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Carabelli G, Binotto I, Armano C, Bertù L, Luini C, Nosetti L, Agosti M, Salvatore S. Study on Nocturnal Infant Crying Evaluation (NICE) and Reflux Disease (RED). Children (Basel) 2024; 11:450. [PMID: 38671666 PMCID: PMC11048841 DOI: 10.3390/children11040450] [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: 03/06/2024] [Revised: 03/31/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Nocturnal infant crying is often empirically treated with acid suppressants. The aim of this study was to evaluate the prevalence and characteristics of gastroesophageal reflux (GER) in infants with unexplained persistent crying. METHODS We enrolled all infants (0-12 months) referred for suspected GER disease who underwent esophageal impedance-pH monitoring (MII-pH) for unexplained persistent crying not improved by parental reassurance, dietary modification or alginate. Gastrointestinal malformation/surgery, neurological impairment and infections were exclusion criteria. Demographic and anthropometric parameters, GER symptoms and questionnaires (I-GERQ-R) and MII-pH data were recorded and analyzed. Normal MII-pH was defined when acid exposure was <3%, symptom index was <50% and symptom association probability was <95%. Acid exposure >5% and >10% was also considered. Statistical analysis was performed using Chi-Square and univariate and multivariable regression analysis. RESULTS We included 50 infants (median age 3.5 months) who fulfilled the study criteria: 30 (60%) had normal MII-pH. I-GERQ-R score was abnormal in 33 (66%) infants, and 21/33 (64%) had normal MII-pH (p = 0.47). In the 26 (52%) infants with nocturnal crying, MII-pH was normal in 16 (54%) (p = 0.82). Associated regurgitation (>3 or >10 episodes/die) did not predict abnormal MII-pH (p = 0.74, p = 0.82, respectively). Univariate and multivariable regression analysis did not identify any clinical variable significantly associated with abnormal MII-pH. CONCLUSIONS Infants with persistent unexplained and nocturnal crying should not be empirically treated with acid inhibitors.
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Affiliation(s)
- Greta Carabelli
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Ivan Binotto
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Chiara Armano
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Lorenza Bertù
- Research Center Tromboembolic Diseases, University of Insubria, 21100 Varese, Italy;
| | - Chiara Luini
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Luana Nosetti
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Massimo Agosti
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Silvia Salvatore
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
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Zaffanello M, Pietrobelli A, Zoccante L, Sacchetto L, Nosetti L, Piazza M, Piacentini G. Insights into Pediatric Sleep Disordered Breathing: Exploring Risk Factors, Surgical Interventions, and Physical and Scholastic Performance at Follow-Up. Children (Basel) 2024; 11:388. [PMID: 38671605 PMCID: PMC11049613 DOI: 10.3390/children11040388] [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: 02/12/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
(1) Background: Sleep-disordered breathing represents a growing public health concern, especially among children and adolescents. The main risk factors for pediatric sleep-disordered breathing in school-age children are tonsillar and adenoid hypertrophy. Adenoidectomy, often in combination with tonsillectomy, is the primary treatment modality for pediatric sleep-disordered breathing. This study aims to comprehensively investigate various risk and protective factors in children with sleep-disordered breathing undergoing adenotonsillar or adenoidal surgeries. We also aim to explore the differences in neuropsychological profiles. (2) Methods: This is an observational, retrospective cohort study. We collected information on adenoidectomy or adenotonsillectomy in children referred to our center. We reviewed the clinical history and preoperative visits and collected data through a telephone questionnaire. The Pediatric Sleep Questionnaire (PSQ) and the Pediatric Quality of Life Inventory (PedsQL) screen sleep-disordered breathing and quality of life, respectively. The data were statistically analyzed using SPSS version 22.0 for Windows (SPSS Inc., Chicago, IL, USA). (3) Results: The study involved 138 patients, but only 100 children participated. A higher percentage of patients with sleep-disordered breathing were observed to have mothers who smoked during pregnancy. A smaller proportion of patients with sleep-disordered breathing habitually used a pacifier. A rise in physical score was associated with a reduced PSQ at follow-up (p = 0.051). An increase in the overall academic score was related to a decrease in the PSQ at follow-up (p < 0.001). A more significant proportion of patients undergoing adenotonsillectomy were observed to have a history of prematurity and cesarean birth. (4) This comprehensive study delves into the intricate interplay of risk and protective factors impacting children with sleep-disordered breathing undergoing adenotonsillectomy and adenoidectomy.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy; (A.P.); (M.P.); (G.P.)
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy; (A.P.); (M.P.); (G.P.)
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital Verona, 37126 Verona, Italy;
| | - Luca Sacchetto
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, 37126 Verona, Italy;
| | - Luana Nosetti
- Department of Pediatrics, Pediatric Sleep Disorders Center, F. Del Ponte Hospital, Insubria University, 21100 Varese, Italy;
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy; (A.P.); (M.P.); (G.P.)
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy; (A.P.); (M.P.); (G.P.)
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Zaffanello M, Ersu RH, Nosetti L, Beretta G, Agosti M, Piacentini G. Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review. Children (Basel) 2024; 11:208. [PMID: 38397319 PMCID: PMC10887195 DOI: 10.3390/children11020208] [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: 12/30/2023] [Revised: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
This review investigates the relationship between pediatric obstructive sleep apnea, often associated with adenotonsillar hypertrophy, and cardiovascular health, particularly pulmonary hypertension. We conducted a comprehensive literature search using electronic databases, including Medline Pub-Med, Scopus, and the Web of Science. The study analyzed a total of 230 articles and screened 48 articles, with 20 included in the final analysis, involving 2429 children. The PRISMA flowchart visually illustrates the selection process, and the ROBINS-E and -I tools help ensure the reliability and validity of the evidence produced by these studies. These studies explored various aspects, including the severity of obstructive sleep apnea, cardiac anomalies, cardiac stress markers, risk factors for pulmonary hypertension, and the impact of adenoidectomy and tonsillectomy on cardiac function. The research found that adenotonsillar hypertrophy and obstructive sleep apnea are significant risk factors for cardiovascular complications, especially pulmonary hypertension, in children. Adenoidectomy and tonsillectomy may provide effective treatments. Following adenoidectomy in relation to obstructive sleep apnea, there appears to be a reduction in mean pulmonary artery pressure during echocardiographic examination. However, the efficacy of these procedures can vary based on the severity of obstructive sleep apnea and individual cardiac conditions. The study also identified concerns regarding data bias. The authors emphasize the need for well-designed clinical studies, including both healthy patients with adenotonsillar hypertrophy and vulnerable children with genetic disorders, to ensure that clinical decisions are based on solid scientific evidence.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics, and Gynecology University of Verona, 37134 Verona, Italy;
| | - Refika Hamutcu Ersu
- Division of Pediatric Respirology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (G.B.)
| | - Giulio Beretta
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (G.B.)
| | - Massimo Agosti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics, and Gynecology University of Verona, 37134 Verona, Italy;
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Ferrari M, Sica E, De Bernardi F, Luini A, Legnaro M, Nosetti L, Castelnuovo P, Cosentino M, Marino F. Reduction of IL-6, IL-8 and β2-ADRENOCEPTOR mRNA levels in circulating polymorphonuclear leukocytes after adenotonsillectomy in children with Obstructive Sleep Apnea Syndrome. Sleep Med 2024; 114:82-85. [PMID: 38157624 DOI: 10.1016/j.sleep.2023.12.017] [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: 08/29/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Obstructive Sleep Apnea Syndrome (OSAS) affects approximately 1-5% of children and is linked to cardiovascular, metabolic, and neurobehavioral complications. Dysregulation of inflammatory process and sympathetic nervous system overstimulation leading to increased catecholamine production may contribute to OSAS pathogenesis. Polymorphonuclear Neutrophils (PMN), key cells in the inflammatory process, express adrenergic receptors, including β2-adrenergic receptor (ADRB2), which modulate their functions through an autocrine/paracrine loop. In this pilot study, we aimed to investigate the relationship between OSAS severity, ADRB2 expression in PMN and patient's inflammatory profile before and after adenotonsillectomy. PATIENTS/METHODS In this pilot study we enrolled OSAS pediatric patients in which ADRB2, IL-6 and IL-8 mRNA expression levels were evaluated in circulating PMN by RT-PCR. RESULTS 9 OSAS pediatric patients, ranged from 3 to 8 years of age, were enrolled in the study. We found that adenotonsillectomy significantly reduced ADRB2 as well as IL-6, IL-8 mRNA expression levels in PMN. CONCLUSIONS These findings offer valuable insights into the underlying immune and inflammatory mechanisms of OSAS and open the way for the development of novel therapeutic approaches.
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Affiliation(s)
- Marco Ferrari
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy.
| | - Eleonora Sica
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy; Department of Paediatrics, University of Insubria, Varese, Italy
| | | | - Alessandra Luini
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Massimiliano Legnaro
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Luana Nosetti
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Marco Cosentino
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Franca Marino
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
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Zaffanello M, Bonacci E, Piacentini G, Nosetti L, Pedrotti E. Pediatric Ocular Health and Obstructive Sleep Apnea Syndrome: A Review. Pediatr Rep 2023; 15:741-749. [PMID: 38133434 PMCID: PMC10747302 DOI: 10.3390/pediatric15040066] [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: 09/23/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Obstructive sleep apnea (OSA) affects neurobehavioral, cognitive, and cardiovascular aspects, particularly in children, by obstructing the upper airways during sleep. While its impact in adult ocular health is recognized, there is ongoing debate about OSA's relevance in pediatrics. This review explores the relationship between OSA and ocular health in children, focusing on the effects and potential improvements through treatment. A systematic search found 287 articles through PubMeD/MEDLINE, Scopus, Web of Science, and ScienceDirect; 94.4% were excluded. After careful selection, six English articles were included, addressing the effects of OSA on children's eyes. Three studies examined choroidal alterations, three explored retinal and optic nerve changes, and two analyzed ocular changes following otorhinolaryngological intervention. The immediate correlation in children is inconclusive, but age may be a contributing factor. Pediatric OSA patients exhibit corneal anomalies and increased optic nerve thickness, possibly due to intermittent hypoxia. OSA influences retinal vascular density in children, with increased density after treatment and reduced choroidal thickness in cases of adenotonsillar hypertrophy. This review emphasized OSA's significant impact on children's ocular health, revealing alterations in the optic nerve, choroid, retina, and cornea. While the direct correlation with the optic nerve is not always evident, OSA raises intraocular pressure and induces structural changes. Treatment holds promise, highlighting the need for regular monitoring to promptly address childhood OSA.
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Affiliation(s)
- Marco Zaffanello
- Pediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy;
| | - Erika Bonacci
- Ophthalmology Clinic, Department of Engineering for Innovation Medicine, University of Verona, 37134 Verona, Italy;
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy;
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Department of Pediatrics, F. Del Ponte Hospital, Insubria University, 21100 Varese, Italy;
| | - Emilio Pedrotti
- Ophthalmology Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37134 Verona, Italy;
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Zaffanello M, Piacentini G, Nosetti L, Zoccante L. Sleep Disordered Breathing in Children with Autism Spectrum Disorder: An In-Depth Review of Correlations and Complexities. Children (Basel) 2023; 10:1609. [PMID: 37892271 PMCID: PMC10605434 DOI: 10.3390/children10101609] [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: 08/29/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Sleep-disordered breathing is a significant problem affecting the pediatric population. These conditions can affect sleep quality and children's overall health and well-being. Difficulties in social interaction, communication, and repetitive behavioral patterns characterize autism spectrum disorder. Sleep disturbances are common in children with ASD. This literature review aims to gather and analyze available studies on the relationship between SDB and children with autism spectrum disorder. We comprehensively searched the literature using major search engines (PubMed, Scopus, and Web of Science). After removing duplicates, we extracted a total of 96 records. We selected 19 studies for inclusion after a thorough title and abstract screening process. Seven articles were ultimately incorporated into this analysis. The research findings presented herein emphasize the substantial influence of sleep-disordered breathing on pediatric individuals diagnosed with autism spectrum disorder (ASD). These findings reveal a high incidence of SDB in children with ASD, emphasizing the importance of early diagnosis and specialized treatment. Obesity in this population further complicates matters, requiring focused weight management strategies. Surgical interventions, such as adenotonsillectomy, have shown promise in improving behavioral issues in children with ASD affected by OSA, regardless of their obesity status. However, more comprehensive studies are necessary to investigate the benefits of A&T treatment, specifically in children with ASD and OSA. The complex relationship between ASD, SDB, and other factors, such as joint hypermobility and muscle hypotonia, suggests a need for multidisciplinary treatment approaches. Physiotherapy can play a critical role in addressing these intricate health issues. Early sleep assessments and tailored weight management strategies are essential for timely diagnosis and intervention in children with ASD. Policy initiatives should support these efforts to enhance the overall well-being of this population. Further research is crucial to understand the complex causes of sleep disturbances in children with ASD and to develop effective interventions considering the multifaceted nature of these conditions.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy;
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy;
| | - Luana Nosetti
- Department of Pediatrics, Pediatric Sleep Disorders Center, “F. Del Ponte” Hospital, Insubria University, 21100 Varese, Italy;
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital Verona, 37126 Verona, Italy;
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Nosetti L, Gozal D. Exploring the bidirectional relationship between asthma and obstructive sleep apnea in Brazilian pediatric patients: one more piece to the Puzzle. J Pediatr (Rio J) 2023; 99:423-424. [PMID: 37253428 PMCID: PMC10492138 DOI: 10.1016/j.jped.2023.05.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- Luana Nosetti
- Insubria University, F. Del Ponte Hospital, Department of Pediatrics, Pediatric Sleep Disorders Center, Varese, Italy
| | - David Gozal
- University of Missouri School of Medicine, Department of Child Health, Child Health Research Institute, Columbia, MO, USA.
