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Musolino AM, Di Sarno L, Buonsenso D, Murciano M, Chiaretti A, Boccuzzi E, Mesturino MA, Villani A. Use of POCUS for the assessment of dehydration in pediatric patients-a narrative review. Eur J Pediatr 2024; 183:1091-1105. [PMID: 38133810 DOI: 10.1007/s00431-023-05394-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
In pediatric practice, POCUS (point-of-care ultrasound) has been mostly implemented to recognize lung conditions and pleural and pericardial effusions, but less to evaluate fluid depletion. The main aim of this review is to analyze the current literature on the assessment of dehydration in pediatric patients by using POCUS. The size of the inferior vena cava (IVC) and its change in diameter in response to respiration have been investigated as a tool to screen for hypovolemia. A dilated IVC with decreased collapsibility (< 50%) is a sign of increased right atrial pressure. On the contrary, a collapsed IVC may be indicative of hypovolemia. The IVC collapsibility index (cIVC) reflects the decrease in the diameter upon inspiration. Altogether the IVC diameter and collapsibility index can be easily determined, but their role in children has not been fully demonstrated, and an estimation of volume status solely by assessing the IVC should thus be interpreted with caution. The inferior vena cava/abdominal aorta (IVC/AO) ratio may be a suitable parameter to assess the volume status in pediatric patients even though there is a need to define age-based thresholds. A combination of vascular, lung, and cardiac POCUS could be a valuable supplementary tool in the assessment of dehydration in several clinical scenarios, enabling rapid identification of life-threatening primary etiologies and helping physicians avoid inappropriate therapeutic interventions. Conclusion: POCUS can provide important information in the assessment of intravascular fluid status in emergency scenarios, but measurements may be confounded by a number of other clinical variables. The inclusion of lung and cardiac views may assist in better understanding the patient's physiology and etiology regarding volume status. What is Known: • In pediatric practice, POCUS (point-of-care ultrasound) has been mostly implemented to recognize lung conditions (like pneumonia and bronchiolitis) and pleural and pericardial effusions, but less to evaluate fluid depletion. • The size of the IVC (inferior vena cava) and its change in diameter in response to respiration have been studied as a possible screening tool to assess the volume status, predict fluid responsiveness, and assess potential intolerance to fluid loading. What is New: • The IVC diameter and collapsibility index can be easily assessed, but their role in predicting dehydration in pediatric age has not been fully demonstrated, and an estimation of volume status only by assessing the IVC should be interpreted carefully. • The IVC /AO(inferior vena cava/abdominal aorta) ratio may be a suitable parameter to assess the volume status in pediatric patients even though there is a need to define age-based thresholds. A combination of vascular, lung, and cardiac POCUS can be a valuable supplementary tool in the assessment of intravascular volume in several clinical scenarios.
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Affiliation(s)
- Anna Maria Musolino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lorenzo Di Sarno
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italia.
| | - Manuel Murciano
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Alessia Mesturino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Cristaldi S, Boni A, Ferro V, Musolino A, Della Vecchia N, Boccuzzi E, Bellelli E, Biagiarelli FS, Aulisa AG, Cirillo M, Raucci U, Villani A. Atraumatic Limping Child, a Challenge for Pediatricians: An Observational Age-Related Study in a Pediatric Emergency Department. Children (Basel) 2024; 11:185. [PMID: 38397297 PMCID: PMC10887381 DOI: 10.3390/children11020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/19/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Atraumatic limping is a frequent cause of consultation in Pediatric Emergency Departments (PED) and often represents a challenge for pediatricians for its variability in etiology ranging from benign causes to potential crippling conditions. The aims of this research are to illustrate the clinical features of acute limping children (LC) and to identify the possible red flags that could help to make a diagnosis of severe pathologies. METHODS We carried out a retrospective study about non-traumatic limping children referred to the PED of Bambino Gesù Children's Hospital over a 2-year period. We divided the cohort into three groups based on the patient's age: toddlers, children and adolescents. We considered crippling conditions: oncologic etiologies, bone or neurological infections, epiphysiolysis, Perthes disease, Guillain Barrè syndrome and non-accidental injuries. RESULTS We analyzed 485 patients. At clinical evaluation, 19.5% of the patients presented at least one sign and/or symptom of red flags. Crippling conditions (6.2% of the total population) showed red flags in 36.7%. Transient synovitis of the hip was the most frequent diagnosis. We found crippling conditions in 30 patients, mostly represented by toddlers. CONCLUSIONS Our data suggest that toddlers and patients presenting red flags should be evaluated with particular suspicion because they have an increased risk of underlying severe conditions.
