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Garancini N, Ricci G, Ghezzi M, Tommasi P, Zunica F, Mandelli A, Zoia E, D'Auria E, Zuccotti GV. Invasive Group A streptococcal infections: are we facing a new outbreak? A case series with the experience of a single tertiary center. Ital J Pediatr 2023; 49:88. [PMID: 37468965 DOI: 10.1186/s13052-023-01494-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND In pediatric age, Group A Streptococcus (GAS) is responsible for a wide spectrum of clinical manifestations, from mild localized infections to life-threatening invasive diseases. In December 2022, the World Health Organization reported an increased incidence of scarlet fever and invasive GAS infections (iGAS) cases in Europe and the United States. In line with these observations, surveillance has been strengthened in our Region, allowing the identification of certified or highly suspected forms of iGAS. CASE PRESENTATION We report here 4 emblematic cases of iGAS admitted to our Intensive Care Unit (ICU) in the short time span from mid-February to mid-March 2023. Particularly, we describe a case of pleuropneumonia (4 year old boy) and a case of respiratory failure (2 year old boy), who necessitated Non-Invasive Ventilation support, a case of Streptococcal Toxic Shock Syndrome (6 year old girl), presenting with multi-organ failure, who needed Invasive Ventilation, and a case of meningitis (5 year old girl). All these patients needed intensive care support. CONCLUSIONS Accurate differential diagnosis and early treatment both could help to reduce the transmission of GAS and consequently the risk of severe iGAS. These cases confirmed the need for close monitoring and appropriate notification, in order to verify their actual increased incidence.
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Affiliation(s)
- Nicolò Garancini
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Giulia Ricci
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Michele Ghezzi
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Paola Tommasi
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Fiammetta Zunica
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Anna Mandelli
- Division of Pediatric Anesthesia and Intensive Care Unit, Department of Pediatrics, Children's Hospital Vittore Buzzi, 20154, Milan, Italy
| | - Elena Zoia
- Division of Pediatric Anesthesia and Intensive Care Unit, Department of Pediatrics, Children's Hospital Vittore Buzzi, 20154, Milan, Italy
| | - Enza D'Auria
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154, Milan, Italy.
| | - Gian Vincenzo Zuccotti
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
- Department of Biomedical and Clinical Science, Università degli Studi di Milano, 20157, Milan, Italy
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2
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Di Profio E, Leone A, Vizzuso S, Fiore G, Pascuzzi MC, Agostinelli M, Dilillo D, Mannarino S, Fiori L, D’Auria E, Fabiano V, Carlucci P, Bova SM, Zoia E, Bosetti A, Calcaterra V, Bertoli S, Verduci E, Zuccotti G. Longitudinal Anthropometry and Body Composition in Children With SARS-CoV-2-Associated Multisystem Inflammatory Syndrome. J Pediatr Gastroenterol Nutr 2023; 76:505-511. [PMID: 36689921 PMCID: PMC10012841 DOI: 10.1097/mpg.0000000000003705] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/08/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Acute coronavirus disease 2019 infection has been shown to negatively affect body composition among adult and malnourished or obesity children. Our aim is to longitudinally evaluate body composition in children affected by the Multisystem Inflammatory Syndrome (MIS-C). METHODS In this cohort study, we recruited 40 patients affected by MIS-C, aged 2-18 years old, who were admitted in our clinic between December 2020 and February 2021. Physical examination for each participant included weight, height, body mass index (BMI) z score, circumferences, and skinfolds assessment. The same measurements were repeated during outpatient follow-up at 10 (T2), 30 (T3), 90 (T4), and 180 (T5) days after hospital discharge. Fat mass and fat free mass were calculated according to skinfolds predictive equations for children and adolescents. A control group was randomly selected among patients attending a pediatric nutritional outpatient clinic. RESULTS BMI z score significantly decrease between preadmission and hospital discharge. Similarly, arm circumference z score, arm muscular area z score, and arm fat area z score significantly decreased, during hospital stay. Fat mass index (FMI) significantly increased over time, peaking at T3. Fat free mass index decreased during hospitalization. CONCLUSIONS To the best of our knowledge, this is the first study to assess body composition in a numerically large pediatric MIS-C population from acute infection to 6 months after triggering event. FMI and anthropometric parameters linked to fat deposits were significantly higher 6 months after acute event. Thus, limiting physical activity and having sedentary lifestyle may lead to an accumulation of adipose tissue even in healthy children who experienced MIS-C and long hospitalization.