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Nosetti L, Zaffanello M, De Bernardi di Valserra F, Simoncini D, Beretta G, Guacci P, Piacentini G, Agosti M. Exploring the Intricate Links between Adenotonsillar Hypertrophy, Mouth Breathing, and Craniofacial Development in Children with Sleep-Disordered Breathing: Unraveling the Vicious Cycle. Children (Basel) 2023; 10:1426. [PMID: 37628425 PMCID: PMC10453215 DOI: 10.3390/children10081426] [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: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
Adenotonsillar hypertrophy has been well-acknowledged as the primary instigator of sleep-disordered breathing in the pediatric population. This condition spans a spectrum, from typical age-related growth that the immune system influences to persistent pathological hypertrophy. Reduction in air spaces, metabolic changes, neurobehavioral alterations, and chronic inflammation characterizes the latter form. As the go-to treatment, adenotonsillectomy has proven effective. However, it is not a guarantee for all patients, leaving us without reliable predictors of treatment success. Evidence suggests a connection between adenotonsillar hypertrophy and specific oral breathing patterns resulting from craniofacial development. This finding implies an intricate interdependence between the two, hinting at a self-sustaining vicious cycle that persists without proper intervention. The theories regarding the relationship between craniofacial conformation and sleep-disordered breathing have given rise to intriguing perspectives. In particular, the "gracilization theory" and the "gravitational hypothesis" have provided fascinating insights into the complex interaction between craniofacial conformation and SDB. Further investigation is crucial to unraveling the underlying pathophysiological mechanisms behind this relationship. It is also vital to explore the risk factors linked to adenotonsillectomy failure, study the long-term effects of adenotonsillar hypertrophy on craniofacial growth, and devise innovative diagnostic techniques to detect upper airway compromise early. Moreover, to assess their efficacy, we must delve into novel therapeutic approaches for cases that do not respond to traditional treatment, including positional therapy and orofacial myofunctional therapy. Though complex and unpredictable, these challenges promise to enhance our understanding and treatment of adenotonsillar hypertrophy and its related complications in children. By taking on this task, we can pave the way for more effective and targeted interventions, ultimately improving affected individuals' well-being and quality of life.
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Affiliation(s)
- Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Francesca De Bernardi di Valserra
- Division of Otorhinolaryngology, Department of Biotechnologies and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy;
| | - Daniela Simoncini
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Giulio Beretta
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Pietro Guacci
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Giorgio Piacentini
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Massimo Agosti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
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Nosetti L, Angriman M, Zaffanello M, Salvatore S, Riggi L, Niespolo AC, Salvatoni A, Agosti M. Increased parental perception of sleep disordered breathing in a cohort of infants with ALTE/BRUE events. Minerva Pediatr (Torino) 2023; 75:490-495. [PMID: 30299025 DOI: 10.23736/s2724-5276.18.05276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND An apparent life-threatening event (ALTE) describes an acute, unexpected change in an infant's breathing, aspect, or behavior frightening to the parent or caretaker. According to the new recent terminology, clinicians should use the term brief resolved unexplained event (BRUE) to describe an event occurring in an infant <1 year of age when the observer reports a sudden, brief, and now resolved episode. The aims of the present study in infants were to investigate sleep disturbances in both ALTE event and after their classification according the new BRUE criteria. METHODS We enrolled (from April to May 2016) 32 consecutive infants referred to our ambulatory for sleep disorders for follow-up after an ALTE episode and 32 pair healthy controls. We administered to parents the adapted questionnaire "Sleep Disturbance Scale for Children - SDSC." RESULTS Among enrolled infants with ALTE, there were 26 infants in line with the new BRUE definition, of which 10 at low risk and 16 at the high-risk event. CONCLUSIONS Infants with ALTE and BRUE had more referred-by-parents' sleep symptoms than controls. In particular, sleep disordered breathing wa prevalent in both, requiring a longer follow-up for this disturbance.
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Affiliation(s)
- Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Marco Angriman
- Department of Pediatrics, Unit of Child Neurology and Neurorehabilitation, Hospital of Bolzano, Bolzano, Italy
| | - Marco Zaffanello
- Division of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy -
| | | | - Letizia Riggi
- Department of Pediatrics, University of Insubria, Varese, Italy
| | | | | | - Massimo Agosti
- Department of Pediatrics, University of Insubria, Varese, Italy
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Zaffanello M, Pietrobelli A, Zoccante L, Ferrante G, Tenero L, Piazza M, Ciceri ML, Nosetti L, Piacentini G. Mental Health and Cognitive Development in Symptomatic Children and Adolescents Scoring High on Habitual Snoring: Role of Obesity and Allergy. Children (Basel) 2023; 10:1183. [PMID: 37508681 PMCID: PMC10377772 DOI: 10.3390/children10071183] [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: 05/13/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Obstructive sleep apnea can have a negative impact on children's and adolescents' neurocognitive abilities and hinder their academic and adaptive progress in academic, social, and/or behavioral dimensions. In this retrospective cross-sectional study, we investigated the influence of body weight conditions and allergy status on long-term mental health, cognitive development, and quality of life in children and adolescents who snored. METHODS The study sample included 47 subjects (age range 4.1 to 15.3 years) who exhibited high levels of snoring and underwent home-based polysomnography between 2015 and 2019. Follow-up assessments (3 years on average between baseline and follow-up) entailed phone interviews with the subject's parents/caregivers who completed three validated questionnaires investigating sleep, quality of life, and parental ratings. RESULTS We found a correlation between age at diagnosis and being retrospectively overweight and high levels of snoring. In addition to a higher risk of developing emotional symptoms (8.2% increase in retrospective overweight status for each unit increase in the emotional score at follow-up) and oppositional behavior (9% increase in retrospective overweight status for each unit of oppositional T points at follow-up), we also noted reduced long-term social symptoms (11% decrease in retrospective overweight status for each unit increase in the social score at follow-up) and cognitive symptoms (10.6% decrease in retrospective overweight status for each unit increase in the cognitive score at follow-up), as well as a 6.1% increase in retrospective allergy status for each unit increase in academic performance at follow-up. CONCLUSIONS Snoring can have negative impacts on mental health and cognitive development in the long term. Early detection and intervention for neuropsychological disorders is important in children and adolescents who score high on snoring. In the long term, the effects of snoring on neuropsychological disorders may vary based on previous body weight and allergy status.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy
| | - Giuliana Ferrante
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Laura Tenero
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Michele Piazza
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Marco Luigi Ciceri
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, Filippo Del Ponte Hospital, Insubria University, 21100 Varese, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
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11
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Zaffanello M, Ferrante G, Zoccante L, Ciceri ML, Nosetti L, Tenero L, Piazza M, Piacentini G. Predictive Power of Oxygen Desaturation Index (ODI) and Apnea-Hypopnea Index (AHI) in Detecting Long-Term Neurocognitive and Psychosocial Outcomes of Sleep-Disordered Breathing in Children: A Questionnaire-Based Study. J Clin Med 2023; 12:jcm12093060. [PMID: 37176501 PMCID: PMC10179379 DOI: 10.3390/jcm12093060] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 03/27/2023] [Revised: 04/09/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Pediatric obstructive sleep apnea can negatively affect children's neurocognitive function and development, hindering academic and adaptive goals. Questionnaires are suitable for assessing neuropsychological symptoms in children with sleep-disordered breathing. The study aimed to evaluate the effectiveness of using the Oxygen Desaturation Index compared to the Obstructive Apnea-Hypopnea Index in predicting long-term consequences of sleep-disordered breathing in children. We conducted a retrospective analysis of respiratory polysomnography recordings from preschool and school-age children (mean age: 5.8 ± 2.8 years) and followed them up after an average of 3.1 ± 0.8 years from the home-based polysomnography. We administered three validated questionnaires to the parents/caregivers of the children by phone. Our results showed that children with an Oxygen Desaturation Index (ODI) greater than one event per hour exhibited symptoms in four domains (physical, school-related, Quality of Life [QoL], and attention deficit hyperactivity disorder [ADHD]) at follow-up, compared to only two symptoms (physical and school-related) found in children with an Obstructive Apnea-Hypopnea Index greater than one event per hour at the time of diagnosis. Our study also found a significant correlation between the minimum SpO2 (%) recorded at diagnosis and several outcomes, including Pediatric Sleep Questionnaire (PSQ) scores, physical, social, and school-related outcomes, and ADHD index at follow-up. These results suggest that the Oxygen Desaturation Index could serve as a valuable predictor of long-term symptoms in children with sleep-disordered breathing, which could inform treatment decisions. Additionally, measuring minimum SpO2 levels may help assess the risk of developing long-term symptoms and monitor treatment outcomes.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital Verona, 37126 Verona, Italy
| | - Marco Luigi Ciceri
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital Verona, 37126 Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, Pediatric Sleep Disorders Center, F. Del Ponte Hospital, Insubria University, 21100 Varese, Italy
| | - Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
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12
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Zaffanello M, Pietrobelli A, Gozal D, Nosetti L, La Grutta S, Cilluffo G, Ferrante G, Piazza M, Piacentini G. Cluster Analysis of Home Polygraphic Recordings in Symptomatic Habitually-Snoring Children: A Precision Medicine Perspective. J Clin Med 2022; 11:jcm11195960. [PMID: 36233827 PMCID: PMC9571925 DOI: 10.3390/jcm11195960] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022] Open
Abstract
(1) Background: Sleep-disordered breathing (SDB) is a frequent problem in children. Cluster analyses offer the possibility of identifying homogeneous groups within a large clinical database. The application of cluster analysis to anthropometric and polysomnographic measures in snoring children would enable the detection of distinctive clinically-relevant phenotypes; (2) Methods: We retrospectively collected the results of nocturnal home-based cardiorespiratory polygraphic recordings and anthropometric measurements in 326 habitually-snoring otherwise healthy children. K-medoids clustering was applied to standardized respiratory and anthropometric measures, followed by Silhouette-based statistics. Respiratory Disturbance Index (RDI) and oxygen desaturation index (≤3%) were included in determining the optimal number of clusters; (3) Results: Mean age of subjects was 8.1 ± 4.1 years, and 57% were males. Cluster analyses uncovered an optimal number of three clusters. Cluster 1 comprised 59.5% of the cohort (mean age 8.69 ± 4.14 years) with a mean RDI of 3.71 ± 3.23 events/hour of estimated sleep (e/ehSleep). Cluster 2 included 28.5% of the children (mean age 6.92 ± 3.43 years) with an RDI of 6.38 ± 3.92 e/ehSleep. Cluster 3 included 12% of the cohort (mean age 7.58 ± 4.73 years) with a mean RDI of 25.5 ± 19.4 e/ehSleep. Weight z-score was significantly lower in cluster 3 [-0.14 ± 1.65] than in cluster 2 [0.86 ± 1.78; p = 0.015] and cluster 1 [1.04 ± 1.78; p = 0.002]. Similar findings emerged for BMI z scores. However, the height z-score was not significantly different among the 3 clusters; (4) Conclusions: Cluster analysis of children who are symptomatic habitual snorers and are referred for clinical polygraphic evaluation identified three major clusters that differed in age, RDI, and anthropometric measures. An increased number of children in the cluster with the highest RDI had reduced body weight. We propose that the implementation of these approaches to a multicenter-derived database of home-based polygraphic recordings may enable the delineation of objective unbiased severity categories of pediatric SDB. Our findings could be useful for clinical implementation, formulation of therapeutic decision guidelines, clinical management, prevision of complications, and long-term follow-up.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
- Correspondence:
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
| | - David Gozal
- Departments of Child Health, and Medical Pharmacology and Physiology, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, F. Del Ponte Hospital, Insubria University, 21100 Varese, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology (IFT), National Research Council, 90146 Palermo, Italy
| | - Giovanna Cilluffo
- Department of Earth and Marine Sciences, University of Palermo, 90133 Palermo, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
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13
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Nosetti L, Zaffanello M, Katz ES, Vitali M, Agosti M, Ferrante G, Cilluffo G, Piacentini G, Grutta SL. Twenty-year follow-up of children with obstructive sleep apnea. J Clin Sleep Med 2022; 18:1573-1581. [PMID: 35164899 DOI: 10.5664/jcsm.9922] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) in children is associated with acute metabolic, cardiovascular, and neuro-cognitive abnormalities. The long-term outcomes of childhood OSA into adulthood has not been established. We performed a 20-year follow-up of patients with polysomnographically documented OSA in childhood compared to a healthy control group to evaluate the long-term anthropometric, sleep, cognitive, and cardiovascular outcomes. METHODS Children diagnosed to have severe OSA between the ages of 1 - 17 years (4.87 ± 2.77) were prospectively contacted by telephone as young adults after approximately 20 years. Data collected included reported anthropometric, educational level, health history, and the Berlin questionnaire. RESULTS Young adults with confirmed severe OSA in childhood had significantly higher adulthood BMI (p=0.038), lower academic degrees (p<0.001), and more snoring (p=0.045) compared to controls. The AHI during childhood trended towards predicting cardiovascular outcomes and the Berlin questionnaire in adulthood. CONCLUSIONS Adults with history of severe childhood OSA have a high risk of having snoring, elevated BMI, and lower academic achievement in adulthood. Thus, children with severe OSA may be at increased risk of chronic diseases later in life. The intervening COVID-19 pandemic has introduced considerable additional neurobehavioral morbidity complicating the identification of the full long-term consequences of childhood OSA.
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Affiliation(s)
- Luana Nosetti
- Pediatric Sleep Disorders Center, Department of Pediatrics, F. Del Ponte Hospital, Insubria University, Varese, Italy
| | | | - Eliot S Katz
- Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Boston MA.,Harvard Medical School, Boston, MA
| | - Maddalena Vitali
- Pediatric Sleep Disorders Center, Department of Pediatrics, F. Del Ponte Hospital, Insubria University, Varese, Italy
| | - Massimo Agosti
- Pediatric Sleep Disorders Center, Department of Pediatrics, F. Del Ponte Hospital, Insubria University, Varese, Italy
| | - Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Giovanna Cilluffo
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | | | - Stefania La Grutta
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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14
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Nenna R, Matera L, Licari A, Manti S, Di Bella G, Pierangeli A, Palamara AT, Nosetti L, Leonardi S, Marseglia GL, Midulla F. An Italian Multicenter Study on the Epidemiology of Respiratory Syncytial Virus During SARS-CoV-2 Pandemic in Hospitalized Children. Front Pediatr 2022; 10:930281. [PMID: 35911833 PMCID: PMC9329524 DOI: 10.3389/fped.2022.930281] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 04/27/2022] [Accepted: 06/20/2022] [Indexed: 01/18/2023] Open
Abstract
Since the beginning of 2020, a remarkably low incidence of respiratory virus hospitalizations has been reported worldwide. We prospectively evaluated 587 children, aged <12 years, admitted for respiratory tract infections from 1 September 2021 to 15 March 2022 in four Italian pediatric hospitals to assess the burden of respiratory viruses during the COVID-19 pandemic in Italy. At admission, a Clinical Respiratory Score was assigned and nasopharyngeal or nasal washing samples were collected and tested for respiratory viruses. Total admissions increased from the second half of October 2021 to the first half of December 2021 with a peak in early November 2021. The respiratory syncytial virus (RSV) incidence curve coincided with the total hospitalizations curve, occurred earlier than in the pre-pandemic years, and showed an opposite trend with respect to the incidence rate of SARS-CoV-2. Our results demonstrated an early peak in pediatric hospitalizations for RSV. SARS-CoV-2 may exhibit a competitive pressure on other respiratory viruses, most notably RSV.
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Affiliation(s)
- Raffaella Nenna
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Luigi Matera
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Sara Manti
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Catania, Italy
| | - Gaia Di Bella
- Department of Pediatrics, Pediatric Sleep Disorders Center, F. Del Ponte Hospital, Insubria University, Varese, Italy
| | - Alessandra Pierangeli
- Laboratory of Virology, Department of Molecular Medicine, Affiliated to Istituto Pasteur Italia, Sapienza University of Rome, Rome, Italy
| | - Anna Teresa Palamara
- Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Luana Nosetti
- Department of Pediatrics, Pediatric Sleep Disorders Center, F. Del Ponte Hospital, Insubria University, Varese, Italy
| | - Salvatore Leonardi
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Catania, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Fabio Midulla
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
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15
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Sica E, De Bernardi F, Nosetti L, Martini S, Cosentino M, Castelnuovo P, Marino F. Catecholamines and children obstructive sleep apnea: a systematic review. Sleep Med 2021; 87:227-232. [PMID: 34638100 DOI: 10.1016/j.sleep.2021.09.007] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder in children and is characterized by recurrent total or partial upper airway collapse episodes during sleep. OSA is associated with cardiovascular, metabolic and neurobehavioural complications related to sympathetic nervous system (SNS) activation. A key role in originating these complications and in underlying pathophysiologic mechanisms can be attributed to altered catecholamines (CAs) metabolism. METHODS A systematic review was performed according to the PRISMA Statement guidelines for research studies correlating OSA in children with catecholamines. RESULTS Only 13 studies out of 151 reports were included in the review. Most studies (9 out of 13) showed increased secretion for some catecholamines in patients with a sleep-related breathing disorder or OSA compared to a control group or post treatment control group. CONCLUSION OSA can activate the sympathetic nervous system (SNS) and increase catecholamines (CAs) production, perhaps contributing to increased morbidity. However, underlying pathophysiologic mechanisms remain still unclear.
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Affiliation(s)
- Eleonora Sica
- PhD Course in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, Varese, Italy; Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
| | | | - Luana Nosetti
- Department of Paediatrics, University of Insubria, Varese, Italy
| | - Stefano Martini
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Marco Cosentino
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Franca Marino
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
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16
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Zaffanello M, Piacentini G, Nosetti L, Ganzarolli S, Franchini M. Thrombotic risk in children with COVID-19 infection: A systematic review of the literature. Thromb Res 2021; 205:92-98. [PMID: 34293539 PMCID: PMC8284063 DOI: 10.1016/j.thromres.2021.07.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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] [Received: 03/17/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/23/2023]
Abstract
Objective Coagulation and inflammatory parameters are mildly altered in children with SARS-CoV-2 (COVID-19) infection, and laboratory evidence of a proinflammatory and procoagulant state has been noted in multisystem inflammatory syndrome in children (MIS-C). It is not clear whether this pediatric condition is related to thrombotic events. With this study we reviewed the literature for thrombotic complications in children with COVID-19 infection and MIS-C. Data sources We searched the Medline PubMed Advanced Search Builder, Scopus, Web Of Science, and Google Scholar electronic databases (until 1 January 2021) using the medical subject headings (MeSH) terms and text words (their combinations and truncated synonyms): (THROMBOSIS OR THROMBOPHILIA) AND (CHILD OR CHILDREN OR INFANT) AND (COVID-19 OR SARS-CoV-2). Study eligibility criteria Inclusion criteria were children with COVID-19 or SARS-COV-2 infection. The search was limited to articles published in English. Exclusion criteria were: reviews of published studies, studies published only as abstracts, letters or conference proceedings, discussion papers, animal studies, or editorials. Results After screening for duplicates, the initial search yielded 86 records: 12 were case reports involving 19 children; comorbidities were absent or mild in 73.7%. The most common site of thrombosis the lung (21%); the most often used drug was heparin (42%). Two studies were an international survey (n = 337 patients) and a large multicenter study (n = 186 patients with MIS-C). The risk of ischemic stroke in SARS-CoV-2 infection (0.82%) and deep venous thrombosis in MIS-C (4.3%) was lower in children than in adults. Conclusions Thrombodic or thromboembolic events are rare in pediatric patients with COVID-19 infection and MIS-C. Nonetheless, as in adults, a high index of suspicion should be maintained in children with COVID-19 infection or MIS-C, particularly in those with comorbidities predisposing to thrombotic events.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Luana Nosetti
- Lombardy Regional SIDS Center, Division of Pediatrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy.
| | - Stefania Ganzarolli
- Pediatric Division, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy.
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17
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Nosetti L, Agosti M, Franchini M, Milan V, Piacentini G, Zaffanello M. Long-Term Pulmonary Damage From SARS-CoV-2 in an Infant With Brief Unexplained Resolved Events: A Case Report. Front Med (Lausanne) 2021; 8:646837. [PMID: 34179037 PMCID: PMC8225923 DOI: 10.3389/fmed.2021.646837] [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] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
A brief unexplained resolved event (BRUE) is an event observed in a child under 1 year of age in which the observer witnesses a sudden, brief but resolved episode of change in skin color, lack of breathing, weakness or poor responsiveness. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease-2019 (COVID-19). We report the case of a previously healthy, full-term infant infected with SARS-CoV-2 when he was 8 months old. Previous to this event, both his grandfather and great-uncle had died of severe pneumonia and his mother had developed respiratory symptoms and fever. Over the following month he was seen five times in the emergency room and was hospitalized twice for recurrent BRUE. At the first hospital admission, after the second emergency room visit, he twice tested positive for COVID-19 after nasopharyngeal swab tests. During his second hospital admission, after the fifth emergency room visit, chest computed tomography revealed typical SARS-CoV-2 pneumonia. During a follow-up examination 6 months later, mild respiratory distress required administration of inhaled oxygen (0.5 L/min) and chest computed tomography disclosed a slight improvement in pulmonary involvement. The clinical manifestation of pulmonary complications from COVID-19 infection was unusual. This is the first report of an infant at high-risk for BRUE, which was the only manifestation of long-term lung involvement due to SARS-CoV-2 pneumonia.
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Affiliation(s)
- Luana Nosetti
- Lombardy Regional Sudden Infant Death Syndrome Center, Division of Pediatrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Massimo Agosti
- Department of Neonatology, Neonatal Intensive Care Unit, and Pediatrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale, Mantova, Italy
| | - Valentina Milan
- Division of Pediatrics, F. Del Ponte Hospital, Varese, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
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18
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Zaffanello M, Piacentini G, Nosetti L, Franchini M. The use of convalescent plasma for pediatric patients with SARS-CoV-2: A systematic literature review. Transfus Apher Sci 2021; 60:103043. [PMID: 33388249 PMCID: PMC7834628 DOI: 10.1016/j.transci.2020.103043] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 12/11/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019 (COVID-19), a severe illness leading to pneumonia, multiorgan failure, and death. With this study, we performed a systematic review of the literature and ongoing clinical trials on convalescent plasma therapy in pediatric patients with COVID-19. The electronic databases Medline PubMed, Scopus, and Web Of Science were searched. Also, clinical trials registries were searched for potentially eligible studies. A total of 90 records were retrieved after duplicate removal. Eight studies were case reports of children treated with convalescent plasma therapy (14 children, age range, 9 weeks to 18 years); 5 children had a chronic disease. During the hospital stay, 5 received drugs (e.g., remdesivir) in addition to convalescent plasma therapy. No convalescent plasma therapy-related adverse events were reported in 5 studies and 3 made no mention of adverse events. Seven studies concluded that convalescent plasma therapy is or could be a useful therapeutic option; one study made no claims. Only 3 of the 13 retrieved trials underway were planned exclusively for children. This is the first systematic review of the literature regarding convalescent plasma therapy for COVID-19 in children. We found insufficient clinical information on the safety and efficacy of convalescent plasma therapy in children. Nevertheless, the positive outcomes of the few case reports published to date suggest that convalescent plasma therapy may be of potential benefit. Further research with well-designed and powered clinical trials is needed.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Luana Nosetti
- Division of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, 21100 Varese, Italy.
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, ASST, 46100 Mantova, Italy.
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19
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Nosetti L, Lonati I, Marelli S, Salsone M, Sforza M, Castelnuovo A, Mombelli S, Masso G, Ferini-Strambi L, Agosti M, Castronovo V. Impact of pre-sleep habits on adolescent sleep: an Italian population-based study. Sleep Med 2021; 81:300-306. [PMID: 33751928 DOI: 10.1016/j.sleep.2021.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/13/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Several evidences demonstrate that pre-sleep habits may negatively impact adolescent sleep, yet few data exist on Italian population. This study aimed to investigate the relationship between pre-sleep habits, use of technology/activity and sleep in Italian adolescents. METHODS Self-report questionnaires including Italian version of School Sleep Habits Survey and use of technology/activity (eg smartphone, PC) at bedtime were administered to 972 adolescents (13-19 years) from Lombardia. We stratified the sample in five groups according to the age: Group I (13-14 years), Group II (15 years), Group III (16 years), Group IV (17 years), Group V (18-19 years). RESULTS Our descriptive analysis reveals a different sleep profile across age-groups: Group III showed highest percentage of bad sleep (26.7%) and frequent nocturnal awakenings (24.1%), Group V had the highest percentage of insufficient sleep (40,4%) and difficulty falling asleep (42.7%) and Group IV presented an elevated difficulty in waking up in the morning (70.1%). A significant negative correlation was found in total group between use of smartphone, internet and studying/doing homework and total sleep time. The use of smartphone, internet videogames, listening to music and studying/doing homework was positively associated with delayed bedtime. CONCLUSIONS This study confirms the great impact of pre-sleep habits, and in particular the use of technology on adolescent sleep. Our results demonstrate that sleep is strongly altered among Italian adolescents using electronic devices in evening. The type of technology may be related to specific sleep profile, emphasizing the importance of stratification analyses to identify associated factors to sleep problems.
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Affiliation(s)
- Luana Nosetti
- Division of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, 21100 Varese, Italy
| | - Irene Lonati
- Division of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, 21100 Varese, Italy
| | - Sara Marelli
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Salsone
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy; Institute of Molecular Bioimaging and Physiology, National Research Council, Segrate, Italy
| | - Marco Sforza
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Castelnuovo
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Samantha Mombelli
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Masso
- Division of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, 21100 Varese, Italy
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Agosti
- Division of Neonatology and Neonatal Intensive Care Unit, "F. Del Ponte" Hospital, 21100 Varese, Italy
| | - Vincenza Castronovo
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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Abstract
Introduction: Prader-Willi syndrome (PWS) is the most well-known condition of genetic obesity. Over the past 20 years, advances have been achieved in the diagnosis and treatment of PWS with a significant improvement in prognosis.Areas covered: This review focuses on the benefits of multidisciplinary approach in children and adolescents with PWS. In particular, the neonatologist and geneticist play a key role in early diagnosis and the clinical follow-up of the PWS patient must be guaranteed by a team including pediatric endocrinologist, psychologist, nutritionist/dietician, neurologist/neuropsychiatrist, sleep specialist, ears, nose and throat specialist (ENT), lung specialist, dentist, orthopedist and ophthalmologist and, eventually, gastroenterologist. We searched PubMed and critically summarized what has been reported in the last 10 years on PWS.Expert opinion: The multidisciplinary care in association with an early diagnosis and GH treatment postpones overweight development and decreases prevalence of obesity in individuals with PWS. Further prognostic improvements are expected through the selection of teams particularly experienced in the management of individuals with PWS and the discovery of new drugs.
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Affiliation(s)
| | - Luana Nosetti
- Pediatric Department, Insubria University, Varese, Italy
| | | | - Massimo Agosti
- Pediatric Department, Insubria University, Varese, Italy
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Salvatore S, Agosti M, Baldassarre ME, D’Auria E, Pensabene L, Nosetti L, Vandenplas Y. Cow's Milk Allergy or Gastroesophageal Reflux Disease-Can We Solve the Dilemma in Infants? Nutrients 2021; 13:297. [PMID: 33494153 PMCID: PMC7909757 DOI: 10.3390/nu13020297] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 12/12/2022] Open
Abstract
Cow's milk allergy (CMA) and gastro-esophageal reflux disease (GERD) may manifest with similar symptoms in infants making the diagnosis challenging. While immediate reaction to cow's milk protein indicate CMA, regurgitation, vomiting, crying, fussiness, poor appetite, sleep disturbances have been reported in both CMA and GERD and in other conditions such as functional gastrointestinal disorders, eosinophilic esophagitis, anatomic abnormalities, metabolic and neurological diseases. Gastrointestinal manifestations of CMA are often non-IgE mediated and clinical response to cow's milk free diet is not a proof of immune system involvement. Neither for non-IgE CMA nor for GERD there is a specific symptom or diagnostic test. Oral food challenge, esophageal pH impedance and endoscopy are recommended investigations for a correct clinical classification but they are not always feasible in all infants. As a consequence of the diagnostic difficulty, both over- and under- diagnosis of CMA or GERD may occur. Quite frequently acid inhibitors are empirically started. The aim of this review is to critically update the current knowledge of both conditions during infancy. A practical stepwise approach is proposed to help health care providers to manage infants presenting with persistent regurgitation, vomiting, crying or distress and to solve the clinical dilemma between GERD or CMA.
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Affiliation(s)
- Silvia Salvatore
- Department of Medicine and Surgery, Pediatric Unit, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (M.A.); (L.N.)
| | - Massimo Agosti
- Department of Medicine and Surgery, Pediatric Unit, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (M.A.); (L.N.)
| | - Maria Elisabetta Baldassarre
- Department of Biomedical Sciences and Human Oncology-Neonatology and NICU Section, “Aldo Moro” University of Bari, 70124 Bari, Italy;
| | - Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy;
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Luana Nosetti
- Department of Medicine and Surgery, Pediatric Unit, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (M.A.); (L.N.)
| | - Yvan Vandenplas
- Kidz Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
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22
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Perniciaro S, Casarin J, Nosetti L, Binda C, Salvatore S, Ghezzi F, Agosti M. Early- and Late-Respiratory Outcome in Very Low Birth Weight with or without Intrauterine Inflammation. Am J Perinatol 2020; 37:S76-S83. [PMID: 32898888 DOI: 10.1055/s-0040-1714257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 01/09/2023]
Abstract
UNLABELLED • IUI is a risk factor for spontaneous preterm birth and contributes to prematurity-associated mortality and morbidity.• HCA greatly affected Apgar's score and lung management of VLBWI at birth and later on with increased incidence of BPD.• HCA + FUN did not significantly impact on respiratory outcome. OBJECTIVE Intrauterine inflammation or infection (IUI) is a risk factor for spontaneous preterm birth and contributes to prematurity-associated mortality and morbidity. IUI can include inflammation, as well as infections of varying degrees of severity and duration. Histological chorioamnionitis (HCA) remains the "gold standard" for the diagnosis but clinical, microbiological, and biochemical criteria are often used to define chorioamnionitis. The impact of intrauterine inflammation on respiratory outcome, in infants with very low birth weight, is still unclear and previous data are conflicting showing increase, decrease, or no risk of respiratory complications. STUDY DESIGN This is a retrospective study aimed to investigate the role of IUI on neonatal respiratory outcome. Histological criteria (HCA alone and HCA + funisitis [FUN]) and "intrauterine inflammation or infection or both" "Triple I" definition were used; different management in delivery room, in the first 7 days of life (early outcome) and incidence of mild, moderate, and severe bronchopulmonary dysplasia (BPD; late outcome) were considered. RESULTS A total of 162 infants with very low birth weight (VLBW) with placenta histology were enrolled. Suspected TRIPLE or fever alone was present in 7.4%, and confirmed TRIPLE or HCA in 29.6% of cases (HCA alone 19.1% vs. HCA + FUN 10.5%). Preterm premature rupture of membrane (p-PROM) was strongly associated with HCA (66.6% in HCA group) and HCA was present in 80% neonates born between 22 and 24 weeks of gestational age (GA). HCA group (GA, 26 weeks; birth weight [BW], 880 g) showed lower Apgar's score, higher intubation rate, and need of ventilation in delivery room, surfactant, duration of noninvasive ventilation (NIV), severe patent ductus arteriosus (PDA), and incidence of BPD compared with no-HCA (GA, 30 weeks; BW, 1,210 g). Length of hospital stay and mortality were higher in HCA group (p = 0.01) and an increasing trend was present for HCA + FUN compared with HCA alone. CONCLUSION HCA greatly affected Apgar's score and lung management of VLBW infants (VLBWI) at birth and later on with increased incidence of BPD, thus impacting length of stay and quality of life, while HCA + FUN did not significantly impact on respiratory outcome. Further studies are needed to clarify the role of HCA and FUN in VLBW neonates.
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Affiliation(s)
- Simona Perniciaro
- Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Luana Nosetti
- Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Chiara Binda
- Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Silvia Salvatore
- Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Massimo Agosti
- Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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23
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Nosetti L, Paglietti MG, Brunetti L, Masini L, La Grutta S, Cilluffo G, Ferrante G, Zaffanello M, Verrillo E, Pavone M, Niespolo AC, Broggi G, Cutrera R. Application of latent class analysis in assessing the awareness, attitude, practice and satisfaction of paediatricians on sleep disorder management in children in Italy. PLoS One 2020; 15:e0228377. [PMID: 32012194 PMCID: PMC6996829 DOI: 10.1371/journal.pone.0228377] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 01/14/2020] [Indexed: 12/18/2022] Open
Abstract
AIM To identify subgroups regarding paediatricians' awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA). METHODS A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value<0.05 was considered statistically significant. RESULTS Two classes were identified: Class 1 (n = 368, 36.29%) "Untrained and poorly satisfied" and Class 2 (n = 646, 63.71%) "Trained and satisfied." Involving paediatric pneumologists or otorhinolaryngologists in clinical practice was associated with an increased probability of Class 2 membership (OR = 5.88, 95%CI [2.94-13.19]; OR = 15.95, 95% CI [10.92-23.81] respectively). Examining more than 20 children with SDB during the last month decreased the probability of Class 2 membership (OR = 0.29, 95% CI [0.14-0.61]). FCPs showed a higher probability of Class 2 membership than PHPs (OR = 4.64, 95% CI [3.31-6.55]). CONCLUSIONS These findings suggest that the LCA approach can provide important information on how education and training could be tailored for different subgroups of paediatricians. In Italy standardized educational interventions improving paediatricians' screening of SDB are needed in order to guarantee efficient management of children with SDB and reduce the burden of disease.
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Affiliation(s)
- Luana Nosetti
- Department of Paediatrics, University of Insubria, Varese, Italy
| | | | | | - Luigi Masini
- Azienda Ospedaliera Santobono—Pausillipon—Napoli, Naples, Italy
| | - Stefania La Grutta
- Institute for Research and Biomedical Innovation (IRIB)- National Research Council (CNR), Palermo, Italy
| | - Giovanna Cilluffo
- Institute for Research and Biomedical Innovation (IRIB)- National Research Council (CNR), Palermo, Italy
- * E-mail:
| | - Giuliana Ferrante
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
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Palmieri VV, Lonero A, Bocchini S, Cassano G, Convertino A, Corica D, Crinò A, Fattorusso V, Ferraris S, Fintini D, Franzese A, Grugni G, Iughetti L, Lia R, Macchi F, Madeo SF, Matarazzo P, Nosetti L, Osimani S, Pajno R, Patti G, Pellegrin MC, Perri A, Ragusa L, Rutigliano I, Sacco M, Salvatoni A, Scarano E, Stagi S, Tornese G, Trifirò G, Wasniewska M, Fischetto R, Giordano P, Licenziati MR, Delvecchio M. Uniparental disomy and pretreatment IGF-1 may predict elevated IGF-1 levels in Prader-Willi patients on GH treatment. Growth Horm IGF Res 2019; 48-49:9-15. [PMID: 31487604 DOI: 10.1016/j.ghir.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/04/2019] [Revised: 08/09/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
Pediatric patients with Prader-Willi syndrome (PWS) can be treated with recombinant human GH (rhGH). These patients are highly sensitive to rhGH and the standard doses suggested by the international guidelines often result in IGF-1 above the normal range. We aimed to evaluate 1 the proper rhGH dose to optimize auxological outcomes and to avoid potential overtreatment, and 2 which patients are more sensitive to rhGH. In this multicenter real-life study, we recruited 215 patients with PWS older than 1 year, on rhGH at least for 6 months, from Italian Centers for PWS care. We collected auxological parameters, rhGH dose, IGF-1 at recruitment and (when available) at start of treatment. The rhGH dose was 4.3 (0.7/8.4) mg/m2/week. At recruitment, IGF-1 was normal in 72.1% and elevated in 27.9% of the patients. In the group of 115 patients with IGF-1 available at start of rhGH, normal pretreatment IGF-1 and uniparental disomy were associated with elevated IGF-1 during the therapy. No difference in height and growth velocity was found between patients treated with the highest and the lowest range dose. The rhGH dose prescribed in Italy seems lower than the recommended one. Normal pretreatment IGF-1 and uniparental disomy are risk factors for elevated IGF-1. The latter seems to be associated with higher sensitivity to GH. In case of these risk factors, we recommend a more accurate titration of the dose to avoid overtreatment and its potential side effects.
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Affiliation(s)
- Viviana Valeria Palmieri
- Department of Biomedicine and Human Oncology, Pediatric Section, University A. Moro, Bari, Italy
| | | | - Sarah Bocchini
- Reference Center for Prader-Willi syndrome, Bambino Gesù Hospital, Research Hospital, Roma, Italy
| | - Gilda Cassano
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessio Convertino
- Reference Center for Prader-Willi syndrome, Bambino Gesù Hospital, Research Hospital, Roma, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Italy
| | - Antonio Crinò
- Reference Center for Prader-Willi syndrome, Bambino Gesù Hospital, Research Hospital, Roma, Italy
| | | | - Silvio Ferraris
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, University of Torino, Torino, Italy
| | - Danilo Fintini
- Reference Center for Prader-Willi syndrome, Bambino Gesù Hospital, Research Hospital, Roma, Italy
| | - Adriana Franzese
- Department of Translational Sciences, University Federico II, Naples, Italy
| | - Graziano Grugni
- Division of Auxology, Italian Auxological Institute, Research Institute, Piancavallo, Verbania, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Francesca Macchi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Simona Filomena Madeo
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, University of Torino, Torino, Italy
| | - Luana Nosetti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Sara Osimani
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Pajno
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppa Patti
- Department of Pediatrics, Giannina Gaslini Institute, Genoa, Italy
| | | | - Annamaria Perri
- Rare Diseases Unit Pediatric Department, University of Bologna, Bologna, Italy
| | | | - Irene Rutigliano
- Department of Pediatrics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Michele Sacco
- Department of Pediatrics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Emanuela Scarano
- Rare Diseases Unit Pediatric Department, University of Bologna, Bologna, Italy
| | - Stefano Stagi
- Anna Meyer Children's University Hospital, Florence, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Italy
| | - Rita Fischetto
- Metabolic Diseases, Clinical Genetics and Diabetology Unit, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Paola Giordano
- Department of Biomedicine and Human Oncology, Pediatric Section, University A. Moro, Bari, Italy
| | - Maria Rosaria Licenziati
- Obesity and Endocrine disease Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maurizio Delvecchio
- Metabolic Diseases, Clinical Genetics and Diabetology Unit, Giovanni XXIII Children's Hospital, Bari, Italy.
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25
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Salvatoni A, Moretti A, Grugni G, Agosti M, Azzolini S, Bonaita V, Cianci P, Corica D, Crinò A, Delvecchio M, Ferraris S, Greggio NA, Iughetti L, Licenziati MR, Madeo SF, Nosetti L, Pajno R, Rutigliano I, Sacco M, Salvatore S, Scarano E, Trifirò G, Wasniewska M. Anthropometric characteristics of newborns with Prader-Willi syndrome. Am J Med Genet A 2019; 179:2067-2074. [PMID: 31361394 DOI: 10.1002/ajmg.a.61304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/11/2019] [Revised: 06/18/2019] [Accepted: 07/09/2019] [Indexed: 11/07/2022]
Abstract
This is a retrospective multicenter nationwide Italian study collecting neonatal anthropometric data of Caucasian subjects with Prader-Willi syndrome (PWS) born from 1988 to 2018. The aim of the study is to provide percentile charts for weight and length of singletons with PWS born between 36 and 42 gestational weeks. We collected the birth weight and birth length of 252 male and 244 female singleton live born infants with both parents of Italian origin and PWS genetically confirmed. Percentile smoothed curves of birth weight and length for gestational age were built through Cole's lambda, mu, sigma method. The data were compared to normal Italian standards. Newborns with PWS showed a lower mean birth weight, by 1/2 kg, and a shorter mean birth length, by 1 cm, than healthy neonates. Females with a 15q11-13 deletion were shorter than those with maternal uniparental maternal disomy of chromosome 15 (p < .0001). The present growth curves may be useful as further traits in supporting a suspicion of PWS in a newborn. Because impaired prenatal growth increases risk of health problems later in life, having neonatal anthropometric standards could be helpful to evaluate possible correlations between the presence or absence of small gestational age and some clinical and metabolic aspects of PWS.
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Affiliation(s)
| | - Alex Moretti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, Verbania, Italy
| | - Massimo Agosti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Sara Azzolini
- Pediatric and Adolescent Endocrinology Unit, Department of Women and Child Health, University of Padova, Padova, Italy
| | - Valentina Bonaita
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paola Cianci
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Domenico Corica
- Department of Human Pathology of the Adult and of the Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Antonino Crinò
- Endocrine Autoimmune Pathology Unit, Bambino Gesù Hospital-IRCCS, Palidoro (Rome), Rome, Italy
| | | | - Silvio Ferraris
- Department of Public and Pediatric Health Sciences, University of Turin, Turin, Italy
| | - Nella A Greggio
- Pediatric and Adolescent Endocrinology Unit, Department of Women and Child Health, University of Padova, Padova, Italy
| | | | - Maria R Licenziati
- Center for Obesity and Related Endocrine Diseases, Department of Neuroscience and Rehabilitation, AORN Santobono-Pausilipon, Naples, Italy
| | - Simona F Madeo
- Pediatric Unit, University of Modena e Reggio, Modena, Italy
| | - Luana Nosetti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberta Pajno
- Department of Pediatrics, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan
| | - Irene Rutigliano
- Pediatric Unit, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Michele Sacco
- Pediatric Unit, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Silvia Salvatore
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Emanuela Scarano
- Pediatric Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Malgorzata Wasniewska
- Department of Human Pathology of the Adult and of the Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
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26
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Nosetti L, Piacentini G, Macchi A, De Bernardi F, Simoncini D, Nicoloso M, Agosti M, Zaffanello M. Nasal cytology in children with primary snoring and obstructive sleep apnoea syndrome. Int J Pediatr Otorhinolaryngol 2019; 122:133-137. [PMID: 31022683 DOI: 10.1016/j.ijporl.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/07/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Rhinitis is an acute or chronic inflammatory condition due to several causes (i.e. infections, allergens). There are controversial results that point out the role of nasal inflammation in primary snoring and obstructive sleep apnoea syndrome (OSAS). METHODS The aim of the present investigation is to study the nasal cytology in 58 children aged from 1 to 15 affected by sleep disordered breathing. RESULTS Inflammation of the nasal mucous was found in 88% of children. The most frequent problems were infectious rhinitis (36%), followed by non-allergic rhinitis (28%) and allergic rhinitis (21%). Infectious rhinitis was found in 31% of children with primary snoring and 41% with OSAS. Allergic rhinitis was found in 35% of children with primary snoring, and 6% with OSAS. Non-allergic rhinitis was found in 19% of children with primary snoring, and 34% with OSAS. Bacteria was found in 59% of children with OSAS and 46% in children with primary snoring. CONCLUSION the most prevalent forms of rhinitis in primary snoring were the allergic rhinitis, and in OSAS group were the non-allergic rhinitis. Bacteria were equally distributed in primary snoring and OSAS children. The nasal cytology provided interesting information that can be used to plan possible treatment strategies.
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Affiliation(s)
- Luana Nosetti
- Division of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy.
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Alberto Macchi
- Department of Otolaryngology, University of Insubria and ASST Laghi, Ospedale di Circolo, Varese, Italy.
| | - Francesca De Bernardi
- Department of Otolaryngology, University of Insubria and ASST Laghi, Ospedale di Circolo, Varese, Italy.
| | - Daniela Simoncini
- Division of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy.
| | - Martina Nicoloso
- Division of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy.
| | - Massimo Agosti
- Division of Neonatology and Neonatal Intensive Care Unit, "F. Del Ponte" Hospital, Varese, Italy.
| | - Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
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Nosetti L, Paglietti MG, Brunetti L, Masini L, La Grutta S, Cilluffo G, Zaffanello M, Verrillo E, Pavone M, Niespolo AC, Broggi G, Cutrera R. A survey around the Italian pediatric units on current clinical practice for Sleep Disordered Breathing (SDB). Ital J Pediatr 2019; 45:75. [PMID: 31242933 PMCID: PMC6595596 DOI: 10.1186/s13052-019-0658-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/08/2018] [Accepted: 05/12/2019] [Indexed: 01/05/2023] Open
Abstract
Background During recent years, interest on Sleep Disordered Breathing (SDB) in pediatric age has increased, due to the impact on quality of life, psycho-physical attitude and other serious morbidities if undiagnosed and untreated. Methods Italian Pediatric Respiratory Diseases Society (SIMRI) SDB-Working Group carried out an exploratory survey in Italy, from January to December 2016, to assess the diagnostic and therapeutic pathways, perception and relevance of SDB in Italian Hospitals. Results A questionnaire was sent to 180 Pediatric Units (PUs) distributed throughout the Italy; 102 Pediatric Units (PUs; 56.6%) answered and among them 57% dealt with SDB, and 94% recognized SDB as a major problem. Instrumental tests performed by the PUs were saturimetry (66%), nocturnal polygraphy with complete cardio-respiratory monitoring (46%) and full polysomnography (23%). In addition, hospital pediatricians reported that 54% of parents were unaware of the SDB and 84% did not know their complications. In the Northern Italy, the diagnosis was frequently performed with instrumental tools and the treatment was often surgical. In the Southern Italy the diagnosis was clinical, and the treatment was usually with drugs. Conclusions The results of our study showed a heterogeneity in the diagnosis and treatment of SDB throughout Italy. Parents know little about SDB and their complications. The operator satisfaction was associated with the availability of tools for diagnosing SDB. Electronic supplementary material The online version of this article (10.1186/s13052-019-0658-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Nosetti
- Pediatric Clinic University of Insubria, Via Ravasi, 2, 21100, Varese, Italy.
| | - M G Paglietti
- Sleep and Long Term Ventilation Unit, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - L Brunetti
- U.O.C. Pediatria Dip. Materno-Infantile, Az. Osp. Ente Ecc. Pia Fondazione di Cura e Religione "Card. G. Panico" Tricase, via S. Pio X, 4, 37100, Tricase (Lecce), Italy
| | - L Masini
- Department of Pediatrics, Santobono Children's Hospital, AORN Santobono-Pausilipon, Pediatric Pulmonology & Respiratory Intermediate Care Unit, , Naples, Italy
| | - S La Grutta
- National Research Council (CNR) Institute of Biomedicine and Molecular Immunology "Alberto Monroy" IBIM, Via Ugo La Malfa, 153, 90146, Palermo, Italy
| | - G Cilluffo
- National Research Council (CNR) Institute of Biomedicine and Molecular Immunology "Alberto Monroy" IBIM, Via Ugo La Malfa, 153, 90146, Palermo, Italy
| | - M Zaffanello
- Pediatric Clinic, University of Verona, Hospital for Women and Children, Piazzale Aristide Stefani, 1, 3716, Verona, Italy
| | - E Verrillo
- Sleep and Long Term Ventilation Unit, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M Pavone
- Sleep and Long Term Ventilation Unit, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A C Niespolo
- Pediatric Clinic University of Insubria, Via Ravasi, 2, 21100, Varese, Italy
| | - G Broggi
- Bocconi University, Via Roberto Sarfatti, 25, 20136, Milan, Italy
| | - R Cutrera
- Sleep and Long Term Ventilation Unit, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Castronovo V, Marelli S, Nosetti L, Lonati I, Agosti M, Broggi G, Castelnuovo A, Fossati A, Somma A, Ferini-Strambi L. 0757 Association Of Sleep And Technologies In A Sample Of Italian Adolescents. Sleep 2019. [DOI: 10.1093/sleep/zsz067.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vincenza Castronovo
- Sleep Disorder Unit, San Raffaele Turro Hospital, Milan, Italy, Milano, Italy
| | - Sara Marelli
- Sleep Disorder Unit, San Raffaele Turro Hospital, Milan, Italy, Milano, Italy
| | - Luana Nosetti
- Clinica Pediatrica Università degli Studi dell’Insubria, Varese, Italy
| | - Irene Lonati
- Clinica Pediatrica Università degli Studi dell’Insubria, Varese, Italy
| | - Massimo Agosti
- Clinica Pediatrica Università degli Studi dell’Insubria, Varese, Italy
| | | | | | - Andrea Fossati
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy, Milano, Italy
| | - Antonella Somma
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy, Milano, Italy
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Levrini L, Nosetti L, Letizia R, Laura M, Agosti M. Sleep Apnea throughout the First Two Years of Life: Assessment of the Effect of Pacifiers in Patients with ALTE. Open Dent J 2019. [DOI: 10.2174/1874210601913010048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:Apparent Life-Threatening Event (ALTE), Obstructive Sleep Apnea syndrome (OSAs) and Sudden Infant Death Syndrome (SIDS) are strongly correlated and few studies analyze the role that pacifiers play in such conditions.Objective:The aim of the study is to evaluate how pacifiers affect sleep apnea among children with a history of ALTE.Methods:10 subjects between 1 month and 2 years of age with a history of idiopathic ALTE were non-selectively recruited. Patients were subjected to cardio-respiratory monitoring at home for two consecutive nights; during the first night, the pacifier was not used, whereas the second night, the pacifier was used by the child for at least four hours sleep. Parents were given an assessment questionnaire to evaluate and report any irritation due to the pacifier use. All obtained traces were blindly analyzed by a pediatric specialist in sleep disorders, more specifically: Peripheral oxygen saturation (SpO2), heart rate (FC), Electrocardiogram (ECG) and the presence of apneas and/or hypopneas were assessed. In order to evaluate the differences between the average values collected from the two groups, a t-test was performed.Results:The use of the pacifier resulted in a statistically significant reduction in the number of pathological apneas/night (-1.7%;p= 0,0024), an improvement in the average SpO2(+ 0.8%;p= 0.3328) and an increase in the value of the minimum SpO2detected (+ 2%;p= 0.2571).Conclusion:The results show that the use of pacifiers improves the respiratory capacity of children that suffer from nocturnal apneas at night.
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Colombo M, Katz ES, Bosco A, Melzi ML, Nosetti L. Brief resolved unexplained events: Retrospective validation of diagnostic criteria and risk stratification. Pediatr Pulmonol 2019; 54:61-65. [PMID: 30549452 DOI: 10.1002/ppul.24195] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/09/2018] [Accepted: 10/25/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES This study retrospectively evaluated the AAP guidelines for diagnosis and risk stratification of Brief Resolved Unexplained Events (BRUE) in a well-characterized cohort of infants admitted with an Apparent Life Threatening Event (ALTE). Further, using prospective follow-up, we endeavored to determine the safety of implementing ambulatory care for the lower risk BRUE population (LR-BRUE) and estimate the cost-savings of this practice. METHODS Retrospective application of the BRUE criteria on infants younger than 12 months of age who had been admitted with an ALTE from 2006 to 2016 at a single tertiary care center in Lombardy, Italy. ALTE patients were classified into three groups; (1) Not a BRUE; (2) Lower-risk (LR)-BRUE; and (3) Higher-risk (HR)-BRUE. Patients were contacted prospectively to obtain long-term follow-up outcomes and medical records and billing databases were reviewed. RESULTS Among the 84 infants admitted for an ALTE, 35 (42%) were not a BRUE, 16 (19%) were a LR-BRUE, and 33 (39%) were a HR-BRUE. Only one of the LR-BRUE patients had a subsequent LR-BRUE event, and was later diagnosed with a seizure disorder. Two HR-BRUE babies had also previously presented with a LR-BRUE. Application of the LR-BRUE guidelines would have decreased health expenditure by 20%. There were no deaths or significant morbidities in either BRUE group. CONCLUSIONS Applying the recent AAP BRUE guidelines and risk stratification to a well-characterized cohort of admitted ALTE patients is a safe and cost-effective approach. Careful out-patient follow-up is recommended as one of our patients with a LR-BRUE had a recurrence, and was subsequently diagnosed with a seizure disorder.
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Affiliation(s)
- Marco Colombo
- Department of Pediatrics, ASST Sette Laghi, Del Ponte Hospital, Varese, Italy
| | - Eliot S Katz
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts
| | | | - Maria L Melzi
- Department of Pediatrics, MBBM Foundation, Monza, Italy
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Nosetti L, Angriman M, Zaffanello M, Salvatore S, Riggi L, Niespolo AC, Salvatoni A, Agosti M. Increased parental perception of sleep disordered breathing in a cohort of infants with ALTE/BRUE events. Minerva Pediatr 2018:S0026-4946.18.05276-3. [PMID: 30299025 DOI: 10.23736/s0026-4946.18.05276-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND An apparent life-threatening event (ALTE) describes an acute, unexpected change in an infant's breathing, aspect, or behavior frightening to the parent or caretaker. According to the new recent terminology, clinicians should use the term Brief Resolved Unexplained Event (BRUE) to describe an event occurring in an infant <1 year of age when the observer reports a sudden, brief, and now resolved episode. The aims of the present study in infants were: to investigate sleep disturbances in both ALTE event and after their classification according the new BRUE criteria. METHODS We enrolled (from April to May 2016) 32 consecutive infants referred to our ambulatory for sleep disorders for follow-up after an ALTE episode and 32 pair healthy controls. We administered to parents the adapted questionnaire "Sleep Disturbance Scale for Children - SDSC". RESULTS Among enrolled infants with ALTE, there were 26 infants in line with the new BRUE definition, of which 10 at low risk and 16 at the high-risk event. CONCLUSIONS BRUE had more referred-by-parents' sleep symptoms than controls. In particular, sleep disordered breathing wa prevalent in both, requiring a longer follow-up for this disturbance.
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Affiliation(s)
- Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Marco Angriman
- Child Neurology and Neurorehabilitation Unit, Department of Pediatrics, Hospital of Bolzano, Bolzano, Italy
| | - Marco Zaffanello
- Pediatric Division, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy -
| | | | - Letizia Riggi
- Department of Pediatrics, University of Insubria, Varese, Italy
| | | | | | - Massimo Agosti
- Department of Pediatrics, University of Insubria, Varese, Italy
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Zaffanello M, Antoniazzi F, Tenero L, Nosetti L, Piazza M, Piacentini G. Sleep-disordered breathing in paediatric setting: existing and upcoming of the genetic disorders. Ann Transl Med 2018; 6:343. [PMID: 30306082 PMCID: PMC6174189 DOI: 10.21037/atm.2018.07.13] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022]
Abstract
Childhood obstructive sleep apnea syndrome (OSAS) is characterized by anatomical and functional upper airway abnormalities as pathophysiological determinants, and clinical symptoms are frequently clear. OSAS is widely described in rare genetic disorders, such as achondroplasia, Down syndrome, Prader-Willi syndrome, Pierre Robin sequence, and mucopolysaccharidosis. Craniofacial and upper airway involvement is frequently morbid conditions. In children with genetic diseases, the clinical symptoms of OSAS are often slight or absent, and related morbidities are usually more severe and can be observed at any age. The present review is aimed to updating the discoveries regarding OSAS on Achondroplasia, Down syndrome, Prader-Willi syndrome, Pierre Robin sequence, Sickle cell disease, or encountered in our clinical practice (Ehlers-Danlos syndrome, Ellis-van Creveld syndrome, Noonan syndrome). Two additional groups of genetic disorders will be focused (mucopolysaccharidoses and osteogenesis imperfecta). The flowing items are covered for each disease: (I) what is the pathophysiology of OSAS? (II) What is the incidence/prevalence of OSAS? (III) What result from the management and prognosis? (IV) What are the recommendations? Considering the worries of OSAS, such as inattention and behavioural problems, daytime sleepiness, failure to thrive, cardiological and metabolic complications, the benefit of a widespread screening and the treatment in children with genetic diseases is undoubtful. The goals of the further efforts can be the inclusion of various genetic diseases into guidelines for the screening of OSAS, updating the shreds of evidence based on the research progression.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Zaffanello M, Lippi G, Tenero L, Piazza M, Sacchetto L, Nosetti L, Gasperi E, Piacentini G. Childhood nasal obstruction and sleep-disordered breathing during clinical setting: Myth or reality? ACTA ACUST UNITED AC 2018. [DOI: 10.18621/eurj.410657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Guidelines are contradictory regarding the use of alginate in infants with persisting gastroesophageal reflux (GER). While The British National Institute for Health and Care (NICE) guidelines consider alginate as a treatment option, the guidelines of the European and North-American Societies for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN, NASPGHAN) do not recommend alginates. AIMS We assessed the efficacy of alginate to reduce GER episodes in infants. METHODS In a prospective, observational study, we consecutively enrolled all infants referred for pH-multiple intraluminal impedance (pH-MII) recording because of persisting GER symptoms not responsive to behavior and dietetic modifications. A 48-h pH-MII was performed in all infants; a baseline recording was performed during the first 24 h while magnesium or sodium alginate was administered during the second 24 h. The primary endpoint was the difference in the total number of GER episodes per 24 h between the baseline day and the second day during which the alginate was administered. The secondary outcome was the difference in symptoms between each period. We also compared other pH-MII data from before and during alginate administration. RESULTS We recruited 43 infants (median age 68 days, range 25-306); three pH-MII tracings were excluded because of artifacts. The median number of all MII reflux episodes was significantly reduced during alginate administration (76.0 vs 69.5; p < 0.001). Crying-fussiness, cough and regurgitation episodes all significantly improved during alginate administration (p = 0.00012; p = 0.005 and p = 0.04, respectively). The following MII parameters also decreased during the alginate administration: acid (19.0 vs 14.5; p < 0.04), non-acid (52.0 vs 49.5; p < 0.004), proximal GER episodes (46.0 vs 41.4; p < 0.007), and bolus exposure index (1.9 vs 1.6; p = 0.002). At least three out of seven pH-MII parameters decreased by > 10% during the alginate period in 31/40 infants (77.5%), without a significant difference between magnesium and sodium alginate. CONCLUSION These results suggest that alginate significantly decreases the number and extension of both acid and non-acid reflux episodes and associated symptoms in infants.
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Affiliation(s)
- Silvia Salvatore
- 0000000121724807grid.18147.3bDivision of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Antonio Ripepi
- 0000000121724807grid.18147.3bDivision of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Koen Huysentruyt
- 0000 0001 2290 8069grid.8767.eKidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan, 101, 1090 Brussels, Belgium
| | - Kristel van de Maele
- 0000 0001 2290 8069grid.8767.eKidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan, 101, 1090 Brussels, Belgium
| | - Luana Nosetti
- 0000000121724807grid.18147.3bDivision of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Massimo Agosti
- Division of Neonatology and Neonatal Intensive Care Unit, “F. Del Ponte” Hospital, Varese, Italy
| | - Alessandro Salvatoni
- 0000000121724807grid.18147.3bDivision of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Yvan Vandenplas
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan, 101, 1090, Brussels, Belgium.
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Zaffanello M, Piacentini G, Sacchetto L, Pietrobelli A, Gasperi E, Barillari M, Cardobi N, Nosetti L, Ramaroli D, Antoniazzi F. Sleep-Disordered Breathing in Children with Rare Skeletal Disorders: A Survey of Clinical Records. Med Princ Pract 2018; 27:451-458. [PMID: 29929197 PMCID: PMC6244108 DOI: 10.1159/000491391] [Citation(s) in RCA: 6] [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: 10/08/2017] [Accepted: 06/21/2018] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Craniofacial disharmony in skeletal diseases is strongly associated with sleep-disordered breathing. This study was aimed at studying the sleep respiratory patterns in young children with rare skeletal disorders. DESIGN This retrospective study included children with achondroplasia (ACH), osteogenesis imperfecta (OI) and Ellis van Creveld Syndrome. Our subjects underwent an in-laboratory overnight respiratory polygraph between January 2012 and April 2016. All medical records were reviewed and brain Magnetic Resonance Imaging was conducted on patients with ACH, nasopharynx, oropharynx and laryngopharynx spaces. PATIENTS Twenty-four children were enrolled, 13 with ACH, 2 with spondyloepiphyseal dysplasia, 1 with odontochondrodysplasia, 6 with OI and 2 with Ellis van Creveld Syndrome. RESULTS Children with ACH, who had adenotonsillectomy, showed fewer sleep respiratory involvement than untreated children. Among 13 patients with ACH, brain magnetic resonance imaging was available in 10 subjects and significant negative correlation was found between sleep respiratory patterns, nasopharynx and oropharynx space (p < 0.05). In 2 patients with spondyloepiphyseal dysplasia, mild-to-moderate sleep respiratory involvement was found. Both subjects had a history of adenotonsillectomy. Mild sleep respiratory involvement was also observed in 4 out of 6 patients with OI. One patient with Ellis van Creveld syndrome had mild sleep respiratory disturbance. CONCLUSIONS Sleep respiratory disturbances were detected in children with ACH, and with less severity also in OI and Ellis van Creveld syndrome. Adenotonsillectomy was successful in ACH in reducing symptoms. In light of our findings, multicenter studies are needed to obtain further information on these rare skeletal diseases.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- *Marco Zaffanello, MD, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division University of Verona, Piazzale Stefani, 1, Woman & Child Hospital, Building 29, IT-37126 Verona (Italy), E-Mail
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Luca Sacchetto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Emma Gasperi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Marco Barillari
- Department of Morphological and Biomedical Sciences, Institute of Radiology, University Hospital of Verona, Verona, Italy
| | - Nicolò Cardobi
- Department of Morphological and Biomedical Sciences, Institute of Radiology, University Hospital of Verona, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Diego Ramaroli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Piumelli R, Davanzo R, Nassi N, Salvatore S, Arzilli C, Peruzzi M, Agosti M, Palmieri A, Paglietti MG, Nosetti L, Pomo R, De Luca F, Rimini A, De Masi S, Costabel S, Cavarretta V, Cremante A, Cardinale F, Cutrera R. Apparent Life-Threatening Events (ALTE): Italian guidelines. Ital J Pediatr 2017; 43:111. [PMID: 29233182 PMCID: PMC5728046 DOI: 10.1186/s13052-017-0429-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 05/19/2017] [Accepted: 08/22/2017] [Indexed: 02/07/2023] Open
Abstract
Five years after the first edition, we have revised and updated the guidelines, re-examining the queries and relative recommendations, expanding the issues addressed with the introduction of a new entity, recently proposed by the American Academy of Pediatrics: BRUE, an acronym for Brief Resolved Unexplained Events. In this manuscript we will use the term BRUE only to refer to mild, idiopathic cases rather than simply replace the acronym ALTE per se.In our guidelines the acronym ALTE is used for severe cases that are unexplainable after the first and second level examinations.Although the term ALTE can be used to describe the common symptoms at the onset, whenever the aetiology is ascertained, the final diagnosis may be better specified as seizures, gastroesophageal reflux, infection, arrhythmia, etc. Lastly, we have addressed the emerging problem of the so-called Sudden Unexpected Postnatal Collapse (SUPC), that might be considered as a severe ALTE occurring in the first week of life.
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Affiliation(s)
- Raffaele Piumelli
- Sleep Breathing Disorders and SIDS Center, Meyer Children's Hospital, Firenze, Italy.
| | - Riccardo Davanzo
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Niccolò Nassi
- Sleep Breathing Disorders and SIDS Center, Meyer Children's Hospital, Firenze, Italy
| | | | - Cinzia Arzilli
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Firenze, Italy
| | - Marta Peruzzi
- Sleep Breathing Disorders and SIDS Center, Meyer Children's Hospital, Firenze, Italy
| | - Massimo Agosti
- Neonatal Intensive Care Unit, Del Ponte Hospital, Varese, Italy
| | - Antonella Palmieri
- SIDS Center, Pediatric Emergency Department, "G. Gaslini" Children's Hospital, Genova, Italy
| | - Maria Giovanna Paglietti
- Pneumology Unit - University Hospital Pediatric Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Luana Nosetti
- Paediatric Department, University of Insubria, Varese, Italy
| | - Raffaele Pomo
- SIDS/ALTE Center, Buccheri la Ferla Hospital, Palermo, Italy
| | | | | | | | - Simona Costabel
- Emergency Department of Paediatrics, G. Gaslini Children's Hospital, Genova, Italy
| | | | - Anna Cremante
- National Neurological Institute IRCCS C, Mondino, Pavia, Italy
| | | | - Renato Cutrera
- Pneumology Unit - University Hospital Pediatric Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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Russotto VS, Macchi F, Arturi E, Barbini M, Pogliaghi M, Nosetti L, Salvatoni A. POI score application at start of GH treatment in Prader-Willi syndrome. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zaffanello M, Piacentini G, Pietrobelli A, Fava C, Lippi G, Maffeis C, Gasperi E, Nosetti L, Bonafini S, Tagetti A, Antoniazzi F. Ambulatory clinical parameters and sleep respiratory events in a group of obese children unselected for respiratory problems. World J Pediatr 2017; 13:577-583. [PMID: 28702869 DOI: 10.1007/s12519-017-0054-1] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/12/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND Obstructive sleep apnea in children is frequently due to tonsil and adenoid hypertrophy. This study aimed to investigate the relationship between ambulatory clinical parameters and sleep respiratory events in obese children. METHODS We carried out a prospective respiratory sleep study between 2013 and 2015. Nails obstruction, tonsils enlargement and palate position were subjectively measured. Italian attention deficit hyperactivity disorder (ADHD) rating scale for parents was also performed. The polygraph study was performed using a portable ambulatory device. RESULTS Forty-four obese children were consecutively recruited into this study. Mild sleep respiratory disturbance was showed in 31.8 % of patients; 18.2% previously had an adeno (tonsillectomy). In 50% of these obese children, both apnea-hypopnea index and oxygen desaturation index showed polygraph abnormal results. ADHD rating scale for parents scores were positive in 9.1% of patients. CONCLUSIONS We found a high rate of mild sleep respiratory disturbance and ADHD-like symptoms referred by parents. The respiratory disturbance was not totally cured by surgery. Finally, otorhinolaryngology variables were not able to explain mild sleep respiratory disturbance.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Cristiano Fava
- Department of Medicine, Section of General Medicine and Hypertension, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Department of Neuroscience, Biomedicine and Movement, Chemistry and Clinical Microscopy Section, University of Verona, Verona, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Emma Gasperi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Sara Bonafini
- Department of Medicine, Section of General Medicine and Hypertension, University of Verona, Verona, Italy
| | - Angela Tagetti
- Department of Medicine, Section of General Medicine and Hypertension, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
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Tenero L, Piacentini G, Nosetti L, Gasperi E, Piazza M, Zaffanello M. Indoor/outdoor not-voluptuary-habit pollution and sleep-disordered breathing in children: a systematic review. Transl Pediatr 2017; 6:104-110. [PMID: 28503417 PMCID: PMC5413472 DOI: 10.21037/tp.2017.03.04] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Exposure to environmental pollutants is advocated to be a major risk factor, with increased morbidity and mortality in humans due to acute and chronic airway inflammation. The aim of the present review is to show the literature research regarding the link between the sleep-disordered breathing and exposure to indoor/outdoor pollution in children. We hypothesized that environmental air pollution can play a role in childhood sleep-disordered breathing. METHODS We conducted an electronic search in Medline (with PubMed interface), Scopus and the ISI Web of Science using the keywords "sleep" or "sleep apnea" or "sleep disordered breathing" and "pollution" and "children" in "Title/Abstract/Keywords", with language restriction (non-English paper) and no date limitation to present. The tobacco smoke pollution is well established linking and is not considered for the present subject. We examined the strength of the evidence according to the Oxford Centre for Evidence-Based Medicine [2011] and the Centre for Evidence-Based Medicine [2009]. RESULTS A total of 105 articles were identified, but 97 of these had to be excluded after an accurate reading of the title, abstract or full text. In the end, eight studies were selected for our analysis for a total of a total of 5,826 children. The results suggest an involvement (grade C) of environmental (not from voluptuary habits) pollution in the worsening of sleep-disordered breathing in children. CONCLUSIONS To date, some studies reported significant differences between areas with higher and lower pollutants and the interventions on indoor pollution reduced sleep-disordered breathing in children. Therefore, although the relevance of the argument is high, the number of studies and the interest in the subject seems at this time quite limited.
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Affiliation(s)
- Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Emma Gasperi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
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Zaffanello M, Piacentini G, Lippi G, Fanos V, Gasperi E, Nosetti L. Obstructive sleep-disordered breathing, enuresis and combined disorders in children: chance or related association? Swiss Med Wkly 2017; 147:w14400. [PMID: 28165541 DOI: 10.4414/smw.2017.14400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Nocturnal enuresis is usually diagnosed and treated by a primary paediatrician or family practitioner; if there is any doubt, the children may be referred to a paediatric urologist. Obstructive sleep-disordered breathing is a complex, multifactorial disorder. Adenotonsillar hypertrophy is considered an important factor associated with obstructive sleep apnoea syndrome. Enuresis and obstructive sleep-disordered breathing are both frequent problems of sleep in childhood. We conducted an electronic search in Medline, Scopus and the ISI Web of Science to look for published material and identify a putative link between nocturnal enuresis and obstructive sleep-disordered breathing. A total number of 98 documents were found, but 24 of these had to be excluded after an attentive reading of the title, abstract or full text because the information therein was not suitable for the aims of our search. Studies have found that children with obstructive sleep apnoea syndrome frequently also have nocturnal enuresis. Both disorders have an underlying sleep disturbance characterised by an altered arousal response and sleep fragmentation. The pathophysiology of enuretic events is seemingly linked to nocturnal obstructive events, causing increased intra-abdominal pressure and altered systemic blood pressure that induces natriuresis and polyuria by altering levels of antidiuretic hormone, and atrial and brain natriuretic peptides. We found 17 studies regarding the urological outcome of treatment for obstructive sleep-disordered breathing in children with enuresis. Although a vast amount of information is now available regarding the relationship between nocturnal enuresis and obstructive sleep-disordered breathing, many of the published studies were uncontrolled, retrospective or prospective cohort studies (grade C recommendation). Resolution of enuresis after medical or surgical treatment for obstructive sleep-disordered breathing has been emphasised. Consequently, symptoms such as snoring, sleep apnoeas and restless sleep should be sought for all children with enuresis. Confirmed obstructive sleep-disordered breathing should be treated promptly; subsequently, the persistence of enuresis requires treatment following the standard protocol.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Paediatric Division, University of Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Paediatric Division, University of Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, Italy
| | - Emma Gasperi
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Paediatric Division, University of Verona, Italy
| | - Luana Nosetti
- Department of Paediatrics, University of Insubria, Varese, Italy
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Monti MC, Borrelli P, Nosetti L, Tajè S, Perotti M, Bonarrigo D, Stramba Badiale M, Montomoli C. Incidence of apparent life-threatening events and post-neonatal risk factors. Acta Paediatr 2017; 106:204-210. [PMID: 26946490 DOI: 10.1111/apa.13391] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 10/09/2015] [Revised: 02/18/2016] [Accepted: 03/02/2016] [Indexed: 01/21/2023]
Abstract
AIM Even though a standard clinical definition for an apparent life-threatening event (ALTE) was established more than two decades ago, the specific International Classification of Disease (ICD) code was firstly included only in 2012. This study estimated the incidence of ALTEs in Northern Italy, together with features and risk factors. METHODS We used the Lombardy Region Hospital Discharge Records (HDR) database to estimate the cumulative incidence for ALTE during 2002-2006 and drew up a risk profile by comparing cases with and without ALTE who were followed in infancy. RESULTS There were 246 infants registered in the HDR with ALTE putative diagnostic codes, suggesting a cumulative incidence of 4.1 per 1000 live births in the study area. Of the 148 cases with clinical co-morbidities, 31% had gastroesophageal reflux and 7% had acute respiratory infections. We analysed follow-up data from 15 ALTE cases and 1619 healthy infants and found that the significant risk factors were gastroesophageal reflux and a family history of sudden death. CONCLUSION We established the regional incidence of ALTE and found risk factors in infants considered healthy in the first week of life and without pathological perinatal conditions. The systematic use of the specific ALTE ICD code (R68.13, ICD-10-CM) and common knowledge about ALTE diagnostic guidelines are clearly needed.
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Affiliation(s)
- Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine Unit of Biostatistics and Clinical Epidemiology University of Pavia Pavia Italy
| | - Paola Borrelli
- Department of Public Health, Experimental and Forensic Medicine Unit of Biostatistics and Clinical Epidemiology University of Pavia Pavia Italy
| | - Luana Nosetti
- Pediatric Emergency Room Pediatric Department University of Varese Varese Italy
| | - Silvia Tajè
- Pediatric Emergency Room Pediatric Department University of Varese Varese Italy
| | - Milena Perotti
- Pediatric Arrhythmias Center IRCCS Istituto Auxologico Italiano Milan Italy
| | | | | | - Cristina Montomoli
- Department of Public Health, Experimental and Forensic Medicine Unit of Biostatistics and Clinical Epidemiology University of Pavia Pavia Italy
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Filonzi L, Nosetti L, Magnani C, Vaghi M, Nganso Fenjiep AF, Marzano FN. ALTE and smoking exposure: which role of detoxification genes polymorphisms? Clin Genet 2016; 90:383-4. [DOI: 10.1111/cge.12788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- L. Filonzi
- Department of Life Sciences; University of Parma; Parma Italy
| | - L. Nosetti
- Pediatric Clinic Insubria; University of Varese; Varese Italy
| | - C. Magnani
- Department of Clinical and Experimental Medicine; University of Parma; Parma Italy
| | - M. Vaghi
- Department of Life Sciences; University of Parma; Parma Italy
| | | | - F. N. Marzano
- Department of Life Sciences; University of Parma; Parma Italy
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Caprioglio A, Meneghel M, Fastuca R, Zecca PA, Nucera R, Nosetti L. Rapid maxillary expansion in growing patients: correspondence between 3-dimensional airway changes and polysomnography. Int J Pediatr Otorhinolaryngol 2014; 78:23-7. [PMID: 24231036 DOI: 10.1016/j.ijporl.2013.10.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 08/01/2013] [Revised: 10/13/2013] [Accepted: 10/15/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of the present prospective study was to investigate the effects of rapid maxillary expansion on the airway correlating airway volumes computed on cone beam computed tomography and polysomnography evaluation of oxygen saturation and apnea/hypopnea index. METHODS The study group comprised 14 caucasian patients (mean age 7.1 ± 0.6 years) undergone to rapid maxillary expansion with Haas type expander banded on second deciduous upper molars. Cone beam computed tomography scans and polysomnography exams were collected before placing the appliance (T0) and after 12 months (T1). Landmarks localization and airway semiautomatic segmentation on cone beam computed tomography scans allowed airway volume computing and measurements. RESULTS Increases of total airway volume, oxygen saturation and apnea/hypopnea index were statistically significant. No correlation was found among total airway volume, oxygen saturation and apnea/hypopnea index changes between the examined timepoints. CONCLUSIONS Computing airway volume on cone beam computed tomography allow to measure the amount of air that flows through nasal cavity, nasopharynx and oropharynx while oxygen saturation and apnea/hypopnea index could give information about functional parameters. In the present study all three variables investigated showed statistically significant differences between T0 and T1 but no correlation was found between increases of the different variables tested.
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Affiliation(s)
| | - Matteo Meneghel
- Department of Orthodontics, University of Insubria, Varese, Italy
| | | | | | - Riccardo Nucera
- Department of Orthodontics, University of Messina, Messina, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
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Cremante A, Nosetti L, Tovaglieri N, Niespolo AC, Spica Russotto V, Mongiardi V, Nespoli L. ["A minute for life": resuscitation techniques in infants with risk for sudden infant death syndrome. Development of an instructional video for parents]. Minerva Pediatr 2013; 65:645-650. [PMID: 24217633] [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: 06/02/2023]
Abstract
AIM The present study describes a project carried out in the Center for SIDS/ALTE of the Pediatric Clinic of Varese, targeted to deliver and provide parents with a movies on PBLS titled "A Minute for Life". The impact on the parent was evaluated by applying a questionnaire. METHODS The movie "A Minute for Life" was given to 308 parents (122 fathers, mean age 35.2 and 186 mothers, mean age 28.4). All parents completed a questionnaire based on 4 parameters: 1. clarity of the content presented; 2. anxiety felt while watching the movie clip 3. reassurance related to their ability to review other times the movie; 4. the perception of its usefulness. RESULTS Regarding the clarity of content, the results provide evidence that 231 parents (75% of the sample) rated him "very clear", while 77 subjects (25%) considered it "quite clear". On the possibility of being able to have at home, 277 parents (90% of subjects) believed it would be very reassuring to see it back Home. According to 231 parents (75% of the sample) the vision of the movie does not convey anxiety, while 77 of them (25% of subjects) felt slightly concerned in relation to vision. With regard to the overall assessment of the movie, all parents (308, 100% of the sample) agreed about its extreme usefulness. CONCLUSION Our study opens the way for further prospective studies regarding the appropriateness and usefulness of the movie. It's also important to consider the release of the movie to all new parents and the possibility of giving first aid courses open to all those who want to be able to act with promptness and expertise if and when necessary.
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Affiliation(s)
- A Cremante
- Centro SIDS, Clinica Pediatrica Università degli Studi dell'Insubria Ospedale di Circolo, Fondazione Macchi Varese, Italia -
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Berini J, Spica Russotto V, Castelnuovo P, Di Candia S, Gargantini L, Grugni G, Iughetti L, Nespoli L, Nosetti L, Padoan G, Pilotta A, Trifirò G, Chiumello G, Salvatoni A. Growth hormone therapy and respiratory disorders: long-term follow-up in PWS children. J Clin Endocrinol Metab 2013; 98:E1516-23. [PMID: 23894156 DOI: 10.1210/jc.2013-1831] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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] [Indexed: 11/19/2022]
Abstract
CONTEXT Adenotonsillar tissue hypertrophy and obstructive sleep apnea have been reported during short-term GH treatment in children with Prader-Willi syndrome (PWS). OBJECTIVE We conducted an observational study to evaluate the effects of long-term GH therapy on sleep-disordered breathing and adenotonsillar hypertrophy in children with PWS. DESIGN This was a longitudinal observational study. PATIENTS AND METHODS We evaluated 75 children with genetically confirmed PWS, of whom 50 fulfilled the criteria and were admitted to our study. The patients were evaluated before treatment (t0), after 6 weeks (t1), after 6 months (t2), after 12 months (t3), and yearly (t4-t6) thereafter, for up to 4 years of GH therapy. The central apnea index, obstructive apnea hypopnea index (OAHI), respiratory disturbance index, and minimal blood oxygen saturation were evaluated overnight using polysomnography. We evaluated the adenotonsillar size using a flexible fiberoptic endoscope. RESULTS The percentage of patients with an OAHI of >1 increased from 3 to 22, 36, and 38 at t1, t4, and t6, respectively (χ(2) = 12.2; P < .05). We observed a decrease in the respiratory disturbance index from 1.4 (t0) to 0.8 (t3) (P < .05) and the central apnea index from 1.2 (t0) to 0.1 (t4) (P < .0001). We had to temporarily suspend treatment for 3 patients at t1, t4, and t5 because of severe obstructive sleep apnea. The percentage of patients with severe adenotonsillar hypertrophy was significantly higher at t4 and t5 than at t0. The OAHI directly correlated with the adenoid size (adjusted for age) (P < .01) but not with the tonsil size and IGF-1 levels. CONCLUSION Long-term GH treatment in patients with PWS is safe; however, we recommend annual polysomnography and adenotonsillar evaluation.
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Affiliation(s)
- Jenny Berini
- Pediatric Unit, Ospedale Del Ponte, Insubria University, 21100 Varese, Italy
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Filonzi L, Magnani C, Nosetti L, Nespoli L, Borghi C, Vaghi M, Nonnis Marzano F. Serotonin transporter role in identifying similarities between SIDS and idiopathic ALTE. Pediatrics 2012; 130:e138-44. [PMID: 22711722 DOI: 10.1542/peds.2011-3331] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Considering previous genetic studies on sudden infant death syndrome (SIDS) and the role of L/L serotonin transporter (5HTT) genotype and correlated genes monoamine oxidase A (MAOA) and dopamine transporter (DAT) in unexpected death, an investigation was carried out verifying their involvement in apparent life-threatening events (ALTE and idiopathic form [IALTE]), also assessing common molecular basis with SIDS. METHODS Differential diagnoses in 76 ALTE infants, distinguishing ALTE from IALTE was elaborated by using clinical-diagnostic data. Genotypes/allelic frequencies of DAT, MAOA, and 5HTT were determined in ALTE and IALTE infants and compared with data obtained from 20 SIDS and 150 controls. RESULTS No association was found between DAT polymorphisms and ALTE/IALTE groups either at the genotype or allelic level (P range .11-.94). MAOA genotypes and allele data comparison between ALTE and controls was not significant; IALTE data showed a tendency for genotypes (P = .09) and were statistically significant for alleles (P = .036); however, MAOA significance disappeared once the Bonferroni correction was applied. 5HTT polymorphisms in IALTE remarked the role of L/L genotype (P < .00001) and L (P < .00001), as previously demonstrated in SIDS. CONCLUSIONS Considering correspondence between 5HTT and MAOA in IALTE and SIDS, we hypothesize that the 2 syndromes are different expressions of a common ethiopathogenesis. In particular, genetic data suggest SIDS events could derive from IALTE episodes occurred during sleep, and therefore out of parental control. Despite its functional role, results highlight the usefulness of 5HTT as a valuable tracer of SIDS risk in IALTE infants. Owing to the small sample size, the results are to be considered preliminary and should be reevaluated in an independent sample.
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Affiliation(s)
- Laura Filonzi
- Department of Evolutionary and Functional Biology, University of Parma, Parma, Italy
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Caprioglio A, Levrini L, Nosetti L, Berini J, Macchi A, Tagliabue A, Tettamanti L. Prevalence of malocclusion in preschool and primary school children with habitual snoring and sleep-disordered breathing. Eur J Paediatr Dent 2011; 12:267-271. [PMID: 22185254] [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: 05/31/2023]
Abstract
AIM Our research aimed to find out whether it was possible to establish a correlation between instrumental polysomnographic variables in children with Sleep Disordered Breathing (SDB) and their clinical dentofacial records. MATERIALS AND METHODS 197 children, 116 (59%) male and 81 (41%) female, age range 0 to 12 years, with a clinical history highly suggestive for SDB were enrolled. All patients underwent full-night Poly-Mesam examination and a specific clinical orthodontic evaluation. A comparison between polysomnographic variables and clinical orthodontic variables was made. RESULTS AND CONCLUSION OSAS can not be diagnosed by the paediatric dentist only by performing a single clinical orthodontic examination of oral cavity, but a polysomnography is essential and, if this should point out any pathology referring to SDB, a cranial lateral cephalometry will then be required.
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Affiliation(s)
- A Caprioglio
- University of Insubria, School of Dentistry, Varese, Italy.
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Piumelli R, Di Pietro P, Longhi L, Donzelli G, Cutrera R, Nespoli L, Magnani C, Nassi N, Becherucci P, Chiappini E, Lapi F, Vannacci A, Mari F, Nosetti L, Rimini A, Salvatore S, Paglietti MG, Palmieri A, Pomo R, Vitale A, Dalla Casa P, De Angelis GL, Macchiarini A, Nonnis-Marzano F, Pisani F, Podestà A. [Assistential-diagnostic guidelines: apparent life-threatening events (ALTE)]. Minerva Pediatr 2009; 61:891-893. [PMID: 19935585] [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: 05/28/2023]
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Orazzo F, Nespoli L, Ito K, Tassinari D, Giardina D, Funis M, Cecchi A, Trapani C, Forgeschi G, Vignini M, Nosetti L, Pigna S, Zanobetti A. Air pollution, aeroallergens, and emergency room visits for acute respiratory diseases and gastroenteric disorders among young children in six Italian cities. Environ Health Perspect 2009; 117:1780-5. [PMID: 20049132 PMCID: PMC2801171 DOI: 10.1289/ehp.0900599] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 08/13/2009] [Indexed: 05/08/2023]
Abstract
BACKGROUND Past studies reported evidence of associations between air pollution and respiratory symptoms and morbidity for children. Few studies examined associations between air pollution and emergency room (ER) visits for wheezing, and even fewer for gastroenteric illness. We conducted a multicity analysis of the relationship between air pollution and ER visits for wheezing and gastroenteric disorder in children 0-2 years of age. METHODS We obtained ER visit records for wheezing and gastroenteric disorder from six Italian cities. A city-specific case-crossover analysis was applied to estimate effects of particulate matter (PM), nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide, adjusting for immediate and delayed effects of temperature. Lagged effects of air pollutants up to 6 prior days were examined. The city-specific results were combined using a random-effect meta-analysis. RESULTS CO and SO(2) were most strongly associated with wheezing, with a 2.7% increase [95% confidence interval (CI), 0.5-4.9] for a 1.04-microg/m(3) increase in 7-day average CO and a 3.4% (95% CI, 1.5-5.3) increase for an 8.0-microg/m(3) increase in SO(2). Positive associations were also found for PM with aerodynamic diameter < or = 10 microg and NO(2). We found a significant association between the 3-day moving average CO and gastroenteric disorders [3.8% increase (95% CI, 1.0-6.8)]. When data were stratified by season, the associations were stronger in summer for wheezing and in winter for gastroenteric disorders. CONCLUSION Air pollution is associated with triggering of wheezing and gastroenteric disorders in children 0-2 years of age; more work is needed to understand the mechanisms to help prevent wheezing in children.
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Affiliation(s)
- Flavia Orazzo
- Pediatric Emergency Room, Santobono’s Hospital, Naples, Italy
| | - Luigi Nespoli
- Pediatric Emergency Room, Pediatric Department, University of Varese, Varese, Italy
| | - Kazuhiko Ito
- Nelson Institute of Environmental Medicine, New York University School of Medicine, New York, New York, USA
| | - Davide Tassinari
- Pediatric Emergency Room, Pediatric Department, University of Bologna, Bologna, Italy
| | | | - Maurizio Funis
- Pediatric Emergency Room, Pediatric Department, Torre Galli, Florence, Italy
| | | | - Chiara Trapani
- Pediatric Emergency Room, Mayer Hospital, Florence, Italy
| | - Gisella Forgeschi
- Pediatric Emergency Room, Ponte a Niccheri Hospital, Florence, Italy
| | - Massimo Vignini
- Pediatric Emergency Room, Pediatric Department, Salesi Hospital, Ancona, Italy
| | - Luana Nosetti
- Pediatric Emergency Room, Pediatric Department, University of Varese, Varese, Italy
| | - Sabrina Pigna
- Pediatric Emergency Room, Gallarate Pediatric Hospital, Gallarate, Italy
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
- Address correspondence to A. Zanobetti, Department of Environmental Health, Exposure Epidemiology, and Risk Program, Harvard School of Public Health, 401 Park Drive, Landmark Center, Suite 415 West, P.O. Box 15698, Boston, MA 02215 USA. Telephone: (617) 384-8751. Fax: (617) 384-8745. E-mail:
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Salvatoni A, Veronelli E, Nosetti L, Berini J, de Simone S, Iughetti L, Bosio L, Chiumello G, Grugni G, Delù G, Castelnuovo P, Trifirò G, Nespoli L. Short-term effects of growth hormone treatment on the upper airways of non severely obese children with Prader-Willi syndrome. J Endocrinol Invest 2009; 32:601-5. [PMID: 19498323 DOI: 10.1007/bf03346516] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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: 12/01/2022]
Abstract
AIMS The aim of this study was to establish whether short-term GH treatment causes obstructive apnea in patients with Prader-Willi syndrome and normal upper airway patency. SUBJECTS AND METHODS We performed an observational longitudinal 6-week GH treatment study. Thirty-four non-severely obese Prader-Willi syndrome patients (20 boys, age range 0.94-11.8 yr, median 2.24 yr) entered an observational longitudinal 6-week study. Sixteen boys received recombinant human GH (rhGH) treatment; the remaining 18 represented the control group and received no treatment. Polysomnography monitoring and othorhinolaringoiatric video endoscopy were performed one night before and after 6 weeks of rhGH treatment (0.03 mg/kg body weight/day). All patients underwent auxologic assessment, fasting blood glucose, insulin and IGF-I evaluation. The main polysomnographic parameter considered was total apnea hypopnea index, consisting of two components: central apnea hypopnea index and obstructive apnea hypopnea index. All patients were free of severe or moderate upper airway obstruction when rhGH treatment began. RESULTS After 6 weeks of rhGH therapy, obstructive apnea hypopnea index increased in 8/16 (50%), decreased in 5/16 (31%), and did not change in 3/16 (19%) patients. The changes were not statistically significant. The rhGH-treated group did not differ from the control group for the apnea hypopnea index both before and after 6 weeks of treatment. Adenoids and tonsils showed a slight increase in 1 and 2 patients on rhGH treatment, respectively, and did not change in the untreated patients. CONCLUSIONS Our data show that short-term rhGH treatment does not cause restrictions of the upper airways in patients with Prader-Willi syndrome and normal upper airway patency.
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Affiliation(s)
- A Salvatoni
- Pediatric Clinic, Insubria University, Varese, Italy.
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