@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 {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 {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 {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 {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 {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 {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} }