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Piastra M, Picconi E, Genovese O, Ferrari V, Morena TC, Valentini P, De Pascale G, Antonelli M, Conti G. Complicated Falciparum Malarial ARDS Requiring Noninvasive Support. Pediatr Infect Dis J 2024; 43:e96-e99. [PMID: 38381957 DOI: 10.1097/inf.0000000000004189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Severe plasmodium falciparum infection can induce respiratory distress and clinical ARDS in children, requiring intensive care admission and respiratory support. We present 3 cases of imported malarial acute respiratory distress syndrome requiring noninvasive ventilation in the pediatric intensive care unit, in the absence of any cerebral involvement. Radiological features and their relationship with severe hematological complications are also illustrated.
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Affiliation(s)
- Marco Piastra
- From the Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Enzo Picconi
- From the Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Orazio Genovese
- From the Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Vittoria Ferrari
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Tony Christian Morena
- From the Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Piero Valentini
- Pediatric Infectious Diseases, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Gennaro De Pascale
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Antonelli
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Giorgio Conti
- From the Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
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Buonsenso D, Giaimo M, Pata D, Rizzi A, Fiori B, Spanu T, Ruggiero A, Attinà G, Piastra M, Genovese O, Vento G, Costa S, Tiberi E, Sanguinetti M, Valentini P. Retrospective Study on Staphylococcus aureus Resistance Profile and Antibiotic Use in a Pediatric Population. Antibiotics (Basel) 2023; 12:1378. [PMID: 37760675 PMCID: PMC10525873 DOI: 10.3390/antibiotics12091378] [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] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/06/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
The growing phenomenon of antibiotic resistance and the presence of limited data concerning the pediatric area prompted us to focus on Staphylococcus aureus infection in this study, its antibiotic resistance profile, and the therapeutic management of affected children. We conducted a retrospective study by collecting clinical data on infants and children with antibiogram-associated S. aureus infection. We enrolled 1210 patients with a mean age of 0.9 years. We analyzed the resistance patterns and found 61.5% resistance to oxacillin, 58.4% resistance to cephalosporins, 41.6% resistance to aminoglycosides, and 38.3% resistance to fluoroquinolones. Importantly, we found no resistance to glycopeptides, a key antibiotic for MRSA infections whose resistance is increasing worldwide. We also found that the main risk factors associated with antibiotic resistance are being aged between 0 and 28 days, the presence of devices, and comorbidities. Antibiotic resistance is a growing concern; knowing the resistance profiles makes it possible to better target the therapy; however, it is important to use antibiotics according to the principles of antibiotic stewardship to limit their spread.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.G.); (D.P.); (A.R.); (G.A.); (G.V.); (S.C.); (E.T.); (P.V.)
- Global Health Center, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Martina Giaimo
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.G.); (D.P.); (A.R.); (G.A.); (G.V.); (S.C.); (E.T.); (P.V.)
| | - Davide Pata
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.G.); (D.P.); (A.R.); (G.A.); (G.V.); (S.C.); (E.T.); (P.V.)
| | - Alessia Rizzi
- Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Barbara Fiori
- Department of Laboratory Sciences and Infectious Disease, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (B.F.); (T.S.); (M.S.)
| | - Teresa Spanu
- Department of Laboratory Sciences and Infectious Disease, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (B.F.); (T.S.); (M.S.)
| | - Antonio Ruggiero
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.G.); (D.P.); (A.R.); (G.A.); (G.V.); (S.C.); (E.T.); (P.V.)
| | - Giorgio Attinà
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.G.); (D.P.); (A.R.); (G.A.); (G.V.); (S.C.); (E.T.); (P.V.)
| | - Marco Piastra
- Department of Emergency, Anesthesiological and Resuscitation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.P.); (O.G.)
| | - Orazio Genovese
- Department of Emergency, Anesthesiological and Resuscitation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.P.); (O.G.)
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.G.); (D.P.); (A.R.); (G.A.); (G.V.); (S.C.); (E.T.); (P.V.)
| | - Simonetta Costa
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.G.); (D.P.); (A.R.); (G.A.); (G.V.); (S.C.); (E.T.); (P.V.)
| | - Eloisa Tiberi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.G.); (D.P.); (A.R.); (G.A.); (G.V.); (S.C.); (E.T.); (P.V.)
| | - Maurizio Sanguinetti
- Department of Laboratory Sciences and Infectious Disease, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (B.F.); (T.S.); (M.S.)
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.G.); (D.P.); (A.R.); (G.A.); (G.V.); (S.C.); (E.T.); (P.V.)
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Salerno A, Picconi E, Genovese O, Piastra M, Pulitanò SM, Tosi F, Mancino A, Pane M, De Sanctis R, Carlini D, Mercuri EM, Conti G. Needleless inhaled anesthesia with sevoflurane: Advantages of a simplified approach for children with spinal muscular atrophy undergoing intrathecal administration of nusinersen. Paediatr Anaesth 2023; 33:282-290. [PMID: 36636888 DOI: 10.1111/pan.14630] [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: 03/31/2021] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND Intrathecal nusinersen administration, a fundamental step in the treatment of spinal muscular atrophy, is challenging in children. AIMS This retrospective monocentric analysis of prospectively collected data evaluated the feasibility of needleless general anesthesia exclusively with sevoflurane, without imaging guidance, for children undergoing nusinersen administration in a 24-month period. METHODS Clinical data included demographics, type of spinal muscular atrophy, presence and severity of scoliosis. Primary outcome was defined by the number of predefined sentinel adverse events related to anesthesia. Secondary outcomes were assessed by duration of the procedure, number of lumbar puncture attempts, and number of failures. Other measures included number and type of moderate, minor and minimal adverse events, as well as number and type of puncture-related adverse events. RESULTS 116 patients (mean age: 8.7 (SD 6.9) years; with scoliosis: 49.1%) underwent 250 lumbar punctures; two cases of prolonged desaturation, considered as sentinel adverse events, (0.8%) were recorded during anesthesia (primary outcome). None of the patients underwent orotracheal intubation nor required an unplanned admission in the Pediatric Intensive Care Unit. No patient required an unplanned or prolonged hospitalization after the procedure. Mean number of puncture attempts was 1.6 (SD 1.3), and mean duration of the procedure was 14.1 (SD 8.3) minutes. No failure in the drug administration occurred (secondary outcomes). CONCLUSION In this single-center experience, needleless general anesthesia with inhaled sevoflurane without imaging guidance has been shown to be feasible for children with spinal muscular atrophy undergoing lumbar puncture for nusinersen administration.
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Affiliation(s)
- Annalisa Salerno
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enzo Picconi
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Orazio Genovese
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia M Pulitanò
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Tosi
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Aldo Mancino
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marika Pane
- Nemo Clinical Centre, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto De Sanctis
- Nemo Clinical Centre, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Debora Carlini
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenio M Mercuri
- Nemo Clinical Centre, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Pane M, Coratti G, Sansone VA, Messina S, Catteruccia M, Bruno C, Sframeli M, Albamonte E, Pedemonte M, Brolatti N, Mizzoni I, D'Amico A, Bravetti C, Berti B, Palermo C, Leone D, Salmin F, de Sanctis R, Pera MC, Piastra M, Genovese O, Ricci F, Cavallina I, Masson R, Zanin R, Agosto C, Salomon E, Bruno I, Magnolato A, Bertini E, Tiziano FD, Bovis F, Mercuri E. Type I Spinal Muscular Atrophy patients treated with nusinersen: 4 year follow-up of motor, respiratory and bulbar function. Eur J Neurol 2023; 30:1755-1763. [PMID: 36880698 DOI: 10.1111/ene.15768] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/11/2022] [Revised: 02/06/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND We report the 4 year follow up in type I patients treated with nusinersen and the changes in motor, respiratory and bulbar function in relation to subtype, age and SMN2 copy number. METHODS The study included SMA 1 patients with at least one assessment after 12, 24 and 48 months from the first dose of nusinersen. The assessments used were Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) and the Hammersmith Infant Neurological Examination (HINE-2). RESULTS Forty-eight patients, with age ranging from 7 days and 12 years (mean 3.3, SD 3.6) were included in the study. The CHOP INTEND and HINE-II score significantly increased between baseline and 48 months (p<0.001). When age at starting treatment subgroups (<210 days, <2 years, 2-4 years, 5-11 years, >12 years) were considered, the CHOP INTEND increased significantly in patients younger than 4 years at treatment, while the HINE-2 increased significantly in patients younger than 2 years at treatment. In a mixed model analysis, age, nutritional and respiratory status were predictive of changes on both scales while SMN2 copy number and decimal classification were not. CONCLUSIONS Our results confirm the safety profile previously reported and support the durability of the efficacy of nusinersen at 4 years with an overall stability or mild improvement and no evidence of deterioration over a long period of time.
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Affiliation(s)
- Marika Pane
- Paediatric Neurology, Catholic University, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Giorgia Coratti
- Paediatric Neurology, Catholic University, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Valeria A Sansone
- Neurorehabilitation Unit, University of Milan, Centro Clinico Nemo, Niguarda Hospital, Milano, Italy
| | - Sonia Messina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michela Catteruccia
- Unit of Neuromuscular and Neurodegenerative disorders, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Claudio Bruno
- Center of Myology and Neurodegenerative Disorders, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Sframeli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emilio Albamonte
- Neurorehabilitation Unit, University of Milan, Centro Clinico Nemo, Niguarda Hospital, Milano, Italy
| | - Marina Pedemonte
- Center of Myology and Neurodegenerative Disorders, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Noemi Brolatti
- Center of Myology and Neurodegenerative Disorders, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Irene Mizzoni
- Unit of Neuromuscular and Neurodegenerative disorders, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative disorders, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Chiara Bravetti
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Beatrice Berti
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Concetta Palermo
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Daniela Leone
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Francesca Salmin
- Neurorehabilitation Unit, University of Milan, Centro Clinico Nemo, Niguarda Hospital, Milano, Italy
| | - Roberto de Sanctis
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Maria Carmela Pera
- Paediatric Neurology, Catholic University, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit, Catholic University and Policlinico Gemelli, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Orazio Genovese
- Pediatric Intensive Care Unit, Catholic University and Policlinico Gemelli, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Federica Ricci
- AOU Città della Salute e della Scienza di Torino, presidio OIRM (SC Neuropsichiatria Infantile), Turin, Italy
| | - Ilaria Cavallina
- AOU Città della Salute e della Scienza di Torino, presidio OIRM (SC Neuropsichiatria Infantile), Turin, Italy
| | - Riccardo Masson
- Fondazione IRCCS Istituto Neurologico Carlo Besta Developmental Neurology Unit, Milan, Italy
| | - Riccardo Zanin
- Fondazione IRCCS Istituto Neurologico Carlo Besta Developmental Neurology Unit, Milan, Italy
| | - Caterina Agosto
- Dipartimento di Salute della Donna e del Bambino, Università di Padova, Padua, Italy
| | - Eleonora Salomon
- Dipartimento di Salute della Donna e del Bambino, Università di Padova, Padua, Italy
| | - Irene Bruno
- Institute for Maternal and Child Health, IRCCS, Burlo Garofolo, Trieste, Italy
| | - Andrea Magnolato
- Institute for Maternal and Child Health, IRCCS, Burlo Garofolo, Trieste, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative disorders, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Francesco Danilo Tiziano
- Institute of Genomic Medicine, Catholic University and Policlinico Gemelli, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Francesca Bovis
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Eugenio Mercuri
- Paediatric Neurology, Catholic University, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
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Piastra M, Ferrari V, Picconi E, Morena TC, Pezza L, De Rosa G, Fedele MC, Genovese O, Onesimo R, Tempera A, Valentini P, Buonsenso D, Visconti F, Zito G, Benassi C, Conti G. Life-threatening complications of streptococcal sepsis: a PICU contemporary series. J Anesth Analg Crit Care 2021. [PMCID: PMC8669399 DOI: 10.1186/s44158-021-00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Life-threatening streptococcal sepsis nowadays represents an uncommon event in previously healthy infants and children. Critically ill patients suffering from severe streptococcal sepsis complications may present with pre-antibiotic era clinical pictures and require a timely clinical approach to achieve restitutio ad integrum.
