, ASST-Settelaghi, Varese, Italy
- Pediatric Emergency Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
- Department of Pediatrics, Hospital Filippo Del Ponte, Varese, Italy
- Department of Pediatrics, Hospital V. Buzzi, Milan, Italy
- Clinical Trial Office, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Child Neurology Unit and Laboratories, Neuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Department of Medicine, Surgery and Health Science, Department of Pediatrics, University of Trieste, Trieste, Italy
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Affiliation(s)
- Paolo Biban
- Department of Neonatal and Pediatric Critical Care, University Hospital of Verona, Verona, Italy
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Sfriso F, Biban P, Paglietti MG, Giuntini L, Rufini E, Mondardini MC, Zaglia F, Cutrera R, De Zan F, Amigoni A. Distribution and characteristics of Italian paediatric intermediate care units in Italy: A national survey. Acta Paediatr 2020; 109:1062-1063. [PMID: 31730257 DOI: 10.1111/apa.15091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Francesca Sfriso
- Department of Woman's and Child's Health University Hospital of Padova Padova Italy
| | - Paolo Biban
- Department of Neonatal and Paediatric Critical Care University Hospital of Verona Verona Italy
| | | | | | | | | | | | | | - Francesca De Zan
- Department of Woman's and Child's Health University Hospital of Padova Padova Italy
| | - Angela Amigoni
- Department of Woman's and Child's Health University Hospital of Padova Padova Italy
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Di Leo V, Biban P, Mercolini F, Martinolli F, Pettenazzo A, Perilongo G, Amigoni A. The quality of life in extracorporeal life support survivors: single-center experience of a long-term follow-up. Childs Nerv Syst 2019; 35:227-235. [PMID: 30415313 DOI: 10.1007/s00381-018-3999-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/19/2018] [Accepted: 10/31/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the health-related quality of life on a very long-term follow-up in patients treated with extracorporeal membrane oxygenation (ECMO) during neonatal and pediatric age. DESIGN Prospective follow-up study. SETTING Pediatric Intensive Care Unit of a tertiary-care University-Hospital. PATIENTS Out of 20 neonates and 21 children treated with ECMO in our center, 24 patients underwent short-term neurological follow-up. Twenty of them underwent long-term neurological follow-up. INTERVENTION Short-term follow-up was performed at 18 months and consisted in clinical evaluation, electroencephalography, and neuroimaging. Long-term follow-up was performed in 2017, at the mean period 19.72 years from ECMO (median 20.75, range 11.50-24.08) and consisted in a standardized questionnaires self-evaluation (PedsQL 4.0 Generic Core Scale) of health-related quality of life and an interviewed about the presence of organ morbidity, school level, or work position. MEASUREMENTS AND MAIN RESULTS Sixty-one percent (25/41) of the patients survived within 30 days after ECMO treatment. Short-term follow-up was performed in 24 patients (1 patient but died before the evaluation): 21 patients (87%) showed a normal neurological status, and 3 developed severe disability. Long-term follow-up was performed in 20 long-term survivors (3 patients were not possible to be contacted and considered lost to follow-up): mean age of patients at long-term follow-up was 21.23 (median 20.96, range 13.33-35.58) years; 90% (18/20) of them have no disability with a complete normal quality of life and 95% have no cognitive impairment. CONCLUSIONS ECMO represents a life-saving treatment for infants and children with respiratory and/or heart failure; survivors show a good quality of life comparable to healthy peers.
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Affiliation(s)
- Valentina Di Leo
- Pediatric Intensive Care Unit, Woman's and Child's Health Department, University Hospital, Via Giustiniani 3, 35128, Padua, Italy
| | - Paolo Biban
- Neonatal and Pediatric Intensive Care Unit, Department of Pediatric, University Hospital, Verona, Italy
| | - Federico Mercolini
- Pediatric Intensive Care Unit, Woman's and Child's Health Department, University Hospital, Via Giustiniani 3, 35128, Padua, Italy
| | - Francesco Martinolli
- Pediatric Intensive Care Unit, Woman's and Child's Health Department, University Hospital, Via Giustiniani 3, 35128, Padua, Italy
| | - Andrea Pettenazzo
- Pediatric Intensive Care Unit, Woman's and Child's Health Department, University Hospital, Via Giustiniani 3, 35128, Padua, Italy
| | - G Perilongo
- Woman's and Child's Department, University Hospital, Padua, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Woman's and Child's Health Department, University Hospital, Via Giustiniani 3, 35128, Padua, Italy.
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Benini F, Castagno E, Barbi E, Congedi S, Urbino A, Biban P, Calistri L, Mancusi RL. Multicentre emergency department study found that paracetamol and ibuprofen were inappropriately used in 83% and 63% of paediatric cases. Acta Paediatr 2018; 107:1766-1774. [PMID: 29505669 DOI: 10.1111/apa.14306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 11/27/2017] [Accepted: 02/28/2018] [Indexed: 11/27/2022]
Abstract
AIM The Pain Practice in Italian Paediatric Emergency Departments assessed how appropriately analgesic drugs were being used by Italian clinicians, based on national paediatric pain guidelines. METHODS This was a retrospective study that involved 17 Italian members of the Pain In Pediatric Emergency Rooms group. It comprised patients up to the age of 14 years who came to hospital emergency departments with pain and were treated with paracetamol, ibuprofen or opioids, such as codeine, tramadol and morphine. RESULTS We studied 1471 patients who were given 1593 doses of analgesics. The median time to administration of analgesia was 25 minutes. Opioids were used in 13.5% of the children, and usage increased with age and with more severe clinical conditions, such as trauma: 1.6% of children under two years, 5.9% aged 3-10 and 8.0% aged 11-14. Inappropriate doses of paracetamol, ibuprofen and opioids were used in 83%, 63% and 33% of cases, respectively. The patient's age was a critical determinant of the correct analgesic dosage; for every one-year increase in the patient's age, the probability of appropriate prescriptions rose 14.8%. CONCLUSION The appropriate use of paracetamol and ibuprofen for paediatric pain in Italian emergency departments was very poor, but improved with age.
