@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 {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} }