Results
We report a series of four patient groups affected by an uncommon life-threatening streptococcal sepsis, each of them exhibiting some distinct features. Streptococcus Agalactiae sepsis was associated with cerebral thrombotic/ischaemic lesions, whereas severe cardiogenic shock was prominent in the Streptococcus Viridans group; Streptococcus Faecalis and β-hemolytic group A Streptococcus patients mostly reported lung complications.
Conclusions
Previous antibiotic treatments should not delay aggressive treatment in the intensive care setting. Early diagnostic suspicion, as well as appropriate and aggressive treatment provided within an intensive care setting are crucial for the clinical outcome.
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Piastra M, Tempera A, De Carolis MP, Pezza L, Genovese O, Benassi C, Morena TC, Picconi E, Zito G, De Rosa G, Conti G, De Luca D. Neonatal Life-Threatening Nonoliguric Hyperkalemia Under Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2021; 11:238-241. [PMID: 34619071 DOI: 10.1089/ther.2021.0009] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To illustrate our experience with two cases of neonatal life-threatening hyperkalemia during therapeutic hypothermia (TH) despite a normal acid-base status, urine output, and preserved renal function. Clinical cases are presented from Pediatric Intensive Care Unit (PICU) admission to the onset of the hyperkalemia, with related complications and after resolution. Similar cases were not retrieved from a critical review of pertinent literature. Severe hyperkalemia pathophysiology and risk factors have been debated. Two full-term adequate for weight female neonates were admitted to PICU because of perinatal asphyxia who underwent TH. Prenatal history was completely uneventful, nor hereditary genetic conditions were reported; moreover, long-term follow-up ruled out any metabolic or renal disease. Despite an accurate evaluation of previous clinical series and literature on TH and perinatal asphyxia, these hyperkalemic episodes remain unexplained. The hypoxic-ischemic insult may affect multiple organs, mainly central nervous system, heart, lung, and kidneys; acute muscle breakdown and consequent rising of myoglobin may also have a precipitating role in acute kidney failure (AKF) and hyperkalemia. Electrolyte imbalance is a possible finding as a consequence of combined cell injury and AKF. In contrast, an isolated severe hyperkalemia is exceedingly rare in nonoliguric neonates.
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Affiliation(s)
- Marco Piastra
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Alessia Tempera
- Neonatal Intensive Care Unit, Maternal-Fetal Department, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Maria Pia De Carolis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucilla Pezza
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Orazio Genovese
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Benassi
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tony C Morena
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enzo Picconi
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Gabriella De Rosa
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Centre Antoine Beclere, Paris-Saclay University Hospitals APHP, Paris, Ile-de France, France.,Physiopathology and Therapeutic Innovation Unit INSERUM U999 Paris, Université Paris-Saclay APHP, Ile-de France, France
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7
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Pane M, Coratti G, Sansone VA, Messina S, Catteruccia M, Bruno C, Sframeli M, Albamonte E, Pedemonte M, D'Amico A, Bravetti C, Berti B, Palermo C, Leone D, Brigati G, Tacchetti P, Salmin F, De Sanctis R, Lucibello S, Pera MC, Piastra M, Genovese O, Bertini E, Vita G, Tiziano FD, Mercuri E. Type I SMA "new natural history": long-term data in nusinersen-treated patients. Ann Clin Transl Neurol 2021; 8:548-557. [PMID: 33547876 PMCID: PMC7951096 DOI: 10.1002/acn3.51276] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 02/05/2023] Open
Abstract
Objective The aim of this paper was to report the 2‐year follow‐up in type I patients treated with Nusinersen and to assess whether possible changes in motor function are related to the subtype, age, or SMN2 copy number. Methods Sixty‐eight patients, with ages ranging from 0.20 to 15.92 years (mean: 3.96; standard deviation: +3.90) were enrolled in the study. All patients were assessed using the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) and the developmental section of the Hammersmith Infant Neurological Examination (HINE‐2) at the time they started treatment and 12 and 24 months after that. Results For both CHOP and HINE‐2 repeated measures analysis of variance showed a significant difference (P < 0.001) between baseline and 12 months, 12 months and 24 months, and baseline and 24‐month scores for the whole group. When age subgroups (<210 days, <2 years, 2–4 years, 5–11 years, 12–18 years) were considered, on the CHOP INTEND the difference was significant between baseline and 24 months in all age subgroups. On the HINE‐2, the difference between baseline and 24 months was significant in all the subgroups before the age of 4 years. Age was predictive of changes on both scales (P < 0.05), whereas SMN2 copy number and decimal classification were not. Interpretation Our results suggest that some improvement of motor function can be observed even after the first year of treatment. This is more obvious in the infants treated in the first 2 years but some improvement can also be found in older children.
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Affiliation(s)
- Marika Pane
- Paediatric Neurology, Catholic University, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Giorgia Coratti
- Paediatric Neurology, Catholic University, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Valeria A Sansone
- Neurorehabilitation Unit, Centro Clinico Nemo, Niguarda Hospital, University of Milan, Milano, Italy
| | - Sonia Messina
- Department of Clinical and Experimental Medicine, University of Messina and Centro Clinico Nemo, Messina, Italy
| | - Michela Catteruccia
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Claudio Bruno
- Center of Myology and Neurodegenerative Disorders, Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Sframeli
- Department of Clinical and Experimental Medicine, University of Messina and Centro Clinico Nemo, Messina, Italy
| | - Emilio Albamonte
- Neurorehabilitation Unit, Centro Clinico Nemo, Niguarda Hospital, University of Milan, Milano, Italy
| | - Marina Pedemonte
- Center of Myology and Neurodegenerative Disorders, Istituto Giannina Gaslini, Genoa, Italy
| | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Chiara Bravetti
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Beatrice Berti
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Concetta Palermo
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Daniela Leone
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Giorgia Brigati
- Center of Myology and Neurodegenerative Disorders, Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Tacchetti
- Center of Myology and Neurodegenerative Disorders, Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Salmin
- Neurorehabilitation Unit, Centro Clinico Nemo, Niguarda Hospital, University of Milan, Milano, Italy
| | - Roberto De Sanctis
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Simona Lucibello
- Paediatric Neurology, Catholic University, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Maria Carmela Pera
- Paediatric Neurology, Catholic University, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit, Catholic University and Policlinico Gemelli, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Orazio Genovese
- Pediatric Intensive Care Unit, Catholic University and Policlinico Gemelli, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Gianluca Vita
- Department of Clinical and Experimental Medicine, University of Messina and Centro Clinico Nemo, Messina, Italy
| | - Francesco Danilo Tiziano
- Institute of Genomic Medicine, Catholic University and Policlinico Gemelli, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Eugenio Mercuri
- Paediatric Neurology, Catholic University, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
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Piastra M, De Bellis A, Morena TC, De Luca D, Pezza L, Pizza A, Genovese O, Mancino A, Picconi E, Conti G. Noninvasive Ventilation in a Pediatric Trauma Center: A Cohort Study. J Intensive Care Med 2021; 37:177-184. [PMID: 33461370 DOI: 10.1177/0885066620983744] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether non-invasive ventilation (NIV) can avoid the need for tracheal intubation and/or reduce the duration of invasive ventilation (IMV) in previously intubated patients admitted to the pediatric intensive care unit (PICU) and developing acute hypoxemic respiratory failure (AHRF) after major traumatic injury. STUDY DESIGN A single center observational cohort study. SETTING Pediatric ICU in a University Hospital (tertiary referral Pediatric Trauma Centre). POPULATION During the 48-month study period, 276 patients (median age 6.4 years) with trauma were admitted to PICU; among 86 of them, who suffered from AHRF and received ventilation (IMV and/or NIV) for more than 12 hrs, 32 patients (median age 8.5 years) were treated with NIV. INCLUSION/EXCLUSION CRITERIA Inclusion criteria: at least 12 hours of NIV; exclusion criteria: patients with facial trauma or congenital malformations; patients receiving IMV <12 hours or perioperative ventilation. MEASUREMENTS AND RESULTS Among NIV patients, 27 (84,3%) were previously on IMV, while 5 (15,6%) could be managed exclusively with NIV. In patients with post-extubation respiratory distress, NIV was successful in 88.4% of cases. Before starting NIV, P/F ratio was 242.7 ± 71. After 8 hours of NIV treatment, a significant oxygenation improvement (PaO2/FiO2 = 354.3 ± 81; p = 0.0002) was found, with no significant changes in carbon dioxide levels. A trend toward increasing ventilation-free time has been evidenced; NIV resulted feasible and generally well tolerated. CONCLUSIONS AHRF in trauma patients is multifactorial and may be due to many reasons, such as lung contusion, aspiration of blood or gastric contents. Systemic inflammatory response and transfusions may also contribute to hypoxia. Our pilot study strongly suggests that NIV can be applied in post-traumatic AHRF: it may successfully reduce the time of both invasive ventilation and deep sedation. Further data from controlled studies are needed to assess the advantage of NIV in pediatric trauma.
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Affiliation(s)
- Marco Piastra
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Andrea De Bellis
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Plastic Surgery and Burn Unit, S. Eugenio Hospital, Rome, Italy
| | - Tony C Morena
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniele De Luca
- Centre Antoine Beclere, Paris-Saclay University Hospitals APHP, Division of Pediatrics and Neonatal Critical Care, Paris, Ile-de France, France
- Université Paris-Saclay APHP, Physiopathology and Therapeutic Innovation Unit INSERUM U999, Paris, Ile-de France, France
| | - Lucilla Pezza
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Pizza
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Orazio Genovese
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Aldo Mancino
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enzo Picconi
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart of Rome, Rome, Italy
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9
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Battini R, Olivieri G, Milone R, Mazio F, Scalise R, Verdolotti T, Primiano G, Genovese O, Mercuri E, Servidei S. Spinal cord demyelination in children: A diagnostic challenge in neuropaediatrics for a good outcome. Brain Dev 2020; 42:457-461. [PMID: 32209270 DOI: 10.1016/j.braindev.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Biotinidase deficiency (BTD) is an autosomal recessive inborn error of metabolism provoking progressive biotin depletion, which causes, in turn, multiple carboxylase deficiency. Its infantile onset is characterized by intractable seizures associated with lethargy, psychomotor regression, hypotonia, feeding and respiratory problems, and cutaneous abnormalities. CASE DESCRIPTION We describe a 52-month-old female whose clinical and neuroradiological pictures were consistent with myelopathy, which is generally more frequent in older patients, as well as with symptoms of an infantile onset of biotinidase deficiency, revealed at 17 months. RESULTS A biochemical biotinidase test revealed a profound deficiency of biotinidase detecting a 10% residual enzymatic activity, which led to the diagnosis of BTD. Gene sequencing revealed a compound heterozigous mutation (c.454A > C/c.1612C > T). CONCLUSION Our findings suggest that even if myelopathy is uncommonly reported in BTD, and generally occurs in older children, its presence in childhood-onset floppiness should always be considered as a possible marker for an atypical presentation of BTD. Although, until recently, BTD myelopathy was believed to be prevalent in older children, a spinal cord involvement has also been described in at least nine cases in early infancy. Thus, another early diagnosis suggests that myelopathy may be more frequent than previously thought, and it is probably underdiagnosed because spinal MRI is not always routinely performed on these children. Early recognition of BTD disease is important as it would lead to prompt treatment, preventing irreversible brain damage and increasing the chances of complete recovery.