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Affiliation(s)
- Elisabetta Di Profio
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Alessandro Leone
- the International Centre for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Sara Vizzuso
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Giulia Fiore
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Martina Chiara Pascuzzi
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Marta Agostinelli
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Dario Dilillo
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Savina Mannarino
- the Pediatric Cardiology Unit, “Vittore Buzzi” Children’s Hospital, Milano, Italy
| | - Laura Fiori
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Enza D’Auria
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Valentina Fabiano
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Patrizia Carlucci
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Stefania Maria Bova
- the Paediatric Neurology Unit, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Elena Zoia
- the Anesthesia and Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, Milano, Italy
| | - Alessandra Bosetti
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Valeria Calcaterra
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
- the Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Simona Bertoli
- Lab of Nutrition and Obesity Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Elvira Verduci
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
- the Department of Health Sciences, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
- the Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
- the Pediatric Clinical Research Centre, Fondazione Romeo ed Enrica Invernizzi, University of Milan, Milan, Italy
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3
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Pelizzo G, Lanfranchi G, Pantaloni M, Camporesi A, Tommasi P, Durante E, Costanzo S, Canonica CMP, Zoia E, Zuccotti G, Ruotolopalmi V, Donzelli C, Tosi GL, Calcaterra V. Epidemiological and Clinical Profile of Pediatric Burns in the COVID-19 Era: The Experience of a Reference Center. Children (Basel) 2022; 9:1735. [PMID: 36421184 PMCID: PMC9688935 DOI: 10.3390/children9111735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 02/08/2024]
Abstract
Pediatric burns represent a significant public health problem. We analyzed the characteristics of pediatric burns in a reference center, in order to identify better strategies for prevention and care. Burn patients admitted to the pediatric departments of our hospital from January 2020 to June 2022 were retrospectively evaluated. Age, gender, the etiology of injuries, the total burn surface area (TBSA), the degree of burns, the length of hospital stay (LOS), concomitant SARS-CoV-2 infection, and burn surface microbial colonization were analyzed. Forty-seven patients were included in the analysis (M:F = 1:0.67). Most of the cases involved patients between 0 and 4 years of age (83%). Hot liquid burns accounted for 79% of cases, flame burns for 9%, thermal burns for 6%, scald burns for 4% and chemical burns for 2%. Mean TBSA was 14 ± 11%. A second-degree lesion was detected in 79% of patients and third-degree in 21%. Mean LOS was 17 days. No additional infection risks or major sequelae were reported in patients with SARS-CoV-2 infection. Fifteen different species of bacteria plus C. parapsilosis were isolated, while no anaerobic microorganisms were detected. In the light of our experience, we recommend a carefully planned and proactive management strategy, always multidisciplinary, to ensure the best care for the burned child.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
| | - Giulia Lanfranchi
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Marcello Pantaloni
- Plastic and Reconstructive Surgery Unit, Fatebenefratelli Sacco Hospital, 20154 Milan, Italy
| | - Anna Camporesi
- Pediatric Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Paola Tommasi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Eleonora Durante
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Sara Costanzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | | | - Elena Zoia
- Pediatric Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Valeria Ruotolopalmi
- Head Nurse Operating Room, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Claudia Donzelli
- Head Nurse Pediatric Surgery Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Giulia Lina Tosi
- Pharmacy Service Manager, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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4
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Camporesi A, Diotto V, Zoia E, Rotta S, Tarantino F, Eccher LMG, Calcaterra V, Pelizzo G, Gemma M. Postoperative apnea after pyloromyotomy for infantile hypertrophic pyloric stenosis. World Jnl Ped Surgery 2022; 5:e000391. [DOI: 10.1136/wjps-2021-000391] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/20/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveInfantile hypertrophic pyloric stenosis (IHPS), which causes gastric outlet obstruction and hypochloremic hypokalemic metabolic alkalosis, could pose a risk of postoperative apnea in patients. The aim of this study is to evaluate the incidence of postoperative apnea in babies admitted to a tertiary-level pediatric surgical center in Milano, Italy with diagnosis of IHPS in 2010–2019. The secondary objective is to evaluate the risk factors for postoperative apnea.MethodsThis is a single-center, retrospective, observational cohort study. All patients admitted to our institution with diagnosis of IHPS during the study period were enrolled. Demographic and surgical variables, along with blood gas parameters, were obtained from the population. Postoperative apnea was defined as a respiratory pause longer than 15 s or a respiratory pause lasting less than 15 s, but associated with either bradycardia (heart rate <120 per minute), desaturation (SatO2 <90%), cyanosis, or hypotonia. Occurrence was obtained from nursing charts and was recorded as a no/yes dichotomous variable.ResultsOf 122 patients, 12 (9.84%) experienced apnea and 110 (90.16%) did not. Using univariate analysis, we found that only postoperative hemoglobin was significantly different between the groups (p=0.03). No significant multivariable model was better than this univariate model for prediction of apnea.ConclusionsPostoperative anemia, possibly due to hemodilution, increased the risk of postoperative apnea. It could be hypothesized that anemia can be added as another apnea-contributing factor in a population at risk due to metabolic changes.
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5
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Mannarino S, Raso I, Garbin M, Ghidoni E, Corti C, Goletto S, Nespoli L, Santacesaria S, Zoia E, Camporesi A, Izzo F, Dilillo D, Fiori L, D'Auria E, Silvestri AD, Dolci A, Calcaterra V, Zuccotti G. Cardiac dysfunction in Multisystem Inflammatory Syndrome in Children: An Italian single-center study. Ital J Pediatr 2022; 48:25. [PMID: 35135600 PMCID: PMC8822778 DOI: 10.1186/s13052-021-01189-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 10/13/2021] [Accepted: 11/30/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a novel condition temporally associated with SARS-CoV2 infection. Cardiovascular involvement is mainly evident as acute myocardial dysfunction in MIS-C. The aim of this study was to describe the cardiac dysfunction in patients with MIS-C, defining the role of severity in the clinical presentations and outcomes in a single cohort of pediatric patients. METHODS A single-center retrospective study on patients diagnosed with MIS-C, according to the Center for Disease Control and Prevention (CDC) definition, and referred to Vittore Buzzi Children's Hospital in Milan from November 2020 to February 2021. Patients were managed according to a local approved protocol. According to the admission cardiac left ventricular ejection fraction (LVEF), the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥45%). Pre-existing, clinical, and laboratory factors were assessed for evaluating outcomes at discharge. RESULTS Thirty-two patients were considered. Cardiac manifestations of MIS-C were reported in 26 patients (81%). Group A included 10 patients (9 M/1F, aged 13 years [IQR 5-15]), and group B included 22 patients (15 M/7 M, aged 9 years [IQR 7-13]). Significant differences were noted among clinical presentations (shock, diarrhea, intensive care unit admission), laboratory markers (leucocytes, neutrophils, and protein C-reactive), and cardiac markers (troponin T and N-terminal pro B-type Natriuretic Peptide) between the groups, with higher compromission in Group A. We found electrocardiogram anomalies in 14 patients (44%) and rhythm alterations in 3 patients (9%), without differences between groups. Mitral regurgitation and coronary involvement were more prevalent in group A. Total length of hospital stay and cardiac recovery time were not statistically different between groups. A recovery of cardiac functioning was reached in all patients. CONCLUSION Despite significant differences in clinical presentations and need for intensive care, all of the MIS-C patients with significant cardiac involvement in this study completely recovered. This suggests that the heart is an involved organ and did not influence prognosis if properly treated and supported in the acute phase.
