TY - JOUR T1 - Administering analgesia sublingually is a suitable option for children with acute abdominal pain in the emergency department. JF - Acta Paediatr Y1 - 2019 A1 - Cozzi, Giorgio A1 - Zanchi, Chiara A1 - Chiaretti, Antonio A1 - Tipo, Vincenzo A1 - Cernich, Marta A1 - D'Anna, Carolina A1 - Fantacci, Claudia A1 - Conversano, Ester A1 - Zanon, Davide A1 - Ronfani, Luca A1 - Barbi, Egidio AB -

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'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.

VL - 108 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30043434?dopt=Abstract ER - TY - JOUR T1 - Adolescent with painful vesicular otitis and vertigo. JF - Arch Dis Child Educ Pract Ed Y1 - 2019 A1 - Conversano, Ester A1 - Cozzi, Giorgio A1 - Poropat, Federico A1 - Di Mascio, Alberto A1 - Salis, Simona A1 - Grasso, Domenico Leonardo A1 - Barbi, Egidio VL - 104 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29440126?dopt=Abstract ER - TY - JOUR T1 - Acute small bowel obstruction in a child with a strict raw vegan diet. JF - Arch Dis Child Y1 - 2018 A1 - Amoroso, Stefano A1 - Scarpa, Maria-Grazia A1 - Poropat, Federico A1 - Giorgi, Rita A1 - Murru, Flora Maria A1 - Barbi, Egidio U1 - http://www.ncbi.nlm.nih.gov/pubmed/29760008?dopt=Abstract ER - TY - JOUR T1 - Adenomyomatosis of the Gallbladder as a Cause of Recurrent Abdominal Pain. JF - J Pediatr Y1 - 2018 A1 - Agrusti, Anna A1 - Gregori, Massimo A1 - Salviato, Tiziana A1 - Codrich, Daniela A1 - Barbi, Egidio KW - Abdominal Pain KW - Adenomyoma KW - Adolescent KW - Biopsy, Needle KW - Cholecystectomy KW - Diagnosis, Differential KW - Female KW - Gallbladder KW - Gallbladder Neoplasms KW - Humans KW - Immunohistochemistry KW - Recurrence KW - Risk Assessment KW - Severity of Illness Index KW - Ultrasonography, Doppler VL - 202 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29903530?dopt=Abstract ER - TY - JOUR T1 - Adolescent with intermittent haematuria. JF - Arch Dis Child Educ Pract Ed Y1 - 2018 A1 - Pillon, Roberto A1 - Pennesi, Marco A1 - Rabach, Ingrid A1 - Barbi, Egidio U1 - http://www.ncbi.nlm.nih.gov/pubmed/29748226?dopt=Abstract ER - TY - JOUR T1 - Anaphylaxis in atypical cold urticaria: case report and review of literature. JF - Ital J Pediatr Y1 - 2018 A1 - Benelli, Elisa A1 - Longo, Giorgio A1 - Barbi, Egidio A1 - Berti, Irene KW - Anaphylaxis KW - Child KW - Cold Temperature KW - Humans KW - Male KW - Swimming KW - Urticaria AB -

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'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.

VL - 44 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30424814?dopt=Abstract ER - TY - JOUR T1 - Acute Abdominal Pain: Recognition and Management of Constipation in the Emergency Department. JF - Pediatr Emerg Care Y1 - 2017 A1 - Norbedo, Stefania A1 - Bassanese, Giulia A1 - Barbieri, Francesca A1 - Barbi, Egidio KW - Abdominal Pain KW - Acute Pain KW - Adolescent KW - Child KW - Child, Preschool KW - Constipation KW - Emergency Service, Hospital KW - Enema KW - Female KW - Humans KW - Incidence KW - Infant KW - Male KW - Retrospective Studies AB -

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.

VL - 33 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28632578?dopt=Abstract ER - TY - JOUR T1 - Authors' Reply to M.S. Raghuraman: "Intranasal Dexmedetomidine for Procedural Sedation in Children, a Suitable Alternative to Chloral Hydrate". JF - Paediatr Drugs Y1 - 2017 A1 - Cozzi, Giorgio A1 - Norbedo, Stefania A1 - Barbi, Egidio KW - Administration, Intranasal KW - Child KW - Chloral Hydrate KW - Dexmedetomidine KW - Humans KW - Hypnotics and Sedatives KW - Infant VL - 19 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28660554?dopt=Abstract ER - TY - JOUR T1 - Acute lobar nephritis in children: Not so easy to recognize and manage. JF - World J Clin Pediatr Y1 - 2016 A1 - Bibalo, Cristina A1 - Apicella, Andrea A1 - Guastalla, Veronica A1 - Marzuillo, Pierluigi A1 - Zennaro, Floriana A1 - Tringali, Carmela A1 - Taddio, Andrea A1 - Germani, Claudio A1 - Barbi, Egidio AB -

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.

VL - 5 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26862513?dopt=Abstract ER - TY - JOUR T1 - Acute pseudotumoral hemicerebellitis in a child: a rare and distinct entity? JF - J Child Neurol Y1 - 2015 A1 - Alberini, Elena A1 - Vellante, Valerio A1 - Zennaro, Floriana A1 - Calligaris, Lorenzo A1 - Barbi, Egidio A1 - Carrozzi, Marco A1 - Devescovi, Raffaella KW - Brain KW - Cerebellar Diseases KW - Child KW - Diagnosis, Differential KW - Encephalitis KW - Humans KW - Magnetic Resonance Imaging KW - Male AB -

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.

VL - 30 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25143480?dopt=Abstract ER - TY - JOUR T1 - Analgesia by cooling vibration during venipuncture in children with cognitive impairment. JF - Acta Paediatr Y1 - 2015 A1 - Schreiber, Silvana A1 - Cozzi, Giorgio A1 - Rutigliano, Rosaria A1 - Assandro, Paola A1 - Tubaro, Martina A1 - Cortellazzo Wiel, Luisa A1 - Ronfani, Luca A1 - Barbi, Egidio AB -

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'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'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.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/26401633?dopt=Abstract ER - TY - JOUR T1 - Appendicitis in children less than five years old: A challenge for the general practitioner. JF - World J Clin Pediatr Y1 - 2015 A1 - Marzuillo, Pierluigi A1 - Germani, Claudio A1 - Krauss, Baruch S A1 - Barbi, Egidio AB -

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.

VL - 4 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26015876?dopt=Abstract ER - TY - JOUR T1 - Acquired long QT syndrome: a focus for the general pediatrician. JF - Pediatr Emerg Care Y1 - 2014 A1 - Marzuillo, Pierluigi A1 - Benettoni, Alessandra A1 - Germani, Claudio A1 - Ferrara, Giovanna A1 - D'Agata, Biancamaria A1 - Barbi, Egidio KW - Adolescent KW - Death, Sudden, Cardiac KW - Electrocardiography KW - Female KW - General Practitioners KW - Humans KW - Long QT Syndrome KW - Ondansetron KW - Risk Factors KW - Serotonin Antagonists AB -

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.

VL - 30 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24694881?dopt=Abstract ER - TY - JOUR T1 - Acute respiratory failure in a child after talc inhalation. JF - Respiration Y1 - 2010 A1 - Patarino, Federica A1 - Norbedo, Stefania A1 - Barbi, Egidio A1 - Poli, Furio A1 - Furlan, Stefano A1 - Savron, Fabio KW - Female KW - Humans KW - Infant KW - Inhalation Exposure KW - Respiratory Insufficiency KW - Talc VL - 79 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19052443?dopt=Abstract ER -