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Affiliation(s)
- Roberta Battini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy; Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.
| | - Giorgia Olivieri
- Division of Metabolism, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Roberta Milone
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Federica Mazio
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II di Napoli, Italy
| | - Roberta Scalise
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Tommaso Verdolotti
- Department of Radiological Sciences, A. Gemelli Hospital, Catholic University, Rome, Italy
| | - Guido Primiano
- UOC Neurofisiopatologia Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Serenella Servidei
- UOC Neurofisiopatologia Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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10
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Piastra M, Tortorolo L, Genovese O, Morena TC, Picconi E, De Rosa G, Conti G. Pulseless ventricular tachycardia and ventricular fibrillation complicating severe traumatic brain injury in pediatrics. Minerva Anestesiol 2019; 85:1366-1367. [PMID: 31486621 DOI: 10.23736/s0375-9393.19.13737-6] [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: 11/08/2022]
Affiliation(s)
- Marco Piastra
- Pediatric Intensive Care Unit and Trauma Center, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy - .,Institute of Anesthesia/Intensive Care, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy -
| | - Luca Tortorolo
- Pediatric Intensive Care Unit and Trauma Center, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Orazio Genovese
- Pediatric Intensive Care Unit and Trauma Center, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Tony C Morena
- Pediatric Intensive Care Unit and Trauma Center, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Enzo Picconi
- Pediatric Intensive Care Unit and Trauma Center, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Gabriella De Rosa
- Unit of Pediatric Cardiology, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit and Trauma Center, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy.,Institute of Anesthesia/Intensive Care, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
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11
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Pane M, Coratti G, Sansone VA, Messina S, Bruno C, Catteruccia M, Sframeli M, Albamonte E, Pedemonte M, D'Amico A, Bravetti C, Berti B, Brigati G, Tacchetti P, Salmin F, de Sanctis R, Lucibello S, Piastra M, Genovese O, Bertini E, Vita G, Tiziano FD, Mercuri E. Nusinersen in type 1 spinal muscular atrophy: Twelve-month real-world data. Ann Neurol 2019; 86:443-451. [PMID: 31228281 DOI: 10.1002/ana.25533] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/04/2019] [Accepted: 06/17/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of the study was to report 12-month changes after treatment with nusinersen in a cohort of 85 type I spinal muscular atrophy patients of ages ranging from 2 months to 15 years and 11 months. METHODS All patients were assessed using the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) and the Hammersmith Infant Neurological Examination-Section 2 (HINE-2). RESULTS Two of the 85 patients had 1 SMN2 copy, 61 had 2 copies, and 18 had 3 copies. In 4 patients the SMN2 copy number was not available. At baseline, the mean CHOP INTEND scores ranged between 0 and 52 (mean = 15.66, standard deviation [SD] = ±13.48), and the mean HINE-2 score was between 0 and 5 (mean = 0.69, SD = ±1.23). There was a difference between baseline and the 12-month scores on both the CHOP INTEND and the HINE-2 for the whole group (p < 0.001), the subgroups with 2 SMN2 copies (p < 0.001), and those with 3 SMN2 copies (p < 0.001). The difference was found not only in patients younger than 210 days at baseline (p < 0.001) but also in those younger than 5 years on the CHOP INTEND and younger than 2 years on the HINE-2. INTERPRETATION Our results, expanding the age range and the severity of type I patients treated with nusinersen over 1 year, provide additional data on the range of efficacy of the drug that will be helpful in making an informed decision on whether to start treatment in patients of different ages and severity. ANN NEUROL 2019;86:443-451.
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Affiliation(s)
- Marika Pane
- Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Agostino Gemelli University Polyclinic Foundation, Scientific Institute for Research and Health Care, Rome
| | - Giorgia Coratti
- Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Agostino Gemelli University Polyclinic Foundation, Scientific Institute for Research and Health Care, Rome
| | - Valeria A Sansone
- Neurorehabilitation Unit, University of Milan, Neuromuscular Omnicentre Clinical Center, Niguarda Hospital, Milan
| | - Sonia Messina
- Department of Clinical and Experimental Medicine, University of Messina and Neuromuscular Omnicentre Clinical Center, Messina
| | - Claudio Bruno
- Center of Myology and Neurodegenerative Disorders, Giannina Gaslini Institute, Genoa
| | - Michela Catteruccia
- Unit of Neuromuscular and Neurodegenerative Disorders, Baby Jesus Children's Hospital, Rome
| | - Maria Sframeli
- Department of Clinical and Experimental Medicine, University of Messina and Neuromuscular Omnicentre Clinical Center, Messina
| | - Emilio Albamonte
- Neurorehabilitation Unit, University of Milan, Neuromuscular Omnicentre Clinical Center, Niguarda Hospital, Milan
| | - Marina Pedemonte
- Center of Myology and Neurodegenerative Disorders, Giannina Gaslini Institute, Genoa
| | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Baby Jesus Children's Hospital, Rome
| | - Chiara Bravetti
- Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Agostino Gemelli University Polyclinic Foundation, Scientific Institute for Research and Health Care, Rome
| | - Beatrice Berti
- Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Agostino Gemelli University Polyclinic Foundation, Scientific Institute for Research and Health Care, Rome
| | - Giorgia Brigati
- Center of Myology and Neurodegenerative Disorders, Giannina Gaslini Institute, Genoa
| | - Paola Tacchetti
- Center of Myology and Neurodegenerative Disorders, Giannina Gaslini Institute, Genoa
| | - Francesca Salmin
- Neurorehabilitation Unit, University of Milan, Neuromuscular Omnicentre Clinical Center, Niguarda Hospital, Milan
| | - Roberto de Sanctis
- Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Agostino Gemelli University Polyclinic Foundation, Scientific Institute for Research and Health Care, Rome
| | - Simona Lucibello
- Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Agostino Gemelli University Polyclinic Foundation, Scientific Institute for Research and Health Care, Rome
| | - Marco Piastra
- Pediatric Intensive Care Unit, Catholic University and Gemelli General Hospital, Agostino Gemelli University Polyclinic Foundation, Scientific Institute for Research and Health Care, Rome
| | - Orazio Genovese
- Pediatric Intensive Care Unit, Catholic University and Gemelli General Hospital, Agostino Gemelli University Polyclinic Foundation, Scientific Institute for Research and Health Care, Rome
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Baby Jesus Children's Hospital, Rome
| | - Giuseppe Vita
- Department of Clinical and Experimental Medicine, University of Messina and Neuromuscular Omnicentre Clinical Center, Messina
| | - Francesco Danilo Tiziano
- Institute of Genomic Medicine, Catholic University and Gemelli General Hospital, Agostino Gemelli University Polyclinic Foundation, Scientific Institute for Research and Health Care, Rome
| | - Eugenio Mercuri
- Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Agostino Gemelli University Polyclinic Foundation, Scientific Institute for Research and Health Care, Rome.,Pediatric Neurology Unit, Catholic University, Rome, Italy
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12
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Di Biagio A, Taramasso L, Gustinetti G, Burastero G, Giacomet V, La Rovere D, Genovese O, Giaquinto C, Rampon O, Carloni I, Hyppolite TK, Palandri L, Bernardi S, Bruzzese E, Badolato R, Gabiano C, Chiappini E, De Martino M, Galli L. Missed opportunities to prevent mother-to-child transmission of HIV in Italy. HIV Med 2019; 20:330-336. [PMID: 30924576 DOI: 10.1111/hiv.12728] [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] [Accepted: 01/25/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Vertical transmission of HIV can be effectively controlled through antenatal screening, antiretroviral treatment and the services provided during and after childbirth for mother and newborn. In Italy, the National Health Service guarantees universal access to prenatal care for all women, including women with HIV infection. Despite this, children are diagnosed with HIV infection every year. The aim of the study was to identify missed opportunities for prevention of mother-to-child transmission of HIV. METHODS The Italian Register for HIV Infection in Children, which was started in 1985 and involves 106 hospitals throughout the country, collects data on all new cases of HIV infection in children. For this analysis, we reviewed the database for the period 2005 to 2015. RESULTS We found 79 HIV-1-infected children newly diagnosed after birth in Italy. Thirty-two of the mothers were Italian. During the pregnancy, only 15 of 19 women with a known HIV diagnosis were treated with antiretroviral treatment, while, of 34 women who had received an HIV diagnosis before labour began, only 23 delivered by caesarean section and 17 received intrapartum prophylaxis. In 25 mothers, HIV infection was diagnosed during pregnancy or in the peripartum period. Thirty-one newborns received antiretroviral prophylaxis and 39 received infant formula. CONCLUSIONS We found an unacceptable number of missed opportunities to prevent mother-to-child transmission (MCTC). Eliminating HIV MTCT is a universal World Health Organization goal. Elucidating organization failures in Italy over the past decade should help to improve early diagnosis and to reach the zero transmission target in newborns.
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Affiliation(s)
- A Di Biagio
- Infectious Diseases Unit, Department of Internal Medicine, Policlinico San Martino Hospital, Genoa, Italy
| | - L Taramasso
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Policlinico San Martino Hospital, Genoa, Italy.,Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Gustinetti
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Policlinico San Martino Hospital, Genoa, Italy
| | - G Burastero
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Policlinico San Martino Hospital, Genoa, Italy
| | - V Giacomet
- Department of Pediatrics, University of Milan, L. Sacco Hospital, Milan, Italy
| | - D La Rovere
- Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - O Genovese
- Pediatric Intensive Care Unit, A. Gemelli Hospital, Catholic University of Rome, Rome, Italy
| | - C Giaquinto
- Department of Child's and Woman's Health, University of Padova, Padova, Italy
| | - O Rampon
- Department of Child's and Woman's Health, University of Padova, Padova, Italy
| | - I Carloni
- Pediatric Unit, Department of Child and Mother Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - T K Hyppolite
- Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - L Palandri
- Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - S Bernardi
- Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - E Bruzzese
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - R Badolato
- Department of Clinical and Experimental Sciences, Institute of Molecular Medicine 'Angelo Nocivelli', University of Brescia, Brescia, Italy
| | - C Gabiano
- SC Pediatric Unit, Regina Margherita Hospital, Turin, Italy
| | - E Chiappini
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - M De Martino
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - L Galli
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
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13
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Vitali I, Genovese O, Conti G, Raffaelli L, D'Addona A, Dell'Anna A, Dassatti L. Effectiveness of a ventilator-associated pneumonia prevention bundle in critically ill children. J BIOL REG HOMEOS AG 2019; 33:643-647. [PMID: 30821138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- I Vitali
- . Gemelli University Hospital Foundation, School of Dental Medicine, Catholic University of the Sacred Heart, Rome,
| | - O Genovese
- Paediatric Intensive Care Unit and Paediatric Trauma Center, A. Gemelli University Hospital Foundation, Catholic University of the Sacred Heart, Rome
| | - G Conti
- Paediatric Intensive Care Unit and Paediatric Trauma Center, A. Gemelli University Hospital Foundation, Catholic University of the Sacred Heart, Rome
| | - L Raffaelli
- A. Gemelli University Hospital Foundation, School of Dental Medicine, Catholic University of the Sacred Heart, Rome
| | - A D'Addona
- A. Gemelli University Hospital Foundation, School of Dental Medicine, Catholic University of the Sacred Heart, Rome
| | - A Dell'Anna
- Anaesthesiology, Resuscitation, Intensive Care Unit and Clinical Tossicology, A. Gemelli University Hospital Foundation, Catholic University of the Sacred Heart, Rome
| | - L Dassatti
- A. Gemelli University Hospital Foundation, School of Dental Medicine, Catholic University of the Sacred Heart, Rome
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Tosi F, Chiaretti A, Buonsenso D, Mensi S, Genovese O, Pittiruti M, Conti G. Spontaneous pulmonary air embolism in a child undergoing procedural deep sedation: case report and review of the literature. Eur Rev Med Pharmacol Sci 2018; 22:7916-7919. [PMID: 30536338 DOI: 10.26355/eurrev_201811_16418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We performed a systematic review of the literature starting from a real case of venous air embolism (VAE) in a young infant undergoing central catheterization during procedural sedation. Air embolism due to internal jugular vein catheterization during procedural sedation is very rare, but it is a potentially life-threatening complication of central catheterization that warrants attention. To our knowledge, this is the first case published in a similar scenario.