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Affiliation(s)
- Sebastian Cristaldi
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Alessandra Boni
- Pneumology and Cystic Fibrosis, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Valentina Ferro
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Nicoletta Della Vecchia
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Elena Boccuzzi
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Elena Bellelli
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Francesco Saverio Biagiarelli
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Angelo Gabriele Aulisa
- Orthopaedics and Traumatology Division, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Marco Cirillo
- Department of Radiology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Umberto Raucci
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Alberto Villani
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
- Systems Medicine Department, University of Rome Tor Vergata, 00133 Rome, Italy
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Mesturino MA, Bitetti C, Clemente A, Krzysztofiak A, Lancella L, Lombardi R, Cursi L, Boccuzzi E, Musolino AM, Villani A. Aggregatibacter actinomycetemcomitans infection in a 15-year-old boy with pulmonary empyema: a case report and review of literature. Ital J Pediatr 2023; 49:42. [PMID: 37004059 PMCID: PMC10066016 DOI: 10.1186/s13052-023-01429-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/10/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Aggregatibacter actinomycetemcomitans (Aa), previously known as Actinobacillus actinomycetemcomitans, is a slow-growing Gram-negative coccobacillus, member of the HACEK group of bacteria colonizing oral flora. Besides causing infectious diseases in the oral cavity such as dental caries and periodontitis, it is responsible for severe extra-oral infections secondary to hematogenous spread or aspiration, such as endocarditis, soft tissue abscesses and osteomyelitis. The diagnosis depends on prolonged bacterial culture of biological material obtained through biopsy. Aa is susceptible to most antibiotics but complete eradication often requires a long term treatment. CASE PRESENTATION We report the case of a 15-year-old previously healthy boy diagnosed with both pulmonary empyema and subphrenic chest wall abscess caused by Aa. He was admitted to our Pediatric Emergency department for evaluation of a right mass associated with marked asthenia and dry cough. After radiological findings etiological diagnosis was made by culture of fluid drainage of pleural empyema. He started empirical antibiotic therapy with intravenous piperacillin/tazobactam, whose sensibility was confirmed by the antibiogram, then, for occurrance of hepatopathy it was switched to ciprofloxacin: the patient almost completely recovered after 6-month therapy. CONCLUSIONS Extra-oral infections caused by Aa are extremely rare, especially in children, and not well described yet. To our knowledge, there is only another similar case described in literature. However, the case described in our manuscript represents the only one presenting with pulmonary empyema without involvement of lung parenchyma in children. We also conducted a brief review of published cases of Aa infection in the pediatric population. This case report reminds us the importance of an accurate inspection of the oral cavity during the examination of pediatric patients.
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Affiliation(s)
- Maria Alessia Mesturino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
| | - Carol Bitetti
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Anna Clemente
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Andrzej Krzysztofiak
- Infectious Diseases and Immunoinfectivology Unit, University Hospital Pediatric Department, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Laura Lancella
- Infectious Diseases and Immunoinfectivology Unit, University Hospital Pediatric Department, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Roberta Lombardi
- Unit of Emergency Radiology, Department of Diagnostic Imaging, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Laura Cursi
- Infectious Diseases and Immunoinfectivology Unit, University Hospital Pediatric Department, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Elena Boccuzzi
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Anna Maria Musolino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Alberto Villani
- Unit of General Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
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Farina E, D'Amore C, Lancella L, Boccuzzi E, Ciofi Degli Atti ML, Reale A, Rossi P, Villani A, Raponi M, Raucci U. Alert sign and symptoms for the early diagnosis of pulmonary tuberculosis: analysis of patients followed by a tertiary pediatric hospital. Ital J Pediatr 2022; 48:90. [PMID: 35698090 PMCID: PMC9195307 DOI: 10.1186/s13052-022-01288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intercepting earlier suspected TB (Tuberculosis) cases clinically is necessary to reduce TB incidence, so we described signs and symptoms of retrospective cases of pulmonary TB and tried to evaluate which could be early warning signs. Methods We conducted a retrospective descriptive study of pulmonary TB cases in children in years 2005–2017; in years 2018–2020 we conducted a cohort prospective study enrolling patients < 18 years accessed to Emergency Department (ED) with signs/symptoms suggestive of pulmonary TB. Results In the retrospective analysis, 226 patients with pulmonary TB were studied. The most frequently described items were contact history (53.5%) and having parents from countries at risk (60.2%). Cough was referred in 49.5% of patients at onset, fever in 46%; these symptoms were persistent (lasting ≥ 10 days) in about 20%. Lymphadenopathy is described in 15.9%. The prospective study enrolled 85 patients of whom 14 (16.5%) were confirmed to be TB patients and 71 (83.5%) were non-TB cases. Lymphadenopathy and contact history were the most correlated variables. Fever and cough lasting ≥ 10 days were less frequently described in TB cases compared to non-TB patients (p < 0.05). Conclusions In low TB endemic countries, pulmonary TB at onset is characterized by different symptoms, i.e. persistent fever and cough are less described, while more relevant are contact history and lymphadenopathy. It was not possible to create a score because signs/symptoms usually suggestive of pulmonary TB (considered in the questionnaire) were not significant risk factors in our reality, a low TB country. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01288-5.