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Affiliation(s)
- Savina Mannarino
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.
| | - Irene Raso
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Massimo Garbin
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Elena Ghidoni
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Carla Corti
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Sara Goletto
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Luisa Nespoli
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Sara Santacesaria
- Pediatric Cardiology Unit, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Elena Zoia
- Anesthesia and Intensive Care Unit, ``Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Anna Camporesi
- Anesthesia and Intensive Care Unit, ``Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Francesca Izzo
- Anesthesia and Intensive Care Unit, ``Vittore Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Dario Dilillo
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Laura Fiori
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Enza D'Auria
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Annalisa De Silvestri
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Alberto Dolci
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy.,Pediatric and Adolescent Unit, Clinical Pathology Laboratory , "Luigi Sacco" Hospital, 27100, Pavia, Italy
| | - Valeria Calcaterra
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.,Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100, Pavia, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.,Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy
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6
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Calcaterra V, Biganzoli G, Dilillo D, Mannarino S, Fiori L, Pelizzo G, Zoia E, Fabiano V, Carlucci P, Camporesi A, Corti C, Mercurio G, Izzo F, Biganzoli E, Zuccotti G. Non-thyroidal illness syndrome and SARS-CoV-2-associated multisystem inflammatory syndrome in children. J Endocrinol Invest 2022; 45:199-208. [PMID: 34312809 PMCID: PMC8312710 DOI: 10.1007/s40618-021-01647-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE COVID-19 disease may result in a severe multisystem inflammatory syndrome in children (MIS-C), which in turn may alter thyroid function (TF). We assessed TF in MIS-C, evaluating its impact on disease severity. METHODS We retrospectively considered children admitted with MIS-C to a single pediatric hospital in Milan (November 2019-January 2021). Non-thyroidal illness syndrome (NTIS) was defined as any abnormality in TF tests (FT3, FT4, TSH) in the presence of critical illness and absence of a pre-existing hormonal abnormality. We devised a disease severity score by combining severity scores for each organ involved. Glucose and lipid profiles were also considered. A principal component analysis (PCA) was performed, to characterize the mutual association patterns between TF and disease severity. RESULTS Of 26 (19 M/7F) patients, median age 10.7 (IQR 5.8-13.3) years, 23 (88.4%) presented with NTIS. A low FT3 level was noted in 15/23 (65.3%), while the other subjects had varying combinations of hormone abnormalities (8/23, 34.7%). Mutually correlated variables related to organ damage and inflammation were represented in the first dimension (PC1) of the PCA. FT3, FT4 and total cholesterol were positively correlated and characterized the second axis (PC2). The third axis (PC3) was characterized by the association of triglycerides, TyG index and HDL cholesterol. TF appeared to be related to lipemic and peripheral insulin resistance profiles. A possible association between catabolic components and severity score was also noted. CONCLUSIONS A low FT3 level is common among MIS-C. TF may be useful to define the impact of MIS-C on children's health and help delineate long term follow-up management and prognosis.
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Affiliation(s)
- V Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Via Aselli 2, 27100, Pavia, Italy.
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.
| | - G Biganzoli
- Pharmacogenomics and Precision Therapeutics Master Degree, University of Milan, 20142, Milan, Italy
| | - D Dilillo
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - S Mannarino
- Pediatric Cardiology Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - L Fiori
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - G Pelizzo
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, University of Milan, 20154, Milan, Italy
| | - E Zoia
- Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - V Fabiano
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy
| | - P Carlucci
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - A Camporesi
- Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - C Corti
- Pediatric Cardiology Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - G Mercurio
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - F Izzo
- Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - E Biganzoli
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, 20122, Milan, Italy
| | - G Zuccotti
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy
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7
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Zuccotti G, Calcaterra V, Mannarino S, D'Auria E, Bova SM, Fiori L, Verduci E, Milanese A, Marano G, Garbin M, Zirpoli S, Fabiano V, Carlucci P, Olivotto S, Gianolio L, De Santis R, Pelizzo G, Zoia E, Dilillo D, Biganzoli EM. Six-month multidisciplinary follow-up in multisystem inflammatory syndrome in children: An Italian single-center experience. Front Pediatr 2022; 10:1080654. [PMID: 36776681 PMCID: PMC9909209 DOI: 10.3389/fped.2022.1080654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND A severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 has been described after infection. A limited number of reports have analyzed the long-term complications related to pro-inflammatory status in MIS-C. We evaluated multiorgan impairment at the 6-month follow-up in MIS-C. METHODS We enrolled 33 pediatric patients consecutively hospitalized for MIS-C and monitored for almost 6 months. The inter-relationship of patient's features and disease severity at admission with long term complications was studied by multivariate analysis. RESULTS Endo-metabolic derangement, cardiac injury, respiratory, renal and gastrointestinal manifestations and neurological involvement are part of the initial presentation. The most abnormalities appear to resolve within the first few weeks, without significant long term dysfunction at the 6-months follow-up, except for endocrine (non-thyroidal illness syndrome in 12.1%, insulin resistance in 21.2%) and neurological system (27.3% cognitive or psychological, behavioral, adaptive difficulties). Endocrine and heart involvement at admission represent a significant factor on the long term sequelae; however no association between severity score and long-term outcome was noted. CONCLUSIONS The severity of initial clinical presentation may be associated to organ domain, however it is not related to long term sequelae. The prevalent organ restoration supports a predominant indirect immune-mediated injury triggered by a systemic inflammatory response; however a direct damage due to the viral entry could be not excluded. Eventhought our preliminary results seem to suggest that MIS-C is not a long-term risk condition for children health, a longer follow-up is mandatory to confirm this hypothesis.