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Affiliation(s)
- F Tosi
- Department of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. danilo.buonsenso@policlinicogemelli
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Picconi E, Tortorolo L, Genovese O, Piastra M, Conti G. Attitude towards pediatric resuscitation among health care professional in an Italian hospital. Resuscitation 2018. [DOI: 10.1016/j.resuscitation.2018.07.137] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Piastra M, Pizza A, Gaddi S, Luca E, Genovese O, Picconi E, De Luca D, Conti G. Dexmedetomidine is effective and safe during NIV in infants and young children with acute respiratory failure. BMC Pediatr 2018; 18:282. [PMID: 30144795 PMCID: PMC6109351 DOI: 10.1186/s12887-018-1256-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 01/12/2018] [Accepted: 08/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Noninvasive ventilation (NIV) is increasingly utilized in infants and young children, though associated with high failure rates due to agitation and poor compliance, mostly if patient-ventilator synchronization is required. METHODS A retrospective cohort study was carried out in an academic pediatric intensive care unit (PICU). Dexmedetomidine (DEX) was infused as unique sedative in 40 consecutive pediatric patients (median age 16 months) previously showing intolerance and agitation during NIV application. RESULTS During NIV clinical application both COMFORT-B Score and Richmond Agitation-Sedation Scale (RASS) were serially evaluated. Four patients experiencing NIV failure, all due to pulmonary condition worsening, required intubation and invasive ventilation. 36 patients were successfully weaned from NIV under DEX sedation and discharged from PICU. All patients survived until home discharge. CONCLUSION Our data suggest that DEX may represent an effective sedative agent in infants and children showing agitation during NIV. Early use of DEX in infants/children receiving NIV for acute respiratory failure (ARF) should be considered safe and capable of improving NIV, thus permitting both lung recruitment and patient-ventilator synchronization.
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Affiliation(s)
- M Piastra
- Pediatric Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCCS and Catholic University of Rome, L.go A.Gemelli, 8, Rome, Italy
| | - A Pizza
- Pediatric Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCCS and Catholic University of Rome, L.go A.Gemelli, 8, Rome, Italy.
| | - S Gaddi
- Pediatric Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCCS and Catholic University of Rome, L.go A.Gemelli, 8, Rome, Italy
| | - E Luca
- Pediatric Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCCS and Catholic University of Rome, L.go A.Gemelli, 8, Rome, Italy
| | - O Genovese
- Pediatric Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCCS and Catholic University of Rome, L.go A.Gemelli, 8, Rome, Italy
| | - E Picconi
- Pediatric Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCCS and Catholic University of Rome, L.go A.Gemelli, 8, Rome, Italy
| | - D De Luca
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, Paris, France
| | - G Conti
- Pediatric Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCCS and Catholic University of Rome, L.go A.Gemelli, 8, Rome, Italy
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17
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Chiaretti A, Conti G, Falsini B, Buonsenso D, Crasti M, Manni L, Soligo M, Fantacci C, Genovese O, Calcagni ML, Di Giuda D, Mattoli MV, Cocciolillo F, Ferrara P, Ruggiero A, Staccioli S, Colafati GS, Riccardi R. Intranasal Nerve Growth Factor administration improves cerebral functions in a child with severe traumatic brain injury: A case report. Brain Inj 2017; 31:1538-1547. [PMID: 28972396 DOI: 10.1080/02699052.2017.1376760] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Antonio Chiaretti
- Institute of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Benedetto Falsini
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Danilo Buonsenso
- Institute of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Crasti
- Institute of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Manni
- Institute of Translational Pharmacology, CNR, Rome, Italy
| | - Marzia Soligo
- Institute of Translational Pharmacology, CNR, Rome, Italy
| | - Claudia Fantacci
- Institute of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Orazio Genovese
- Pediatric Intensive Care Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Lucia Calcagni
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Di Giuda
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Fabrizio Cocciolillo
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Ferrara
- Institute of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Susanna Staccioli
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, Rome, Italy
| | | | - Riccardo Riccardi
- Pediatric Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
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18
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Piastra M, De Luca D, Genovese O, Tosi F, Caliandro F, Zorzi G, Massimi L, Visconti F, Pizza A, Biasucci DG, Conti G. Clinical Outcomes and Prognostic Factors for Spontaneous Intracerebral Hemorrhage in Pediatric ICU: A 12-Year Experience. J Intensive Care Med 2017; 34:1003-1009. [PMID: 28847237 DOI: 10.1177/0885066617726049] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the pediatric population, spontaneous intracerebral hemorrhage (sICH) is as common as ischemic stroke and accounts for significant mortality and morbidity. Differently from the ischemic stroke, there are few guidelines for directing management of sICH. This article aims to analyze both clinical outcomes and prognostic factors in order to produce tools for the design of prospective randomized studies addressed to implement treatment of pediatric sICH. METHODS Twelve-year retrospective review of a single-center consecutivesICH pediatric cases admitted to the pediatric intensive care unit (PICU). Selected end points were survival, PICU stay, and dichotomized Glasgow Outcome Score (GOS), with recovery and moderate disability (GOS 4-5) classified as favorable outcome and vegetative state or severe disability (GOS 2-3) classified as unfavorable. RESULTS Data of 107 children younger than 14 years admitted to our PICU due to sICH were analyzed. Overall PICU mortality was 24.2%. On multivariate analysis, the single factor markedly influencing survival was the presence of midline shift (P = .002). In PICU survivors, there were 42 GOS 2-3 and 39 GOS 4-5. A low Glasgow Coma Scale (GCS) on PICU admission was predictive of severe neurological impairment in survivors (P = .003). Intraventricular hemorrhage and infratentorial origin did not influence outcome in this series. CONCLUSION The severity of presentation of sICH expressed by the midline shift and the GCS at PICU admission are significant prognostic factors for survival and neurological outcome. Some prognostic factors of the adult population have not been confirmed.
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Affiliation(s)
- Marco Piastra
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Daniele De Luca
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy.,Neonatal and Pediatric Intensive Care, Paris Sud Hospital, Paris, France
| | - Orazio Genovese
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Federica Tosi
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy.,Pediatric Neuroanesthesiology, Emergency Department Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Francesca Caliandro
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Giulia Zorzi
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Luca Massimi
- Pediatric Neurosurgery, "A. Gemelli" Teaching Hospital, Catholic University Medical School, Rome, Italy
| | - Federico Visconti
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Alessandro Pizza
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Daniele G Biasucci
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy
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19
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Dell'Orto V, Piastra M, Genovese O, Escourrou G, Conti G, De Luca D. Feasibility of whole body hypothermia for neonates without congenital heart defects surviving in-hospital cardiac arrest unrelated to perinatal asphyxia. Resuscitation 2017; 119:e5-e7. [PMID: 28705732 DOI: 10.1016/j.resuscitation.2017.07.007] [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: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Valentina Dell'Orto
- Division of Pediatrics and Neonatal Critical Care, "A.Beclere" Medical Center, South Paris University Hospital, APHP, Paris, France
| | - Marco Piastra
- Pediatric Intensive Care Unit and Trauma Center, Dept of Critical Care, "A.Gemelli" University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Orazio Genovese
- Pediatric Intensive Care Unit and Trauma Center, Dept of Critical Care, "A.Gemelli" University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Guillaume Escourrou
- Division of Pediatrics and Neonatal Critical Care, "A.Beclere" Medical Center, South Paris University Hospital, APHP, Paris, France
| | - Giorgio Conti
- Pediatric Intensive Care Unit and Trauma Center, Dept of Critical Care, "A.Gemelli" University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A.Beclere" Medical Center, South Paris University Hospital, APHP, Paris, France.
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20
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Pizza A, Picconi E, Piastra M, Genovese O, Biasucci DG, Conti G. Early versus late tracheostomy in pediatric intensive care unit: does it matter? A 6-year experience. Minerva Anestesiol 2017; 83:836-843. [PMID: 28358176 DOI: 10.23736/s0375-9393.17.11681-0] [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: 11/08/2022]
Abstract
BACKGROUND The aim of this study is to examine the clinical data of children who underwent tracheostomy during their stay in Pediatric Intensive Care Unit (PICU), in order to describe the relationship between the timing of tracheostomy, the length of PICU stay and the occurrence of ventilator-associated pneumonia (VAP). METHODS This is a retrospective cohort study that collects all patients undergoing tracheostomy during their PICU stay over a six-year period. Data collection included PICU length of stay, days of intubation, days of mechanical ventilation, primary indication for tracheostomy, information about VAP and decannulations. The early tracheostomy group was defined as patients who had ten or fewer days of continuous ventilation, whereas the late tracheostomy group had more than ten days of continuous ventilation. RESULTS A significant decrease in the rate of VAP incidence was noticed in the early tracheostomy group vs. late group (P=0.004, OR=0.39, 95% CI: 0.18-0.85). No differences were observed about decannulation, need of long-term ventilation and death rate. Significant decreases of days of mechanical ventilation and PICU stay were found in subgroup of patients who underwent early tracheostomy and were decannulated within 18 months. CONCLUSIONS No standard timing for tracheostomy placement has been established in the pediatric population. Early tracheostomy can shorten the days of ventilation and hospitalization in PICU and reduce the incidence of VAP, but further studies are needed to identify patient categories in which it can be of benefit.