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Affiliation(s)
- Elisa Farina
- Unit of Internal Medicine, Celio Military Hospital, Rome, Italy
| | - Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- Division of Immunology and Infectious Diseases, Department (DPUO), University-Hospital Pediatric, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Elena Boccuzzi
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Antonino Reale
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paolo Rossi
- Medical Direction, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Alberto Villani
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Umberto Raucci
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Musolino AM, Ferro V, Supino MC, Boccuzzi E, Scateni S, Sinibaldi S, Cursi L, Schingo PMS, Reale A, Campana A, Raponi M, Villani A, Tomà P. One Year of Lung Ultrasound in Children with SARS-CoV-2 Admitted to a Tertiary Referral Children's Hospital: A Retrospective Study during 2020-2021. Children (Basel) 2022; 9:761. [PMID: 35626938 PMCID: PMC9139579 DOI: 10.3390/children9050761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/07/2022] [Accepted: 05/18/2022] [Indexed: 02/07/2023]
Abstract
During the COVID-19 pandemic, the lung ultrasound (LU) turned out to be a pivotal tool to study the lung involvement in the adult population, but the same was not well evaluated in children. We detected the LU patterns through an integrated approach with clinical−laboratory features in children hospitalized for COVID-19 in relation to the temporal trend of the Italian epidemic. We conducted a retrospective study which took place at a pediatric tertiary hospital from 15 March 2020 to 15 March 2021. We compared the characteristics of the initial phase of the first COVID-19 year—in the spring and summer (15 March−30 September 2020)—and those of the second phase—in the autumn and winter (1 October 2020−15 March 2021). Twenty-eight patients were studied both in the first and in the second phase of the first COVID-19 year. The disease severity score (DSS) was significantly greater in the second phase (p = 0.015). In the second phase of the first COVID-19 year, we detected a more significant occurrence of the following LU features than in the first phase: the irregular pleural line (85.71% vs. 60.71%; p = 0.035), the B-lines (89.29% vs. 60%; p = 0.003) and the several but non-coalescent B-lines (89.29% vs. 60%; p = 0.003). The LU score correlated significantly with the DSS, with a moderate relationship (r = 0.51, p < 0.001). The combined clinical, laboratory and ultrasound approaches might be essential in the evaluation of pulmonary involvement in children affected by COVID-19 during different periods of the pandemic.
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Affiliation(s)
- Anna Maria Musolino
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Valentina Ferro
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Maria Chiara Supino
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Elena Boccuzzi
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Simona Scateni
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Serena Sinibaldi
- Pediatric Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00050 Palidoro, Italy; (S.S.); (A.C.)
| | - Laura Cursi
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | | | - Antonino Reale
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Andrea Campana
- Pediatric Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00050 Palidoro, Italy; (S.S.); (A.C.)
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Alberto Villani
- General Pediatrics Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (P.M.S.S.); (P.T.)
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Ferro V, Boccuzzi E, Colafati GS, De Benedictis A, Supino MC, Faa MF, Musolino AM, Reale A, Raucci U. Children With a Soft Scalp Hematoma Presenting to the Emergency Department More Than 24 Hours After a Head Injury. Pediatr Emerg Care 2022; 38:e1217-e1223. [PMID: 35358149 DOI: 10.1097/pec.0000000000002682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The soft scalp hematoma is one of the clinical markers used as a predictor for the presence of intracranial injury in children with a head trauma. We evaluated the significance of time presentation in the management of these patients. METHODS We conducted a retrospective study of children and adolescents aged 0 to <18 years by comparing the clinical, radiological, and epidemiological features in those presenting within 24 hours with those presenting greater than 24 hours after a head injury. RESULTS We identified 188 and 98 patients with early presentation and late presentation, respectively. The percentage of children aged 0 to <6 months was lower in those with late presentation (6.12%) than those with early presentation (20.21%) with a significant difference (P < .001). Likewise, the percentage of children aged ≥24 months was lower in children with late presentation (7.14%) than those with early presentation (34.04%) with a significant difference (P < .001). The severe mechanism rate was more elevated in early presentation (38.83%) with a significant difference (-14.34%; 95% confidence interval [CI], -25.34% to -3.34%; P = .015). The symptom rate resulted higher in early presentation (14.36%) with a significant difference (-11.30%; 95% CI, -17.36% to 5.22%; P = .003). The parietal scalp hematoma occurred mostly in children with late presentation (85.71%) with a significant difference (19.76%; 95% CI, 10.07% to 29.45%; P < .001). The occipital scalp hematoma rate was higher in early presentation with a significant difference (-17.50%; 95% CI, -22.99% to -12.12%; P < .001). There was no significant difference in the prevalence of different types of intracranial injury, and the only 5 patients needing a neurosurgical intervention were exclusively children with an early presentation. CONCLUSION Although children with soft scalp hematoma presenting to the emergency department greater than 24 hours after a head injury may have pathological findings on computed tomography, all of them had a good short- and long-term outcomes, and no neurological deterioration aroused the medical attention on follow-up. For this subset of patients that does not experience red flags (neurological symptoms, focal signs on examination, or severe injury mechanism), a wait-and-see approach might be more appropriate rather than neuroimaging.
