@article {10750, title = {Administering analgesia sublingually is a suitable option for children with acute abdominal pain in the emergency department.}, journal = {Acta Paediatr}, volume = {108}, year = {2019}, month = {2019 Jan}, pages = {143-148}, abstract = {

AIM: Acute abdominal pain is a frequent complaint in children attending emergency departments. The aim of this study was to investigate the pain score reductions when children with acute abdominal pain received medication sublingually.

METHODS: We carried out a multicentre randomised controlled trial in three children{\textquoteright}s hospitals in Italy between March 2015 and June 2017. Children from four to 18~years of age with acute abdominal pain were recruited if their self-reported pain was at least six on a scale from 0-10. The children were randomised to receive ketorolac 0.5~mg/kg (n~=~70) or tramadol 2~mg/kg (n~=~70) sublingually or a melt in the mouth powder of 20~mg/kg paracetamol (n~=~70). The main study outcome was the pain scores for the three drugs after two hours.

RESULTS: The 210 children (58.6\% girls) had a median age of 12~years with an interquartile range of 9-14.3. The median pain scores at two hours were not significantly different between ketorolac 2.0 (interquartile ranges, IQR 0.0-4.3) and tramadol 3.0 (IQR 1.0-5.0) vs paracetamol 3.0 (IQR 0.8-5.0). The median pain reductions were all 5.0 points.

CONCLUSION: Delivering analgesia sublingually was a suitable option for pain relief in children with acute abdominal pain in the emergency department.

}, issn = {1651-2227}, doi = {10.1111/apa.14514}, author = {Cozzi, Giorgio and Zanchi, Chiara and Chiaretti, Antonio and Tipo, Vincenzo and Cernich, Marta and D{\textquoteright}Anna, Carolina and Fantacci, Claudia and Conversano, Ester and Zanon, Davide and Ronfani, Luca and Barbi, Egidio} } @article {10752, title = {Adolescent with painful vesicular otitis and vertigo.}, journal = {Arch Dis Child Educ Pract Ed}, volume = {104}, year = {2019}, month = {2019 Apr}, pages = {103-105}, issn = {1743-0593}, doi = {10.1136/archdischild-2017-313883}, author = {Conversano, Ester and Cozzi, Giorgio and Poropat, Federico and Di Mascio, Alberto and Salis, Simona and Grasso, Domenico Leonardo and Barbi, Egidio} } @article {10777, title = {Facing somatic symptom disorder in the emergency department.}, journal = {J Paediatr Child Health}, volume = {55}, year = {2019}, month = {2019 Jan}, pages = {7-9}, abstract = {

Somatic symptom disorder is a condition in which a patient{\textquoteright}s subjective report of physical symptoms is associated with distress; disruption of day-to-day functioning; or disproportionate thoughts, feelings and behaviours regarding the symptoms, whether or not they are associated with an identified medical condition. While somatic symptom disorder affects a considerable proportion of children and adolescents presenting to the emergency department (ED), it has not been well investigated in the ED literature, nor is there much formal training in, or guidelines for, how to care for affected patients in the ED. The aim of this paper is to highlight the historical clues commonly reported by these patients in order to try to help the emergency physicians recognise patients affected by a somatic symptom disorder. Adolescent age, the presence of daily subjective symptoms presenting daily for weeks or months, a long medical history record, an extensive diagnostic workup and, most of all, disproportionate functional impairment related to the symptoms are all features strongly suggestive of this disorder. Emergency physicians should become used to taking advantage of these clues to formulate a positive diagnosis of somatic symptom disorder according to the most recent diagnostic criteria. Emergency physicians have the unique opportunity to contribute to the correct diagnosis and treatment of these patients and to have a positive impact on their prognosis.

}, issn = {1440-1754}, doi = {10.1111/jpc.14246}, author = {Cozzi, Giorgio and Barbi, Egidio} } @article {10844, title = {Retrospective study showed that palpitations with tachycardia on admission to a paediatric emergency department were related to cardiac arrhythmias.}, journal = {Acta Paediatr}, volume = {108}, year = {2019}, month = {2019 Feb}, pages = {328-332}, abstract = {

AIM: This retrospective study reviewed the prevalence and long-term prognosis of children aged 0-18 with palpitations who were admitted to the emergency department (ED) of an Italian paediatric hospital.

METHODS: We examined all admissions to the ED of the IRCCS Burlo Garofolo between January 2009 and December 2015 by selecting triage diagnoses of palpitations. The hospital discharge cards were reviewed to assess vital parameters, physical examinations, diagnostic tests, cardiology consultations and final diagnoses.

RESULTS: Of the 142 803 patients who attended our ED for any reason, 96 (0.07\%) complained of palpitations. Despite this low prevalence, it was noteworthy that 13.5\% had a real underlying arrhythmic cause and needed medical assistance. Over half (52.1\%) were women and the mean age was 12.7 years. At the long-term follow-up, at a mean of 47 {\textpm} 23 months, 53.8\% of patients with a cardiac arrhythmia had received medical therapy and 46.1\% had undergone trans-catheter ablation for supraventricular tachycardia. A heart rate above 146 beats per minute or palpitations for more than an hour was statistically related to a cardiac arrhythmia.

CONCLUSION: Palpitations were an infrequent cause of admission to our ED, but 13.5\% who displayed them had an underlying cardiac arrhythmia.

}, issn = {1651-2227}, doi = {10.1111/apa.14486}, author = {Bobbo, Marco and Amoroso, Stefano and Tamaro, Gianluca and Gesuete, Valentina and D{\textquoteright}agata Mottolese, Biancamaria and Barbi, Egidio and Ventura, Alessandro} } @article {10856, title = {When Long-Lasting Food Selectivity Leads to an Unusual Genetic Diagnosis: A Case Report.}, journal = {J Adolesc Health}, volume = {64}, year = {2019}, month = {2019 Jan}, pages = {137-138}, abstract = {

Hereditary fructose intolerance is an autosomal recessive disorder of fructose metabolism caused by catalytic deficiency of aldolase B enzyme [1]. The disease is typically expressed when fructose- and sucrose-containing foods are first introduced in the diet; acute manifestations include nausea, vomiting, abdominal distress, and symptomatic hypoglycemia [1,2]. Chronic fructose ingestion eventually leads to poor feeding, growth retardation and gradual liver and/or renal failure [3,4]. Some patients may remain undiagnosed until adulthood because of a self-protective avoidance of sweet tasting food that prevents the development of acute toxicity from fructose containing food; however, these subjects may suffer intermittent symptoms throughout life, leading to potentially serious misdiagnosis [4]. We report the case of a patient with unrecognized hereditary fructose intolerance in which chronic gastrointestinal complaints, low body weight, and unexplained food avoidance were addressed as manifestations of an eating disorder during adolescence.

}, issn = {1879-1972}, doi = {10.1016/j.jadohealth.2018.07.014}, author = {Da Lozzo, Prisca and Magnolato, Andrea and Del Rizzo, Irene and Sirchia, Fabio and Bruno, Irene and Barbi, Egidio} } @article {10749, title = {Acute small bowel obstruction in a child with a strict raw vegan diet.}, journal = {Arch Dis Child}, year = {2018}, month = {2018 May 14}, issn = {1468-2044}, doi = {10.1136/archdischild-2018-314910}, author = {Amoroso, Stefano and Scarpa, Maria-Grazia and Poropat, Federico and Giorgi, Rita and Murru, Flora Maria and Barbi, Egidio} } @article {10746, title = {Adenomyomatosis of the Gallbladder as a Cause of Recurrent Abdominal Pain.}, journal = {J Pediatr}, volume = {202}, year = {2018}, month = {2018 11}, pages = {328-328.e1}, keywords = {Abdominal Pain, Adenomyoma, Adolescent, Biopsy, Needle, Cholecystectomy, Diagnosis, Differential, Female, Gallbladder, Gallbladder Neoplasms, Humans, Immunohistochemistry, Recurrence, Risk Assessment, Severity of Illness Index, Ultrasonography, Doppler}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2018.05.020}, author = {Agrusti, Anna and Gregori, Massimo and Salviato, Tiziana and Codrich, Daniela and Barbi, Egidio} } @article {10751, title = {Adolescent with intermittent haematuria.}, journal = {Arch Dis Child Educ Pract Ed}, year = {2018}, month = {2018 May 10}, issn = {1743-0593}, doi = {10.1136/archdischild-2018-315049}, author = {Pillon, Roberto and Pennesi, Marco and Rabach, Ingrid and Barbi, Egidio} } @article {10756, title = {Anaphylaxis in atypical cold urticaria: case report and review of literature.}, journal = {Ital J Pediatr}, volume = {44}, year = {2018}, month = {2018 Nov 13}, pages = {135}, abstract = {

BACKGROUND: Cold-induced urticaria is a kind of physical urticaria characterized by the appearance of wheals after exposure to cold. The atypical form is a rare sub-type characterized by appearance of hives even in areas not directly exposed to the cold and by a negative cold stimulation test. Its diagnosis is often challenging because of the lack of specific tests and it is usually based on the patient{\textquoteright}s clinical history. Hypotension due to generalized exposure to the cold is described both in the typical and the atypical forms.

CASE PRESENTATION: We describe a 9-year-old boy who, at the beginning of the summer after the first swim in the sea, developed generalized urticaria, dyspnea, conjunctival hyperemia, blurred vision and loss of strength. The child was treated with intramuscular steroid and intravenous antihistamine, and the symptoms quickly resolved. Insect bite, contact with fish and drug ingestion were denied, and no unusual food had been eaten before the swim. A tentative diagnosis was made of either aquagenic urticaria or cold urticaria, but the specific tests were negative. Although the cause was unknown, prophylactic treatment with antihistamines was prescribed but in spite of this, wheals developed all over the body, after every swim in the sea. The child then came to our attention and relying on clinical history a diagnosis of atypical cold urticaria was made: development of hives even in areas not directly exposed to cold and a negative response to the cold stimulation test, are the characteristic features of this rare form of cold urticaria.

CONCLUSION: Atypical cold urticaria should be suspected in all cases of anaphylaxis related to cold exposure (i.e. contact with water) with a negative cold stimulation test.

}, keywords = {Anaphylaxis, Child, Cold Temperature, Humans, Male, Swimming, Urticaria}, issn = {1824-7288}, doi = {10.1186/s13052-018-0578-6}, author = {Benelli, Elisa and Longo, Giorgio and Barbi, Egidio and Berti, Irene} } @article {10760, title = {Boy with fish-mouth meatus.}, journal = {Arch Dis Child}, year = {2018}, month = {2018 Jun 14}, issn = {1468-2044}, doi = {10.1136/archdischild-2018-315360}, author = {Cortellazzo Wiel, Luisa and Pederiva, Federica and Castagnetti, Marco and Barbi, Egidio and Pennesi, Marco} } @article {10437, title = {A Child with Diminished Linear Growth and Waddling Gait.}, journal = {J Pediatr}, volume = {201}, year = {2018}, month = {2018 10}, pages = {297-297.e1}, keywords = {Abnormalities, Multiple, Child, Dwarfism, Female, Gait, Humans, Osteochondrodysplasias, Radiography}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2018.04.007}, author = {Tamaro, Gianluca and Pederiva, Federica and Dibello, Daniela and Gregori, Massimo and Carbone, Marco and Pantaleoni, Francesca and Dentici, Maria Lisa and Niceta, Marcello and Barbi, Egidio} } @article {10513, title = {Does the Application of Heat Gel Pack After Eutectic Mixture of Local Anesthetic Cream Improve Venipuncture or Intravenous Cannulation Success Rate in Children? A Randomized Control Trial.}, journal = {Pediatr Emerg Care}, volume = {34}, year = {2018}, month = {2018 Feb}, pages = {e24-e27}, abstract = {

OBJECTIVE: Needle-related procedures are the most common sources of pain for children in the hospital setting. The most used topical anesthetic, eutectic mixture of local anesthetic (EMLA) cream, may cause transient vasoconstriction. It has been postulated that this vasoconstriction may decrease vein visualization. The application of heat gel pack after removal of EMLA cream in the site of venipuncture counteracts the vasoconstriction, improving vein visualization. We assessed using a prospective randomized controlled trial whether the application of heat gel pack increases the needle procedure success rate. The primary study outcome was procedural success rate at the first attempt.