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Affiliation(s)
- Alessandro Pizza
- Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy
| | - Enzo Picconi
- Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy -
| | - Marco Piastra
- Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy
| | - Orazio Genovese
- Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy
| | - Daniele G Biasucci
- Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy
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21
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Piastra M, Tempera A, Luca E, Buffone E, Cafforio C, Briganti V, Genovese O, Marano M, Rigante D. Kidney injury owing to Streptococcus pneumoniae infection in critically ill infants and children: report of four cases. Paediatr Int Child Health 2016; 36:282-287. [PMID: 26365297 DOI: 10.1179/2046905515y.0000000055] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Streptococcus pneumoniae sepsis has high morbidity, particularly if complicated by renal injury. Four patients with S. pneumonia invasive infections complicated by renal disorders are presented. The first case was an 18-month-old girl with pneumococcal empyema complicated by haemolytic uraemic (HUS) syndrome. She made a full recovery after mechanical ventilation, inotropic support and haemodiafiltration. The second was a 4-year-old boy who presented with acute post-infectious glomerulonephritis associated with bilateral pneumococcal pneumonia. He too made a complete recovery. The third was a newborn girl with pneumococcal meningitis complicated by acute respiratory distress syndrome and acute renal failure. The fourth patient was an 8-month-old boy with pneumococcal pneumonia and meningitis complicated by HUS and with fulminant thrombotic thrombocytopenic purpura. Despite full support including mechanical ventilation and haemodiafiltration, he died 4 days after admission. On follow-up, all three survivors recovered completely from their pulmonary symptoms and had normal renal function and cardio-circulatory status in the mid-term.
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Affiliation(s)
- M Piastra
- a PICU, Emergency Department and Institute of Anaesthesia/Intensive CareM , Catholic University Medical School UCSC , Rome ; Neonatal ICU
| | - A Tempera
- b S. Camillo-Forlanini Hospital Rome ; Department of Paediatrics , Catholic University Medical School , Rome
| | - E Luca
- a PICU, Emergency Department and Institute of Anaesthesia/Intensive CareM , Catholic University Medical School UCSC , Rome ; Neonatal ICU
| | - E Buffone
- b S. Camillo-Forlanini Hospital Rome ; Department of Paediatrics , Catholic University Medical School , Rome
| | - C Cafforio
- b S. Camillo-Forlanini Hospital Rome ; Department of Paediatrics , Catholic University Medical School , Rome
| | - V Briganti
- b S. Camillo-Forlanini Hospital Rome ; Department of Paediatrics , Catholic University Medical School , Rome
| | - O Genovese
- a PICU, Emergency Department and Institute of Anaesthesia/Intensive CareM , Catholic University Medical School UCSC , Rome ; Neonatal ICU
| | - M Marano
- d Infectious Diseases Unit and ICU Bambino Gesù Paediatric Hospital , Rome , Italy
| | - D Rigante
- c Department of Paediatric Sciences , Catholic University Medical School , Rome
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Calitri C, Gabiano C, Galli L, Chiappini E, Giaquinto C, Buffolano W, Genovese O, Esposito S, Bernardi S, De Martino M, Tovo PA. The second generation of HIV-1 vertically exposed infants: a case series from the Italian Register for paediatric HIV infection. BMC Infect Dis 2014; 14:277. [PMID: 24885649 PMCID: PMC4035828 DOI: 10.1186/1471-2334-14-277] [Citation(s) in RCA: 13] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 04/09/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the Highly Active Antiretroviral Therapy (HAART) era, the prognosis of children perinatally infected with HIV-1 has significantly improved, so the number of perinatally-infected females entering child-bearing age and experiencing motherhood is increasing. METHODS A description of the medical history and pregnancy outcomes of women with perinatal acquired HIV-1 infection enrolled in the Italian Register for HIV infection in Children. RESULTS Twenty-three women had 29 pregnancies. They had started an antiretroviral therapy at a median of 7.7 years (interquartile range, IQR 2.3 - 11.4), and had experienced a median of 4 therapeutic regimens (IQR 2-6). Twenty women (87%) had taken zidovudine (AZT) before pregnancy, in 14 cases as a starting monotherapy. In 21 pregnancies a protease inhibitor-based regimen was used. At delivery, the median of CD4+ T lymphocytes was 450/μL (IQR 275-522), and no viral load was detectable in 15 cases (reported in 21 pregnancies). Twenty-eight children were delivered through caesarean section (median gestational age: 38 weeks, IQR 36-38, median birth weight: 2550 grams, IQR 2270 - 3000). Intravenous AZT was administered during delivery in 26 cases. All children received oral AZT (median: 42 days, IQR 31 - 42), with no adverse events reported. No child acquired HIV-1 infection. CONCLUSIONS Despite a long history of maternal infection, multiple antiretroviral regimens and, perhaps, the development of drug-resistant viruses, the risk of mother-to-child transmission does not seem to have increased among the second-generation of HIV-1 exposed infants.
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Affiliation(s)
| | - Clara Gabiano
- Department of Paediatrics, University of Turin, Turin, Italy
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Wilma Buffolano
- Coordinating Centre for Perinatal Infection of Campania Region, Translational Medical Sciences Department of Federico II University, Naples, Italy
| | - Orazio Genovese
- Department of Emergency, Catholic University of Rome, Rome, Italy
| | - Susanna Esposito
- Paediatric Clinic 1, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Bernardi
- Department of Immunology and Infectious Diseases, "Bambino Gesù" Children’s Hospital, Rome, Italy
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Chiaretti A, Benini F, Pierri F, Vecchiato K, Ronfani L, Agosto C, Ventura A, Genovese O, Barbi E. Safety and efficacy of propofol administered by paediatricians during procedural sedation in children. Acta Paediatr 2014; 103:182-7. [PMID: 24138461 DOI: 10.1111/apa.12472] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [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: 06/13/2013] [Revised: 08/23/2013] [Accepted: 10/16/2013] [Indexed: 12/12/2022]
Abstract
AIM The aim of this study was to determine the safety and the efficacy of paediatrician-administered propofol in children undergoing different painful procedures. METHODS We conducted a retrospective study over a 12-year period in three Italian hospitals. A specific training protocol was developed in each institution to train paediatricians administering propofol for painful procedures. RESULTS In this study, 36,516 procedural sedations were performed. Deep sedation was achieved in all patients. None of the children experienced severe side effects or prolonged hospitalisation. There were six calls to the emergency team (0.02%): three for prolonged laryngospasm, one for bleeding, one for intestinal perforation and one during lumbar puncture. Nineteen patients (0.05%) developed hypotension requiring saline solution administration, 128 children (0.4%) needed O2 ventilation by face mask, mainly during upper endoscopy, 78 (0.2%) patients experienced laryngospasm, and 15 (0.04%) had bronchospasm. There were no differences in the incidence of major complications among the three hospitals, while minor complications were higher in children undergoing gastroscopy. CONCLUSION This multicentre study demonstrates the safety and the efficacy of paediatrician-administered propofol for procedural sedation in children and highlights the importance of appropriate training for paediatricians to increase the safety of this procedure in children.
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Affiliation(s)
- Antonio Chiaretti
- Department of Paediatrics; Catholic University Medical School; Rome Italy
| | - Franca Benini
- Department of Paediatrics; Paediatric Pain and Palliative Care Service; University of Padua; Padua Italy
| | - Filomena Pierri
- Department of Paediatric Oncology; Catholic University Medical School; Rome Italy
| | - Katy Vecchiato
- Paediatric Residency; University of Trieste; Trieste Italy
| | - Luca Ronfani
- Epidemiology and Biostatistics Unit; Institute for Maternal and Child Health - “IRCCS “Burlo Garofolo”; Trieste Italy
| | - Caterina Agosto
- Department of Paediatrics; Paediatric Pain and Palliative Care Service; University of Padua; Padua Italy
| | - Alessandro Ventura
- Department of Paediatrics; Institute for Maternal and Child Health - “IRCCS “Burlo Garofolo”; Trieste Italy
| | - Orazio Genovese
- Paediatric Intensive Care Unit; Catholic University Medical School; Rome Italy
| | - Egidio Barbi
- Department of Paediatrics; Institute for Maternal and Child Health - “IRCCS “Burlo Garofolo”; Trieste Italy
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24
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Piastra M, Cavallaro F, Genovese O, De Luca D, Biasucci DG, De Sanctis R, Pietrini D, Conti G. Double cooling for pericardial tamponade and cardiac arrest after rewarming in neonatal asphyxia. Resuscitation 2013; 84:e83-4. [PMID: 23528679 DOI: 10.1016/j.resuscitation.2013.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 03/10/2013] [Accepted: 03/13/2013] [Indexed: 10/27/2022]
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De Luca D, Piastra M, Tosi F, Pulitano S, Mancino A, Genovese O, Pietrini D, Conti G. Pharmacological Therapies for Pediatric and Neonatal ALI/ARDS: An Evidence-Based Review. Curr Drug Targets 2012; 13:906-16. [DOI: 10.2174/138945012800675687] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/24/2011] [Accepted: 10/03/2011] [Indexed: 11/22/2022]
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26
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Buonsenso D, Pirronti T, Genovese O, Gargiullo L, Ranno O, Valentini P. Side Effects of the Immune System: Lessons from Tuberculosis-Related Immune Reconstitution Inflammatory Syndrome. EUR J INFLAMM 2012. [DOI: 10.1177/1721727x1201000101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Immune reconstitution inflammatory syndrome (IRIS) is a recently described syndrome among human immunodeficiency virus (HIV)-infected patients attributable to the recovery of the immune system during antiretroviral therapy. A growing number of researches on this syndrome have been conducted in recent years, but IRIS in children has not been widely studied. We report the case of a 4.5 month-old, tuberculosis (TB)-HIV co-infected girl who developed IRIS two months after beginning antiretroviral and anti-TB medications. We moreover review the immunopathogenesis of TB-HIV coinfection and IRIS, with particular regard to TB-related IRIS.
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Affiliation(s)
- D. Buonsenso
- Department of Pediatrics, A. Gemelli Hospital-Catholic University of the Sacred Heart, Rome, Italy
| | - T. Pirronti
- Department of Bioimaging and Radiological Sciences, A. Gemelli Hospital-Catholic University of the Sacred Heart, Rome, Italy
| | - O. Genovese
- Department of Anesthesiology and Intensive Care, A. Gemelli Hospital-Catholic University of the Sacred Heart, Rome, Italy
| | - L. Gargiullo
- Department of Pediatrics, A. Gemelli Hospital-Catholic University of the Sacred Heart, Rome, Italy
| | - O. Ranno
- Department of Pediatrics, A. Gemelli Hospital-Catholic University of the Sacred Heart, Rome, Italy
| | - P. Valentini
- Department of Pediatrics, A. Gemelli Hospital-Catholic University of the Sacred Heart, Rome, Italy
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Chiappini E, Galli L, Lisi C, Gabiano C, Giaquinto C, Giacomet V, Buffolano W, Esposito S, Badolato R, Berbardi S, Cellini M, Dodi I, Faldella G, Osimani P, Genovese O, Nicastro E, Viscoli C, Salvini F, Tovo PA, Maurizio DM. Risk of Perinatal HIV Infection in Infants Born in Italy to Immigrant Mothers. Clin Infect Dis 2011; 53:310-3. [DOI: 10.1093/cid/cir344] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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28
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Piastra M, De Luca D, Marzano L, Stival E, Genovese O, Pietrini D, Conti G. The number of failing organs predicts non-invasive ventilation failure in children with ALI/ARDS. Intensive Care Med 2011; 37:1510-6. [PMID: 21755397 DOI: 10.1007/s00134-011-2308-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 06/23/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Non-invasive positive pressure ventilation (NIV) is being increasingly used in paediatric critical care, although its use in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is still debated. No definite data are available for the prediction of NIV outcome in such selected populations. We aimed to identify which factors might affect NIV failure in paediatric ALI/ARDS patients. METHODS A retrospective cohort study using comprehensive predictivity analysis was performed. All children admitted to our paediatric intensive care unit over a 4-year period for ALI/ARDS were reviewed. Basic, clinical, physiological parameters and their change after 1 h of NIV were considered and subjected to univariate analysis. Candidate prognostic variables were then subjected to multicollinearity scrutiny and logistic regression. Finally, variables significant in the logistic regression were subjected to predictivity analysis. RESULTS The number of organ failures at admission (NOF) is a strong predictor of NIV failure (odds ratio 5.26; p = 0.004). Having only one organ failure provides a probability of NIV success of 85.7% (sensitivity 87%; specificity 49%). One NIV failure will be predicted and avoided for every four cases in which the presence of other organ failures is incorporated into the clinical decision. CONCLUSIONS NOF significantly predicts the NIV failure. Children with no organ failures other than ALI/ARDS may safely be treated with NIV.