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Affiliation(s)
| | | | | | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neuro-Rehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Ferro V, Nacca R, Boccuzzi E, Federici T, Ossella C, Merenda A, Toniolo RM, Musolino AM, Reale A, Raucci U. Trend of hoverboard related injuries at a pediatric emergency department. Ital J Pediatr 2022; 48:54. [PMID: 35365202 PMCID: PMC8973941 DOI: 10.1186/s13052-022-01227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Understanding how the use of hoverboards (HBs) can affect a child's safety is crucial. We describe the characteristics of HB related injuries and provide key messages about child prevention when using these leisure devices. METHODS This was a retrospective study at an emergency department (ED) of a level-III-trauma center from 2016 to 2019. We tested the differences in children presenting for injury associated with HBs between 2016-2017 and 2018-2019 to better describe the temporal trend of the phenomenon. RESULTS The rate of Injury associated with HBs / Total injury per 1,000 increased from 0.84 in 2016 to 7.7 in 2017, and then there was a gradual decline. The likelihood of injury was more common in younger children, increasing by 17% with decreasing age in 2018-2019 compared with 2016-2017 (OR: 0.83; 95%CI: 0.71-0.97; p = 0.021). The occurrence of injury in the April-June period was over twice as common in 2018-2019 (OR: 2.05; 95%CI: 1.0-2.05; p = 0.05). Patients were over 4 times more likely to have injured the lower extremity during the 2018-2019 period rather than other body regions (OR: 4.58; 95%CI: 1.23-4.58; p = 0.02). The odds of the indoor injury were more than twice as high in 2018-2019 (OR: 2.04; 95%CI: 1.077-2.04; p = 0.03). CONCLUSION Despite a decrease in the frequency of HB related injuries after 2017, during the 2018-2019 period, the younger the children, the more they were exposed to injury risk, in addition to a greater occurrence of indoor injuries from HBs compared with 2016-2017. The enhancement of preventive measures is necessary to ensure child safety when using HBs.
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Affiliation(s)
- Valentina Ferro
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Raffaella Nacca
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Tatiana Federici
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Ossella
- Emergency Department, Bambino Gesù Children Hospital, IRCCS, Palidoro, Italy
| | - Alessandra Merenda
- U.O.C. of Orthopedics and Traumatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Renato Maria Toniolo
- U.O.C. of Orthopedics and Traumatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Maria Musolino
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonino Reale
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Musolino AM, Tomà P, De Rose C, Pitaro E, Boccuzzi E, De Santis R, Morello R, Supino MC, Villani A, Valentini P, Buonsenso D. Ten Years of Pediatric Lung Ultrasound: A Narrative Review. Front Physiol 2022; 12:721951. [PMID: 35069230 PMCID: PMC8770918 DOI: 10.3389/fphys.2021.721951] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/17/2021] [Indexed: 12/04/2022] Open
Abstract
Lung diseases are the most common conditions in newborns, infants, and children and are also the primary cause of death in children younger than 5 years old. Traditionally, the lung was not thought to be a target for an ultrasound due to its inability to penetrate the gas-filled anatomical structures. With the deepening of knowledge on ultrasound in recent years, it is now known that the affected lung produces ultrasound artifacts resulting from the abnormal tissue/gas/tissue interface when ultrasound sound waves penetrate lung tissue. Over the years, the application of lung ultrasound (LUS) has changed and its main indications in the pediatric population have expanded. This review analyzed the studies on lung ultrasound in pediatrics, published from 2010 to 2020, with the aim of highlighting the usefulness of LUS in pediatrics. It also described the normal and abnormal appearances of the pediatric lung on ultrasound as well as the benefits, limitations, and possible future challenges of this modality.
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Affiliation(s)
- Anna Maria Musolino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenio Pitaro
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Rita De Santis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- General Pediatric and Infectious Disease Unit, Internal Care Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
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9
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Scialanga B, Buonsenso D, Scateni S, Valentini P, Schingo PMS, Boccuzzi E, Mesturino MA, Ferro V, Chiaretti A, Villani A, Supino MC, Musolino AM. Lung Ultrasound to Detect Pneumothorax in Children Evaluated for Acute Chest Pain in the Emergency Department: An Observational Pilot Study. Front Pediatr 2022; 10:812246. [PMID: 35372158 PMCID: PMC8965612 DOI: 10.3389/fped.2022.812246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Spontaneous pneumothorax is a relatively uncommon and poorly studied condition in children. While several protocols have been developed to evaluate the use of lung ultrasound for dyspneic adult patients in the emergency department, no specific guidelines are present for pediatric emergency physicians. OBJECTIVES We prospectively analyzed children with acute chest pain and clinical suspicion of pneumothorax evaluated at the pediatric emergency department. METHODS We consecutively enrolled children aged 5-17 years presenting to the pediatric emergency department with clinically suspected pneumothorax based on sudden onset of acute chest pain. After clinical examination, all children underwent lung ultrasound followed by chest X-ray (reference standard). We enrolled 77 children, of which 13 (16.9%) received a final diagnosis of pneumothorax. RESULTS The lung point had a sensitivity of 92.3% (95% CI 77.8-100) and a specificity of 100% (95% CI 94.4-100) for the detection of pneumothorax. The "barcode sign" had a sensitivity of 100% (95% CI 75.3-100) and a specificity of 100% (95% CI 94.4-100) for the detection of pneumothorax. CONCLUSION Lung ultrasound is highly accurate in detecting or excluding pneumothorax in children with acute chest pain evaluated in the pediatric emergency department. If pneumothorax is suspected, but the lung point is not visible, the barcode sign should always be sought as it could be a form of massive pneumothorax.