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Affiliation(s)
- Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy.,Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy.,Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Enza D'Auria
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Laura Fiori
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Elvira Verduci
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy.,Department of Health Sciences, University of Milano, Milano, Italy
| | - Alberto Milanese
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Giuseppe Marano
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Massimo Garbin
- Pediatric Cardiology Unit, Buzzi Children's Hospital, Milan, Italy
| | | | - Valentina Fabiano
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy.,Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Sara Olivotto
- Pediatric Neurology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Laura Gianolio
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Gloria Pelizzo
- Pediatric Surgery Department, Buzzi Children's Hospital, Milan, Italy
| | - Elena Zoia
- Intensive Care Unit, Buzzi Children's Hospital, Milan, Italy
| | - Dario Dilillo
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
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8
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Camporesi A, Abecasis F, Torres EM, Zoia E, Izzo F, Ferrario S, Melloni EMT. The parental psychological distress caused by separation from their critically ill child during the COVID-19 pandemic: A tale of two cities. Front Pediatr 2022; 10:909210. [PMID: 36186626 PMCID: PMC9520916 DOI: 10.3389/fped.2022.909210] [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: 03/31/2022] [Accepted: 08/12/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION A child's critical illness is a stressful event for the entire family, causing significant emotional distress among parents and changes to family functioning. The Severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-CoV-2) pandemic has abruptly caused modifications in visitation policies of Pediatric Intensive Care Units (PICUs) in many countries. We hypothesized that caregivers with no or severely restricted access to PICUs would demonstrate increased psychological distress as compared to those who had limitless access (LA) to PICUs. METHODS Sociodemographic variables, levels of psychological distress, ratings of family functioning, and ability to cope with stressful events were collected with an online survey in a group of caregivers after their child's hospitalization. Ratings of psychological distress were compared between caregivers with no/severely restricted (NA) and with LA to PICUs. RESULTS Measures of depression, anxiety, and global severity index (GSI) of psychological distress were significantly higher in NA caregivers as compared to LA. Among demographic characteristics of the sample, only gender influenced the severity of psychological symptoms: women showed an increased score on levels of somatization, depression, anxiety, and GSI. Avoidant coping style positively correlated with measures of depression. Univariate General Linear Model (GLM) analyses of the effects of sex, age, visitation policies of PICUs, and score of avoidant coping strategies on measures of psychological distress confirmed a significant univariate effect of no access to PICUs on parents' psychopathological scores. CONCLUSION Restrictions imposed on visitation policies in PICU during the pandemic negatively impacted families' psychological wellbeing. A balance between the safety of patients, families, and health care professionals and meeting the needs of families is of utmost importance.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Milan, Italy
| | - Francisco Abecasis
- Pediatric Intensive Care Unit, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Erica M Torres
- Pediatric Intensive Care Unit, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Elena Zoia
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Milan, Italy
| | - Francesca Izzo
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Milan, Italy
| | - Stefania Ferrario
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Milan, Italy
| | - Elisa Maria Teresa Melloni
- Psychiatry & Clinical Psychobiology Unit, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
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9
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Verduci E, Risé P, Di Profio E, Fiori L, Vizzuso S, Dilillo D, Mannarino S, Zoia E, Calcaterra V, Pinna C, Sala A, Zuccotti G. Blood Fatty Acids Profile in MIS-C Children. Metabolites 2021; 11:metabo11110721. [PMID: 34822379 PMCID: PMC8624489 DOI: 10.3390/metabo11110721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/21/2023] Open
Abstract
MIS-C (multisystem inflammatory syndrome in children) linked to SARS-CoV-2 infection, is a pathological state observed in subjects younger than 21 years old with evidence of either current SARS-CoV-2 infection or exposure within the 4 weeks prior to the onset of symptoms, the presence of documented fever, elevated markers of inflammation, at least two signs of multisystem involvement, and, finally, lack of an alternative diagnosis. They share with adult COVID-19 patients the presence of altered markers of inflammation, but unlike most adults the symptoms are not pulmonary but are affecting several organs. Lipid mediators arising from polyunsaturated fatty acids (PUFA) play an important role in the inflammatory response, with arachidonic acid-derived compounds, such as prostaglandins and leukotrienes, mainly pro-inflammatory and ω3 PUFA metabolites such as resolvins and protectins, showing anti-inflammatory and pro-resolution activities. In order to assess potential alterations of these FA, we evaluated the blood fatty acid profile of MIS-C children at admission to the hospital, together with biochemical, metabolic and clinical assessment. All the patients enrolled showed altered inflammatory parameters with fibrinogen, D-dimer, NT-proBNP, ferritin, aspartate aminotransferase (AST), C-reactive protein (CRP) and TrygIndex levels over the reference values in all the subjects under observation, while albumin and HDL-cholesterol resulted below the normal range. Interestingly, linoleic acid (LA), arachidonic acid (AA) and the ω3 PUFA docosahexaenoic acid (DHA) results were lower in our study when compared to relative amounts reported in the other studies, including from our own laboratory. This significant alteration is pointing out to a potential depletion of these PUFA as a result of the systemic inflammatory condition typical of these patients, suggesting that LA- and AA-derived metabolites may play a critical role in this pathological state, while ω3 PUFA-derived pro-resolution metabolites in these subjects may not be able to provide a timely, physiological counterbalance to the formation of pro-inflammatory lipid mediators. In conclusion, this observational study provides evidence of FA alterations in MIS-C children, suggesting a significant contribution of ω6 FA to the observed inflammatory state, and supporting a potential dietary intervention to restore an appropriate balance among the FAs capable of promoting the resolution of the observed inflammatory condition.
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Affiliation(s)
- Elvira Verduci
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (E.D.P.); (L.F.); (S.V.); (D.D.); (V.C.); (G.Z.)
- Department of Health Sciences, University of Milano, 20142 Milano, Italy
| | - Patrizia Risé
- Department of Pharmaceutical Sciences, University of Milan, 20133 Milano, Italy; (P.R.); (C.P.)
| | - Elisabetta Di Profio
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (E.D.P.); (L.F.); (S.V.); (D.D.); (V.C.); (G.Z.)
- Department of Animal Sciences for Health, Animal Production and Food Safety, University of Milan, 20133 Milan, Italy
| | - Laura Fiori
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (E.D.P.); (L.F.); (S.V.); (D.D.); (V.C.); (G.Z.)
| | - Sara Vizzuso
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (E.D.P.); (L.F.); (S.V.); (D.D.); (V.C.); (G.Z.)
| | - Dario Dilillo
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (E.D.P.); (L.F.); (S.V.); (D.D.); (V.C.); (G.Z.)
| | - Savina Mannarino
- Pediatric Cardiology Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Elena Zoia
- Anesthesia and Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (E.D.P.); (L.F.); (S.V.); (D.D.); (V.C.); (G.Z.)
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Christian Pinna
- Department of Pharmaceutical Sciences, University of Milan, 20133 Milano, Italy; (P.R.); (C.P.)
| | - Angelo Sala
- Department of Pharmaceutical Sciences, University of Milan, 20133 Milano, Italy; (P.R.); (C.P.)
- IRIB, C.N.R., 90146 Palermo, Italy
- Correspondence:
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (E.D.P.); (L.F.); (S.V.); (D.D.); (V.C.); (G.Z.)