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Affiliation(s)
- Franca Benini
- Pediatric Pain and Palliative Care Service; Department of Women's and Children's Health; University Hospital; Padova Italy
| | - Emanuele Castagno
- S.C. Pediatria d'Urgenza - A.O.U. Città della Salute e della Scienza di Torino- Ospedale Infantile Regina Margherita Children's Hospital; Torino Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health (IRCCS) Burlo Garofolo; Trieste Italy
| | - Sabrina Congedi
- Pediatric Pain and Palliative Care Service; Department of Women's and Children's Health; University Hospital; Padova Italy
| | - Antonio Urbino
- S.C. Pediatria d'Urgenza - A.O.U. Città della Salute e della Scienza di Torino- Ospedale Infantile Regina Margherita Children's Hospital; Torino Italy
| | - Paolo Biban
- Emergency Unit; Department of Pediatrics; University Hospital; Verona Italy
| | - Lucia Calistri
- Department of Emergency Medicine; Anna Meyer Children's University Hospital; Firenze Italy
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Maguolo A, Antoniazzi F, Spano A, Fiorini E, Gaudino R, Mauro M, Cantalupo G, Biban P, Maitz S, Cavarzere P. Clinical pitfalls in the diagnosis of segmental overgrowth syndromes: a child with the c.2740G > A mutation in PIK3CA gene. Ital J Pediatr 2018; 44:110. [PMID: 30231930 PMCID: PMC6146629 DOI: 10.1186/s13052-018-0568-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/06/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overgrowth syndromes are known as a heterogeneous group of conditions characterized by a generalized or segmental, symmetric or asymmetric, overgrowth that may involve several tissues. These disorders, which present a wide range of phenotypic variability, are often caused by mosaic somatic mutations in the genes associated with the PI3K/AKT/mTOR cellular pathway, a signaling cascade that plays a key role in cellular growth. Overgrowth syndromes are frequently misdiagnosed. Given that they are also associated to an increased oncologic risk, it is important to distinguish the clinical characteristic of these disorders since the first months of life. CASE PRESENTATION We report the case of a seven-year-old male child with macrocephaly and right lateralized overgrowth, reported from birth. The patient arrived to our attention after an initial diagnosis of isolated benign macrocephaly was formulated at the age of 12 months. Afterwards, the child presented a moderate intellectual disability and pain episodes at right lower limb. We repeated a brain Magnetic Resonance Imaging that revealed ventriculomegaly, cerebellar tonsillar ectopia, a markedly thick corpus callosum, and white matter abnormalities. The diagnosis of segmental overgrowth syndrome was formulated according to the clinical presentation and confirmed by the finding of the variant c.2740G > A in the gene PIK3CA presented in somatic mosaicism. CONCLUSIONS Our patient is the first children with the c.2740G > A variant in PIK3CA gene reported in Italy. We underline the importance of the genotype-phenotype correlation in the diagnostic process of overgrowth syndromes and emphasize the strict correlation between the mutation c.2740G > A in the PIK3CA gene and the Megalencephaly-Capillary Malformation syndrome phenotype.
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Affiliation(s)
- Alice Maguolo
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Franco Antoniazzi
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy.,Regional Center for the Diagnosis and Treatment of Children and Adolescents Rare Skeletal Disorders, Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Alice Spano
- Medical Genetic Specialization, University of Milan, Milan, Italy
| | - Elena Fiorini
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Rossella Gaudino
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Margherita Mauro
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Paolo Biban
- Pediatric Intensive Care Unit, Universitary Hospital of Verona, Verona, Italy
| | - Silvia Maitz
- Clinical Pediatric Genetics Unit, Pediatrics Clinics, MBBM Foundation, S. Gerardo Hospital, Monza, Italy
| | - Paolo Cavarzere
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy.
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Stefana A, Padovani EM, Biban P, Lavelli M. Fathers' experiences with their preterm babies admitted to neonatal intensive care unit: A multi-method study. J Adv Nurs 2018; 74:1090-1098. [PMID: 29350787 DOI: 10.1111/jan.13527] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to investigate fathers' emotional experiences of their infant's preterm birth and subsequent stay in neonatal intensive care unit. BACKGROUND When a baby is born preterm, there is also the premature interruption of the process of preparation for fatherhood. As a result, the impact on fathers of the preterm birth can bring negative consequences for the development of father-infant relationship. DESIGN A multi-method approach was used which included ethnographic observation, semi-structured interviews with fathers, a self-report questionnaire and clinical information between September 2015-March 2017. METHOD Data were analysed using a mixed-method: a thematic analysis of data from the interviews and quantitative analyses to detect possible clusters of fathers' emotional experiences and associations between clusters and fathers' and/or infants' characteristics. RESULTS Two clusters were identified. The "fathers-of-preterm-infants" touched their baby as soon as they were given the opportunity and without fear that they would harm their infant. They were struck by their baby's physical appearance. In contrast, the "preterm fathers" preferred not to touch their baby when first given the chance, for fear of breaking/damaging/infecting her/him. They were struck both by the baby's physical appearance and by the technology/equipment around her/him and were afraid that their infant would die. All the "fathers-of-preterm-infants", but only just over half of the "preterm fathers", were actively engaged in their infant's care. Clusters were associated with the infant's gestational age. CONCLUSION Fathers of preterm infants should receive personalized support specifically addressed to them and based on the infant's gestational age.