METHODS: The study enrolled 400 children, 200 of whom applied heat gel pack after removing EMLA (treatment group) and 200 did not (control group). Procedural success rate at the first attempt, vein perception before procedure, procedural pain, and adverse events were recorded in both groups.

RESULTS: Eighty-eight percent of the procedures were successful at the first attempt in the treatment group and 89\% in the control group (P = 0.876). Vein perception was not significantly different in the 2 groups (P = 0.081). Pain score after the procedure was similar in the 2 groups.

CONCLUSIONS: This study shows that the application of heat gel pack after removal of EMLA cream does not improve venipuncture or intravenous cannulation success rate.

}, keywords = {Anesthetics, Local, Child, Child, Preschool, Female, Hot Temperature, Humans, Lidocaine, Lidocaine, Prilocaine Drug Combination, Male, Pain, Pain Management, Phlebotomy, Prilocaine, Prospective Studies}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000001248}, author = {Schreiber, Silvana and Cozzi, Giorgio and Patti, Giuseppa and Taddio, Andrea and Montico, Marcella and Pierobon, Chiara and Barbi, Egidio} } @article {10434, title = {A Giant Ovarian Cyst in an Adolescent.}, journal = {J Pediatr}, volume = {199}, year = {2018}, month = {2018 08}, pages = {279}, keywords = {Child, Cystadenoma, Serous, Female, Humans, Ovarian Neoplasms}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2018.03.015}, author = {Corrias, Francesca and Pederiva, Federica and Cozzi, Giorgio and Ammar, Lydie and Cattaruzzi, Elisabetta and Lembo, Maria Antonietta and Barbi, Egidio} } @article {10447, title = {Girl With Chest Pain.}, journal = {Ann Emerg Med}, volume = {72}, year = {2018}, month = {2018 Aug}, pages = {e17-e18}, issn = {1097-6760}, doi = {10.1016/j.annemergmed.2018.03.010}, author = {Scarpa, Maria-Grazia and Rabach, Ingrid and Canuto, Arianna and Sanabor, Daniela and Barbi, Egidio and Schleef, Jurgen} } @article {10744, title = {A Girl with Delayed Puberty and Bumpy Lips.}, journal = {J Pediatr}, volume = {203}, year = {2018}, month = {2018 12}, pages = {454-454.e1}, keywords = {Adolescent, Exons, Female, Genes, Dominant, Humans, Lip, Multiple Endocrine Neoplasia Type 2b, Neoplasm Metastasis, Puberty, Delayed, Thyroid Neoplasms, Thyroidectomy, Tongue}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2018.05.043}, author = {Andrade, Stefanny and Sirchia, Fabio and Faleschini, Elena and Barbi, Egidio} } @article {10441, title = {Impact of near infrared light in pediatric blood drawing Centre on rate of first attempt success and time of procedure.}, journal = {Ital J Pediatr}, volume = {44}, year = {2018}, month = {2018 May 25}, pages = {60}, abstract = {

BACKGROUND: Peripheral blood access and venipuncture are a stressful and painful experience in pediatric patients; moreover, it is estimated that more than one attempt is required to achieve the procedure in about one third of children. For this reason, we investigated if Near-infrared light technology routinely used, could give an advantage to venipuncture in a pediatric blood center setting.

METHODS: We conducted an open, pseudo-randomized controlled trial with two parallel arms, in the blood-drawing center, with enrolment of 115 patients between 0 and 18~years, in 14 consecutive working days. Fifty-three subjects were enrolled in group 1 (VeinViewer{\textregistered}) and 62 in group 2 (control group). We divided patients into three subgroups considering their age (< 5~years, 6-10~years, > 10~years). The primary study outcome was to assess if the use of VeinViewer{\textregistered} was associated with a reduction of time to perform blood sampling. The secondary outcome was to analyze VienViewer{\textregistered}{\textquoteright}s impact on first attempt success rate in blood sampling.

RESULTS: No difference was found regarding the duration of blood sampling between the two groups, even after stratifying the patients into the three age subgroups. There was no difference between the two groups in the success at the first attempt in blood sampling.

CONCLUSIONS: Routine use of VeinViewer{\textregistered} is not useful to reduce time of the procedure during venipuncture.

TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov, with number NCT03277092 , on September 8, 2017.

}, keywords = {Adolescent, Age Factors, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Infrared Rays, Lighting, Male, Phlebotomy, Time Factors}, issn = {1824-7288}, doi = {10.1186/s13052-018-0501-1}, author = {Conversano, Ester and Cozzi, Giorgio and Pavan, Matteo and Minute, Marta and Gortan, Elena and Montico, Marcella and Vecchi Brumatti, Liza and Ronfani, Luca and Barbi, Egidio} } @article {10800, title = {Inclusion cyst of anterior fontanelle.}, journal = {Arch Dis Child}, year = {2018}, month = {2018 Aug 21}, issn = {1468-2044}, doi = {10.1136/archdischild-2018-315727}, author = {Udina, Chiara and Calligaris, Lorenzo and Berti, Irene and Cattaruzzi, Elisabetta and Barbi, Egidio} } @article {10804, title = {Intranasal dexmedetomidine, as midazolam-sparing drug, for MRI in preterm neonates.}, journal = {Paediatr Anaesth}, volume = {28}, year = {2018}, month = {2018 08}, pages = {747-748}, issn = {1460-9592}, doi = {10.1111/pan.13454}, author = {Bua, Jenny and Massaro, Marta and Cossovel, Francesca and Monasta, Lorenzo and Brovedani, Pierpaolo and Cozzi, Giorgio and Barbi, Egidio and Demarini, Sergio and Travan, Laura} } @article {10429, title = {A Klinefelter boy with congenital adrenal hyperplasia: too much or too little androgens?}, journal = {Ital J Pediatr}, volume = {44}, year = {2018}, month = {2018 Apr 03}, pages = {43}, abstract = {

BACKGROUND: The simultaneous occurrence of Klinefelter Syndrome (KS) and Congenital Adrenal Hyperplasia (CAH) is an exceptional event: there are just three case reports (two children and a 51 years old man) describing males affected by both KS and 21OHD (21-hydroxylase deficiency) CAH, the first causing androgen deficiency, the latter leading to androgen excess.

CASE REPORT: We report the 4th case of association of KS and CAH in a young man with CAH with good androgen control and with normal secondary sex characteristics, whose Klinefelter syndrome was diagnosed because of reduced testicular volume. He was the first reported case of association of KS and CAH who started androgen replacement therapy in the pubertal age and whose pubertal development was described and followed up step by step.

CONCLUSION: In a boy with CAH and small testicular volume, it{\textquoteright}s important to consider that hypogonadism may be masked by the adrenal androgens excess and a karyotype should be performed once testicular adrenal rests have been ruled out.

}, keywords = {Adolescent, Adrenal Hyperplasia, Congenital, Androgens, Follow-Up Studies, Hormone Replacement Therapy, Humans, Klinefelter Syndrome, Male, Rare Diseases, Risk Assessment, Testis}, issn = {1824-7288}, doi = {10.1186/s13052-018-0485-x}, author = {Zanella, Giada and Tornese, Gianluca and Mascheroni, Elisabetta and Faleschini, Elena and Ventura, Alessandro and Barbi, Egidio} } @article {10818, title = {Multicentre emergency department study found that paracetamol and ibuprofen were inappropriately used in 83\% and 63\% of paediatric cases.}, journal = {Acta Paediatr}, volume = {107}, year = {2018}, month = {2018 Oct}, pages = {1766-1774}, 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{\textquoteright}s age was a critical determinant of the correct analgesic dosage; for every one-year increase in the patient{\textquoteright}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.

}, issn = {1651-2227}, doi = {10.1111/apa.14306}, author = {Benini, Franca and Castagno, Emanuele and Barbi, Egidio and Congedi, Sabrina and Urbino, Antonio and Biban, Paolo and Calistri, Lucia and Mancusi, Rossella Letizia} } @article {10821, title = {Needle-related pain and distress management during needle-related procedures in children with and without intellectual disability.}, journal = {Eur J Pediatr}, volume = {177}, year = {2018}, month = {2018 Dec}, pages = {1753-1760}, abstract = {

Children with intellectual disability frequently undergo needle-related procedures for diagnosis or treatment. Nevertheless, only a few studies deal with pain and distress management during the procedure in this population of children. This study aimed to investigate the number of anxiety and pain management techniques performed during needle procedure in children with intellectual disability (cases) compared to a population of children without intellectual disability (controls). This multicenter cohort study was performed from July 2016 to January 2018 in the pediatric ward of four urban hospitals in Italy. Eligible subjects were children with and without intellectual disability, from 4 to 17~years old, who needed venipuncture or intravenous cannulation for diagnosis or treatment. Use of topical anesthesia, distraction techniques, and physical or verbal comfort during procedures were recorded. Pain and anxiety scores were also recorded. Forty-seven cases and 94 controls were recruited. Three pain- and anxiety-relieving techniques were performed during the procedure in 12 (25\%) cases and in 10 controls (11\%); two techniques were performed in 23 (50\%) cases and in 26 (28\%) controls; 12 (25\%) cases and 52 (55\%) controls received only one.Conclusion: In this series, children with intellectual disability received significantly more relieving techniques, but experienced more pain and anxiety when compared to children without intellectual disability. What is Known: {\textbullet} Children with intellectual disability experience more episodes of pain than cognitively healthy ones, and almost 10\% of these episodes are due to medical procedures. What is New: {\textbullet} Children with intellectual disability despite receiving more relieving techniques during a needle-related procedure experienced more pain and anxiety when compared to healthy children.

}, keywords = {Adolescent, Anxiety, Child, Child, Preschool, Cohort Studies, Female, Humans, Intellectual Disability, Italy, Male, Pain Management, Pain Measurement, Pain, Procedural, Phlebotomy}, issn = {1432-1076}, doi = {10.1007/s00431-018-3237-4}, author = {Pascolo, Paola and Peri, Francesca and Montico, Marcella and Funaro, Mishelle and Parrino, Roberta and Vanadia, Francesca and Rusalen, Francesca and Vecchiato, Luca and Benini, Franca and Congedi, Sabrina and Barbi, Egidio and Cozzi, Giorgio} } @article {10826, title = {Off-label drugs use in pediatric palliative care.}, journal = {Ital J Pediatr}, volume = {44}, year = {2018}, month = {2018 Nov 29}, pages = {144}, abstract = {

BACKGROUND: Paediatric palliative care (PPC) aim to ensure the control of symptoms and the best possible quality of life for patients whose underlying disease, characterized by an unstoppable evolution and negative prognosis, no longer responds to specific treatments. The scientific evidence in this context are very deficient and, in order to obtain welfare objectives consistent with the situation, in the overwhelming majority of cases the prescription of drugs is off-label for indication of use and/or for age and/or for way of administration and/or formulation. The Agenzia Italiana del Farmaco - AIFA and the Italian Society of Palliative Care (Societ{\`a} Italiana di Cure Palliative - SICP), under a dedicated working group, wrote a document that collects the scientific evidence available to support the off-label use of medicines more frequently used in PPC. The goal is to certify the consolidated off-label use of these drugs and propose their use under the Law 648/96, in the absence of data from its pivotal clinical trials. Aim of the commentary is to report the conditions for this important work and to present the 10 drugs, usually used off-label in PPC and in pain therapy, now included in Law 648/96.

CONCLUSION: This work is deemed essential to resolve, at least in part, the lack of availability of medicines researched and approved.

}, issn = {1824-7288}, doi = {10.1186/s13052-018-0584-8}, author = {De Zen, Lucia and Marchetti, Federico and Barbi, Egidio and Benini, Franca} } @article {10829, title = {Pain Intensity and Risk of Bone Fracture in Children With Minor Extremity Injuries.}, journal = {Pediatr Emerg Care}, year = {2018}, month = {2018 Jan 23}, abstract = {

OBJECTIVES: Injuries are one of the most common causes of pediatric emergency department (ED) visit. The aim of this study was to investigate the relationship between the intensity of pain at the ED visit of children presenting with an extremity injury and the risk of fracture.