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10
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Pelizzo G, Vestri E, Del Re G, Filisetti C, Osti M, Camporesi A, Rizzo D, De Angelis A, Zoia E, Tommasi P, Zuccotti G, Calcaterra V. Supporting the Regional Network for Children with Burn Injuries in a Pediatric Referral Hospital for COVID-19. Healthcare (Basel) 2021. [PMID: 34066726 DOI: 10.339/healthcare9050551] [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] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Considerable reorganization of the regional network for pediatric burn treatment during the pandemic was required to cope with severe burn injuries in small children. In support of the emergency network for burns during the COVID-19 pandemic, we referred to regional indications for centralization in our hospital for all children aged less than 5 years who presented with severe burns, >15% of total body surface area (TBSA), or who necessitated admittance to the pediatric intensive care unit (PICU). A new service with a dedicated management protocol was set up to treat pediatric burns in our SARS-CoV-2 pediatric hospital during the lockdown period. A multidisciplinary burn treatment team was set up to offer compassionate and comprehensive burn care. Patient's clinical data, burn features, treatment and follow up were recorded. A higher number of admissions was recorded from February to December 2020 compared with the same period in 2019 (52 vs. 32 admissions). Eighteen patients were admitted to the COVID-19 Service (10 M/8 F; 3.10 ± 2.6 yrs); ten children (55.5%) were hospitalized in the ward and eight in the ICU (44.5%). Fifty percent of the cases presented with lesions extending over >15% TBSA; in one case, TBSA was 35%. All patients suffered 2nd-degree burns; while five patients also had 3rd degree lesions covering more than 15% TBSA. All of the injuries occurred at home. No major secondary infections were recorded. Successful treatment was achieved in 94.4% of cases. The average length of stay was 15.2 ± 12.6 days. A proactive, carefully planned service, involving a multidisciplinary team, was created to ensure appropriate care in a pediatric hospital during the COVID-19 period, despite the effective pandemic associated challenges. Better health promotion in pediatric burn cases should also include dedicated TBSA assessment and a database of children's burn characteristics.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy.,Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20122 Milan, Italy
| | - Elettra Vestri
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Giulia Del Re
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Claudia Filisetti
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Monica Osti
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy.,Department of Surgery, Policlinico San Donato, 20097 Milan, Italy
| | - Anna Camporesi
- Pediatric Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Dario Rizzo
- Outpatients Unit, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | | | - Elena Zoia
- Pediatric Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Paola Tommasi
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20122 Milan, Italy.,Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy.,Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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11
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Pelizzo G, Costanzo S, Maestri L, Selvaggio GGO, Pansini A, Zuccotti GV, Zoia E, De Filippis G, Visconti A, Calcaterra V. The Challenges of a Children's Hospital during the COVID-19 Pandemic: The Pediatric Surgeon's Point of View. Pediatr Rep 2020; 12:114-123. [PMID: 33198282 PMCID: PMC7717660 DOI: 10.3390/pediatric12030025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/30/2020] [Accepted: 06/11/2020] [Indexed: 12/24/2022] Open
Abstract
During the coronavirus disease of 2019 (COVID-19) emergency, in the pediatric surgical setting, it has been essential to avoid and contain infections as well as to protect both the patients and the surgical team. During this emergency, procedures and workflow were adapted to provide the safest possible environment for both the surgical team and the patients. Pediatric surgical activities were reorganized during the COVID-19 pandemic at the "Vittore Buzzi" Children's Hospital, which is a pediatric/maternal hospital located in Milan (Lombardy Region), Italy. Resources were optimized in order to maintain high levels of care and quality of assistance. During the COVID-19 emergency, the pediatric surgical department at the "Vittore Buzzi" Children's Hospital became an acute care surgical service. For the reorganization of surgical activities, institutional protocols were adapted in order to preserve the pediatric-specific characteristics of our service; five crucial points were specifically addressed. The pediatric surgical procedures carried out during the initial two months of the Italian lockdown are also reported. Continuity of care was maintained for children affected by severe diseases, such as tumors and neurosurgical conditions, whose treatment could not be deferred. Telemedicine and telecommunication were adopted as quick-support modalities for pre- and post-operative care. This reorganization allowed us to preserve the "pediatric specificity" and all care-related procedures offered at this high-quality/high-volume surgical care referral center.
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Affiliation(s)
- Gloria Pelizzo
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy; (S.C.); (L.M.); (G.G.O.S.); (A.P.)
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, 20157 Milano, Italy;
- Correspondence: ; Tel.: +39-02-6363-5435
| | - Sara Costanzo
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy; (S.C.); (L.M.); (G.G.O.S.); (A.P.)
| | - Luciano Maestri
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy; (S.C.); (L.M.); (G.G.O.S.); (A.P.)
| | - Giorgio Giuseppe Orlando Selvaggio
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy; (S.C.); (L.M.); (G.G.O.S.); (A.P.)
| | - Andrea Pansini
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy; (S.C.); (L.M.); (G.G.O.S.); (A.P.)
| | - Gian Vincenzo Zuccotti
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, 20157 Milano, Italy;
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy;
| | - Elena Zoia
- Department of Pediatrics, Anesthesiology and Intensive Care Unit, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy;
| | - Giuseppe De Filippis
- “V. Buzzi” Children’s Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.D.F.); (A.V.)
| | - Alessandro Visconti
- “V. Buzzi” Children’s Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.D.F.); (A.V.)