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Affiliation(s)
- Barbara Scialanga
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Institute for Research and Health Care (IRCCS), Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli, Institute for Research and Health Care (IRCCS), Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Scateni
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Institute for Research and Health Care (IRCCS), Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Paolo Maria Salvatore Schingo
- Department of Diagnostic Imaging, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Elena Boccuzzi
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Alessia Mesturino
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Valentina Ferro
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Chiaretti
- Department of Woman and Child Health and Public Health, Institute for Research and Health Care (IRCCS), Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Chiara Supino
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Anna Maria Musolino
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
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10
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Boccuzzi E, Ferro VA, Cinicola B, Schingo PM, Strocchio L, Raucci U. Uncommon Presentation of Childhood Leukemia in Emergency Department: The Usefulness of an Early Multidisciplinary Approach. Pediatr Emerg Care 2021; 37:e412-e416. [PMID: 30461671 DOI: 10.1097/pec.0000000000001694] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ABSTRACT Leukemia is the most common childhood malignancy, and it is often characterized by pallor, fatigue, cytopenia, and organomegaly; sometimes musculoskeletal symptoms, mainly characterized by diffuse bone pain in the lower extremities, are the onset clinical characteristics of the disease. In these cases, the disease may initially be misdiagnosed as reactive arthritis, osteomyelitis, or juvenile idiopathic arthritis delaying appropriate diagnosis and management. Even if leukopenia, thrombocytopenia, and a history of nighttime pain are reported to be the most important predictive factors for a pediatric leukemia, blood examinations can sometimes be subtle or within normal limits, and this represents a further diagnostic difficulty. Radiological findings of leukemic bone involvement are described in patients with musculoskeletal symptoms of acute lymphoblastic leukemia and often appear before hematologic anomalies, but they are not specific for the disease. However, they could be helpful to get the right diagnosis if integrated with other features; thus, it is important knowing them, and it is mandatory for the multidisciplinary comparison to talk about dubious cases even in an emergency setting. We describe 4 patients visited in the emergency department for musculoskeletal complaints and having radiological lesions and a final diagnosis of acute lymphoblastic leukemia, in whom the onset of the manifestations could mimic orthopedic/rheumatologic diseases.
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Affiliation(s)
- Elena Boccuzzi
- From the Emergency Pediatric Department, Bambino Gesù Children's Hospital, IRCCS
| | - Valentina A Ferro
- From the Emergency Pediatric Department, Bambino Gesù Children's Hospital, IRCCS
| | - Bianca Cinicola
- Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome
| | | | - Luisa Strocchio
- Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Umberto Raucci
- From the Emergency Pediatric Department, Bambino Gesù Children's Hospital, IRCCS
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11
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Pandolfi E, Gesualdo F, Rizzo C, Russo L, Campagna I, Carloni E, Concato C, Linardos G, Villani A, Ciampini S, Reale A, Boccuzzi E, Midulla F, Tozzi AE. The impact of pertussis in infants: insights from a hospital-based enhanced surveillance system, Lazio region, Italy, 2016 to 2019. ACTA ACUST UNITED AC 2021; 26. [PMID: 34142648 PMCID: PMC8212589 DOI: 10.2807/1560-7917.es.2021.26.24.2000562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Routine surveillance systems for pertussis often suffer from under-recognition and under-reporting. Aim Our aim was to describe the epidemiology and the clinical features of pertussis in children younger than 1 year in an Italian region, detected through an enhanced hospital surveillance system. Methods From 2016 to 2019, we monitored the incidence and the clinical characteristics of hospitalised pertussis cases younger than 1 year in two paediatric hospitals involved in the PERTINENT project. Results We detected 141 pertussis cases, corresponding to an estimated incidence of 105.8 per 100.000 in 2016, 91.7 per 100.000 in 2017, 64.5 per 100.000 in 2018 and 40.9 per 100.000 in 2019, based on the hospitals’ catchment area, roughly corresponding to the Lazio region. A total of 101 cases (77.1%) had a household member with cough or other respiratory symptoms. The most frequent combination of symptoms was paroxysmal cough with apnoea in the absence of fever. Almost 40% had been prescribed an antibiotic treatment before hospitalisation, and the median time from symptom onset to contact with the hospital was 8 days. Thirty-one (22.0%) had complications. Conclusion An enhanced surveillance system showed a high incidence of pertussis among infants in the Lazio region, where the impact of this disease may still be underestimated. Increasing the coverage of pertussis immunisation among pregnant women and improving the capacity for early detection in primary care may contribute to reducing the impact of pertussis among infants.