METHODS: We conducted a retrospective study, considering all patients presenting to the ED of a children{\textquoteright}s hospital in Italy, with an accidental extremity injury, between May and December 2015. We selected all children aged 8 to 17 years who underwent an x-ray. Children with major, multiple, or nonextremity injuries were excluded. Age, sex, spontaneous and palpation pain, local swelling, time between injury, and medical evaluation were recorded. Sensibility and specificity of spontaneous and palpation pain in detecting a fracture were calculated.

RESULTS: We reviewed 994 medical records; of these, 344 (34.6\%) reported a fracture. Children{\textquoteright}s median age was 12 years (interquartile range [IQR], 10-14). Median spontaneous pain at the ED visit was not significantly different between children with and without a fracture: 4.0 (1.0-6.0) and 5 (1.0-6.0), respectively (P = 0.129). Children with mild palpation pain and children without an increase of pain of at least 2 points between spontaneous and palpation pain were fractured in 3.2\% and 0.97\% of cases, respectively.

CONCLUSIONS: In this series, pain intensity in children with a minor extremity injury was not a good marker of fracture. Nevertheless, children with mild palpation pain or with a mild increase of pain between spontaneous and palpation pain had a low risk of fracture.

}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000001418}, author = {Zanchi, Chiara and Giangreco, Manuela and Ronfani, Luca and Germani, Claudio and Giorgi, Rita and Calligaris, Lorenzo and Norbedo, Stefania and Liccari, Giulio and Cozzi, Giorgio and Barbi, Egidio} } @article {10864, title = {Red Flags in Torticollis: A Historical Cohort Study.}, journal = {Pediatr Emerg Care}, volume = {34}, year = {2018}, month = {2018 Jul}, pages = {463-466}, abstract = {

OBJECTIVE: This study aimed to assess the spectrum of pathologies responsible for torticollis in children presenting to the emergency department and to evaluate the associated symptoms to determine clinical red flags for hospitalization.

METHODS: This was a historical retrospective cohort study. Medical records of children evaluated in our emergency department for torticollis from 2008 to 2013 were reviewed.

RESULTS: Among 392 identified patients, 61\% had postural torticollis,19.4\% infection related, 16.3\% traumatic, and 3.5\% other. Twenty-five patients (6.4\%) were hospitalized. Four variables were strongly and independently related to the severe outcome: fever, sore throat, headache, and age.

CONCLUSIONS: The association of 2 or 3 of these 4 features carried a risk of 32\% and 58\%, respectively, of having a severe illness.

}, keywords = {Adolescent, Child, Child, Preschool, Cohort Studies, Emergency Service, Hospital, Female, Hospitalization, Humans, Male, Retrospective Studies, Torticollis}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000001377}, author = {Starc, Meta and Norbedo, Stefania and Tubaro, Martina and Ronfani, Luca and Bassanese, Giulia and Barbi, Egidio} } @article {10848, title = {Teaching pain recognition through art: the Ramsay-Caravaggio sedation scale.}, journal = {Ital J Pediatr}, volume = {44}, year = {2018}, month = {2018 Jan 31}, pages = {20}, abstract = {

BACKGROUND: Clinical observation is a key component of medical ability, enabling immediate evaluation of the patient{\textquoteright}s emotional state and contributing to a clinical clue that leads to final decision making. In medical schools, the art of learning to look can be taught using medical humanities and especially visual arts. By presenting a Ramsay sedation score (RSS) integrated with Caravaggio{\textquoteright}s paintings during a procedural sedation conference for pediatric residents, we want to test the effectiveness of this approach to improve the quality of learning.

METHODS: In this preliminary study, we presented videos showing sedated pediatric patients in the setting of a procedural sedation lesson to two randomized groups of residents, one attending a lesson on RSS explained through the masterpieces of Caravaggio, the other without artistic support. A week later we tested their learning with ten multi-choice questions focused on theoretical questions about sedation monitoring and ten more questions focused on recognizing the appropriate RSS viewing the videos. The primary outcome was the comparison of the total number of RSS layers properly recognized in both groups. We also evaluated the appreciation of the residents of the use of works of art integrated with the lesson.

RESULTS: Eleven students were randomized to each group. Two residents in the standard lesson did not attend the test. The percentage of correct answers on the theoretical part was similar, 82\% in the art group and 89\% in the other (p > 0.05). No difference was found in the video recognition part of the RSS recognition test. Residents exposed to paintings shown great appreciation for the integration of the lesson with the Caravaggio{\textquoteright}s masterpieces.

CONCLUSIONS: Adding artwork to a standard medical conference does not improve the performance of student tests, although this approach has been greatly appreciated by residents.

}, keywords = {Clinical Competence, Conscious Sedation, Deep Sedation, Education, Medical, Graduate, Female, Hospitals, University, Humans, Internship and Residency, Italy, Male, Medicine in the Arts, Monitoring, Physiologic, Pain Measurement, Paintings, Pediatrics, Video Recording}, issn = {1824-7288}, doi = {10.1186/s13052-018-0453-5}, author = {Poropat, Federico and Cozzi, Giorgio and Magnolato, Andrea and Monasta, Lorenzo and Borrometi, Fabio and Krauss, Baruch and Ventura, Alessandro and Barbi, Egidio} } @article {10857, title = {Young Child in Respiratory Distress.}, journal = {Ann Emerg Med}, volume = {71}, year = {2018}, month = {2018 01}, pages = {17-53}, keywords = {Acute Disease, Child, Preschool, Female, Humans, Pulmonary Atelectasis, Radiography, Thoracic, Respiratory Insufficiency}, issn = {1097-6760}, doi = {10.1016/j.annemergmed.2017.07.004}, author = {Cozzi, Giorgio and Conversano, Ester and Cattaruzzi, Elisabetta and Barbi, Egidio} } @article {10559, title = {Acute Abdominal Pain: Recognition and Management of Constipation in the Emergency Department.}, journal = {Pediatr Emerg Care}, volume = {33}, year = {2017}, month = {2017 Oct}, pages = {e75-e78}, abstract = {

OBJECTIVE: The main aim of the study was to investigate the incidence and the clinically relevant features of functional constipation in patients evaluated for acute abdominal pain in a tertiary care pediatric emergency department.

METHODS: This is a retrospective study. We analyzed 4394 medical records and recorded the information (demographics, triage code, symptoms, medical history, physical evaluation, laboratory tests, radiological studies, procedures, and treatments) of all patients admitted for acute abdominal pain to the emergency department of the IRCCS Burlo Garofolo, Trieste, during 2010 to 2013.

RESULTS: In this study, a quarter of patients (1020) presenting in the emergency department with acute abdominal pain were affected by functional constipation. Acute pain associated with functional constipation is generally rated from moderate to severe, and the location of the pain on physical evaluation was not a sufficient criterion to guide diagnosis. Isolated vomiting may be present in a minority of cases. Digital rectal exploration was never performed; the majority of patients were treated by means of an enema with prompt relief. Six percent of patients with constipation underwent radiological studies.

CONCLUSIONS: This study confirms that the medical history provides a pivotal role in the diagnosis of functional constipation. Digital rectal exploration and x-rays should be avoided in this setting, whereas an enema plays a useful diagnostic and therapeutic role in our study patients.

}, keywords = {Abdominal Pain, Acute Pain, Adolescent, Child, Child, Preschool, Constipation, Emergency Service, Hospital, Enema, Female, Humans, Incidence, Infant, Male, Retrospective Studies}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000001039}, author = {Norbedo, Stefania and Bassanese, Giulia and Barbieri, Francesca and Barbi, Egidio} } @article {10531, title = {Authors{\textquoteright} Reply to M.S. Raghuraman: "Intranasal Dexmedetomidine for Procedural Sedation in Children, a Suitable Alternative to Chloral Hydrate".}, journal = {Paediatr Drugs}, volume = {19}, year = {2017}, month = {2017 08}, pages = {377}, keywords = {Administration, Intranasal, Child, Chloral Hydrate, Dexmedetomidine, Humans, Hypnotics and Sedatives, Infant}, issn = {1179-2019}, doi = {10.1007/s40272-017-0246-0}, author = {Cozzi, Giorgio and Norbedo, Stefania and Barbi, Egidio} } @article {10501, title = {A boy with fever and arthralgia.}, journal = {BMJ}, volume = {356}, year = {2017}, month = {2017 03 29}, pages = {j1347}, keywords = {Anti-Bacterial Agents, Anti-Inflammatory Agents, Non-Steroidal, Antibodies, Bacterial, Aortic Valve Insufficiency, Arthralgia, Child, Echocardiography, Echocardiography, Doppler, Color, Fever, Humans, Male, Mitral Valve Insufficiency, Rheumatic Fever, Rheumatic Heart Disease, Streptolysins}, issn = {1756-1833}, doi = {10.1136/bmj.j1347}, author = {Poropat, Federico and Pastore, Serena and Gesuete, Valentina and Barbi, Egidio} } @article {10528, title = {Children with cancer: a survey on the experience of Italian primary care pediatricians.}, journal = {Ital J Pediatr}, volume = {43}, year = {2017}, month = {2017 May 25}, pages = {48}, abstract = {

BACKGROUND: Cancer is the second cause of death in children and its diagnosis can be difficult, due to the presence of vague and non-specific symptoms. The primary care pediatrician is often involved in the diagnostic process, but no longer in child care once the treatment started. Care models involving both primary care pediatricians and oncologic referral centre highlighted a higher family satisfaction when they worked together. We conducted a survey on primary care pediatricians involved in childhood cancer in order to describe the actual situation.

METHODS: We conducted a retrospective survey enrolling primary care pediatricians from a north-eastern area of Italy. They received a questionnaire that consisted in two parts: the first one aimed to assess the physician{\textquoteright}s seniority and experience and the second one pertained to each case of cancer and explored the relationship between the pediatrician, the family and the referral centre, and pediatricians degree of satisfaction and emotional impact.

RESULTS: We obtained data from 79 pediatricians who described 150 cancer cases. In 99 cases the primary care pediatrician had visited the child at the onset of symptoms and had referred him to the hospital. In 89 cases, he understood the severity of the disease. In 53.3\% of cases the pediatrician was informed by the referral centre. The relationship between the pediatrician and child{\textquoteright}s family improved in 38\% of cases and this was related with their participation to the multidisciplinary meetings on child health.

CONCLUSIONS: Primary pediatricians{\textquoteright} sharing in the management of their patients with cancer was not satisfactory. Development of specific protocols targeted to an integrated care is needed to increase primary pediatricians{\textquoteright} involvement and families{\textquoteright} satisfactions.

}, keywords = {Child, Child, Preschool, Cross-Sectional Studies, Disease-Free Survival, Female, Humans, Italy, Male, Needs Assessment, Neoplasms, Outcome Assessment (Health Care), Pediatricians, Practice Patterns, Physicians{\textquoteright}, Prevalence, Primary Health Care, Retrospective Studies, Risk Assessment, Survival Analysis}, issn = {1824-7288}, doi = {10.1186/s13052-017-0365-9}, author = {Minute, Marta and Cozzi, Giorgio and Plotti, Chiara and Montanari, Giuseppe and Pecile, Paolo and Zanazzo, Giulio Andrea and Ventura, Alessandro and Barbi, Egidio} } @article {10536, title = {First-time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream.}, journal = {Acta Paediatr}, volume = {106}, year = {2017}, month = {2017 May}, pages = {773-778}, abstract = {

AIM: More than 50\% of children report apian during venepuncture or intravenous cannulation and using local anaesthetics before needle procedures can lead to different success rates. This study examined how many needle procedures were successful at the first attempt when children received either a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream.

METHODS: We conducted this multicentre randomised controlled trial at three tertiary-level children{\textquoteright}s hospitals in Italy in 2015. Children aged three to 10 years were enrolled in an emergency department, paediatric day hospital and paediatric ward and randomly allocated to receive a warm lidocaine and tetracaine patch or EMLA cream. The primary outcome was the success rate at the first attempt.

RESULTS: The analysis included 172 children who received a warm lidocaine and tetracaine patch and 167 who received an EMLA cream. The needle procedure was successful at the first attempt in 158 children (92.4\%) who received the warm patch and in 142 children (85.0\%) who received the cream (p = 0.03). The pain scores were similar in both groups.