| | - Valeria Calcaterra
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy;
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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12
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Parri N, Magistà AM, Marchetti F, Cantoni B, Arrighini A, Romanengo M, Felici E, Urbino A, Da Dalt L, Verdoni L, Armocida B, Covi B, Mariani I, Giacchero R, Musolino AM, Binotti M, Biban P, Fasoli S, Pilotto C, Nicoloso F, Raggi M, Miorin E, Buonsenso D, Chiossi M, Agostiniani R, Plebani A, Barbieri MA, Lanari M, Arrigo S, Zoia E, Lenge M, Masi S, Barbi E, Lazzerini M. Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks. Eur J Pediatr 2020; 179:1315-1323. [PMID: 32495147 PMCID: PMC7269687 DOI: 10.1007/s00431-020-03683-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 02/07/2023]
Abstract
Detailed data on clinical presentations and outcomes of children with COVID-19 in Europe are still lacking. In this descriptive study, we report on 130 children with confirmed COVID-19 diagnosed by 28 centers (mostly hospitals), in 10 regions in Italy, during the first months of the pandemic. Among these, 67 (51.5%) had a relative with COVID-19 while 34 (26.2%) had comorbidities, with the most frequent being respiratory, cardiac, or neuromuscular chronic diseases. Overall, 98 (75.4%) had an asymptomatic or mild disease, 11 (8.5%) had moderate disease, 11 (8.5%) had a severe disease, and 9 (6.9%) had a critical presentation with infants below 6 months having significantly increased risk of critical disease severity (OR 5.6, 95% CI 1.3 to 29.1). Seventy-five (57.7%) children were hospitalized, 15 (11.5%) needed some respiratory support, and nine (6.9%) were treated in an intensive care unit. All recovered.Conclusion:This descriptive case series of children with COVID-19, mostly encompassing of cases enrolled at hospital level, suggest that COVID-19 may have a non-negligible rate of severe presentations in selected pediatric populations with a relatively high rates of comorbidities. More studies are needed to further understand the presentation and outcomes of children with COVID-19 in children with special needs. What is Known: • There is limited evidence on the clinical presentation and outcomes of children with COVID-19 in Europe, and almost no evidence on characteristics and risk factors of severe cases. What is New: • Among a case series of 130 children, mostly diagnosed at hospital level, and with a relatively high rate (26.2%) of comorbidities, about three-quarter had an asymptomatic or mild disease. • However, 57.7% were hospitalized, 11.5% needed some respiratory support, and 6.9% were treated in an intensive care unit.
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Affiliation(s)
- Niccolò Parri
- Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy
| | | | | | - Barbara Cantoni
- Healthcare Professional Department Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Arrighini
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | | | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Urbino
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Liviana Da Dalt
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua, Italy
| | - Lucio Verdoni
- Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Benedetta Armocida
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Benedetta Covi
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | | | - Anna Maria Musolino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Binotti
- Neonatal and Pediatric Intensive Care Unit, Maggiore della Carità University Hospital, Novara, Italy
| | - Paolo Biban
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
| | | | - Chiara Pilotto
- Division of Paediatrics, Department of Medicine DAME, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
| | | | | | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Anna Plebani
- Pediatric Emergency Unit, Filippo Del Ponte Hospital, ASST-Settelaghi, Varese, Italy
| | | | - Marcello Lanari
- Pediatric Emergency Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Serena Arrigo
- Department of Pediatrics, Hospital Filippo Del Ponte, Varese, Italy
| | - Elena Zoia
- Department of Pediatrics, Hospital V. Buzzi, Milan, Italy
| | - Matteo Lenge
- Clinical Trial Office, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Child Neurology Unit and Laboratories, Neuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
| | - Stefano Masi
- Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Department of Medicine, Surgery and Health Science, Department of Pediatrics, University of Trieste, Trieste, Italy
| | - Marzia Lazzerini
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - on behalf of the CONFIDENCE and COVID-19 Italian Pediatric Study Networks
- Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy
- Department of Pediatrics, Community Pediatrics, Ravenna, Italy
- Department of Pediatrics, Ravenna Hospital, Ravenna, Italy
- Healthcare Professional Department Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
- IRCCS Istituto Gaslini, Genoa, Italy
- Pediatric and Pediatric Emergency Unit, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua, Italy
- Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Department of Pediatrics, Lodi Hospital, Lodi, Italy
- Department of Pediatric Emergency Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Neonatal and Pediatric Intensive Care Unit, Maggiore della Carità University Hospital, Novara, Italy
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
- Paediatric Unit, Carlo Poma Hospital, Mantua, Italy
- Division of Paediatrics, Department of Medicine DAME, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
- Family Pediatrician, Udine, Italy
- ICU, Pain Therapy Unit, Rovereto Hospital, Trento, Italy
- Department of Pediatrics, Latisana-Palmanova, ASUFC, Udine, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Pediatrics, ASL 4 Liguria, Lavagna, Italy
- Department of Pediatrics, Ospedale San Jacopo, Pistoia, Italy
- Pediatric Emergency Unit, Filippo Del Ponte Hospital, ASST-Settelaghi, Varese, Italy
- Pediatric Emergency Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
- Department of Pediatrics, Hospital Filippo Del Ponte, Varese, Italy
- Department of Pediatrics, Hospital V. Buzzi, Milan, Italy
- Clinical Trial Office, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Child Neurology Unit and Laboratories, Neuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Department of Medicine, Surgery and Health Science, Department of Pediatrics, University of Trieste, Trieste, Italy
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Zirpoli S, Munari AM, Primolevo A, Scarabello M, Costanzo S, Farolfi A, Lista G, Zoia E, Zuccotti GV, Riccipetitoni G, Righini A. Agreement between magnetic resonance imaging and computed tomography in the postnatal evaluation of congenital lung malformations: a pilot study. Eur Radiol 2019; 29:4544-4554. [PMID: 30796572 DOI: 10.1007/s00330-019-06042-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/20/2018] [Accepted: 01/24/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare postnatal magnetic resonance imaging (MRI) with the reference standard computed tomography (CT) in the identification of the key features for diagnosing different types of congenital lung malformation (CLM). METHODS Respiratory-triggered T2-weighted single-shot turbo spin echo (ss-TSE), respiratory-triggered T1-weighted turbo field echo (TFE), balanced fast field echo (BFFE), and T2-weighted MultiVane sequences were performed at 1.5 T on 20 patients prospectively enrolled. Two independent radiologists examined the postnatal CT and MRI evaluating the presence of cysts, hyperinflation, solid component, abnormal arteries and/or venous drainage, and bronchocele. Diagnostic performance of MRI was calculated and the agreement between the findings was assessed using the McNemar-Bowker test. Interobserver agreement was measured with the kappa coefficient. RESULTS CT reported five congenital pulmonary airway malformations (CPAMs), eight segmental bronchial atresias, five bronchopulmonary sequestrations (BPS), one congenital lobar overinflation, one bronchogenic cyst, and three hybrid lesions. MRI reported the correct diagnosis in 19/20 (95%) patients and the malformation was correctly classified in 22/23 cases (96%). MRI correctly identified all the key findings described on the CT except for the abnormal vascularization (85.7% sensitivity, 100% specificity, 100% PPV, 94.1% NPV, 95% accuracy for arterial vessels; 57.1% sensitivity, 100% specificity, 100% PPV, 84.2% NPV, 87% accuracy for venous drainage). CONCLUSIONS MRI can represent an effective alternative to CT in the postnatal assessment of CLM. In order to further narrow the gap with CT, the use of contrast material and improvements in sequence design are needed to obtain detailed information on vascularization, which is essential for surgical planning. KEY POINTS • Congenital lung malformations (CLMs) can be effectively studied by MRI avoiding radiation exposure. • Crucial features of CLM have similar appearance when comparing CT with MRI. • MRI performs very well in CLM except for aberrant vessel detection and characterization.