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Affiliation(s)
- Alberto Stefana
- Department of Human Sciences, University of Verona, Verona, Italy
| | - Ezio Maria Padovani
- Neonatal and Pediatric Intensive Care Unit, University Hospital of Verona, Verona, Italy
| | - Paolo Biban
- Neonatal and Pediatric Intensive Care Unit, University Hospital of Verona, Verona, Italy
| | - Manuela Lavelli
- Department of Human Sciences, University of Verona, Verona, Italy
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Mazzaferri F, Cordioli M, Conti M, Storato S, Be G, Biban P, Concia E, Merighi M. Symptomatic congenital Cytomegalovirus deafness: the impact of a six-week course of antiviral treatment on hearing improvement. Infez Med 2017; 25:347-350. [PMID: 29286014] [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: 06/07/2023]
Abstract
Congenital Cytomegalovirus infection is the leading non-genetic cause of neurosensory deafness. We compared the outcomes of a treated group of children to an untreated group. The effect of antiviral therapy on hearing improvement between baseline and 2-year follow-up was statistically significant. These results suggest that the benefit of 6-week therapy is not limited to preventing further hearing deterioration.
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Affiliation(s)
- Fulvia Mazzaferri
- Diagnostic and Public Health Department, Infectious Diseases and Tropical Medicine Section, University of Verona, Verona, Italy
| | - Maddalena Cordioli
- Diagnostic and Public Health Department, Infectious Diseases and Tropical Medicine Section, University of Verona, Verona, Italy
| | - Michela Conti
- Diagnostic and Public Health Department, Infectious Diseases and Tropical Medicine Section, University of Verona, Verona, Italy
| | - Silvia Storato
- Diagnostic and Public Health Department, Infectious Diseases and Tropical Medicine Section, University of Verona, Verona, Italy
| | - Giorgia Be
- Diagnostic and Public Health Department, Infectious Diseases and Tropical Medicine Section, University of Verona, Verona, Italy
| | - Paolo Biban
- Neonatal Intensive Care Unit, Verona University Hospital, Verona, Italy
| | - Ercole Concia
- Diagnostic and Public Health Department, Infectious Diseases and Tropical Medicine Section, University of Verona, Verona, Italy
| | - Mara Merighi
- Diagnostic and Public Health Department, Infectious Diseases and Tropical Medicine Section, University of Verona, Verona, Italy
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Marchetti F, Bonati M, Maestro A, Zanon D, Rovere F, Arrighini A, Barbi E, Bertolani P, Biban P, Da Dalt L, Guala A, Mazzoni E, Pazzaglia A, Perri PF, Reale A, Renna S, Urbino AF, Valletta E, Vitale A, Zangardi T, Clavenna A, Ronfani L. Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial. PLoS One 2016; 11:e0165441. [PMID: 27880811 PMCID: PMC5120790 DOI: 10.1371/journal.pone.0165441] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/07/2016] [Indexed: 01/28/2023] Open
Abstract
The use of antiemetics for vomiting in acute gastroenteritis in children is still a matter of debate. We conducted a double-blind randomized trial to evaluate whether a single oral dose of ondansetron vs domperidone or placebo improves outcomes in children with gastroenteritis. After failure of initial oral rehydration administration, children aged 1–6 years admitted for gastroenteritis to the pediatric emergency departments of 15 hospitals in Italy were randomized to receive one oral dose of ondansetron (0.15 mg/kg) or domperidone (0.5 mg/kg) or placebo. The primary outcome was the percentage of children receiving nasogastric or intravenous rehydration. A p value of 0.014 was used to indicate statistical significance (and 98.6% CI were calculated) as a result of having carried out two interim analyses. 1,313 children were eligible for the first attempt with oral rehydration solution, which was successful for 832 (63.4%); 356 underwent randomization (the parents of 125 children did not give consent): 118 to placebo, 119 to domperidone, and 119 to ondansetron. Fourteen (11.8%) needed intravenous rehydration in the ondansetron group vs 30 (25.2%) and 34 (28.8%) in the domperidone and placebo groups, respectively. Ondansetron reduced the risk of intravenous rehydration by over 50%, both vs placebo (RR 0.41, 98.6% CI 0.20–0.83) and domperidone (RR 0.47, 98.6% CI 0.23–0.97). No differences for adverse events were seen among groups. In a context of emergency care, 6 out of 10 children aged 1–6 years with vomiting due to gastroenteritis and without severe dehydration can be managed effectively with administration of oral rehydration solution alone. In children who fail oral rehydration, a single oral dose of ondansetron reduces the need for intravenous rehydration and the percentage of children who continue to vomit, thereby facilitating the success of oral rehydration. Domperidone was not effective for the symptomatic treatment of vomiting during acute gastroenteritis.