CONCLUSION: This study showed that the first-time needle procedure success was 7.4\% higher in children receiving a warm lidocaine and tetracaine patch than EMLA cream.

}, keywords = {Anesthetics, Local, Catheterization, Peripheral, Child, Child, Preschool, Female, Hot Temperature, Humans, Lidocaine, Lidocaine, Prilocaine Drug Combination, Male, Pain, Phlebotomy, Prilocaine, Tetracaine}, issn = {1651-2227}, doi = {10.1111/apa.13764}, author = {Cozzi, Giorgio and Borrometi, Fabio and Benini, Franca and Neri, Elena and Rusalen, Francesca and Celentano, Loredana and Zanon, Davide and Schreiber, Silvana and Ronfani, Luca and Barbi, Egidio} } @article {10508, title = {Intranasal Dexmedetomidine for Procedural Sedation in Children, a Suitable Alternative to Chloral Hydrate.}, journal = {Paediatr Drugs}, volume = {19}, year = {2017}, month = {2017 Apr}, pages = {107-111}, abstract = {

Sedation is often required for children undergoing diagnostic procedures. Chloral hydrate has been one of the sedative drugs most used in children over the last 3 decades, with supporting evidence for its efficacy and safety. Recently, chloral hydrate was banned in Italy and France, in consideration of evidence of its carcinogenicity and genotoxicity. Dexmedetomidine is a sedative with unique properties that has been increasingly used for procedural sedation in children. Several studies demonstrated its efficacy and safety for sedation in non-painful diagnostic procedures. Dexmedetomidine{\textquoteright}s impact on respiratory drive and airway patency and tone is much less when compared to the majority of other sedative agents. Administration via the intranasal route allows satisfactory procedural success rates. Studies that specifically compared intranasal dexmedetomidine and chloral hydrate for children undergoing non-painful procedures showed that dexmedetomidine was as effective as and safer than chloral hydrate. For these reasons, we suggest that intranasal dexmedetomidine could be a suitable alternative to chloral hydrate.

}, keywords = {Administration, Intranasal, Child, Chloral Hydrate, Dexmedetomidine, Humans, Hypnotics and Sedatives}, issn = {1179-2019}, doi = {10.1007/s40272-017-0217-5}, author = {Cozzi, Giorgio and Norbedo, Stefania and Barbi, Egidio} } @article {10567, title = {Intranasal Dexmedetomidine Sedation as Adjuvant Therapy in Acute Asthma Exacerbation With Marked Anxiety and Agitation.}, journal = {Ann Emerg Med}, volume = {69}, year = {2017}, month = {2017 01}, pages = {125-127}, abstract = {

We describe 2 patients with acute asthma exacerbation who were admitted to the emergency department (ED) with severe~agitation and restlessness as a prominent finding, for which bedside asthma treatment sedation with intranasal dexmedetomidine was performed. In both cases, dexmedetomidine allowed the patients to rest and improved tolerance to treatment. Dexmedetomidine is a unique sedative with an excellent safety profile and minimal effect on respiratory function. These properties render it particularly promising for the management of severe agitation in children admitted to the ED with acute asthma exacerbation.

}, keywords = {Acute Disease, Administration, Intranasal, Anxiety, Asthma, Child, Preschool, Dexmedetomidine, Emergency Service, Hospital, Female, Humans, Hypnotics and Sedatives, Infant, Psychomotor Agitation}, issn = {1097-6760}, doi = {10.1016/j.annemergmed.2016.08.005}, author = {Cozzi, Giorgio and Lega, Sara and Giorgi, Rita and Barbi, Egidio} } @article {10519, title = {Mental Health Problems in Children and Adolescents in the Emergency Department: "The Times They Are A-Changin{\textquoteright}".}, journal = {Pediatr Emerg Care}, volume = {33}, year = {2017}, month = {2017 07}, pages = {e8}, keywords = {Adolescent, Child, Emergency Service, Hospital, Humans, Mental Disorders, Mental Health Services, Patient Admission}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000001193}, author = {Cozzi, Giorgio and Minute, Marta and Ventura, Giovanna and Barbi, Egidio} } @article {10573, title = {A premenarcheal girl with urogenital bleeding.}, journal = {Arch Dis Child}, volume = {102}, year = {2017}, month = {2017 May}, pages = {472}, issn = {1468-2044}, doi = {10.1136/archdischild-2016-311730}, author = {Lora, Angela and Scrimin, Federica and Taddio, Andrea and Ventura, Alessandro and Barbi, Egidio} } @article {10551, title = {Risk of hospitalisation after early-revisit in the emergency department.}, journal = {J Paediatr Child Health}, volume = {53}, year = {2017}, month = {2017 Sep}, pages = {850-854}, abstract = {

AIM: Early-revisits are frequent in the paediatric emergency department (ED) setting, but few data are available about early-revisited patients. The aim of this study was to investigate the hospitalisation rate of a population of early-revisited patients and to detect if an early-revisited patient was at risk of a more severe disease.

METHODS: Between June 2014 and January 2015, we conducted a retrospective cohort study, considering all patients presented to the ED of a tertiary level children{\textquoteright}s hospital in Italy. We selected all patients who were revisited within 72 h from the initial visit (study cohort), while all other patients accessed in the same period were considered the control cohort. The two cohorts were compared for age, gender, triage category, hospitalisation rate, diagnosis at admission and hospital length of stay.

RESULTS: In the study period, we reviewed 10 750 visits, of which 430 (4\%) were unplanned revisits for the same chief complaint within 72 h from the initial visit. Hospitalisation rate of early-revisited patients was significantly higher compared to control patients (8.4 vs. 2.9\%). Hospitalisation rate increases in parallel with the number of revisits, but in many cases, it was not directly related to a worst triage category, neither to a longer hospital length of stay.

CONCLUSION: Early revisited patients in the ED had a significantly higher risk of hospitalisation, but this risk was only partially related to their clinical conditions.

}, keywords = {Adolescent, Child, Child, Preschool, Emergency Service, Hospital, Female, Hospitalization, Humans, Infant, Italy, Male, Retrospective Studies, Risk Assessment, Tertiary Care Centers, Time Factors}, issn = {1440-1754}, doi = {10.1111/jpc.13561}, author = {Cozzi, Giorgio and Ghirardo, Sergio and Fiorese, Ilaria and Proietti, Ilaria and Monasta, Lorenzo and Minute, Marta and Barbi, Egidio and Calligaris, Lorenzo} } @article {10477, title = {Somatic symptom disorder was common in children and adolescents attending an emergency department complaining of pain.}, journal = {Acta Paediatr}, volume = {106}, year = {2017}, month = {2017 Apr}, pages = {586-593}, abstract = {

AIM: The aim of this study was to quantify the prevalence of somatic pain in a paediatric emergency department (ED).

METHODS: We conducted a prospective observational study using patients admitted to the ED of an Italian children{\textquoteright}s hospital between December 2014 and February 2015. We enrolled children aged 7-17 who turned up at the ED complaining of pain. Patients and parents were asked to fill in a questionnaire to allow the analysis of the patients{\textquoteright} medical history and provide contact details for follow-up. We divided the enrolled patients into four groups: post-traumatic pain, organic pain, functional pain and somatic pain. The questionnaire was used to define pain characteristics and to generate an impairment score.

RESULTS: Of the 713 patients who met inclusion criteria, 306 (42.9\%) were enrolled in the study. Of these, 135 (44.0\%) suffered from post-traumatic pain, 104 (34.0\%) from organic pain, 41 (13.4\%) from functional pain and 26 (8.6\%) from somatic pain. Somatic pain patients had endured pain longer, had missed more school days and had suffered severe functional impairment.

CONCLUSION: This study highlighted that somatic pain was a significant contributor to paediatric emergency room visits and should be suspected and diagnosed in children reporting pain.

}, keywords = {Adolescent, Child, Emergency Service, Hospital, Female, Humans, Italy, Male, Medically Unexplained Symptoms, Pain, Prospective Studies}, issn = {1651-2227}, doi = {10.1111/apa.13741}, author = {Cozzi, Giorgio and Minute, Marta and Skabar, Aldo and Pirrone, Angela and Jaber, Mohamad and Neri, Elena and Montico, Marcella and Ventura, Alessandro and Barbi, Egidio} } @article {10478, title = {A Teenager with Sudden Unilateral Breast Enlargement.}, journal = {J Pediatr}, volume = {182}, year = {2017}, month = {2017 03}, pages = {394}, keywords = {Bullying, Child, Gynecomastia, Hematoma, Humans, Male, Wounds, Nonpenetrating}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2016.11.044}, author = {Pellegrin, Maria Chiara and Naviglio, Samuele and Cattaruzzi, Elisabetta and Barbi, Egidio and Ventura, Alessandro} } @article {8309, title = {Acute lobar nephritis in children: Not so easy to recognize and manage.}, journal = {World J Clin Pediatr}, volume = {5}, year = {2016}, month = {2016 Feb 8}, pages = {136-42}, abstract = {

Acute lobar nephritis (ALN) is a localized non-liquefactive inflammatory renal bacterial infection, which typically involves one or more lobes. ALN is considered to be a midpoint in the spectrum of upper urinary tract infection, a spectrum ranging from uncomplicated pyelonephritis to intrarenal abscess. This condition may be difficult to recognize due to the lack of specific symptoms and laboratory findings. Therefore the disease is probably underdiagnosed. Computed tomography scanning represents the diagnostic gold standard for ALN, but magnetic resonance imagine could be considered in order to limit irradiation. The diagnosis is relevant since initial intravenous antibiotic therapy and overall length of treatment should not be shorter than 3 wk. We review the literature and analyze the ALN clinical presentation starting from four cases with the aim to give to the clinicians the elements to suspect and recognize the ALN in children.

}, issn = {2219-2808}, doi = {10.5409/wjcp.v5.i1.136}, author = {Bibalo, Cristina and Apicella, Andrea and Guastalla, Veronica and Marzuillo, Pierluigi and Zennaro, Floriana and Tringali, Carmela and Taddio, Andrea and Germani, Claudio and Barbi, Egidio} } @article {7693, title = {Current concepts in management of pain in children in the emergency department.}, journal = {Lancet}, volume = {387}, year = {2016}, month = {2016 Jan 2}, pages = {83-92}, abstract = {

Pain is common in children presenting to emergency departments with episodic illnesses, acute injuries, and exacerbation of chronic disorders. We review recognition and assessment of pain in infants and children and discuss the manifestations of pain in children with chronic illness, recurrent pain syndromes, and cognitive impairment, including the difficulties of pain management in these patients. Non-pharmacological interventions, as adjuncts to pharmacological management for acute anxiety and pain, are described by age and development. We discuss the pharmacological management of acute pain and anxiety, reviewing invasive and non-invasive routes of administration, pharmacology, and adverse effects.

}, keywords = {Acute Pain, Analgesics, Opioid, Anesthetics, Local, Anti-Inflammatory Agents, Non-Steroidal, Anxiety, Child, Emergency Medicine, Emergency Service, Hospital, Humans, Pain Management, Pediatrics, Stress, Psychological}, issn = {1474-547X}, doi = {10.1016/S0140-6736(14)61686-X}, author = {Krauss, Baruch S and Calligaris, Lorenzo and Green, Steven M and Barbi, Egidio} } @article {8489, title = {The Great Pretender: Pediatric Wandering Spleen: Two Case Reports and Review of the Literature.}, journal = {Pediatr Emerg Care}, year = {2016}, month = {2016 Feb 10}, abstract = {

Wandering spleen is a rare condition, typically not only due to embryological defects of the splenic ligaments, but also secondary to trauma and splenomegaly. The most common presentation is acute abdomen with a mobile abdominal mass or recurrent abdominal pain. However, the spleen may be temporary in its normal position, and patients could be asymptomatic. A familiarity, if present, strengthens the diagnostic suspect.Abdominal ultrasonography and computed tomography are the examination of choice, and the management is surgical.

}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000000642}, author = {Radillo, Lucia and Taddio, Andrea and Ghirardo, Sergio and Bramuzzo, Matteo and Pederiva, Federica and Maschio, Massimo and Barbi, Egidio} } @article {8347, title = {Hand-held computers can help to distract children undergoing painful venipuncture procedures.}, journal = {Acta Paediatr}, volume = {105}, year = {2016}, month = {2016 Aug}, pages = {930-4}, abstract = {

AIM: Needle-related procedures can be painful for children, and distraction provides ideal pain relief in blood-drawing centres. This study assessed the effectiveness of playing a computer game during venipuncture, compared with low-tech distraction by a nurse.