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Affiliation(s)
- Salvatore Zirpoli
- Pediatric Radiology and Neuroradiology, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy.
| | - Alice Marianna Munari
- Pediatric Radiology and Neuroradiology, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | | | - Marco Scarabello
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Sara Costanzo
- Department of Pediatric Surgery, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Andrea Farolfi
- Department of Pediatrics, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Gianluca Lista
- Neonatal Intensive Care Unit, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Elena Zoia
- Pediatric Intensive Care Unit, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Giovanna Riccipetitoni
- Department of Pediatric Surgery, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Andrea Righini
- Pediatric Radiology and Neuroradiology, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
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14
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Wolfler A, Raimondi G, Pagan de Paganis C, Zoia E. The infant with severe bronchiolitis: from high flow nasal cannula to continuous positive airway pressure and mechanical ventilation. Minerva Pediatr 2018; 70:612-622. [DOI: 10.23736/s0026-4946.18.05358-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Ardissino G, Daccò V, Testa S, Civitillo CF, Tel F, Possenti I, Belingheri M, Castorina P, Bolsa-Ghiringhelli N, Tedeschi S, Paglialonga F, Salardi S, Consonni D, Zoia E, Salice P, Chidini G. Hemoconcentration: a major risk factor for neurological involvement in hemolytic uremic syndrome. Pediatr Nephrol 2015; 30:345-52. [PMID: 25149851 DOI: 10.1007/s00467-014-2918-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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] [Received: 04/28/2014] [Revised: 06/28/2014] [Accepted: 07/15/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Shigatoxin-associated hemolytic uremic syndrome (STEC-HUS) is a common thrombotic microangiopathy (TMA) in which central nervous system (CNS) involvement is responsible for the majority of deaths and for severe long-term sequelae. We have analyzed the role of hemoconcentration in disease severity. METHODS This was a retrospective review of the records and laboratory data at presentation of all patients with STEC-HUS cases (n = 61) over a 10-year period. The patients were grouped into three severity classes: group A, comprising patients who did not require dialysis; group B, patients who were dialyzed without CNS involvement; group C, patients with CNS involvement. RESULTS Patients with CNS involvement (group C) had a higher mean hemoglobin level (11.2 ± 2.3 g/dL) than those of group A or B ( 9.4 ± 2.1 and 7.5 ± 1.9 g/dL, respectively; p < 0.0001). We also observed that the higher the initial hemoglobin level, the more severe the long-term renal damage (p < 0.007). CONCLUSIONS In patients with STEC-HUS, hemoconcentration and hypovolemia may be responsible for more severe ischemic organ damage (both short and long term) at disease onset, and these signs should be regarded as risk factors for CNS damage and for more severe TMA. Therefore, we recommend that hydration status should be actively monitored in HUS patients and that dehydration, when diagnosed, should be promptly corrected.
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Affiliation(s)
- Gianluigi Ardissino
- Center for HUS Control, Prevention and Management, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy,
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16
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Leva E, Cardarelli M, Di Cesare A, Fava G, Venegoni A, Stringhi C, Maestri L, Zoia E, Pansini L. [Intestinal intussusception: easy diagnosis in the 21st Century? Outcome of five years experiences]. Pediatr Med Chir 2005; 27:38-40. [PMID: 16922012] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
UNLABELLED Intussusception is an entity well codify in pediatric surgery, with guidelines well defined since years in terms of imaging and procedures. MATERIAL From January '99 to Dec. '03, 25 children were admitted to the Department of Pediatric Surgery of the Children's Hospital of Milan. All the aspects related to the pathology have been evaluated in the study. RESULTS 25 patients have been studied. 23/25 presented severe pain, 19/25 normal bowel movements in the last 3 hours and in 9/25 a mass were detected at clinical examination.19/25 were submitted to laparotomy after failure of reduction through barium enema, and in 17/19 a manual reduction were performed. Only 2 patients required a bowel resection with primary anastomosis. The analysis of the delay of diagnosis, the delta-T between beginning of the symptoms and first medical evaluation was of 16,23 h. (3-72), and the delta-T between the first evaluation and diagnosis was 18,7 h. The interval between diagnosis and surgery was of 4,3. CONCLUSION Authors believe that intussusception still represent a challenge for medical and surgical emergency team, supported by the data in literature. Imaging procedures must not be constricted in case of minimal suspicions of intestinal intussusception.
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Affiliation(s)
- E Leva
- Ospedale dei Bambini V. Buzzi, ICP Milano, Divisione di Chirurgia Pediatrica.
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17
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18
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Calderini E, Accorsi A, Adrario E, Bettelli G, Carrani L, Cornara G, De Gasperi A, Della Rocca G, Di Castri D, Frova G, Gregorini P, Iapichino G, Landoni G, Lombardo G, Mondello E, Paolillo GM, Peduto VA, Petrini F, Piazza L, Pierdominici S, Pietropaoli P, Rosi R, Salvo I, Santagostino R, Savoia G, Serafini G, Solca M, Stella L, Tavola M, Torri G, Tufano R, Vesconi S, Zoia E, Zuccoli P. Guidelines for completing the Perioperative Anesthesia Record. Minerva Anestesiol 2002; 68:879-892, 892-904. [PMID: 12586989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- E Calderini
- Istituti Clinici di Perfezionamento, Via della Commenda 12, 20122 Milano, Italy.