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Affiliation(s)
- Federico Marchetti
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo”, Trieste, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Alessandra Maestro
- Pharmacy and Clinical Pharmacology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo”, Trieste, Italy
| | - Davide Zanon
- Pharmacy and Clinical Pharmacology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo”, Trieste, Italy
| | - Francesca Rovere
- Pharmacy and Clinical Pharmacology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo”, Trieste, Italy
| | - Alberto Arrighini
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, A.O. Spedali Civili, Brescia, Italy
| | - Egidio Barbi
- Pediatric Emergency Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo”, Trieste, Italy
| | - Paolo Bertolani
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Biban
- Pediatric Emergency Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Andrea Guala
- Department of Pediatrics, Ospedale Castelli, Verbania, Italy
| | - Elisa Mazzoni
- Department of Pediatrics, Ospedale Maggiore, Bologna, Italy
| | - Anna Pazzaglia
- Emergency Department, Pediatric Hospital A. Meyer, Firenze, Italy
| | | | - Antonino Reale
- Emergency Department, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - Salvatore Renna
- Emergency Room and Emergency Medicine Division, G. Gaslini Institute, Genova, Italy
| | | | - Enrico Valletta
- Department of Pediatrics, Ospedale G.B. Morgagni - L. Pierantoni, Forlì, Italy
| | - Antonio Vitale
- Department of Pediatrics and Pediatric Emergency, "San Giuseppe Moscati" National Hospital (AORN), Avellino, Italy
| | - Tiziana Zangardi
- Pediatric Emergency Department, Azienda Ospedaliera - University of Padova, Padova, Italy
| | - Antonio Clavenna
- Laboratory for Mother and Child Health, Department of Public Health, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo”, Trieste, Italy
- * E-mail:
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Rosati A, Ilvento L, L'Erario M, De Masi S, Biggeri A, Fabbro G, Bianchi R, Stoppa F, Fusco L, Pulitanò S, Battaglia D, Pettenazzo A, Sartori S, Biban P, Fontana E, Cesaroni E, Mora D, Costa P, Meleleo R, Vittorini R, Conio A, Wolfler A, Mastrangelo M, Mondardini MC, Franzoni E, McGreevy KS, Di Simone L, Pugi A, Mirabile L, Vigevano F, Guerrini R. Efficacy of ketamine in refractory convulsive status epilepticus in children: a protocol for a sequential design, multicentre, randomised, controlled, open-label, non-profit trial (KETASER01). BMJ Open 2016; 6:e011565. [PMID: 27311915 PMCID: PMC4916612 DOI: 10.1136/bmjopen-2016-011565] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Status epilepticus (SE) is a life-threatening neurological emergency. SE lasting longer than 120 min and not responding to first-line and second-line antiepileptic drugs is defined as 'refractory' (RCSE) and requires intensive care unit treatment. There is currently neither evidence nor consensus to guide either the optimal choice of therapy or treatment goals for RCSE, which is generally treated with coma induction using conventional anaesthetics (high dose midazolam, thiopental and/or propofol). Increasing evidence indicates that ketamine (KE), a strong N-methyl-d-aspartate glutamate receptor antagonist, may be effective in treating RCSE. We hypothesised that intravenous KE is more efficacious and safer than conventional anaesthetics in treating RCSE. METHODS AND ANALYSIS A multicentre, randomised, controlled, open-label, non-profit, sequentially designed study will be conducted to assess the efficacy of KE compared with conventional anaesthetics in the treatment of RCSE in children. 10 Italian centres/hospitals are involved in enrolling 57 patients aged 1 month to 18 years with RCSE. Primary outcome is the resolution of SE up to 24 hours after withdrawal of therapy and is updated for each patient treated according to the sequential method. ETHICS AND DISSEMINATION The study received ethical approval from the Tuscan Paediatric Ethics Committee (12/2015). The results of this study will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NCT02431663; Pre-results.
