@article {1875, title = {Pain in cognitively impaired children: a focus for general pediatricians.}, journal = {Eur J Pediatr}, volume = {172}, year = {2013}, month = {2013 Jan}, pages = {9-14}, abstract = {

UNLABELLED: Pain in children with cognitive impairment and cerebral palsy is a particularly relevant issue due to its high prevalence and impact on quality of life. We review available evidence about prevalence of pain, causes and specific treatment, recognition and use of specific pain scales, physiology, and consequences of pain in this subset of patients.

CONCLUSIONS: Pain is very common and is a critical determinant of quality of life in children with cognitive impairment and cerebral palsy. The diseases and associated complications that frequently expose these patients to pain can be treated and pain prevented. For patients with communication difficulties, appropriate, effective, validated tools are available and should be used to diagnose pain in itself, to >choose analgesic treatment and to determine effectiveness of these therapies. The level of awareness of pediatricians towards this issue seems to be quite low.

}, keywords = {Analgesics, Cerebral Palsy, Child, Cognition Disorders, Humans, Pain, Pain Measurement, Quality of Life}, issn = {1432-1076}, doi = {10.1007/s00431-012-1720-x}, author = {Massaro, M and Pastore, S and Ventura, A and Barbi, E} } @article {1910, title = {Treatment with pamidronate for osteoporosis complicating long-term intestinal failure.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {55}, year = {2012}, month = {2012 Nov}, pages = {615-8}, abstract = {

Long-term home parenteral nutrition (PN) is a potential risk for developing osteoporosis. Various attempts have been made to treat bone disease both by modifying the composition of PN and by administering hormones, such as calcitonin, parathyroid hormone, and sexual hormones. Bisphosphonates are recognized as a medication useful for the treatment of several bone disorders associated with excessive reabsorption. Nevertheless, there have been no paediatric studies on bisphosphonates use for intestinal failure-associated bone disease. Our study includes 6 paediatric patients receiving extremely long-term home PN (at least 3 years) who showed radiological and clinical signs of osteoporosis. Diagnosis of bone disease was made after a median period of 127.5 PN months. Treatment consisted in 2 cycles of intravenous pamidronate, 30 mg/m once per month for 6 months consecutively. They all showed a significant improvement in bone mineral density, evaluated after 6 and 12 months of pamidronate treatment. In our sample anthropometrical variables (weight, height, and body mass index) are not related with the z-score trend. Our patients had normal levels of calcium, phosphorus, and vitamin D, and proper nutrient intake. At the last follow-up, dual-energy x-ray absorptiometry scan showed that no patients had a z-score lower than -2.5; moreover, nobody developed bone fractures during the 108-month follow-up. The patients did not have any prominent adverse effect. Finally, in our experience, pamidronate is effective for improving bone mineral density and safe in patients with intestinal failure-associated bone disease.

}, keywords = {Absorptiometry, Photon, Adolescent, Bone Density, Bone Density Conservation Agents, Child, Child, Preschool, Diphosphonates, Female, Humans, Intestinal Diseases, Male, Osteoporosis, Parenteral Nutrition, Home}, issn = {1536-4801}, doi = {10.1097/MPG.0b013e31825f1c7d}, author = {Pastore, S and Londero, M and Barbieri, F and Di Leo, G and Paparazzo, R and Ventura, A} }