METHODS: We conducted this prospective, randomised controlled trial at the blood-drawing centre of a tertiary-level children{\textquoteright}s hospital in Italy. Half of the 200 children played Angry Birds on a hand-held computer while the other half were distracted by a second, specifically trained nurse who sang to them, read a book, blew bubbles or played with puppets. Pain was measured using a faces pain scale for children aged 4-7 years and a numeric scale for children aged 8-13 years.

RESULTS: The 200 children had a median age of eight years. Children reported significant pain in 16 cases (16\%) in the hand-held computer distraction group and in 15 cases (15\%) in the nurse-led low-tech distraction group (p = 0.85). The procedural success rate at the first attempt was not different in the two groups.

CONCLUSION: Playing a game on a hand-held computer meant that only one in six children reported pain during venipuncture, but it was not superior to being distracted by nurses.

}, issn = {1651-2227}, doi = {10.1111/apa.13454}, author = {Crevatin, Franca and Cozzi, Giorgio and Braido, Elena and Bertossa, Gabriella and Rizzitelli, Patrizia and Lionetti, Daniela and Matassi, Daniela and Calusa, Dorotea and Ronfani, Luca and Barbi, Egidio} } @article {8290, title = {A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children{\textquoteright}s anxiety and pain levels in emergency department.}, journal = {Eur J Pediatr}, volume = {175}, year = {2016}, month = {2016 May}, pages = {645-50}, abstract = {

UNLABELLED: The aim of the study is to investigate if the presence of medical clowns during painful procedures in the emergency department (ED) affects children{\textquoteright}s anxiety and pain. Forty children (4-11 years) admitted to the ED with the need of painful procedures were prospectively enrolled. They were randomly assigned to the clown group, where children interacted with clowns or to the control group in which they were entertained by parents and ED nurses. The children{\textquoteright}s anxiety was assessed by the Children{\textquoteright}s Anxiety and Pain Scales; pain was evaluated with the Numerical Rating Scale and Wong-Backer Scale, according to the children{\textquoteright}s age. Staff and clown{\textquoteright}s opinions were evaluated by means of dedicated questionnaires. Children{\textquoteright}s anxiety levels in the clown group were significantly lower than those compared with the control group, while children{\textquoteright}s pain levels did not change between the two groups.

CONCLUSION: The presence of clowns in the ED before and during painful procedures was effective in reducing children{\textquoteright}s anxiety.

WHAT IS KNOWN: {\textbullet} Anxiety and fear caused by medical procedures exacerbate children{\textquoteright}s pain and may interfere with the procedure. {\textbullet} To reduce anxiety, fear, and pain and to facilitate patient{\textquoteright}s evaluation, different non-pharmacological approaches have been proposed and positive effects of laughter and humor have been reported. What is New: {\textbullet} The presence of clowns in the waiting room and in the ED during medical evaluation and painful procedures helps to reduce children{\textquoteright}s anxiety.

}, issn = {1432-1076}, doi = {10.1007/s00431-015-2688-0}, author = {Felluga, Margherita and Rabach, Ingrid and Minute, Marta and Montico, Marcella and Giorgi, Rita and Lonciari, Isabella and Taddio, Andrea and Barbi, Egidio} } @article {8490, title = {Torticollis as the Presenting Sign of Cervical Spondylodiscitis.}, journal = {Pediatr Emerg Care}, year = {2016}, month = {2016 Feb 10}, abstract = {

Acquired torticollis is a common clinical finding in children evaluated in the pediatric emergency department. It may be the presentation symptom of different illnesses, such as trauma, muscle contraction, infections, or malignancies, and an accurate differential diagnosis is required to correctly identify the cause and choose the right treatment. Spondylodiscitis is a low-grade bacterial infection that involves intervertebral disks and the adjacent vertebral bodies. Spondylodiscitis of the cervical spine is unusual and may be a rare cause of torticollis. We report the case of a 4-year-old male patient admitted to the emergency department for a 5-day history of painful torticollis. Blood tests showed an elevated erythrocyte sedimentation rate. The radiograph of the cervical spine showed a thin fifth cervical soma. The magnetic resonance imaging of cervical spine showed the alteration of cervical vertebral bodies and intervertebral disks, suggesting the diagnosis of cervical spondylodiscitis. The patient recovered after endovenous antibiotic treatment. We suggest that cervical spondylodiscitis should be suspected and investigated by means of an magnetic resonance imaging in every case of unexplained torticollis with persisting symptoms.

}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000000643}, author = {Pizzol, Antonio and Bramuzzo, Matteo and Pillon, Roberto and Taddio, Andrea and Barbi, Egidio} } @article {3586, title = {Acute pseudotumoral hemicerebellitis in a child: a rare and distinct entity?}, journal = {J Child Neurol}, volume = {30}, year = {2015}, month = {2015 Mar}, pages = {496-9}, abstract = {

A pseudotumoral presentation of acute hemicerebellitis is rare in pediatric age. The authors report a new single case study of a 7-year-old child with pseudotumoral unilateral cerebellitis mimicking an intracranial tumor, which clinically presented itself with signs of intracranial hypertension and mild contralateral hemiparesis, completely recovered after anti-inflammatory therapy. Brain magnetic resonance imaging (MRI) was essential for the differential diagnosis between inflammatory and neoplastic processes. The literature highlighting specific clues about pseudotumoral hemicerebellitis as a distinct clinical and radiological entity is reviewed.

}, keywords = {Brain, Cerebellar Diseases, Child, Diagnosis, Differential, Encephalitis, Humans, Magnetic Resonance Imaging, Male}, issn = {1708-8283}, doi = {10.1177/0883073814545114}, author = {Alberini, Elena and Vellante, Valerio and Zennaro, Floriana and Calligaris, Lorenzo and Barbi, Egidio and Carrozzi, Marco and Devescovi, Raffaella} } @article {8042, title = {Analgesia by cooling vibration during venipuncture in children with cognitive impairment.}, journal = {Acta Paediatr}, year = {2015}, month = {2015 Sep 24}, abstract = {

AIM: Children with cognitive impairment experience pain more frequently than healthy children and are more likely to require venipuncture or intravenous cannulation for various procedures. They are frequently unable to report pain and often receive poor pain assessment and management. This study assessed the effectiveness of physical analgesia during vascular access in children with cognitive impairments.

METHODS: We conducted a prospective randomised controlled study at a tertiary-level children{\textquoteright}s hospital in Italy from April to May 2015 to assess whether a cooling vibration device called Buzzy decreased pain during venipuncture and intravenous cannulation in children with cognitive impairment. None of the children had verbal skills and the main cognitive impairments were cerebral palsy, epileptic encephalopathy and genetic syndromes.

RESULTS: We tested 70 children with a median age of nine years: 34 in the Buzzy group and 36 in the no-intervention group. Parents were trained in the use of the Noncommunicating Children{\textquoteright}s Pain Checklist - postoperative version scale, and they reported no or mild procedural pain in 32 cases (91.4\%) in the Buzzy group and in 22 cases (61.1\%) in the no-intervention group (p = 0.003).

CONCLUSION: Cooling vibration analgesia during vascular access reduced pain in children with cognitive impairment.

}, issn = {1651-2227}, doi = {10.1111/apa.13224}, author = {Schreiber, Silvana and Cozzi, Giorgio and Rutigliano, Rosaria and Assandro, Paola and Tubaro, Martina and Cortellazzo Wiel, Luisa and Ronfani, Luca and Barbi, Egidio} } @article {7689, title = {Appendicitis in children less than five years old: A challenge for the general practitioner.}, journal = {World J Clin Pediatr}, volume = {4}, year = {2015}, month = {2015 May 8}, pages = {19-24}, abstract = {

Acute appendicitis is one of the most common indications for abdominal surgery in pediatrics with peak incidence in the second decade of life. Acute appendicitis in the first years of life is an uncommon event. The clinical presentation is often varied and the diagnosis may be overshadowed by other medical conditions. Gastroenteritis is the most common misdiagnosis, with a history of diarrhea present in 33\% to 41\% of patients. Pain is the most common presenting symptom in children less than 5 years old, followed by vomiting, fever, anorexia and diarrhea. The most common physical sign is focal tenderness (61\% of the patients) followed by guarding (55\%), diffuse tenderness (39\%), rebound (32\%), and mass (6\%). Neonatal appendicitis is a very rare disease with high mortality; presenting symptoms are nonspecific with abdominal distension representing the main clinical presentation. The younger the patient, the earlier perforation occurs: 70\% of patients less than 3 years develop a perforation within 48 h of onset of symptoms. A timely diagnosis reduces the risk of complications. We highlight the epidemiology, pathophysiology, clinical signs and laboratory clues of appendicitis in young children and suggest an algorithm for early diagnosis.

}, issn = {2219-2808}, doi = {10.5409/wjcp.v4.i2.19}, author = {Marzuillo, Pierluigi and Germani, Claudio and Krauss, Baruch S and Barbi, Egidio} } @article {7780, title = {Different presentations of mevalonate kinase deficiency: a case series.}, journal = {Clin Exp Rheumatol}, volume = {33}, year = {2015}, month = {2015 May-Jun}, pages = {437-42}, abstract = {

OBJECTIVES: We aimed to raise awareness among paediatricians and physicians about this often misunderstood condition.

METHODS: We discussed the clinical profiles associated with late or wrong diagnosis of mevalonate kinase deficency (MKD) in a single centre case series.

RESULTS: We analysed the most common challenges and pitfalls that a clinician might face during the diagnostic process. Five main clinical profiles were characterised.

CONCLUSIONS: We propose a new perspective on MKD, suggesting that the presentation of this disease can vary from patient to patient.

}, keywords = {Age Factors, Bacterial Infections, Child, Child, Preschool, Diagnosis, Differential, Diagnostic Errors, Female, Genetic Predisposition to Disease, Humans, Infant, Inflammatory Bowel Diseases, Male, Mevalonate Kinase Deficiency, Phenotype, Predictive Value of Tests, Recurrence, Risk Factors, Sepsis, Vasculitis, Young Adult}, issn = {0392-856X}, author = {De Pieri, Carlo and Taddio, Andrea and Insalaco, Antonella and Barbi, Egidio and Lepore, Loredana and Ventura, Alessandro and Tommasini, Alberto} } @article {7768, title = {Fainting Starting Parenteral Nutrition.}, journal = {Pediatr Emerg Care}, volume = {31}, year = {2015}, month = {2015 Sep}, pages = {648}, abstract = {

Complications such as mechanical accidents, infections, and thrombosis are commonly described in the presence of a central venous catheter. We present a case of a boy who had fainting episodes due to dislocation of a central venous catheter.

}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000000387}, author = {Pederiva, Federica and Barbi, Egidio and Zennaro, Floriana and Neri, Elena} } @article {8082, title = {Nasal irrigation with saline solution significantly improves oxygen saturation in infants with bronchiolitis.}, journal = {Acta Paediatr}, year = {2015}, month = {2015 Nov 26}, abstract = {

AIM: Published guidelines do not recommend nasal irrigation in bronchiolitis, but it is common practice in Italy, despite a lack of data on its benefits or adverse effects. This single-blind, multicentre, randomised controlled trial compared nasal irrigation using either isotonic 0.9\% sodium chloride or hypertonic 3\% sodium chloride with simple supportive care in infants with bronchiolitis.

METHOD: We randomly assigned 133 Infants up one year of age, who were admitted to the emergency department with bronchiolitis and an oxygen saturation (SpO2) of between 88-94\%, to the isotonic (n=47), hypertonic (n=44) or standard care (n=42) groups. Variations in SpO2 and the wheeze, air exchange, respiratory rate, muscle use (WARM) respiratory distress score were recorded at zero, five, 15, 20 and 50 minutes.

RESULTS: Five minutes after the intervention, the median SpO2 value (95\%) in the isotonic group was higher than both the hypertonic (94\%) and the standard care (93\%) groups. The differences between the isotonic and standard treatment groups were statistically significant at each time point, while the hypertonic group only reached significantly higher values after 50 minutes. However, the WARM score did not improve.