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Affiliation(s)
- Elisabetta Pandolfi
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Francesco Gesualdo
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Caterina Rizzo
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Luisa Russo
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Ilaria Campagna
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Emanuela Carloni
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Carlo Concato
- Bambino Gesù Children's Hospital, IRCCS, Virology Unit, Rome, Italy
| | - Giulia Linardos
- Bambino Gesù Children's Hospital, IRCCS, Virology Unit, Rome, Italy
| | - Alberto Villani
- Bambino Gesù Children's Hospital, IRCCS, Paediatric and Infectious Diseases Unit, Rome, Italy
| | - Sara Ciampini
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Antonino Reale
- Bambino Gesù Children's Hospital, IRCCS, Emergency Department, Rome, Italy
| | - Elena Boccuzzi
- Bambino Gesù Children's Hospital, IRCCS, Emergency Department, Rome, Italy
| | - Fabio Midulla
- Sapienza University, Department of Paediatrics, Rome, Italy
| | - Alberto E Tozzi
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
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12
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Musolino AM, Boccuzzi E, Supino MC, Scialanga B, De Sanctis F, Buonsenso D, Sinibaldi S, Tomà P. Point-of-care lung ultrasound in the diagnosis and monitoring of paediatric patients with spontaneous pneumothorax in SARS-CoV-2 infection. J Paediatr Child Health 2021; 57:604-606. [PMID: 33655654 PMCID: PMC8014564 DOI: 10.1111/jpc.15410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 01/20/2023]
Abstract
Point-of-care lung ultrasound is a widely used tool in the diagnosis and management of patients with pulmonary diseases and now with SARS-CoV-2 infection. We describe two cases of pneumothorax which are, as far as we know, among the first reported in COVID-19 patients younger than 18 years. The diagnostic and monitoring role of point-of-care lung ultrasound has been extremely useful in the management of patients.
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Affiliation(s)
- Anna M Musolino
- Pediatric Emergency Unit, Department of Emergency and General PediatricsBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Elena Boccuzzi
- Pediatric Emergency Unit, Department of Emergency and General PediatricsBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Maria C Supino
- Pediatric Emergency Unit, Department of Emergency and General PediatricsBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Barbara Scialanga
- Pediatric Emergency Unit, Department of Emergency and General PediatricsBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Francesco De Sanctis
- Anesthesiology and Pediatric Intensive CareBambino Gesù Children's Hospital, IRCCSPalidoroItaly
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public HealthA. Gemelli University Polyclinic Foundation, IRCCSRomeItaly,Department of Basic Biotechnological Sciences, Intensivological and Perioperative ClinicsCatholic University of the Sacred HeartRomeItaly
| | - Serena Sinibaldi
- Pediatric Unit, Department of Emergency and General PediatricsBambino Gesù Children's Hospital, IRCCSPalidoroItaly
| | - Paolo Tomà
- Department of ImagingBambino Gesù Children's Hospital, IRCCSRomeItaly
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13
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Musolino AM, Buonsenso D, Massolo AC, Gallo M, Supino MC, Boccuzzi E. Point of care ultrasound in the paediatric acute care setting: Getting to the 'heart' of respiratory distress. J Paediatr Child Health 2021; 57:318-322. [PMID: 33295654 DOI: 10.1111/jpc.15308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/27/2020] [Accepted: 11/15/2020] [Indexed: 01/13/2023]
Abstract
Point-of-care ultrasound (POCUS) is a growing interesting tool in the emergency setting. Its usefulness in diagnostic and therapeutic pathway of patients with respiratory distress in addition to clinical evaluation is well established in adult emergency medicine while paediatric specific data, although growing, remain limited. We report a case series of paediatric patients presenting with respiratory distress successfully diagnosed with cardiac dysfunction following POCUS evaluations. Lung POCUS, in combination with cardiac POCUS, is a very useful supplementary diagnostic tool to assess the breathless child and to rapidly identify life-threatening primary etiologies or secondary physiologies. Thus, fast echocardiography is a desirable aid for paediatric emergency physicians and should be supported in all paediatric emergency settings following an adequate training that is mandatory regarding image acquisition and data interpretation.
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Affiliation(s)
- Anna M Musolino
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, A. Gemelli University Polyclinic Foundation, IRCCS, Rome, Italy.,Department of Basic Biotechnological Sciences, Intensivological and Perioperative Clinics, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna C Massolo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mariasara Gallo
- Specialization School in Anesthesia, Resuscitation and Pain Therapy, Sapienza University of Rome, Rome, Italy
| | - Maria C Supino
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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14
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Cursi L, Boccuzzi E, Lancella L, Longo D, Figá Talamanca L, Bozzola E, Villani A. HHV6-related mild encephalopathy with reversible splenial lesion (MERS) presenting with urinary and fecal retention in an Italian adolescent. Infez Med 2019; 27:97-102. [PMID: 30882387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mild encephalopathy with a reversible splenial lesion (MERS) is an uncommon clinico-radiological entity characterized by magnetic resonance imaging (MRI) findings of a reversible lesion in the splenium of corpus callosum associated with a significant neurological manifestation of encephalopathy. The majority of reported cases involve the Asiatic population and are closely associated with infection. We report the case of an adolescent with an HHV6-related MERS presenting with hyponatremia and urinary and fecal retention. To our knowledge, urinary retention is not a constant aspect of the disease and has rarely been described, while fecal retention has never been reported before. Despite the self-limiting nature of the disease, it is mandatory to suspect it for a faster diagnosis and it might be useful to know its rare occurrences in order to better understand its etiopathogenetic mechanisms.