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Affiliation(s)
- Anna Rosati
- Paediatric Neurology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Lucrezia Ilvento
- Paediatric Neurology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | | | - Annibale Biggeri
- Department of Statistics, ‘G Parenti’, University of Florence, Florence, Italy
| | - Giancarlo Fabbro
- Department of Statistics, ‘G Parenti’, University of Florence, Florence, Italy
| | - Roberto Bianchi
- Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Stoppa
- DEA Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lucia Fusco
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Domenica Battaglia
- Department of Child Neurology and Psychiatry, Catholic University, Rome, Italy
| | - Andrea Pettenazzo
- Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Stefano Sartori
- Paediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Paolo Biban
- Department of Neonatal and Paediatric Intensive Care, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elena Fontana
- Unit of Child Neuropsychiatry, University of Verona, Verona, Italy
| | - Elisabetta Cesaroni
- Child Neuropsychiatry Unit, Polytechnic University of the Marche, Ancona, Italy
| | - Donatella Mora
- Intensive Care Unit, Polytechnic University of the Marche, Ancona, Italy
| | - Paola Costa
- Intensive Care Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Rosanna Meleleo
- Department of Neuropsychiatry Ward, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Roberta Vittorini
- Department of Paediatric Neurology, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Alessandra Conio
- Paediatric Intensive Care Unit, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Andrea Wolfler
- Department of Anaesthesia and Intensive Care, Women and Children's Hospital Vittore Buzzi, ICP, Milan, Italy
| | - Massimo Mastrangelo
- Paediatric Neurology Unit, Women and Children's Hospital Vittore Buzzi, ICP, Milan, Italy
| | - Maria Cristina Mondardini
- Department of Paediatric Anaesthesia and Intensive Care, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Emilio Franzoni
- Child Neuropsychiatry Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Kathleen S McGreevy
- Research, Innovation and International Relations, Meyer Children's Hospital, Florence, Italy
| | | | - Alessandra Pugi
- Clinical Trial Office Meyer Children's Hospital, Florence, Italy
| | | | - Federico Vigevano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Renzo Guerrini
- Paediatric Neurology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
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Benini F, Piga S, Zangardi T, Messi G, Tomasello C, Pirozzi N, Cuttini M, ocerino A, Crichiutti G, Barbi E, Biban P, Ghizzi C, Benedetti M, rrighini A, Podestà AF, Scalfaro C, Stringhi C, Rotta S, Salvo IRD, Fossali E, rbino A, Taglietto M, Marciano C, Piccotti E, Manfredini L, Mannelli F, Messeri A, Cardoni G, Piattellini GM, Midulla F, Chiaretti A, Campa A, Borrometi F, Maremonti P, Grandolfo R, Fucà F, Parrino R. Nationwide study of headache pain in Italy shows that pain assessment is still inadequate in paediatric emergency care. Acta Paediatr 2016; 105:e200-8. [PMID: 26792256 PMCID: PMC4825404 DOI: 10.1111/apa.13335] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 07/29/2015] [Revised: 10/21/2015] [Accepted: 01/15/2016] [Indexed: 11/29/2022]
Abstract
Aim Italian national guidelines on pain management were published in 2010, but there is little information on how effective pain management is in paediatric emergency care, with other countries reporting poor levels. Using headache as an indicator, we described pain assessment in Italian emergency departments and identified predictors of algometric scale use. Methods All Italian paediatric and maternal and child hospitals participated, plus four general hospitals. Data on all children aged 4–14 years admitted during a one‐month period with headache as their chief complaint were abstracted from clinical records. Multivariable analyses identified predictors of algometric assessment, taking into account the cluster study design. Results We studied 470 admissions. During triage, pain was assessed using a standardised scale (41.5%), informally (15.5%) or was not recorded (42.9%). Only 32.1% of the children received analgesia in the emergency department. The odds ratios for predictors of algometric assessment were non‐Italian nationality (3.6), prehospital medication (1.8), admission to a research hospital (7.3) and a more favourable nurses‐to‐admissions ratio of 10.8 for the highest versus lowest tertile. Conclusion Despite national guidelines, paediatric pain assessment in Italian emergency care was suboptimal. Hospital variables appeared to be stronger predictors of adequate assessment than patient characteristics.
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Affiliation(s)
- Franca Benini
- Paediatric Department University Hospital Padova Italy
| | - Simone Piga
- Unit of Epidemiology Bambino Gesù Children's Hospital Rome Italy
| | - Tiziana Zangardi
- Department of Emergency Medicine University Hospital Padova Italy
| | - Gianni Messi
- Department of Emergency Medicine Burlo Garofolo Children's Hospital Trieste Italy
| | - Caterina Tomasello
- Department of Emergency Medicine Bambino Gesù Children's Hospital Rome Italy
| | - Nicola Pirozzi
- Department of Emergency Medicine Bambino Gesù Children's Hospital Rome Italy
| | - Marina Cuttini
- Research Unit of Perinatal Epidemiology Bambino Gesù Children's Hospital Rome Italy
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Segatti A, Alessandrini L, Zanelli S, Santuz P, Biban P, Luciani G, Squintani G, Donato F, Romito S. 117. Phrenic nerve palsy in pediatric heart surgery: The neurophysiological contribution in follow up and decision making. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.09.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Marchisio P, Bianchini S, Villani A, Verri G, Bernardi F, Porta A, Biban P, Caimmi S, Iughetti L, Krzysztofiak A, Garazzino S, Romanin B, Salvini F, Lancella L, Landini S, Galeone C, Esposito S, Principi N. Diagnosis and management of acute mastoiditis in a cohort of Italian children. Expert Rev Anti Infect Ther 2015; 12:1541-8. [PMID: 25382701 DOI: 10.1586/14787210.2014.982093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 11/08/2022]
Abstract
OBJECTIVE The Italian Society for Pediatric Infectious Diseases created a registry to determine the management of pediatric acute mastoiditis (AM) in Italy. METHODS A cross-sectional survey of paediatricians was conducted to evaluate hospitalization due to AM in Italian pediatric wards between 1 January 2002, and 31 December 2013. RESULTS A total of 913 children (561 males, 61.4%) were included in this study. The annual number of AM cases significantly increased during the study period (30 in 2002 and 98 in 2013) but only among older children (≥ 4 years old; p = 0.02). AM complications occurred in 69 (7.6%) of the children and sequelae were observed in 13 (1.4%) patients. CONCLUSION The annual number of pediatric AM cases admitted to Italian pediatric wards increased in the past few years; this increase was strictly age-related. The risk of severe AM complications appeared relatively low, and most AM cases could be treated conservatively.