CONCLUSION: A single nasal irrigation with saline solution significantly improved oxygen saturation in infants with bronchiolitis. This article is protected by copyright. All rights reserved.

}, issn = {1651-2227}, doi = {10.1111/apa.13282}, author = {Schreiber, Silvana and Ronfani, Luca and Ghirardo, Sergio and Minen, Federico and Taddio, Andrea and Jaber, Mohamad and Rizzello, Elisa and Barbi, Egidio} } @article {7763, title = {Normal saline flushes performed once daily maintain peripheral intravenous catheter patency: a randomised controlled trial.}, journal = {Arch Dis Child}, volume = {100}, year = {2015}, month = {2015 Jul}, pages = {700-3}, abstract = {

OBJECTIVE: Recent evidence supports the use of normal saline flushes in place of heparin to maintain the patency of peripheral intravenous locks (IVLs); however, there are no data regarding the recommended flush frequency.

STUDY DESIGN: This was an open, non-inferiority, randomised controlled trial. Children with IVLs, aged 1-17 years, were randomly assigned to receive saline flushing every 12 h (group A) or every 24 h (group B). The main outcome was the maintenance of catheter patency.

RESULTS: Four hundred patients were randomised; 198 subjects were analysed in the 12 h group and 199 in the 24 h group (three patients were lost at follow-up). Occlusion occurred in 15 children (7.6\%) in group A versus 9 (4.5\%) in group B (p=0.21). The difference in catheter patency was +3.1\% in favour of the 24 h group (95\% CI -1.6\% to 7.7\%), showing the non-inferiority of the 24 h procedure (the non-inferiority margin was set at -4\%). Catheter-related complications were not different between the two groups (12.1\% in group A vs 9.5\% in group B; p=0.42).

CONCLUSIONS: A flushing procedure with one flush per day allows maintenance of catheter patency without an increase in catheter-related complications. We propose a simplification of the flushing procedure with only one flush per day, thereby reducing costs (materials use and nursing time), labour and unnecessary manipulation of the catheters which can cause distress in younger children and their parents.

TRIAL REGISTRATION NUMBER: The study is registered in the international database ClinicalTrial.gov under registration number NCT02221024.

}, keywords = {Adolescent, Catheterization, Peripheral, Catheters, Indwelling, Child, Child, Preschool, Equipment Failure, Female, Humans, Infant, Male, Outcome Assessment (Health Care), Risk Assessment, Sodium Chloride, Therapeutic Irrigation}, issn = {1468-2044}, doi = {10.1136/archdischild-2014-307478}, author = {Schreiber, Silvana and Zanchi, Chiara and Ronfani, Luca and Delise, Anna and Corbelli, Alessandra and Bortoluzzi, Rosamaria and Taddio, Andrea and Barbi, Egidio} } @article {7735, title = {Ondasetron Is More Likely Than Ketamine to Cause Ventricular Tachycardia.}, journal = {Pediatr Emerg Care}, volume = {31}, year = {2015}, month = {2015 Aug}, pages = {e4}, keywords = {Anesthetics, Dissociative, Female, Humans, Ketamine, Tachycardia, Ventricular}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000000521}, author = {Marzuillo, Pierluigi and Rabach, Ingrid and Barbi, Egidio} } @article {7734, title = {Phleboliths as a marker of slow-flow venous malformation.}, journal = {Arch Dis Child}, volume = {100}, year = {2015}, month = {2015 Nov}, pages = {1012}, issn = {1468-2044}, doi = {10.1136/archdischild-2015-308935}, author = {Calligaris, Lorenzo and Berti, Irene and Barbi, Egidio} } @article {7778, title = {A Shining Scrotal Fountain.}, journal = {J Pediatr}, volume = {167}, year = {2015}, month = {2015 Jul}, pages = {205.e1}, keywords = {Child, Edema, Humans, Male, Penile Diseases, Scrotum}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2015.04.011}, author = {Copertino, Marco and Benelli, Elisa and Gregori, Massimo and Barbi, Egidio and Ventura, Alessandro} } @article {7777, title = {A young soccer player with sudden pain after kicking the ball.}, journal = {BMJ}, volume = {350}, year = {2015}, month = {2015}, pages = {h1944}, keywords = {Adolescent, Athletic Injuries, Emergency Medicine, Fractures, Bone, Humans, Ilium, Male, Soccer}, issn = {1756-1833}, doi = {10.1136/bmj.h1944}, author = {Lega, Sara and Rabach, Ingrid and Barbi, Egidio and Ventura, Alessandro} } @article {3515, title = {Acquired long QT syndrome: a focus for the general pediatrician.}, journal = {Pediatr Emerg Care}, volume = {30}, year = {2014}, month = {2014 Apr}, pages = {257-61}, abstract = {

Acquired long QT syndrome (LQTS) is a disorder of cardiac repolarization most often due to specific drugs, hypokalemia, or hypomagnesemia that may precipitate torsade de pointes and cause sudden cardiac death. Common presentations of the LQTS are palpitations, presyncope, syncope, cardiac arrest, and seizures. An abnormal 12-lead electrocardiogram obtained while the patient is at rest is the key to diagnosis. The occurrence of drug-induced LQTS is unpredictable in any given individual, but a common observation is that most patients have at least 1 identifiable risk factor in addition to drug exposure. The cornerstone of the management of acquired LQTS includes the identification and discontinuation of any precipitating drug and the correction of metabolic abnormalities, such as hypokalemia or hypomagnesemia. Most of the episodes of torsade de pointes are short-lived and terminate spontaneously. We propose a management protocol that could be useful for the daily practice in the emergency pediatric department to reduce the risk of acquired QT prolongation.

}, keywords = {Adolescent, Death, Sudden, Cardiac, Electrocardiography, Female, General Practitioners, Humans, Long QT Syndrome, Ondansetron, Risk Factors, Serotonin Antagonists}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000000108}, author = {Marzuillo, Pierluigi and Benettoni, Alessandra and Germani, Claudio and Ferrara, Giovanna and D{\textquoteright}Agata, Biancamaria and Barbi, Egidio} } @article {3501, title = {A boy with sudden headache.}, journal = {Pediatr Emerg Care}, volume = {30}, year = {2014}, month = {2014 Mar}, pages = {182-4}, abstract = {

Headache is a common presenting complaint in pediatric emergency departments. The goal of emergent evaluation is to identify those children with potentially life-threatening conditions. We present the case of an adolescent boy presenting with headache and hypertension who was diagnosed with a catecholamine-secreting abdominal paraganglioma. Genetic testing eventually led to the diagnosis of SDHB-related hereditary paraganglioma-pheochromocytoma syndrome. Alarm features ("red flags") in children presenting with headache are reviewed, as well as the main features of paragangliomas and the indications for genetic testing.

}, keywords = {Abdominal Neoplasms, Adolescent, Emergencies, Headache, Humans, Male, Paraganglioma}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000000090}, author = {Norbedo, Stefania and Naviglio, Samuele and Murru, Flora Maria and Cavallin, Roberta and Giurici, Nagua and Rabusin, Marco and Barbi, Egidio} } @article {3572, title = {A comparison of three scales for measuring pain in children with cognitive impairment.}, journal = {Acta Paediatr}, volume = {103}, year = {2014}, month = {2014 Nov}, pages = {e495-500}, abstract = {

AIM: Pain is a neglected problem in children with cognitive impairments, and few studies compare the clinical use of specific pain scales. We compared the Non-Communicating Children{\textquoteright}s Pain Checklist Postoperative Version (NCCPC-PV), the Echelle Douleur Enfant San Salvador (DESS) and the Children{\textquoteright}s Hospital of Eastern Ontario Pain Scale (CHEOPS). The first two were developed for children with cognitive impairment, and the third is a more general pain scale.

METHODS: Two external observers and the child{\textquoteright}s caregiver assessed 40 children with cognitive impairment for pain levels. We assessed inter-rater agreement, correlation, dependence on knowledge of the child{\textquoteright}s behaviour, simplicity and adequacy in pain rating according to the caregiver for all three scales.

RESULTS: The correlation between the NCCPC-PV and the DESS was strong (Spearman correlation coefficient = 0.76) and better than between each scale and the CHEOPS. Although the DESS showed better inter-rater agreement, it was more dependent on familiarity with the child and was judged more difficult to use by all observers. The NCCPC-PV was the easiest use and the most appropriate for rating the child{\textquoteright}s pain.

CONCLUSION: The NCCPC-PV was the easiest to use for pain assessment in cognitively impaired children and should be adopted in clinical settings.

}, issn = {1651-2227}, doi = {10.1111/apa.12748}, author = {Massaro, Marta and Ronfani, Luca and Ferrara, Giovanna and Badina, Laura and Giorgi, Rita and D{\textquoteright}Osualdo, Flavio and Taddio, Andrea and Barbi, Egidio} } @article {3493, title = {Cow{\textquoteright}s milk allergy in children, from avoidance to tolerance.}, journal = {Endocr Metab Immune Disord Drug Targets}, volume = {14}, year = {2014}, month = {2014 Mar}, pages = {47-53}, abstract = {

Food allergy is the primary cause of anaphylaxis in paediatric age affecting roughly 4\% of children and their families worldwide, and requiring changes in dietary habits. The prognosis for food allergy in children has traditionally been regarded as good for the most frequent allergens, however the prognosis for cow{\textquoteright}s milk allergy in the pediatric age is currently considered to be worse than previously believed. There is now enough evidence that measures of avoidance for children at risk did not have any preventive effect whatsoever, but they still came to be counterproductive by avoiding the physiological interaction between food allergens and gastrointestinal mucosal immune system. Programs of specific oral tolerance induction (SOTI) have obtained interesting results in the treatment of food allergy supporting the idea that antigen exposure through gastrointestinal section is important to allow the development of tolerance. Nevertheless this approach is not yet considered "ready" for community recommendations. In this paper we describe our experience in the field of SOTI in children with cow{\textquoteright}s milk allergy.

}, keywords = {Animals, Cattle, Child, Child, Preschool, Desensitization, Immunologic, Humans, Immune Tolerance, Milk Hypersensitivity, Milk Substitutes, Retrospective Studies}, issn = {2212-3873}, author = {Calligaris, Lorenzo and Longo, Giorgio and Badina, Laura and Berti, Irene and Barbi, Egidio} } @article {3564, title = {Diagnostic accuracy of ultrasonography for hand bony fractures in paediatric patients.}, journal = {Arch Dis Child}, volume = {99}, year = {2014}, month = {2014 Dec}, pages = {1087-90}, abstract = {

OBJECTIVE: Hand fractures are common in childhood, and radiography is the standard diagnostic procedure. US has been used to evaluate bone injuries, mainly in adults for long-bone trauma; there are only a few studies about hand fractures in children. The purpose of this study was to evaluate and confirm the safety and applicability of the US diagnostic procedure in comparison to X-ray diagnosis.

STUDY DESIGN: This cross-sectional study involved a convenience sample of young patients (between 2 and 17 years old) who were taken to the emergency department due to hand trauma. After clinical assessment, patients with a suspected hand fracture first underwent X-ray, and subsequently US examination by two different operators; a radiologist experienced in US and a trained emergency physician in "double-blind" fashion. US and radiographic findings were then compared, and sensitivity as well as specificity was calculated.

RESULTS: A total of 204 patients were enrolled in the study. Seventy-nine fractures of phalanges or metacarpals were detected by standard radiography. When US imaging was performed by an expert radiologist, 72 fractures were detected with sensitivity and a specificity of 91.1\% and 97.6\%, respectively. Sensitivity and specificity were found to be (respectively) 91.5\% and 96.8\% when US was performed by the ED physicians.

CONCLUSIONS: US imaging showed excellent sensitivity and specificity results in the diagnosis of hand fractures in children. The study also showed a great agreement between the results of the US carried out by the senior radiologist and those carried out by the paediatric emergency physician, suggesting that US can be performed by an ED physician, allowing a rapid and accurate evaluation in ED and could become the first diagnostic approach whenever a hand fracture is suspected.