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Affiliation(s)
- Marco Piastra
- Paediatric Intensive Care Unit, Department of Anaesthesiology and Intensive Care University Hospital A. Gemelli, Catholic University of the Sacred Heart, L.go A. Gemelli 8, 00168 Rome, Italy
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Baroncelli S, Pinnetti C, Genovese O, Tamburrini E, Floridia M. Hematological effects of zidovudine prophylaxis in newborn infants with and without prenatal exposure to zidovudine. J Med Virol 2011; 83:551-6. [DOI: 10.1002/jmv.21986] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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30
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Giaquinto C, Penazzato M, Rosso R, Bernardi S, Rampon O, Nasta P, Ammassari A, Antinori A, Badolato R, Castelli Gattinara G, d'Arminio Monforte A, De Martino M, De Rossi A, Di Gregorio P, Esposito S, Fatuzzo F, Fiore S, Franco A, Gabiano C, Galli L, Genovese O, Giacomet V, Giannattasio A, Gotta C, Guarino A, Martino A, Mazzotta F, Principi N, Regazzi MB, Rossi P, Russo R, Saitta M, Salvini F, Trotta S, Viganò A, Zuccotti G, Carosi G. Italian consensus statement on paediatric HIV infection. Infection 2010; 38:301-19. [PMID: 20514509 DOI: 10.1007/s15010-010-0020-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 03/17/2010] [Indexed: 02/01/2023]
Abstract
The objective of this document is to identify and reinforce current recommendations concerning the management of HIV infection in infants and children in the context of good resource availability. All recommendations were graded according to the strength and quality of the evidence and were voted on by the 57 participants attending the first Italian Consensus on Paediatric HIV, held in Siracusa in 2008. Paediatricians and HIV/AIDS care specialists were requested to agree on different statements summarizing key issues in the management of paediatric HIV. The comprehensive approach on preventing mother-to-child transmission (PMTCT) has clearly reduced the number of children acquiring the infection in Italy. Although further reduction of MTCT should be attempted, efforts to personalize intervention to specific cases are now required in order to optimise the treatment and care of HIV-infected children. The prompt initiation of treatment and careful selection of first-line regimen, taking into consideration potency and tolerance, remain central. In addition, opportunistic infection prevention, adherence to treatment, and long-term psychosocial consequences are becoming increasingly relevant in the era of effective antiretroviral combination therapies (ART). The increasing proportion of infected children achieving adulthood highlights the need for multidisciplinary strategies to facilitate transition to adult care and maintain strategies specific to perinatally acquired HIV infection.
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Affiliation(s)
- C Giaquinto
- Dipartimento di Pediatria, Università degli Studi di Padova, Padova, Italy
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Chiaretti A, Leoni C, Barone G, Genovese O, Brahe C, Mariotti P, Conti G. Increased levels of glial cell-derived neurotrophic factor in CSF of infants with SMA. Pediatr Neurol 2009; 41:195-9. [PMID: 19664536 DOI: 10.1016/j.pediatrneurol.2009.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 03/20/2009] [Accepted: 04/01/2009] [Indexed: 11/18/2022]
Abstract
The cause of motor neuron death in spinal muscular atrophy is still debated. In experimental animal models, neurotrophic factors have great potency in supporting motor neuron survival and differentiation, but there are no clinical studies on neurotrophin involvement in disease progression and motor neuron dysfunction. The aim of this study was to investigate the expression of three neurotrophic factors: nerve growth factor, brain-derived neurotrophic factor, and glial cell-derived neurotrophic factor in the cerebrospinal fluid of six infants with spinal muscular atrophy type I and six controls. The levels of neurotrophic factors were measured using an immunoenzymatic assay. A statistically significant increase in glial cell-derived neurotrophic factor levels was observed in patients with spinal muscular atrophy, compared with controls, whereas nerve growth factor and brain-derived neurotrophic factor did not show significant differences between groups. Glial cell-derived neurotrophic factor is one of the most powerful survival factors for spinal motor neurons. The increase of glial cell-derived neurotrophic factor may represent a response to the loss and damage of neuronal cells at the site of spinal lesion and is possibly related to axonal sprouting and synaptic reorganization of the damaged spinal motor neurons.
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Affiliation(s)
- Antonio Chiaretti
- Pediatric Intensive Care Unit, Catholic University School of Medicine, Rome, Italy.
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Chiappini E, Galli L, Tovo PA, Gabiano C, Lisi C, Bernardi S, Viganò A, Guarino A, Giaquinto C, Esposito S, Badolato R, Di Bari C, Rosso R, Genovese O, Masi M, Mazza A, de Martino M. Five-year follow-up of children with perinatal HIV-1 infection receiving early highly active antiretroviral therapy. BMC Infect Dis 2009; 9:140. [PMID: 19709432 PMCID: PMC2753343 DOI: 10.1186/1471-2334-9-140] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [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: 10/27/2008] [Accepted: 08/26/2009] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Early highly active antiretroviral therapy (HAART), started within the first months of age, has been proven to be the optimal strategy to prevent immunological and clinical deterioration in perinatally HIV-infected children. Nevertheless, data about long-term follow-up of early treated children are lacking. METHODS We report data from 40 perinatally HIV-infected-children receiving early HAART, with a median follow-up period of 5.96 years (interquartile range [IQR]:4.21-7.62). Children were enrolled at birth in the Italian Register for HIV Infection in Children. Comparison with 91 infected children born in the same period, followed-up from birth, and receiving deferred treatment was also provided. RESULTS Nineteen children (47.5%) were still receiving their first HAART regimen at last follow-up. In the remaining children the first regimen was discontinued, after a median period of 3.77 years (IQR: 1.71-5.71) because of viral failure (8 cases), liver toxicity (1 case), structured therapy interruption (3 cases), or simplification/switch to a PI-sparing regimen (9 cases). Thirty-nine (97.5%) children showed CD4+ T-lymphocyte values>25%, and undetectable viral load was reached in 31 (77.5%) children at last visit. Early treated children displayed significantly lower viral load than not-early treated children, until 6 years of age, and higher median CD4+ T-lymphocyte percentages until 4 years of age. Twenty-seven (29.7%) not-early treated vs. 0/40 early treated children were in clinical category C at last follow-up (P < 0.0001). CONCLUSION Our findings suggest that clinical, virologic and immunological advantages from early-HAART are long-lasting. Recommendations indicating the long-term management of early treated children are needed.
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Affiliation(s)
- Elena Chiappini
- Department of Pediatrics, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Pediatrics, University of Florence, Florence, Italy
| | | | - Clara Gabiano
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Catiuscia Lisi
- Department of Statistics, University of Florence, Florence, Italy
| | | | - Alessandra Viganò
- Infectious Diseases Unit- Department of Paediatrics, "L. Sacco" Hospital, University of Milan, Milan, Italy
| | - Alfredo Guarino
- Department of Pediatrics, "Federico II" University, Naples, Italy
| | | | - Susanna Esposito
- Department of Maternal and Pediatric Sciences," Milan University, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagali e Regina Elena, Milan, Italy
| | | | - Cesare Di Bari
- Clinic of Infectious Diseases, " Giovanni XXIII" Pediatric Hospital, Bari, Italy
| | - Raffaella Rosso
- Infectious Diseases Clinic, University of Genoa, San Martino Hospital, Genoa, Italy
| | | | - Massimo Masi
- Pediatric Clinic, "S. Orsola" Hospital, Bologna University, Bologna, Italy
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Galli L, Puliti D, Chiappini E, Gabiano C, Ferraris G, Mignone F, Viganò A, Giaquinto C, Genovese O, Anzidei G, Badolato R, Buffolano W, Maccabruni A, Salvini F, Cellini M, Ruggeri M, Manzionna M, Bernardi S, Tovo P, de Martino M. Is the interruption of antiretroviral treatment during pregnancy an additional major risk factor for mother-to-child transmission of HIV type 1? Clin Infect Dis 2009; 48:1310-7. [PMID: 19309307 DOI: 10.1086/597774] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is currently an experts' agreement discouraging interruption of antiretroviral treatment (ART) during the first trimester of pregnancy in women infected with human immunodeficiency virus type 1 (HIV-1). However, this recommendation is poorly supported by data. We evaluated the effects of discontinuing ART during pregnancy on the rate of mother-to-child transmission. METHODS Logistic regression models were performed in a prospective cohort of 937 children who were perinatally exposed to HIV-1 to estimate adjusted odds ratios for confounding factors on mother-to-child transmission, including maternal interruption of ART. RESULTS Among 937 pregnant women infected with HIV-1, ART was interrupted in 81 (8.6%) in the first trimester and in 11 (1.2%) in the third trimester. In the first trimester, the median time at suspension of ART was 6 weeks (interquartile range [IQR], 5-6 weeks) and the time without treatment was 8 weeks (IQR, 7-11 weeks). In the third trimester, the median time at suspension of ART was 32 weeks (IQR, 23-36 weeks) and the time without treatment was 6 weeks (IQR, 2-9 weeks). The plasma viral load was similar in women who had treatment interrupted in the first trimester and in those who did not have treatment interrupted. Overall, the rate of mother-to-child transmission in the whole cohort was 1.3% (95% confidence interval [CI], 0.7%-2.3%), whereas it was 4.9% (95% CI, 1.9%-13.2%) when ART was interrupted in the first trimester and 18.2% (95% CI, 4.5%-72.7%) when ART was interrupted in the third trimester. In the multiple logistic regression models, only interruption of ART during either the first or the third trimester, maternal mono- or double therapy, delivery by a mode other than elective cesarean delivery, and a viral load at delivery >4.78 log(10) copies/mL were independently associated with an increased rate of mother-to-child transmission. CONCLUSIONS Discontinuing ART during pregnancy increases the rate of mother-to-child transmission of HIV-1, either when ART is stopped in the first trimester and subsequently restarted or when it is interrupted in the third trimester. This finding supports recommendations to continue ART in pregnant women who are already receiving treatment for their health.