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Affiliation(s)
- Paola Marchisio
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
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Lista G, Boni L, Scopesi F, Mosca F, Trevisanuto D, Messner H, Vento G, Magaldi R, Del Vecchio A, Agosti M, Gizzi C, Sandri F, Biban P, Bellettato M, Gazzolo D, Boldrini A, Dani C. Sustained lung inflation at birth for preterm infants: a randomized clinical trial. Pediatrics 2015; 135:e457-64. [PMID: 25624390 DOI: 10.1542/peds.2014-1692] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [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: 11/24/2022] Open
Abstract
BACKGROUND Studies suggest that giving newly born preterm infants sustained lung inflation (SLI) may decrease their need for mechanical ventilation (MV) and improve their respiratory outcomes. METHODS We randomly assigned infants born at 25 weeks 0 days to 28 weeks 6 days of gestation to receive SLI (25 cm H2O for 15 seconds) followed by nasal continuous positive airway pressure (nCPAP) or nCPAP alone in the delivery room. SLI and nCPAP were delivered by using a neonatal mask and a T-piece ventilator. The primary end point was the need for MV in the first 72 hours of life. The secondary end points included the need for respiratory supports and survival without bronchopulmonary dysplasia (BPD). RESULTS A total of 148 infants were enrolled in the SLI group and 143 in the control group. Significantly fewer infants were ventilated in the first 72 hours of life in the SLI group (79 of 148 [53%]) than in the control group (93 of 143 [65%]); unadjusted odds ratio: 0.62 [95% confidence interval: 0.38-0.99]; P = .04). The need for respiratory support and survival without BPD did not differ between the groups. Pneumothorax occurred in 1% (n = 2) of infants in the control group compared with 6% (n = 9) in the SLI group, with an unadjusted odds ratio of 4.57 (95% confidence interval: 0.97-21.50; P = .06). CONCLUSIONS SLI followed by nCPAP in the delivery room decreased the need for MV in the first 72 hours of life in preterm infants at high risk of respiratory distress syndrome compared with nCPAP alone but did not decrease the need for respiratory support and the occurrence of BPD.
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Affiliation(s)
- Gianluca Lista
- Division of Neonatology, "V. Buzzi" Children's Hospital, ICP, Milan, Italy
| | - Luca Boni
- Clinical Trials Coordinating Center, Istituto Toscano Tumori, Florence, Department of Human Pathology and Oncology, University of Florence, Florence, Italy
| | - Fabio Scopesi
- Neonatal ICU (NICU), Istituto G. Gaslini, Genoa, Italy
| | - Fabio Mosca
- Neonatal ICU, Department of Mother and Infant Science, Fondazione IRCCS ''Ca' Granda'' Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | - Giovanni Vento
- Division of Neonatology, Catholic University of Rome, Italy
| | - Rosario Magaldi
- Division of Neonatology, Neonatal ICU, Ospedali Riuniti, Azienda Ospedaliero-Universitaria, Foggia, Italy
| | | | - Massimo Agosti
- Maternal and Child Health Department, Del Ponte Hospital, A.O. Di Circolo Fondazione Macchi, Varese, Italy
| | - Camilla Gizzi
- Division of Neonatology, S. Giovanni Calibita Hospital Fatebenefratelli, Isola Tiberina, Rome, Italy
| | - Fabrizio Sandri
- Maternal and Pediatrics Department, Maggiore Hospital, Bologna, Italy
| | - Paolo Biban
- Department of Pediatrics, Pediatric and Neonatal ICU, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Diego Gazzolo
- Department of Maternal Fetal and Neonatal Medicine, C. Arrigo Children's Hospital, Alessandria, Italy
| | - Antonio Boldrini
- Division of Neonatology and Neonatal ICU, S. Chiara Hospital, University of Pisa, Pisa, Italy; and
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy
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Cavarzere P, Biban P, Gaudino R, Perlini S, Sartore L, Chini L, Silvagni D, Antoniazzi F. Diagnostic pitfalls in the assessment of congenital hypopituitarism. J Endocrinol Invest 2014; 37:1201-9. [PMID: 25080869 DOI: 10.1007/s40618-014-0139-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The diagnosis of congenital hypopituitarism is difficult and often delayed because its symptoms are nonspecific. AIM To describe the different clinical presentations of children with congenital hypopituitarism to reduce the time for diagnosis and to begin a precocious and appropriate treatment. STUDY DESIGN We analyzed a cohort of five children with congenital hypopituitarism, describing their clinical, biochemical and radiological characteristics from the birth to diagnosis. RESULTS As first sign of the disease, all of five patients presented a neonatal hypoglycemia, associated in four cases with jaundice. In all these four cases, the clinicians hypothesized a metabolic disease delaying the diagnosis, which was performed in only two cases within the neonatal period. In the other three cases, the diagnosis was formulated at 2, 5 and 8 years of life because there was severe and precocious growth impairment. CONCLUSIONS It is important to suspect congenital hypopituitarism in the presence of persistent neonatal hypoglycemia associated with jaundice and of a precocious and severe reduction of the growth velocity in childhood. In all these cases, it is necessary to undertake a hypothalamic-pituitary magnetic resonance imaging scan as soon as possible, and to start appropriate treatment.