}, keywords = {Adolescent, Child, Child, Preschool, Cross-Sectional Studies, Double-Blind Method, Emergency Service, Hospital, Female, Fractures, Bone, Hand Bones, Humans, Italy, Male, Sensitivity and Specificity}, issn = {1468-2044}, doi = {10.1136/archdischild-2013-305678}, author = {Neri, Elena and Barbi, Egidio and Rabach, Ingrid and Zanchi, Chiara and Norbedo, Stefania and Ronfani, Luca and Guastalla, Veronica and Ventura, Alessandro and Guastalla, Pierpaolo} } @article {3500, title = {Doing without codeine: why and what are the alternatives?}, journal = {Ital J Pediatr}, volume = {40}, year = {2014}, month = {2014}, pages = {16}, abstract = {

Codeine is a mild opioid widely used as an analgesic in various age groups, including various pediatric settings. It is a prodrug that owes its analgesic effect almost entirely to the principal metabolite: morphine. The genetic polymorphisms can contribute to making the pharmacokinetics of codeine hard to predict and this it is particularly important in the pediatric population because infants and children have greater susceptibility to the side-effects of morphine. In recent years there have been several reports in the literature on the risks relating to the use of codeine. In August 2012, the American Food and Drugs Administration began to revise its recommendations for the safe use of codeine and in February 2013, established that codeine should not be used for postoperative pain control in children undergoing adenoidectomy and/or tonsillectomy and did restrict the use of this drug in the pediatric population. In June 2013, the European Medicine Agency opted the same decision. In July 2013, the Agenzia Italiana del Farmaco prohibit the use of medicines containing codeine for patients under 12~years old and recommended a limited use of the drug, in many other situations. Complying with these recommendations naturally means changing habits and treatment strategies well established in pediatric practice, but other drugs, tools and techniques available enable us to continue to assure an adequate pain control in pediatric patients, irrespective of their age and situation. The article proposes same alternatives of pain control drugs.

}, keywords = {Acetaminophen, Analgesics, Non-Narcotic, Analgesics, Opioid, Child, Codeine, Humans, Pain Measurement, Pain, Postoperative, Tonsillectomy}, issn = {1824-7288}, doi = {10.1186/1824-7288-40-16}, author = {Benini, Franca and Barbi, Egidio} } @article {3481, title = {Paracetamol: a focus for the general pediatrician.}, journal = {Eur J Pediatr}, volume = {173}, year = {2014}, month = {2014 Apr}, pages = {415-25}, abstract = {

UNLABELLED: Paracetamol (acetaminophen) is one of the most popular and widely used drugs for the treatment of pain and fever in children. This drug has multiple mechanisms of action, but its pharmacodynamic is still not well known. The central nervous system is the main site of action and it mirrors the paracetamol effect compartment. The recommended dosages and routes of administration should be different whether paracetamol is used for the treatment of pain or fever. For example, the rectal route, while being efficacious for the treatment of fever, should be avoided in pain management. Paracetamol is a safe drug, but some clinical conditions and concomitant drugs, which are frequent in clinical practice, may increase the risk of paracetamol toxicity. Therefore, it is important to optimize its administration to avoid overdoses and maximize its effect. The principal mediator of the paracetamol toxicity is the N-acetyl-p-benzo-quinone imine (NAPQI), a toxic product of the paracetamol metabolism, which could bind cysteine groups on proteins forming paracetamol-protein adduct in the liver.

CONCLUSION: Although frequently prescribed, the concept of "effect compartment concentration" and the possible co-factors that could cause toxicity at recommended doses are not familiar to all pediatricians and general practitioners. We reviewed the literature concerning paracetamol mechanisms of action, we highlighted some relevant pharmacodynamic concepts for clinical practice, and we summarized the possible risk factors for toxicity at therapeutic dosages.

}, keywords = {Acetaminophen, Analgesics, Non-Narcotic, Child, Drug Overdose, Fever, Humans, Pain, Risk Factors}, issn = {1432-1076}, doi = {10.1007/s00431-013-2239-5}, author = {Marzuillo, Pierluigi and Guarino, Stefano and Barbi, Egidio} } @article {3514, title = {A precordial rub in a boy with a severe attack of ulcerative colitis.}, journal = {Pediatr Emerg Care}, volume = {30}, year = {2014}, month = {2014 Apr}, pages = {268}, abstract = {

A case of a pneumomediastinum mimicking a pericarditis in a boy with an occult perforation due to ulcerative colitis is reported. Pneumomediastinum is a rare complication of severe attacks of ulcerative colitis, with or without the previous development of a toxic megacolon, that should be considered in the differential diagnosis.

}, keywords = {Adolescent, Colitis, Ulcerative, Diagnosis, Differential, Humans, Intestinal Perforation, Male, Mediastinal Emphysema, Pericarditis, Radiography, Thoracic}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000000111}, author = {Badina, Laura and Ferrara, Giovanna and Guastalla, Pierpaolo and Barbi, Egidio} } @article {3482, title = {Procedural sedation for intra-articular corticosteroid injections in juvenile idiopathic arthritis (JIA) should be a standard of care.}, journal = {Eur J Pediatr}, volume = {173}, year = {2014}, month = {2014 Jun}, pages = {831}, keywords = {Arthritis, Juvenile, Conscious Sedation, Female, Glucocorticoids, Humans, Male, Pain, Patient Preference}, issn = {1432-1076}, doi = {10.1007/s00431-013-2246-6}, author = {Pastore, Serena and Gortani, Giulia and Taddio, Andrea and Barbi, Egidio} } @article {3578, title = {Re: Tramadol can selectively manage moderate pain in children following European advice limiting codeine use.}, journal = {Acta Paediatr}, volume = {103}, year = {2014}, month = {2014 Nov}, pages = {e466}, issn = {1651-2227}, doi = {10.1111/apa.12763}, author = {Calligaris, Lorenzo and Marzuillo, Pierluigi and Barbi, Egidio} } @article {3573, title = {Tramadol can selectively manage moderate pain in children following European advice limiting codeine use.}, journal = {Acta Paediatr}, volume = {103}, year = {2014}, month = {2014 Nov}, pages = {1110-6}, abstract = {

UNLABELLED: The European Medicine Agency recommendations limiting codeine use in children have created a void in managing moderate pain. We review the evidence on the pharmacokinetic, pharmacodynamic and safety profile of tramadol, a possible substitute for codeine.

CONCLUSION: Tramadol appears to be safe in both paediatric inpatients and outpatients. It may be appropriate to limit the current use of tramadol to monitored settings in children with risk factors for respiratory depression, subject to further safety evidence.

}, issn = {1651-2227}, doi = {10.1111/apa.12738}, author = {Marzuillo, Pierluigi and Calligaris, Lorenzo and Barbi, Egidio} } @article {1994, title = {Is treatment with hydroxychloroquine effective in surfactant protein C deficiency?}, journal = {Arch Bronconeumol}, volume = {49}, year = {2013}, month = {2013 May}, pages = {213-5}, abstract = {

We present the case of two twin brothers with surfactant protein C deficiency who were treated with hydroxychloroquine for three years, with apparent success. The exact physiopathology of this disease is not known and there is no specific treatment for it. There is merely news from a few previous descriptions in the literature about the use of hydroxychloroquine for surfactant protein C deficiency with satisfactory results. Two years after the treatment was withdrawn, the twins were evaluated once again: they presented no new infections, growth and general state were normal and chest CT showed a notable additional reduction in the interstitial pneumopathy. These data seem to cast some doubt on the efficacy of hydroxychloroquine, and they suggest that the clinical improvement was simply the natural evolution of the disease.

}, keywords = {Disease Progression, Diseases in Twins, Dyspnea, Failure to Thrive, Humans, Hydroxychloroquine, Infant, Newborn, Male, Pulmonary Alveolar Proteinosis, Pulmonary Surfactant-Associated Protein C, Respiratory Insufficiency, Tomography, X-Ray Computed, Twins, Monozygotic}, issn = {1579-2129}, doi = {10.1016/j.arbres.2012.08.005}, author = {Rabach, Ingrid and Poli, Furio and Zennaro, Floriana and Germani, Claudio and Ventura, Alessandro and Barbi, Egidio} } @article {1865, title = {A child with severe pneumomediastinum and ABCA3 gene mutation: a puzzling connection.}, journal = {Arch Bronconeumol}, volume = {48}, year = {2012}, month = {2012 Apr}, pages = {139-40}, keywords = {Anemia, ATP-Binding Cassette Transporters, Child, Preschool, Dyspnea, Genetic Predisposition to Disease, Heterozygote, Humans, Intensive Care, Leukocytosis, Male, Mediastinal Emphysema, Mutation, Missense, Point Mutation, Pulmonary Emphysema, Respiratory Tract Infections, Subcutaneous Emphysema, Tomography, X-Ray Computed}, issn = {1579-2129}, doi = {10.1016/j.arbres.2011.11.008}, author = {Copertino, Marco and Barbi, Egidio and Poli, Furio and Zennaro, Floriana and Ferrari, Maurizio and Carrera, Paola and Ventura, Alessandro} } @article {1935, title = {The dietary paradox in food allergy: yesterday{\textquoteright}s mistakes, today{\textquoteright}s evidence and lessons for tomorrow.}, journal = {Curr Pharm Des}, volume = {18}, year = {2012}, month = {2012}, pages = {5782-7}, abstract = {

During the last decades the prevalence of food allergy has significantly increased among children and antigen avoidance still remains the standard care for the management of this condition. Most reactions are IgE-mediated with a high risk of anaphylaxis requiring emergency medications in case of inadvertent ingestion. Recent studies showed that continuous administration of the offending food, rather than an elimination diet, could promote the development and maintenance of oral tolerance. Indeed, intestinal transit of food proteins and their interaction with gut-associated lymphoid tissue (GALT) is the essential prerequisite for oral tolerance. On the contrary, low-dose cutaneous exposure to environmental foods in children with atopic dermatitis and altered skin barrier facilitates allergic sensitization. The timing and the amount of cutaneous and oral exposure determine whether a child will have allergy or tolerance. Furthermore, previous preventive strategies such as the elimination diet during pregnancy and breastfeeding, prolonged exclusive breastfeeding and delayed weaning to solid foods did not succeed in preventing the development of food allergy. On the other hand, there could be an early narrow window of immunological opportunity to expose children to allergenic foods and induce natural tolerance. Finally, the gradual exposure to the offending food through special protocols of specific oral tolerance induction (SOTI) may be a promising approach to a proactive treatment of food allergy.

}, keywords = {Anaphylaxis, Antigens, Breast Feeding, Child, Dermatitis, Atopic, Female, Food Hypersensitivity, Humans, Immunoglobulin E, Pregnancy, Time Factors}, issn = {1873-4286}, author = {Badina, Laura and Barbi, Egidio and Berti, Irene and Radillo, Oriano and Matarazzo, Lorenza and Ventura, Alessandro and Longo, Giorgio} } @article {1944, title = {Endoscopic treatment of primary vesicoureteral reflux.}, journal = {N Engl J Med}, volume = {367}, year = {2012}, month = {2012 Jul 5}, pages = {88; author reply 89}, keywords = {Female, Humans, Ureteroscopy, Vesico-Ureteral Reflux}, issn = {1533-4406}, doi = {10.1056/NEJMc1204964$\#$SA1}, author = {Pennesi, Marco and L{\textquoteright}erario, Ines and Barbi, Egidio} } @article {1976, title = {Lingual schwannoma in pediatric patients.}, journal = {J Craniofac Surg}, volume = {23}, year = {2012}, month = {2012 Sep}, pages = {e454-6}, abstract = {

We present the case of a 15-year-old boy who presented to our emergency department because of a soft lesion growing on the back of his tongue. On examination, a vegetant mass on the posteromidline lingual part of the body of the tongue was noticed: it was not painful, even if the boy reported discomfort because of its size; there was no bleeding or signs of infection. The magnetic resonance imaging showed the lesion as trilobated and capsulated, but was not diriment to define a diagnosis; excisional biopsy was performed under general anesthesia, and the mass was identified as a schwannoma. Schwannoma, or neurilemmoma, is a benign tumor originating from Schwann cells of the nerve sheath surrounding peripheral nerves. It is slow-growing, usually solitary, and encapsulated. Intraoral schwannomas are rare and account for 1\% of lesions of the head and neck region. There is no sex predilection. The symptoms depend on size and location of the tumor. Recurrence is rare after complete surgical resection. The present study aimed to retrospectively describe our experience with a case of neurilemmoma of the tongue presenting in childhood, the diagnostic methods used, the surgical decision, and the treatment outcome and to analyze the data and review the literature available on this type of tumor. The etiology, clinical presentation, differential diagnosis, and management are discussed.