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Affiliation(s)
- Luisa Galli
- Department of Pediatrics, University of Florence, Italy
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Chiaretti A, Barone G, Riccardi R, Antonelli A, Pezzotti P, Genovese O, Tortorolo L, Conti G. NGF, DCX, and NSE upregulation correlates with severity and outcome of head trauma in children. Neurology 2009; 72:609-16. [PMID: 19221293 DOI: 10.1212/01.wnl.0000342462.51073.06] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Secondary brain damage after traumatic brain injury (TBI) involves neuroinflammatory mechanisms, mainly dependent on the intracerebral production of specific biomarkers, such as cytokines, neurotrophic factors, and neuron-specific enolase (NSE). NSE is associated with neuronal damage, while neurotrophic factors play a neuroprotective role due to their ability to modulate neuronal precursor biosynthesis, such as doublecortin (DCX). However, the relationships between the expression of these factors and the severity and outcome of TBI are not understood. METHODS To determine whether the concentrations of neurotrophic factors (nerve growth factor [NGF], brain-derived neurotrophic factor [BDNF], glial-derived neurotrophic factor [GDNF]), DCX, and NSE in the CSF of children with TBI correlate with the severity of brain damage and neurologic outcome, we prospectively collected CSF samples from 32 children at 2 and 48 hours after admission for severe TBI and from 32 matched controls. Severity of TBI was evaluated by Glasgow Coma Scale and neurologic outcome by Glasgow Outcome Score. RESULTS Early NGF, DCX, and NSE concentrations correlated significantly with the severity of head injury, whereas no correlation was found for BDNF and GDNF. Furthermore, NGF and DCX upregulation and lower NSE expression were associated with better neurologic outcomes. No significant association was found between BDNF and GDNF expression and outcome. CONCLUSIONS Nerve growth factor (NGF), doublecortin (DCX), and neuron-specific enolase concentrations in the CSF are useful markers of brain damage following severe traumatic brain injury (TBI). NGF and DCX upregulation correlates also with better neurologic outcome and could be useful to obtain clinical and prognostic information in children with severe TBI.
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Affiliation(s)
- A Chiaretti
- Terapia Intensiva Pediatrica, Policlinico Gemelli, Largo Gemelli, 1-00168 Rome, Italy.
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Chiappini E, Galli L, Tovo PA, Gabiano C, Lisi C, Ferraris G, Viganò A, Giaquinto C, Bernardi S, Badolato R, Genovese O, Salvini F, Maccabruni A, Anzidei G, Rosso R, Buffolano W, Cellini M, Casadei AM, Faldella G, Ruggeri M, Osimani P, Manzionna MM, Dodi I, Gotta C, Esposito S, Gariel D, De Martino M. Low prevalence of selective IgA deficiency in infected children born to HIV-seropositive mothers: an in vivo model for speculation on selective IgA deficiency pathogenesis. Int J Immunopathol Pharmacol 2009; 21:1035-9. [PMID: 19144291 DOI: 10.1177/039463200802100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anecdotal reports of restored immunoglobulin production in individuals with common variable immunodeficiency after acquiring HIV infection suggest that perturbation of the immune system occurring during HIV infection may force some underlying functional defects. These findings raise intriguing questions about the pathogenesis of common variable immunodeficiency. No study has investigated the possible influence of HIV infection on the development of selective IgA deficiency, a primary immunologic defect genetically related to common variable immunodeficiency. IgA serum levels were evaluated in a large cohort of children born to HIV-infected mothers from 1985 to 2006. To avoid differences possibly due to different follow-up durations we considered only infected and non-infected children aged over 4 years at last-follow-up. The study included 1,157 non-infected children and 964 infected children, aged ≥ 4 years at last-follow-up and with availability of two or more serum IgA determinations over six months of age. No child displayed immunoglobulin values compatible with diagnosis of common variable immunodeficiency. However, 0/964 infected children vs. 5/1157 non-infected children had selective IgA deficiency (P=0.048). It may be speculated that several immunological alterations, occurring simultaneously in perinatal HIV infection, surpass the functional defect exhibited in some children with selective IgA deficiency. Our data may shed light on the pathogenesis of selective IgA deficiency.
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Chiaretti A, Antonelli A, Mastrangelo A, Pezzotti P, Tortorolo L, Tosi F, Genovese O. Interleukin-6 and nerve growth factor upregulation correlates with improved outcome in children with severe traumatic brain injury. J Neurotrauma 2008; 25:225-34. [PMID: 18352836 DOI: 10.1089/neu.2007.0405] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Secondary brain damage after traumatic brain injury (TBI) involves neuro-inflammatory mechanisms that are mainly dependent on the intracerebral production of cytokines. Interleukin-6 (IL-6) may have a role both in the pathogenesis of neuronal damage and in the recovery mechanisms of injured neurons through the modulation of nerve growth factor (NGF) biosynthesis. However, the relationship between IL-6 and NGF expression and the severity and outcome of TBI remains controversial. We have conducted a prospective observational clinical study to determine whether the concentration of IL-6 and NGF in the cerebrospinal fluid (CSF) of children with TBI correlates with the severity of the injury and neurologic outcome of patients. CSF samples were collected from 29 children at 2 h (time T1) and 48 h (time T2) after severe TBI, and from 31 matched controls. TBI severity was evaluated by Glasgow Coma Scale (GCS) and neurologic outcome by Glasgow Outcome Score (GOS). CSF concentrations of IL-6 and NGF were measured by immunoenzymatic assays. Early NGF concentrations (T1) correlated significantly with head injury severity, whereas no correlation was found between GCS and IL-6. Furthermore, IL-6 and NGF upregulation after injury was associated with better neurologic outcomes. Based on these findings, we posit that NGF expression is a useful marker of brain damage following severe TBI. Moreover, the early upregulation of both IL-6 and NGF, which correlates with a favorable neurologic outcome, may reflect an endogenous attempt at neuroprotection in response to the damaging biochemical and molecular cascades triggered by traumatic insult.
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Affiliation(s)
- Antonio Chiaretti
- Pediatric Intensive Care Unit, Catholic University Medical School, Rome, Italy.
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Chiaretti A, Antonelli A, Riccardi R, Genovese O, Pezzotti P, Di Rocco C, Tortorolo L, Piedimonte G. Nerve growth factor expression correlates with severity and outcome of traumatic brain injury in children. Eur J Paediatr Neurol 2008; 12:195-204. [PMID: 17881264 PMCID: PMC3704228 DOI: 10.1016/j.ejpn.2007.07.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 06/26/2007] [Accepted: 07/30/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Secondary brain damage after traumatic brain injury (TBI) involves neuro-inflammatory mechanisms, mainly dependent on the intracerebral production of cytokines. In particular, interleukin 1beta (IL-1beta) is associated with neuronal damage, while interleukin 6 (IL-6) exerts a neuroprotective role due to its ability to modulate neurotrophins biosynthesis. However, the relationship between these cytokines and neurotrophins with the severity and outcome of TBI remains still controversial. AIMS To determine whether the concentration of IL-1beta and IL-6 and neurotrophins (nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF)) in the cerebrospinal fluid (CSF) of children with TBI correlates with the severity of the injury and its neurologic outcome. METHODS Prospective observational clinical study in a university hospital. CSF samples were collected from 27 children at 2h (Time T1) and 48 h (Time T2) after severe TBI, and from 21 matched controls. Severity of TBI was evaluated by GCS and neurologic outcome by GOS. CSF concentrations of cytokines and neurotrophins were measured by immunoenzymatic assays. RESULTS Early NGF and IL-1beta concentrations (T1) correlated significantly with the severity of head injury, whereas no correlation was found for IL-6, BDNF, and GDNF. Furthermore, higher NGF and IL-6 and lower IL-1beta expression at T2 were associated with better neurologic outcomes. No significant association was found between BDNF or GDNF expression and neurologic outcome. CONCLUSIONS NGF concentration in CSF is a useful marker of brain damage following severe TBI and its up-regulation, in the first 48 h after head injury together with lower IL-1beta expression, correlates with a favorable neurologic outcome. Clinical and prognostic information may also be obtained from IL-6 expression.
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Affiliation(s)
- Antonio Chiaretti
- Paediatric Intensive Care Unit, Catholic University School of Medicine, Rome, Italy.
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Chiaretti A, Antonelli A, Genovese O, Fernandez E, Giuda D, Mariotti P, Riccardi R. Intraventricular nerve growth factor infusion improves cerebral blood flow and stimulates doublecortin expression in two infants with hypoxic-ischemic brain injury. Neurol Res 2008; 30:223-8. [PMID: 18282376 DOI: 10.1179/016164107x247948] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE AND IMPORTANCE Hypoxic-ischemic brain injuries in childhood are associated with poor neurological outcome. Recently, experimental and clinical works show that nerve growth factor (NGF) reduces neurological deficits and promotes endothelial cells proliferation and angiogenesis following hypoxic-ischemic brain injuries. After brain stroke, new neurons express a protein, called doublecortin (DCX), which indicates a new marker for neurogenesis and migrating neuroblasts. This study investigates the effects of intraventricular NGF administration in two infants with severe hypoxic-ischemic brain damage and its role in both the cerebral perfusion and neurogenesis. CLINICAL PRESENTATION Two infants, aged 8 and 13 months, with hypoxic-ischemic brain damage, secondary to prolonged cardiorespiratory arrest, were treated with intraventricular NGF administration. Before the therapy, both infants were comatose, aphasic and showed flaccid tetraparesis. After 1 month NGF treatment, their neurological conditions improved, electro-encephalography (EEG) examinations showed increased alpha/theta ratio, and single photon emission computed tomography (SPECT) works demonstrated a better cerebral perfusion. The DCX expression in the cerebrospinal fluid (CSF) increased concomitantly with increasing levels of NGF. INTERVENTION The drug utilized was 2.5S NGF purified and lyophilized from male mouse submaxillary glands. The NGF administration was started 4 months after ischemic brain injury. NGF (0.1 mg) was administered via the external drainage catheter into the right cerebral ventricle once a day for 10 consecutive days. CONCLUSION Our study shows that the intraventricular NGF administration improves the cerebral perfusion and stimulates the pathway of neurogenesis differentiation with the activation of DCX biosynthesis.
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Affiliation(s)
- Antonio Chiaretti
- Pediatric Intensive Care Unit, Catholic University Medical School, Rome, Italy.
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Chiaretti A, Genovese O, Antonelli A, Tortorolo L, Ruggiero A, Focarelli B, Di Rocco C. Patient-controlled analgesia with fentanil and midazolam in children with postoperative neurosurgical pain. Childs Nerv Syst 2008; 24:119-24. [PMID: 17639417 DOI: 10.1007/s00381-007-0429-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pain is the most common discomfort experienced by children undergoing major operations. It is most often not adequately treated because of inexperience and unfounded fears related to the use of opioid drugs. In adults, patient-controlled analgesia (PCA) is widely administered, while in children, its use with opioid drugs is still under evaluation for safety and efficacy. OBJECTIVES The objective of the study is to evaluate the safety and efficacy of an opioid drug (fentanil) administered by PCA associated with a sedative-adjuvant drug (midazolam) administered by continuous infusion in children having undergone major neurosurgical procedures. MATERIALS AND METHODS Sixteen children with moderate to severe postoperative pain were treated with fentanil by PCA (booster doses of 1 microg/kg) plus continuous infusion of midazolam (2 microg/kg per min) by an intravenous route. To evaluate safety and efficacy of this analgesic protocol, different subjective and objective parameters were monitored at 4-h intervals. In addition, patients' satisfaction was assessed by a questionnaire at the end of the treatment. MAIN RESULTS All children experienced a good degree of analgesia and did not require any other analgesic drug during the treatment. Both subjective and objective parameters improved after starting pain-relieving treatment, and no major side effects occurred. The analysis of the answers of the questionnaire administered to the children showed a high grade of satisfaction. CONCLUSIONS PCA with fentanil plus continuous infusion of midazolam is a safe and efficacious method for analgesia in children with moderate to severe postoperative neurosurgical pain. The association of midazolam to fentanil also contributes to control anxiety and stress in this subset of patients and does not show any important side effects.