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Affiliation(s)
- Paolo Cavarzere
- Pediatric Division, Department of Pediatrics, Universitary Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy,
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Baraldi E, Lanari M, Manzoni P, Rossi GA, Vandini S, Rimini A, Romagnoli C, Colonna P, Biondi A, Biban P, Chiamenti G, Bernardini R, Picca M, Cappa M, Magazzù G, Catassi C, Urbino AF, Memo L, Donzelli G, Minetti C, Paravati F, Di Mauro G, Festini F, Esposito S, Corsello G. Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants. Ital J Pediatr 2014; 40:65. [PMID: 25344148 PMCID: PMC4364570 DOI: 10.1186/1824-7288-40-65] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 01/14/2023] Open
Abstract
Acute bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization in children less than 1 year of age worldwide. It is usually a mild disease, but some children may develop severe symptoms, requiring hospital admission and ventilatory support in the ICU. Infants with pre-existing risk factors (prematurity, bronchopulmonary dysplasia, congenital heart diseases and immunodeficiency) may be predisposed to a severe form of the disease. Clinical diagnosis of bronchiolitis is manly based on medical history and physical examination (rhinorrhea, cough, crackles, wheezing and signs of respiratory distress). Etiological diagnosis, with antigen or genome detection to identify viruses involved, may have a role in reducing hospital transmission of the infection. Criteria for hospitalization include low oxygen saturation (<90-92%), moderate-to-severe respiratory distress, dehydration and presence of apnea. Children with pre-existing risk factors should be carefully assessed. To date, there is no specific treatment for viral bronchiolitis, and the mainstay of therapy is supportive care. This consists of nasal suctioning and nebulized 3% hypertonic saline, assisted feeding and hydration, humidified O2 delivery. The possible role of any pharmacological approach is still debated, and till now there is no evidence to support the use of bronchodilators, corticosteroids, chest physiotherapy, antibiotics or antivirals. Nebulized adrenaline may be sometimes useful in the emergency room. Nebulized adrenaline can be useful in the hospital setting for treatment as needed. Lacking a specific etiological treatment, prophylaxis and prevention, especially in children at high risk of severe infection, have a fundamental role. Environmental preventive measures minimize viral transmission in hospital, in the outpatient setting and at home. Pharmacological prophylaxis with palivizumab for RSV bronchiolitis is indicated in specific categories of children at risk during the epidemic period. Viral bronchiolitis, especially in the case of severe form, may correlate with an increased incidence of recurrent wheezing in pre-schooled children and with asthma at school age. The aim of this document is to provide a multidisciplinary update on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications, identify gaps in knowledge and drive future research.
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Affiliation(s)
- Eugenio Baraldi
- SIMRI-Società Italiana per le Malattie Respiratorie Infantili, Italy.
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Gaffuri M, Cristofaletti A, Mansoldo C, Biban P. Acute onset of bilateral visual loss during sildenafil therapy in a young infant with congenital heart disease. BMJ Case Rep 2014; 2014:bcr-2014-204262. [PMID: 24895393 DOI: 10.1136/bcr-2014-204262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of posterior non-arteritic ischaemic optic neuropathy (NAION) causing bilateral visual loss in a 7-month-old female infant, after a therapeutic course with sildenafil, a phosphodiesterase type 5 inhibitors (PDE5i). The patient was affected by a complex cyanotic congenital heart defect and had undergone cavopulmonary anastomosis (Glenn operation) 3 months ago. After 2 months of recurring chylothorax, a course of oral sildenafil was administered, with the hypothesis that pulmonary vascular resistances were increased. Approximately 4 weeks later the acute onset of visual worsening and poor pupillary light reflex prompted the diagnosis of posterior NAION. Despite a rapid cessation of PDE5i and systemic treatment with corticosteroids, no visual recovery was noticed at 2-year follow-up. NAION has been associated with PDE5i therapy in adults, but to the best of our knowledge it is almost unheard of in children. We suggest close monitoring of visual function in children undergoing treatment with sildenafil.
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Affiliation(s)
- Marcella Gaffuri
- Department of Paediatrics, Neonatal and Paediatric Intensive Care, Verona, Italy
| | | | - Caterina Mansoldo
- Department of Ophtalmology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Paolo Biban
- Department of Neonatal and Paediatric Intensive Care, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Citti A, Peca D, Petrini S, Cutrera R, Biban P, Haass C, Boldrini R, Danhaive O. Ultrastructural characterization of genetic diffuse lung diseases in infants and children: a cohort study and review. Ultrastruct Pathol 2014; 37:356-65. [PMID: 24047351 DOI: 10.3109/01913123.2013.811454] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pediatric diffuse lung diseases are rare disorders with an onset in the neonatal period or in infancy, characterized by chronic respiratory symptoms and diffuse interstitial changes on imaging studies. Genetic disorders of surfactant homeostasis represent the main etiology. Surfactant protein B and ABCA3 deficiencies typically cause neonatal respiratory failure, which is often lethal within a few weeks or months. Although heterozygous ABCA3 mutation carriers are mostly asymptomatic, there is growing evidence that monoallelic mutations may affect surfactant homeostasis. Surfactant protein C mutations are dominant or sporadic disorders leading to a broad spectrum of manifestations from neonatal respiratory distress syndrome to adult pulmonary fibrosis. The authors performed pathology and ultrastructural studies in 12 infants who underwent clinical lung biopsy. One carried a heterozygous SP-B mutation, 3 carried SP-C mutations, and 7 carried ABCA3 mutations (5 biallelic and 2 monoallelic). Optical microscopy made it possible to distinguish between surfactant-related disorders and other forms. One of the ABCA3 monoallelic carriers had morphological features of alveolar capillary dysplasia, a genetic disorder of lung alveolar, and vascular development. One patient showed no surfactant-related anomalies but had pulmonary interstitial glycogenosis, a developmental disorder of unknown origin. Electron microscopy revealed specific lamellar bodies anomalies in all SP-B, SP-C, and ABCA3 deficiency cases. In addition, the authors showed that heterozygous ABCA3 mutation carriers have an intermediate ultrastructural phenotype between homozygous carriers and normal subjects. Lung biopsy is an essential diagnostic procedure in unexplained diffuse lung disorders, and electron microscopy should be performed systematically, since it may reveal specific alterations in genetic disorders of surfactant homeostasis.