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Affiliation(s)
- Laura Cursi
- University Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesú Children's Hospital, IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Department, Bambino Gesú Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- University Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesú Children's Hospital, IRCCS, Rome, Italy
| | - Daniela Longo
- Imaging Department, Neuroradiology Unit, Bambino Gesú Children's Hospital, IRCCS, Rome, Italy
| | - Lorenzo Figá Talamanca
- Imaging Department, Neuroradiology Unit, Bambino Gesú Children's Hospital, IRCCS, Rome, Italy
| | - Elena Bozzola
- University Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesú Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- University Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesú Children's Hospital, IRCCS, Rome, Italy
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15
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Lancella L, Di Camillo C, Vittucci AC, Boccuzzi E, Bozzola E, Villani A. Measles lessons in an anti-vaccination era: public health is a social duty, not a political option. Ital J Pediatr 2017; 43:102. [PMID: 29141656 PMCID: PMC5688720 DOI: 10.1186/s13052-017-0420-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/06/2017] [Indexed: 11/17/2022] Open
Abstract
Background Measles virus, member of the genus Morbillivirus in the family Paramyxoviridae, is a highly contagious human pathogen. An effective live-attenuated vaccine is available and its use has the potential to eradicate the disease from the human population. Although the vaccine was introduced in national vaccination schedules, several measles outbreaks have occurred because of insufficient vaccination coverage. Since early January 2017, a new outbreak of measles in Italy has been observed. Methods We analyzed all the patients admitted to the Emergency Department of Bambino Gesù Children Hospital of Rome from the 1st of January 2017 to the end of May 2017 and discharged with diagnosis of suspected or confirmed measles or admitted to the Pediatric and Infectious Disease Unit. For each confirmed case, demographic data, vaccination history, exposure to source case, clinical presentation, date of onset of symptoms, hospitalization, laboratory test results, complications and therapy were collected. Results From the 1st of January 2017 to the 31st of May 2017, we enrolled 139 patients who were conducted to the Emergency Department of Bambino Gesù Children’s Hospital because of measles: 33 patients were discharged with the diagnosis of suspected measles by clinical manifestations; 33 discharged with the diagnosis of confirmed measles by laboratory tests and 73 were admitted to the Pediatric and Infectious Disease Unit. Seven patients, who were exposed to mothers with measles, were admitted to receive treatment with Measles Immune Globulin intravenously. Among the 66 patients admitted to the hospital with measles, 31 cases (47%) occurred in unvaccinated individuals who were age-eligible for measles vaccination; 29 (44%) were infants too young to be vaccinated; only five patients (8%) received one dose of measles-containing vaccine. Out of the 66 patients, 35 (53%) developed complications. Acute respiratory failure was the most reported complications (20%). Death, due to multiorgan failure by measles, occurred in one 9-girl-year-age patient with genetic disorders who was unvaccinated. Conclusions Measles still represents a serious public health problem worldwide. Vaccination against measles is safe, effective, and cost-effective. High vaccination coverage (>95%) with two doses of measles vaccine is crucial to elimination. Health care professionals play an important role in vaccination uptake and prevention of measles spread during an outbreak.
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Affiliation(s)
- L Lancella
- General Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - C Di Camillo
- General Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - A C Vittucci
- General Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - E Boccuzzi
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - E Bozzola
- General Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - A Villani
- General Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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16
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Valentini D, Ianiro G, Di Bartolo I, Di Camillo C, Boccuzzi E, Vittucci AC, Ruggeri FM, Monini M. Hospital-acquired rotavirus and norovirus acute gastroenteritis in a pediatric unit, in 2014-2015. J Med Virol 2017; 89:1768-1774. [DOI: 10.1002/jmv.24866] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/08/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Diletta Valentini
- Pediatric and Infectious Disease Unit; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Giovanni Ianiro
- Department of Food Safety; Nutrition and Veterinary Public Health; Istituto Superiore di Sanità; Rome Italy
| | - Ilaria Di Bartolo
- Department of Food Safety; Nutrition and Veterinary Public Health; Istituto Superiore di Sanità; Rome Italy
| | - Chiara Di Camillo
- Pediatric and Infectious Disease Unit; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Elena Boccuzzi
- Pediatric and Infectious Disease Unit; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Anna C. Vittucci
- Pediatric and Infectious Disease Unit; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Franco M. Ruggeri
- Department of Food Safety; Nutrition and Veterinary Public Health; Istituto Superiore di Sanità; Rome Italy
| | - Marina Monini
- Department of Food Safety; Nutrition and Veterinary Public Health; Istituto Superiore di Sanità; Rome Italy
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17
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Marchili MR, Boccuzzi E, Vittucci AC, Aufiero LR, Vicari S, Villani A. Hypertransaminasemia and hypophosphoremia in an adolescent with anorexia nervosa: an event to watch for. Ital J Pediatr 2016; 42:49. [PMID: 27188310 PMCID: PMC4869384 DOI: 10.1186/s13052-016-0258-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background Case Presentation Conclusions
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18
