@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 {10753, title = {Afebrile seizures in infants: Never forget magnesium!}, journal = {J Paediatr Child Health}, volume = {54}, year = {2018}, month = {2018 Apr}, pages = {446-448}, issn = {1440-1754}, doi = {10.1111/jpc.13854}, author = {Minute, Marta and Ventura, Giovanna and Giorgi, Rita and Faletra, Flavio and Costa, Paola and Cozzi, Giorgio} } @article {10416, title = {Anti-transglutaminase 6 Antibody Development in Children With Celiac Disease Correlates With Duration of Gluten Exposure.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {66}, year = {2018}, month = {2018 Jan}, pages = {64-68}, abstract = {

OBJECTIVES: Antibodies against transglutaminase 6 (anti-TG6) have been implicated in neurological manifestations in adult patients with genetic gluten intolerance, and it is unclear whether autoimmunity to TG6 develops following prolonged gluten exposure. We measured the anti-TG6 in children with celiac disease (CD) at the diagnosis time to establish a correlation between these autoantibodies and the duration of gluten exposure. We investigated a correlation between anti-TG6 and the presence of neurological disorders.

METHODS: Anti-TG6 (IgA/IgG) were measured by ELISA in sera of children with biopsy-proven CD and of children experiencing gastrointestinal disorders. CD patients positive for anti-TG6 were retested after 2 years of gluten-free diet (GFD).

RESULTS: We analyzed the sera of 274 CD children and of 121 controls. Anti-TG6 were detected in 68/274 (25\%) CD patients and in 19/121 (16\%) controls, with significant difference between the 2 groups (P = 0.04). None of the CD patients and of the controls testing positive for anti-TG6 were experiencing neurological disorders. Eleven of 18 (61\%) CD patients with other autoimmune diseases were positive for anti-TG6. In CD patients, a significant correlation between the gluten exposure before the CD diagnosis and anti-TG6 concentration was found (P = 0.006 for IgA; P < 0.0001 for IgG). After GFD anti-TG6 concentrations were significantly reduced (P < 0.001). No significant correlation was observed between anti-TG6 and anti-TG2 serum concentrations.

CONCLUSIONS: Anti-TG6 are more prevalent in children with untreated CD in the absence of overt neurological disorders. The synthesis of the anti-TG6 is related to a longer exposure to gluten before the CD diagnosis, and the autoimmunity against TG6 is gluten dependent and disappeared during GFD.

}, issn = {1536-4801}, doi = {10.1097/MPG.0000000000001642}, author = {De Leo, Luigina and Aeschlimann, Daniel and Hadjivassiliou, Marios and Aeschlimann, Pascale and Salce, Nicola and Vatta, Serena and Ziberna, Fabiana and Cozzi, Giorgio and Martelossi, Stefano and Ventura, Alessandro and Not, Tarcisio} } @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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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} }