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Affiliation(s)
- Antonio Chiaretti
- Pediatric Intensive Care Unit, A. Gemelli Hospital, Catholic University of Rome, Largo A. Gemelli, 8, 00168, Rome, Italy.
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Mariotti P, Fasano A, Contarino MF, Della Marca G, Piastra M, Genovese O, Pulitanò S, Chiaretti A, Bentivoglio AR. Management of status dystonicus: Our experience and review of the literature. Mov Disord 2007; 22:963-8. [PMID: 17427939 DOI: 10.1002/mds.21471] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Status dystonicus (SD) is a life threatening disorder that develops in patients with both primary and secondary dystonia, characterized by acute worsening of symptoms with generalized and severe muscle contractions. To date, no information is available on the best way to treat this disorder. We review the previously described cases of SD and two new cases are reported, one of which occurring in a child with static encephalopathy, and the other one in a patient with pantothenate kinase-associated neurodegeneration. Both patients were admitted to an intensive care unit and treated with midazolam and propofol. This approach proved to be useful in the former while the progressive nature of the dystonia of the second patient required the combination of intrathecal baclofen infusion and bilateral pallidal deep brain stimulation. We believe that a rapid and aggressive approach is justified to avoid the great morbidity and mortality which characterize SD. Our experience, combined with the data available in the literature, might permit to establish the best strategies in managing this rare and severe condition.
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Affiliation(s)
- Paolo Mariotti
- Istituto di Neuropsichiatria Infantile, Università Cattolica del Sacro Cuore, Roma, Italia
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Visocchi M, Chiaretti A, Genovese O, Di Rocco F. Haemodynamic patterns in children with posttraumatic diffuse brain swelling. A preliminary study in 6 cases with neuroradiological features consistent with diffuse axonal injury. Acta Neurochir (Wien) 2007; 149:347-56. [PMID: 17426998 DOI: 10.1007/s00701-006-1102-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Accepted: 12/13/2006] [Indexed: 12/22/2022]
Abstract
BACKGROUND In the present report we describe the cerebral haemodynamics and the neuroradiological findings observed in six consecutive children, three males and three females aged 4-15.6 yrs (mean age 8.95) displaying a neuroradiological pattern consistent with diffuse axonal injury (DAI) along with slit ventricles. METHODS All the patients were admitted to the Paediatric Intensive Care Unit with GCS scores less than 8 after a severe brain injury. Serial head computed to mography (CT) and magnetic resonance (MR) scans demonstrated a radiological pattern of DAI. Transcranial Doppler Sonography (TCD) of the middle cerebral arteries was performed through the temporal bone window in all the patients. All patients but one underwent a continuous monitoring of intracranial pressure (ICP) and cerebral extraction of O(2) (CEO(2)). Treatment with barbiturates and hyperventilation was necessary in all the cases. In one patient, a bilateral decompressive cran iectomy was performed in order to decrease severe in tracranial hypertension. RESULTS Hyperflow along with intracranial hyper tension, variably responsive to barbiturate medication, was observed in all the patients by means of TCD and CEO(2). CONCLUSIONS Intracranial hypertension can be elevated in pediatric posttraumatic hyperflow syndromes associated with DAI. The observation of the time course of the parameters studied allowed us to modify the pharmacological treatment and/or perform surgical decompression (external cerebrospinal fluid (CSF) drainage in five cases; decompressive craniectomy in one case). Compartmental hyperflow TCD pattern was evident in only one patient. Although the limited number of pa tients in our series does not allow definite conclusions, we strongly believe that TCD, with ICP and CEO(2) monitoring, are useful tools in planning surgical strategy in children with neuroradiological signs of DAI.
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Affiliation(s)
- M Visocchi
- Institute of Neurosurgery, Catholic University Medical School, Rome, Italy.
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Rigante D, Capoluongo E, Bertoni B, Ansuini V, Chiaretti A, Piastra M, Pulitanò S, Genovese O, Compagnone A, Stabile A. First report of macrophage activation syndrome in hyperimmunoglobulinemia D with periodic fever syndrome. ACTA ACUST UNITED AC 2007; 56:658-61. [PMID: 17265501 DOI: 10.1002/art.22409] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We describe for the first time a case of macrophage activation syndrome in a child with hyperimmunoglobulinemia D with periodic fever syndrome who required intensive care support. Up-regulated monokine production, high serum levels of triglycerides and ferritin, clotting abnormalities with hypofibrinogenemia, and rapidly evolving pancytopenia should alert the clinician to the possible diagnosis of macrophage activation syndrome, even in autoinflammatory diseases characterized basically by the periodic recurrence of unprovoked inflammatory attacks. Bone marrow aspiration showing well-differentiated macrophages phagocytosing hematopoietic elements remains the main tool for a final diagnosis, and cyclosporine is the best strategy for treatment.
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Affiliation(s)
- Donato Rigante
- Department of Pediatric Sciences, Università Cattolica Sacro Cuore, Rome, Italy.
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Piastra M, Caresta E, Tempera A, Langer A, Zorzi G, Pulitanò S, Chiaretti A, Genovese O, Viola L, Tortorolo L, Polidori G. Sharing features of uncommon respiratory syncytial virus complications in infants. Pediatr Emerg Care 2006; 22:574-8. [PMID: 16912626 DOI: 10.1097/01.pec.0000230704.74022.3e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 11/25/2022]
Abstract
We describe 4 nonconsecutive cases of infants admitted to Catholic University pediatric intensive care unit (PICU) because of complicated respiratory syncytial virus (RSV) infection during winter RSV outbreaks from the year 2000 to the year 2003. A hyponatremic epileptic status (as in the first case) has been reported by several authors as a rare RSV complication, potentially leading to death. The second infant developed a serious pulmonary edema after a subglottic obstruction (croup) associated with RSV infection. The remaining 2 infants developed a pneumothorax and subcutaneous emphysema while breathing spontaneously during an RSV bronchiolitis. In all infants, a full recovery and PICU discharge was achieved despite the need for mechanical ventilation in cases 1 and 2. Increased intrapleural negative pressure or its combination with hypoxia/hypercapnia has been suggested as the common factor possibly joining these different clinical pictures.
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Affiliation(s)
- Marco Piastra
- Pediatric Intensive Care Unit, Catholic University Medical School, Gemelli Hospital, Rome, Italy.
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Piastra M, Tempera A, Caresta E, Chiaretti A, Genovese O, Zorzi G, Pulitanò S, Pietrini D, Polidori G. Lung injury from "liquid ecstasy": a role for coagulation activation? Pediatr Emerg Care 2006; 22:358-60. [PMID: 16714966 DOI: 10.1097/01.pec.0000215369.64106.9c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/25/2022]
Abstract
We describe our second clinical observation of pulmonary injury after a "liquid ecstasy" ingestion/inhalation by a 3-year-old girl. Apart from the deep coma state, a markedly asymmetric pulmonary compromise was recorded. A transient coagulation activation was detected, possibly triggered off by the toxic effect on the lung alveolar-capillary membrane.
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Affiliation(s)
- Marco Piastra
- Pediatric Intensive Care Unit, Catholic University Medical School, Gemelli Hospital, Rome, Italy.
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Rendeli C, Ausili E, Tabacco F, Focarelli B, Pantanella A, Di Rocco C, Genovese O, Fundarò C. Polyethylene glycol 4000 vs. lactulose for the treatment of neurogenic constipation in myelomeningocele children: a randomized-controlled clinical trial. Aliment Pharmacol Ther 2006; 23:1259-65. [PMID: 16611288 DOI: 10.1111/j.1365-2036.2006.02872.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To compare the therapeutic effectiveness and tolerability of low daily doses of polyethylene glycol 4000 vs. lactulose in the treatment of neurogenic constipation in children with myelomeningocele. METHODS Sixty-seven children with chronic neurogenic constipation were randomized allocated to receive either polyethylene glycol 4000 (0.50 g/kg) or lactulose (1.5 g/kg) for 6 months. Patients or their parents reported frequency and modality of evacuation and side effects on a diary card. Primary outcome was bowel frequency > or =3/week, and the second one was side effects at the end of treatment. RESULTS Complete remission of constipation was reported by a significantly (P < 0.01) higher number of patients treated with polyethylene glycol compared with lactulose. At the end of the study, 46% patients of polyethylene glycol group and 22% of the lactulose group were asymptomatic. Compared with lactulose, patients treated with polyethylene glycol reported higher bowel frequency (5.1 vs. 2.9 bowel movements/week, P < 0.01) and reduction of encopresis. Neither lactulose nor polyethylene glycol caused clinically-significant serious side effects and palatability was similar. CONCLUSIONS Polyethylene glycol 4000 compared with lactulose provided a higher success rate, without significant side effects, for the treatment of constipation in myelomeningocele children.
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Affiliation(s)
- C Rendeli
- Department of Paediatric Science, Catholic University Medical School, Rome, Italy.
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Chiaretti A, Genovese O, Riccardi R, Di Rocco C, Di Giuda D, Mariotti P, Pulitanò S, Piastra M, Polidori G, Colafati GS, Aloe L. Intraventricular nerve growth factor infusion: a possible treatment for neurological deficits following hypoxic-ischemic brain injury in infants. Neurol Res 2005; 27:741-6. [PMID: 16197811 DOI: 10.1179/016164105x35611] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE AND IMPORTANCE Hypoxic-ischemic brain injuries in childhood are associated with poor neurological outcome. Unfortunately, no new therapeutic approaches have been proposed. Recently, animal studies show that nerve growth factor (NGF) can reduce neurological deficits following hypoxic-ischemic brain injuries. The objective of this study is to demonstrate the therapeutic effects of intraventricular NGF infusion in severe post-ischemic damage. CLINICAL PRESENTATION Two infants, aged 9 and 8 months, with hypoxic-ischemic brain damage, secondary to prolonged cardiorespiratory arrest and stabilized after the conventional treatment, were treated with intraventricular NGF infusion. Before the therapy both infants were comatose with asymmetrical tetraparesis; their Glasgow Coma Scale (GCS) was 4 and 5, respectively. One month after the treatment, their GCS was 8 and 9, respectively. EEG examinations performed after the NGF infusion showed an increased alpha/theta ratio. MRI showed a reduction of malacic areas in the brain. A SPECT study, performed only in one infant, demonstrated that the NGF treatment resulted in an improvement of regional cerebral perfusion in right temporal and occipital cortices. INTERVENTION The drug utilized was 2.5S NGF purified and lyophilized from male mouse submaxillary glands. NGF infusion was started about 30 days after the hypoxic-ischemic brain injury. 0.1 mg NGF was administered via the external drainage catheter into the right cerebral ventricle once a day for 10 days consecutively. CONCLUSION Our observations are interesting, but further studies are necessary to confirm the effects of NGF in hypoxic-ischemic brain injuries in infants.
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Affiliation(s)
- Antonio Chiaretti
- Pediatric Intensive Care Unit, Catholic University Medical School, Rome, Italy.
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Chiaretti A, Zorzi G, Di Rocco C, Genovese O, Antonelli A, Piastra M, Polidori G, Aloe L. