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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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Porcaro F, Paglietti MG, Diamanti A, Petreschi F, Schiavino A, Negro V, Pecora V, Fiocchi A, Cutrera R. Authors' reply - anaphylactic shock with methylprednisolone, Kounis syndrome and Hypersitivity to corticosteroids: a clinical paradox. Ital J Pediatr 2019; 45:5. [PMID: 30616660 PMCID: PMC6323731 DOI: 10.1186/s13052-018-0600-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
In our letter, we comment the paper of Kounis et al., that highlights a poor-known clinical entity determined by systemic use of corticosteroids, the so-called “Kounis syndrome type I”. We appreciated and shared the intent of Authors to treat the important issue of high risk of adverse drug reaction in patients with atopic diathesis and we confirm the need to administer corticosteroids with caution in patients suffering from allergic disease.
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Affiliation(s)
- F Porcaro
- Respiratory Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy.
| | - M G Paglietti
- Respiratory Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - A Diamanti
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - F Petreschi
- Respiratory Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - A Schiavino
- Respiratory Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - V Negro
- Respiratory Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - V Pecora
- Division of Allergy, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A Fiocchi
- Division of Allergy, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - R Cutrera
- Respiratory Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
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Racca F, Cutrera R, Robba C, Caldarelli V, Paglietti MG, De Angelis MC, Sekhon MS, Gualino J, Bella C, Passoni N, Ranieri VM. Respiratory failure due to upper airway obstruction in children: use of the helmet as bridge interface. Minerva Anestesiol 2015; 81:175-178. [PMID: 24918190] [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: 06/03/2023]
Abstract
Upper airway obstruction (UAO) can cause severe respiratory distress in young children by increasing inspiratory muscle load and decreasing alveolar ventilation, ultimately resulting in hypercapnia and hypoxemia which have long term negative cardiovascular effects. Although non-invasive continuous positive airway pressure (CPAP) improves gas exchange in these patients, use of conventional interfaces (nasal mask, nasal pillow and facial mask) may cause significant discomfort and lead to CPAP intolerance. We report five cases of children affected by UAO who experienced CPAP intolerance via application of conventional interfaces. Alternatively, we acutely applied helmet-CPAP which resulted in improved breathing pattern and gas exchange. Thereafter, patients received training with respect to a nasal CPAP interface, allowing successful long term treatment. In conclusion, these five clinical cases demonstrate that helmet-CPAP can be used acutely in children with UAO if compliance to conventional modalities is problematic, allowing for sufficient time to achieve compliance to nasal-CPAP.
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Affiliation(s)
- F Racca
- Anesthesiology and Intensive Care Unit, SS Antonio Biagio e Cesare Arrigo Hospital, Alessandria, Italy -
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Rossetti E, Bianchi R, Paglietti MG, Cutrera R, Picardo S. Severe phenotype of rapid-onset obesity, hypoventilation, hypothalamic dysfunction, and autonomic dysfunction syndrome. Minerva Anestesiol 2014; 80:744-745. [PMID: 24492667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- E Rossetti
- DEA-ARCO Department, Pediatric Intensive Care Unit, IRCCS, Bambino Gesù Children's Hospital, Rome, Italy -
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Caldarelli V, Gregoretti C, Paglietti MG, Pavone M, Bertaina A, Chiarini Testa MB, Cutrera R. Late respiratory failure after hematopoietic stem cells transplant: just "lung failure"? Minerva Anestesiol 2013; 79:969-970. [PMID: 23449246] [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: 06/01/2023]
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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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Pavone M, Paglietti MG, Petrone A, Crinò A, De Vincentiis GC, Cutrera R. Adenotonsillectomy for obstructive sleep apnea in children with Prader-Willi syndrome. Pediatr Pulmonol 2006; 41:74-9. [PMID: 16283627 DOI: 10.1002/ppul.20334] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [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: 11/10/2022]
Abstract
The aim of our study was to evaluate the efficacy of adenotonsillectomy for the treatment of obstructive sleep apnea syndrome (OSA) in pediatric patients with Prader-Willi syndrome (PWS), and to describe the postoperative complications. Five patients (4 males; median age, 4.4 years; range, 1.6-14.2 years) were studied. All patients underwent an overnight cardiorespiratory sleep study. All patients had adenotonsillar hypertrophy (ATH), and two were also obese. The preoperative obstructive apnea/hypopnea index (AHI; median and range) was 12.2 (9.0-19.9) events/hr; the mean oxygen saturation was 95 (79-96)%; the nadir oxygen saturation was 71 (58-78)%; and the oxygen desaturation index (ODI) was 15.8 (11.4-35.9) events/hr. Preoperatively, patients were classified as having moderate to severe OSA. A second sleep study, performed 16 (3-43) months after adenotonsillectomy, showed a significant decrease in AHI (P = 0.009) and ODI (P = 0.009). Mean and nadir oxygen saturation did not differ significantly postsurgery (P = 0.188, P = 0.073, respectively). Four out of five children showed at least one postoperative complication. Difficult awakening from anesthesia, hemorrhages, and respiratory complications requiring reintubation and/or supplemental oxygen administration were observed. In conclusion, patients with PWS and OSA who underwent adenotonsillectomy showed a significant decrease in AHI and number of oxygen desaturations.
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Affiliation(s)
- M Pavone
- Respiratory Unit, Bambino Gesù Children's Research Hospital, Rome, Italy.
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Abstract
With the aim of determining normal reference values for our sleep laboratory and evaluating the reliability of automated analysis for scoring polysomnographic studies in children, we recorded polysomnograms in 16 healthy boarding-school children. Sleep recordings were obtained with a computer system (Medilog SAC, Oxford Instruments). Polysomnographic variables were monitored continuously on a 16-channel recorder equipped with a video. Data were acquired on optical disk for computer-assisted data interpretation. Sleep stages and respiratory events were also scored visually by operator. Comparison with visual scores showed that the computer system significantly overscored wakefulness (W) (p<0.02) and stage IV (p<0.001) and underscored stage II (p<0.001) and rapid eye movement (REM) sleep (p<0.001). It also assigned respiratory events a higher score than did visual scoring, as shown by the higher apnoea index (AI) and hypopnoea index (HI) (AI p<0.03; HI p<0.001). Regression analysis showed a significant correlation between visual and automated scores for central (r=0.679; p<0.004) and obstructive apnoea (r=0.631; p<0.008). Computer apnoea scores did not correlate with visual scores. Much remains to be done before computer-based scoring systems can be relied upon, without visual scoring, for polysomnographic sleep studies in children. Their main advantage at present is that they offer a convenient means of saving paper, space and time.
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Affiliation(s)
- M P Villa
- Il Cattedra di Clinica Pediatrica, Università La Sapienza, Rome, Italy
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