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19
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Oppizzi M, Zoia E, Franco A, Gerli C, Vendrame G, Guarracino F, Marino G, Paolillo G. [Diastolic dysfunction in cardiac surgery intensive care. Study methods, changes and prognosis]. Minerva Anestesiol 1997; 63:29-38. [PMID: 9213837] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The natural history of patients with coronary artery disease and diastolic dysfunction who underwent coronary artery bypass grafting (CABG) is not well known. The aims of our study were to evaluate the incidence of diastolic dysfunction, its evolution after CABG and its possible correlation with adverse in-ICU prognosis. We studied 88 consecutive patients scheduled for CABG with not severely depressed left ventricular function (ejection fraction > 35%) and multivessels disease. Buckberg cardioplegia was used for myocardial protection. Diastolic function was investigated by recording mitral and venous pulmonary flow by transesophageal Doppler echocardiography (TEE). TEE examination was performed in operative room pre and post-bypass, at ICU arrival and after three months. Diastolic dysfunction was defined as mild, moderate and severe. Adverse in ICU events were defined as: use of inotropic drugs or ventricular mechanical support, an ICU stay > 24 hours, perioperative myocardial infarction and death. The study group was compared with a control group. T-Student test was used; a p < 0.05 was considered significant. A reduced diastolic function was present in 77% of patients at baseline examination. Diastolic dysfunction did not worsen significantly after hypothermic cardiac arrest and reperfusion. It persisted during ICU stay and normalized after three months from CABG in the majority of patients (85%). Diastolic failure was not associated with an adverse ICU prognosis (adverse events: 18 versus 13%; p = ns).
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Affiliation(s)
- M Oppizzi
- Istituto di Ricerca e Cura a Carattiere Scientifico, Ospedale San Raffaele, Milano
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Papa M, Camesasca C, Santoro F, Zoia E, Fragasso G, Giannico S, Chierchia SL. Fetal echocardiography in detecting anomalous pulmonary venous connection: four false positive cases. Heart 1995; 73:355-8. [PMID: 7756069 PMCID: PMC483829 DOI: 10.1136/hrt.73.4.355] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [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: 01/27/2023] Open
Abstract
Prenatal detection of congenital heart disease is possible from the 16th week of pregnancy, the ideal time being the mid-trimester, when most cardiac abnormalities can be detected. However, identification of anomalous pulmonary venous connection is difficult before birth and the sensitivity of fetal echocardiography in detecting this anomaly is low. Four cases are reported in which fetal echocardiographic findings obtained during the third trimester of pregnancy were highly suggestive of anomalous pulmonary venous connection. Right ventricular and atrial dominance associated with an enlarged coronary sinus or dilated superior vena cava were identified and considered to be indirect markers of the anomaly. No other cardiac anomaly was detectable. In all cases right ventricular and atrial dominance with dilated coronary sinus or superior vena cava were confirmed after birth despite the presence of normal pulmonary venous connections. These results confirm that the prenatal detection of this condition is difficult and should be based on the direct visualisation of anomalous pulmonary venous connections. The sole detection of indirect signs, such as right atrial and ventricular dominance with or without a dilated coronary sinus, superior vena cava, or inferior vena cava, does not warrant the diagnosis of anomalous pulmonary venous connection. Since the pulmonary venous flow in the human fetus is not as small as is commonly assumed, an anomalous drainage should be detectable when present and therefore should be specifically sought if the anomaly is suspected. The reasons for the presence of such transient cardiac anomalies remain obscure, but they might be related to functional or morphological rearrangement of the heart during fetal and perinatal life.
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Affiliation(s)
- M Papa
- Division of Cardiology, Istituto Scientifico San Raffaele, University of Milan
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21
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Corno A, Papa M, Santoro F, Zoia E. Aneurysm of the membranous ventricular septum in transposition of the great arteries. J Thorac Cardiovasc Surg 1993; 105:369-71. [PMID: 8429670] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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22
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Corno A, Zoia E, Santoro F, Camesasca C, Biagioli B, Grossi A. Epicardial damage induced by topical cooling during paediatric cardiac surgery. Br Heart J 1992; 67:174-6. [PMID: 1540438 PMCID: PMC1024749 DOI: 10.1136/hrt.67.2.174] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To study electrocardiographic changes in infants and children in whom topical cooling was used during surgical repair of congenital heart defects. DESIGN A retrospective study of all patients who had surgical repair of congenital heart disease during cold blood cardioplegia and topical cooling from January to August 1990. Eleven patients (group 1) had topical cooling with ice and 15 (group 2) with cold saline. PATIENTS All 36 paediatric patients operated on during this period. All the available electrocardiographic records were analysed. Ten patients in whom reliable records were not available were excluded. Twenty six patients entered in this retrospective study. INTERVENTIONS Topical cooling with ice or with a slush of cold saline. MAIN OUTCOME MEASURE Recordings from all the precordial leads were examined and scored as the sum of the maximum ST elevation (mV) in each precordial lead. The score obtained for each electrocardiogram was recorded together with the timing of the electrocardiogram (preoperative, arrival in intensive care unit immediately after surgery, postoperatively in the intensive care unit, and at discharge). RESULTS There were no differences between the two groups in terms of demographic data, diagnosis, duration of ischaemia, and postoperative myocardial performance. There was temporary ST elevation during the first 48 postoperative hours in all the children in group 1 but in only seven of the 15 children in group 2 (Fisher's test, p less than 0.005). The mean (SD) score for maximum ST elevation was 1.34 (0.83) mV in group 1 and 0.52 (0.64) mV in group 2 (Student's t test, p less than 0.01). CONCLUSIONS These temporary electrocardiographic changes in the presence of adequate myocardial performance were attributed to epicardial damage induced by hypothermicosmotic injury. The use of ice for topical cooling may damage the epicardium in children.
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Affiliation(s)
- A Corno
- Cardiothoracic Centre, University of Milan, Hospital "S Raffaele", Milan, Italy
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23
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Calderini E, Salvo I, Colombo S, Zoia E, Ferrario P, Giannini A, Torri G. [Washout curve of isoflurane in adult and aged patients]. Minerva Anestesiol 1988; 54:345-8. [PMID: 3249622] [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: 01/04/2023]
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24
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Torri G, Calderini E, Venturino M, Salvo I, Zoia E, Colombo S, Ferrario P. [Recovery from halogen anesthesia in elderly patients]. Minerva Anestesiol 1988; 54:85-8. [PMID: 3059231] [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: 01/03/2023]
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