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Argent AC, Biban P. What's new on NIV in the PICU: does everyone in respiratory failure require endotracheal intubation? Intensive Care Med 2014; 40:880-4. [PMID: 24711087 DOI: 10.1007/s00134-014-3274-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 03/17/2014] [Indexed: 01/26/2023]
Affiliation(s)
- Andrew C Argent
- School of Child and Adolescent Health, Institute of Child Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa,
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Abstract
Coma-induced blisters is a rare condition associated with prolonged impairment of conscious level, which is relatively well-known in adults following overdose with barbiturates. However, it has been very rarely described in children. A case of coma-bullae occurring in an 11-year-old child with meningoencephalitis is herein reported. The bullous lesions occurred on the limbs and trunks, and evolved into necrotic ulcers in a few days. No correlation with any drug overdosage was found. A skin biopsy revealed epidermal and eccrine sweat gland necrosis with abundant neutrophils, and thrombosis of the vessels in the lower dermis. A comprehensive review of the literature showed that only 5 cases of coma-bullae in children have been published so far. Coma blistering resolves spontaneously within days or weeks. Diagnosis of coma-bullae may require careful clinical-pathologic correlation to exclude other blistering diseases in children.
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Affiliation(s)
- Laura Bosco
- 1Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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Zampieri N, Pietrobelli A, Biban P, Soffiati M, Dall'agnola A, Camoglio FS. Lactobacillus paracasei subsp. paracasei F19 in Bell's stage 2 of necrotizing enterocolitis. Minerva Pediatr 2013; 65:353-360. [PMID: 24051968] [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: 06/02/2023]
Abstract
AIM The aim of this trial is to evaluate the role Lactobacillus paracasei in Bell's stage 2 in order to prevent the clinical progression to stage 3. METHODS A prospective study was approved and started in December 2008. Patients were infants with birth weight 600 to 1500 g. One group received probiotic supplementation (L. paracasei susp.paracasei F-19) and the control group received only standard medical treatment. The primary outcome was the progression to stage 3 as defined by Bell's modified criteria. Inclusion and exclusion criteria were created and discussed with parents before treatment. RESULTS Thirty-two patients (stage 2 NEC) were considered eligible for the study. Group A: 18 patients and Group B: 14 patients. Three patients in group A and six patients in group B had a clinical history of Bell's stage 3 NEC (P<0.05); oral supplementation of L. paracasei reduced the clinical progression of NEC. It was considered that an improvement in intestinal motility might have contributed to this result. CONCLUSION The use of Lactobacillus paracasei subsp. paracasei F-19 is safe; the low progression rate to stage 3 NEC suggests that the use of this probiotic in stage 2 NEC could be a valuable therapeutic option.
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Affiliation(s)
- N Zampieri
- Department of Anesthetic and Surgical Sciences Pediatric Surgical Unit University of Verona, Verona, Italy -
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Dani C, Lista G, Pratesi S, Boni L, Agosti M, Biban P, Del Vecchio A, Gazzolo D, Gizzi C, Magaldi R, Messner H, Mosca F, Sandri F, Scopesi F, Trevisanuto D, Vento G. Sustained lung inflation in the delivery room in preterm infants at high risk of respiratory distress syndrome (SLI STUDY): study protocol for a randomized controlled trial. Trials 2013; 14:67. [PMID: 23497495 PMCID: PMC3599289 DOI: 10.1186/1745-6215-14-67] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 07/16/2012] [Accepted: 02/19/2013] [Indexed: 12/04/2022] Open
Abstract
Background Some studies have suggested that the early sustained lung inflation (SLI) procedure is effective in decreasing the need for mechanical ventilation (MV) and improving respiratory outcome in preterm infants. We planned the present randomized controlled trial to confirm or refute these findings. Methods/Design In this study, 276 infants born at 25+0 to 28+6 weeks’ gestation at high risk of respiratory distress syndrome (RDS) will be randomized to receive the SLI maneuver (25 cmH2O for 15 seconds) followed by nasal continuous positive airway pressure (NCPAP) or NCPAP alone in the delivery room. SLI and NCPAP will be delivered using a neonatal mask and a T-piece ventilator. The primary endpoint is the need for MV in the first 72 hours of life. The secondary endpoints include the need and duration of respiratory support (NCPAP, MV and surfactant), and the occurrence of bronchopulmonary dysplasia (BPD). Trial registration Trial registration number:
NCT01440868
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Affiliation(s)
- Carlo Dani
- Department of Surgical and Medical Critical Care, Section of Neonatology, Careggi University Hospital, Viale Morgagni 85, Florence 50141, Italy.
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