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Lo Vecchio A, Lancella L, Tagliabue C, De Giacomo C, Garazzino S, Mainetti M, Cursi L, Borali E, De Vita MV, Boccuzzi E, Castellazzi L, Esposito S, Guarino A. Clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country. Eur J Clin Microbiol Infect Dis 2016; 36:177-185. [PMID: 27696233 DOI: 10.1007/s10096-016-2793-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/16/2016] [Indexed: 02/07/2023]
Abstract
Clostridium difficile infection (CDI) is increasingly found in children worldwide, but limited data are available from children living in southern Europe. A 6-year retrospective study was performed to investigate the epidemiology, clinical features, treatment, and risk of recurrence in Italy. Data of children with community- and hospital-acquired CDI (CA-CDI and HA-CDI, respectively) seen at seven pediatric referral centers in Italy were recorded retrospectively. Annual infection rates/10,000 hospital admissions were calculated. Logistic regression was used to investigate risk factors for recurrence. A total of 177 CDI episodes was reported in 148 children (83 males, median age 55.3 months), with a cumulative infection rate of 2.25/10,000 admissions, with no significant variability over time. The majority of children (60.8 %) had CA-CDI. Children with HA-CDI (39.2 %) had a longer duration of symptoms and hospitalization (p = 0.003) and a more common previous use of antibiotics (p = 0.0001). Metronidazole was used in 70.7 % of cases (87/123) and vancomycin in 29.3 % (36/123), with similar success rates. Recurrence occurred in 16 children (10.8 %), and 3 (2 %) of them presented a further treatment failure. The use of metronidazole was associated with a 5-fold increase in the risk of recurrence [odds ratio (OR) 5.18, 95 % confidence interval (CI) 1.1-23.8, p = 0.03]. Short bowel syndrome was the only underlying condition associated with treatment failure (OR 5.29, 95 % CI 1.17-23.8, p = 0.03). The incidence of pediatric CDI in Italy is low and substantially stable. In this setting, there is a limited risk of recurrence, which mainly concerns children treated with oral metronidazole and those with short bowel syndrome.
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Affiliation(s)
- A Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - L Lancella
- Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Rome, Italy
| | - C Tagliabue
- Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Gaetano Pini 3, Milan, Italy
| | - C De Giacomo
- Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - S Garazzino
- Regina Margherita Children's Hospital, University of Turin, Piazza Polonia 94, Turin, Italy
| | - M Mainetti
- Hospital of Ravenna, Via Vincenzo Randi 5, Ravenna, Italy
| | - L Cursi
- Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Rome, Italy
| | - E Borali
- Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - M V De Vita
- Regina Margherita Children's Hospital, University of Turin, Piazza Polonia 94, Turin, Italy
| | - E Boccuzzi
- Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Rome, Italy
| | - L Castellazzi
- Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Gaetano Pini 3, Milan, Italy
| | - S Esposito
- Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Gaetano Pini 3, Milan, Italy
| | - A Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
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Krzysztofiak A, Bozzola E, Lancella L, Boccuzzi E, Vittucci AC, Marchesi A, Villani A. Linezolid therapy in a perinatal late-onset Staphylococcus aureus sepsis complicated by spondylodiscitis and endophthalmitis. Infez Med 2015; 23:353-357. [PMID: 26700087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report the case of a two-month-old immunocompetent girl affected by Staphylococcus aureus sepsis complicated with pneumonia and pleural effusion, spondylodiscitis and endophthalmitis treated with linezolid. She developed a S. aureus sepsis in the neonatal period antibiotically treated with clinical resolution. Ten days after therapy discontinuation, the infant experienced a new S. aureus sepsis complicated by pneumonia with pleural effusion. Due to the presence of dorsal swelling, a pulmonary computer tomography was performed that showed a dorsal D5-D6 spondylodiscitis. Since the sepsis was scarcely responsive to several appropriate antibiotics, we finally decided to treat the patient with linezolid. A few weeks after changing antibiotics, the child underwent an ophthalmologic visit. Due to the finding of ocular lesions, imaging examinations were performed. The diagnosis was compatible with retinoblastoma, such that the eye was enucleated. Nevertheless, histological and microbiological investigations did not confirm the tumour hypothesis, but revealed a S. aureus abscess with retinal detachment. The child completed antibiotic therapy with linezolid and was visited periodically at the Infectious Disease Unit for a follow-up. She underwent progressive resolution of discitis and did not present any further flare of sepsis. Nevertheless, she still has a replacement device in her right eye and a D5-D6 severe kyphosis with spinal fusion.
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Affiliation(s)
- Andrzej Krzysztofiak
- Department of Paediatrics, Paediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elena Bozzola
- Department of Paediatrics, Paediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- Department of Paediatrics, Paediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Department of Paediatrics, Paediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Chiara Vittucci
- Department of Paediatrics, Paediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Marchesi
- Department of Paediatrics, Paediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Paediatrics, Paediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Casinelli E, Boccuzzi E, Versacci P, Marino B. Truncus arteriosus with unilateral absence of the left proximal pulmonary artery and DiGeorge syndrome. J Card Surg 2010; 26:559. [PMID: 20880083 DOI: 10.1111/j.1540-8191.2010.01124.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boccuzzi E, Casinelli E, Versacci P, Marino B. Isolated cleft of the mitral valve: its pathogenic relationship with endocardial cushion defects. Tex Heart Inst J 2010; 37:503; author reply 503. [PMID: 20844640 PMCID: PMC2929856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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