}, keywords = {Adolescent, Diagnosis, Differential, Humans, Magnetic Resonance Imaging, Male, Neurilemmoma, Tongue Neoplasms}, issn = {1536-3732}, doi = {10.1097/SCS.0b013e318262d9c7}, author = {Manna, Francesco and Barbi, Egidio and Murru, Flora and Bussani, Rossana} } @article {1887, title = {Sedation with intranasal midazolam of Angolan children undergoing invasive procedures.}, journal = {Acta Paediatr}, volume = {101}, year = {2012}, month = {2012 Jul}, pages = {e296-8}, abstract = {

AIM: Ambulatory surgery is a daily requirement in poor countries, and limited means and insufficient trained staff lead to the lack of attention to the patient{\textquoteright}s pain. Midazolam is a rapid-onset, short-acting benzodiazepine which is used safely to reduce pain in children. We evaluated the practicability of intranasal midazolam sedation in a suburban hospital in Luanda (Angola), during the surgical procedures.

METHODS: Intranasal midazolam solution was administered at a dose of 0.5 mg/kg. Using the Ramsay{\textquoteright}s reactivity score, we gave a score to four different types of children{\textquoteright}s behaviour: moaning, shouting, crying and struggling, and the surgeon evaluated the ease of completing the surgical procedure using scores from 0 (very easy) to 3 (managing with difficulty).

RESULTS: Eighty children (median age, 3 years) were recruited, and 140 surgical procedures were performed. Fifty-two children were treated with midazolam during 85 procedures, and 28 children were not treated during 55 procedures. We found a significant difference between the two groups on the shouting, crying and struggling parameters (p < 0.001). The mean score of the ease of completing the procedures was significantly different among the two groups (p < 0.0001).

CONCLUSION: These results provide a model of procedural sedation in ambulatory surgical procedures in poor countries, thus abolishing pain and making the surgeon{\textquoteright}s job easier.

}, keywords = {Administration, Intranasal, Adolescent, Ambulatory Surgical Procedures, Angola, Child, Child Behavior, Child, Preschool, Conscious Sedation, Crying, Female, Humans, Hypnotics and Sedatives, Infant, Male, Midazolam, Prospective Studies}, issn = {1651-2227}, doi = {10.1111/j.1651-2227.2012.02691.x}, author = {Kawanda, Lumana and Capobianco, Ivan and Starc, Meta and Felipe, Daniel and Zanon, Davide and Barbi, Egidio and Munkela, Nadine and Rodrigues, Ver{\'o}nica and Malundo, L{\'u}is and Not, Tarcisio} } @article {1827, title = {Successful induction of oral tolerance in Netherton syndrome.}, journal = {Allergol Immunopathol (Madr)}, volume = {40}, year = {2012}, month = {2012 Sep-Oct}, pages = {316-7}, keywords = {Allergens, Alopecia, Child, Preschool, Desensitization, Immunologic, Disease-Free Survival, Eczema, Female, Food Hypersensitivity, Hair Follicle, Humans, Immune Tolerance, Immunoglobulin E, Infant, Newborn, Mouth, Netherton Syndrome, Treatment Outcome}, issn = {1578-1267}, doi = {10.1016/j.aller.2011.07.005}, author = {Pastore, Serena and Gorlato, Gaia and Berti, Irene and Barbi, Egidio and Ventura, Alessandro} } @article {1775, title = {Comparison of propofol versus propofol-ketamine combination in pediatric oncologic procedures performed by non-anesthesiologists.}, journal = {Pediatr Blood Cancer}, volume = {57}, year = {2011}, month = {2011 Dec 15}, pages = {1163-7}, abstract = {

BACKGROUND: Limited data are available on the best option (short acting sedatives, opioids, or ketamine) in oncologic procedural sedation performed by non-anesthesiologists. The aim of the present prospective study is to compare the safety and efficacy of propofol-ketamine versus propofol alone, managed by trained pediatricians, in children with cancer undergoing painful procedures.

PROCEDURES: Data on 121 children with acute lymphatic leukemia (ALL) undergoing procedural sedations (lumbar punctures and bone marrow aspirations) were prospectively collected and included drug doses, side effects, pain assessment, and sedation degree. Children were randomly assigned to one of the two groups: P (n = 62) receiving propofol alone and K (n = 59) in whom a ketamine-propofol combination was used.

RESULTS: In group K, the total dose of propofol required was significantly lower than in group P (3.9 {\textpm} 3.6 mg/kg vs. 5.1 {\textpm} 3.6 mg/kg; P < 0.001). The incidence of hypotension was also significantly lower (11\% vs. 39\%; P < 0.001). Major O(2) desaturations (defined as SatO(2) < 88\%) occurred principally in group P (7 vs. 1; P = 0.05). Both best analgesia and shorter recovery time were obtained with the propofol-ketamine association. No differences were observed in the degree of sedation and in the awakening quality score between the two groups.

CONCLUSIONS: The combination of propofol and ketamine produced statistically significant clinical advantages combined with a higher profile of safety in children with cancer undergoing painful procedures.

}, keywords = {Biopsy, Needle, Bone Marrow Examination, Child, Conscious Sedation, Female, Humans, Hypnotics and Sedatives, Ketamine, Male, Neoplasms, Pediatrics, Physicians, Propofol, Spinal Puncture}, issn = {1545-5017}, doi = {10.1002/pbc.23170}, author = {Chiaretti, Antonio and Ruggiero, Antonio and Barbi, Egidio and Pierri, Filomena and Maurizi, Palma and Fantacci, Claudia and Bersani, Giulia and Riccardi, Riccardo} } @article {1603, title = {Concentrated midazolam for intranasal administration: a pilot study.}, journal = {Pediatr Emerg Care}, volume = {27}, year = {2011}, month = {2011 Mar}, pages = {245-7}, keywords = {Administration, Intranasal, Child, Child, Preschool, Conscious Sedation, Dose-Response Relationship, Drug, Female, Humans, Hypnotics and Sedatives, Infant, Male, Midazolam, Pain, Pilot Projects, Preoperative Care}, issn = {1535-1815}, doi = {10.1097/PEC.0b013e31820db93b}, author = {Calligaris, Lorenzo and Davide, Zanon and Alessandra, Maestro and De Bortoli, Romina and Chiaretti, Antonio and Barbi, Egidio} } @article {1599, title = {Intranasal lidocaine and midazolam for procedural sedation in children.}, journal = {Arch Dis Child}, volume = {96}, year = {2011}, month = {2011 Feb}, pages = {160-3}, abstract = {

OBJECTIVE: To evaluate the safety and efficacy of a sedation protocol based on intranasal lidocaine spray and midazolam (INM) in children who are anxious and uncooperative when undergoing minor painful or diagnostic procedures, such as peripheral line insertion, venipuncture, intramuscular injection, echocardiogram, CT scan, audiometry testing and dental examination and extractions.

PATIENTS AND DESIGN: 46 children, aged 5-50 months, received INM (0.5 mg/kg) via a mucosal atomiser device. To avoid any nasal discomfort a puff of lidocaine spray (10 mg/puff) was administered before INM. The child{\textquoteright}s degree of sedation was scored using a modified Ramsay sedation scale. A questionnaire was designed to evaluate the parents{\textquoteright} and doctors{\textquoteright} opinions on the efficacy of the sedation. Statistical analysis was used to compare sedation times with children{\textquoteright}s age and weight.

RESULTS: The degree of sedation achieved by INM enabled all procedures to be completed without additional drugs. Premedication with lidocaine spray prevented any nasal discomfort related to the INM. The mean duration of sedation was 23.1 min. The depth of sedation was 1 on the modified Ramsay scale. The questionnaire revealed high levels of satisfaction by both doctors and parents. Sedation start and end times were significantly correlated with age only. No side effects were recorded in the cohort of children studied.

CONCLUSIONS: This study has shown that the combined use of lidocaine spray and atomised INM appears to be a safe and effective method to achieve short-term sedation in children to facilitate medical care and procedures.

}, keywords = {Administration, Intranasal, Anesthetics, Local, Anxiety, Child, Preschool, Conscious Sedation, Diagnostic Techniques and Procedures, Female, Humans, Hypnotics and Sedatives, Infant, Lidocaine, Male, Midazolam, Minimally Invasive Surgical Procedures, Nebulizers and Vaporizers, Nose Diseases, Prospective Studies}, issn = {1468-2044}, doi = {10.1136/adc.2010.188433}, author = {Chiaretti, Antonio and Barone, Giuseppe and Rigante, Donato and Ruggiero, Antonio and Pierri, Filomena and Barbi, Egidio and Barone, Giovanni and Riccardi, Riccardo} } @article {1786, title = {Safety and efficacy of high-dose acarbose treatment for dumping syndrome.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {53}, year = {2011}, month = {2011 Jul}, pages = {113-4}, abstract = {

Dumping syndrome (DS) is a complication of Nissen fundoplication. Dietary strategies can ameliorate symptoms, but this approach is not always foolproof. Limited evidence reports the efficacy of acarbose for children who are unresponsive to feeding manipulations. We report 8 patients with DS aged between 7 and 24 months. In 4 of 8 nutritional strategies failed, and acarbose treatment was started. The initial dose was 25 mg for meals, and increased until postprandial glucose was stable. In 3 of 4 children the final dose was higher than previously reported, without adverse effects. Acarbose is useful to treat DS in cases of failure of dietary strategies.

}, keywords = {Acarbose, Child, Preschool, Dumping Syndrome, Female, Humans, Hyperglycemia, Hypoglycemic Agents, Infant, Male, Postprandial Period, Treatment Outcome}, issn = {1536-4801}, doi = {10.1097/MPG.0b013e31820ae6d1}, author = {De Cunto, Angela and Barbi, Egidio and Minen, Federico and Ventura, Alessandro} } @article {1604, title = {Successful treatment of acne with isotretinoin in chronic granulomatous disease.}, journal = {Eur J Dermatol}, volume = {21}, year = {2011}, month = {2011 Jan-Feb}, pages = {111-2}, keywords = {Acne Vulgaris, Adult, Anti-Infective Agents, Comorbidity, Dermatologic Agents, Granulomatous Disease, Chronic, Humans, Isotretinoin, Male, Trimethoprim-Sulfamethoxazole Combination}, issn = {1167-1122}, doi = {10.1684/ejd.2010.1171}, author = {Barbi, Egidio and Berti, Irene and Minute, Marta and Zennaro, Floriana} } @article {1737, title = {Acute respiratory failure in a child after talc inhalation.}, journal = {Respiration}, volume = {79}, year = {2010}, month = {2010}, pages = {340}, keywords = {Female, Humans, Infant, Inhalation Exposure, Respiratory Insufficiency, Talc}, issn = {1423-0356}, doi = {10.1159/000181013}, author = {Patarino, Federica and Norbedo, Stefania and Barbi, Egidio and Poli, Furio and Furlan, Stefano and Savron, Fabio} } @article {1675, title = {Splenomegaly as presentation of a wandering spleen.}, journal = {J Pediatr}, volume = {157}, year = {2010}, month = {2010 Nov}, pages = {859.e1}, keywords = {Child, Female, Humans, Splenomegaly, Wandering Spleen}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2010.04.046}, author = {Maschio, Massimo and Cozzi, Giorgio and Sanabor, Daniela and Zennaro, Floriana and Gloria, Pelizzo and Barbi, Egidio} } @article {1618, title = {Use of ketamine continuous infusion for pediatric sedation in septic shock.}, journal = {Pediatr Emerg Care}, volume = {26}, year = {2010}, month = {2010 Sep}, pages = {689-90}, keywords = {Anesthetics, Dissociative, Child, Conscious Sedation, Humans, Infusions, Intravenous, Ketamine, Male, Shock, Septic}, issn = {1535-1815}, doi = {10.1097/PEC.0b013e3181f196e6}, author = {Barbi, Egidio and Rizzello, Elisa and Taddio, Andrea} }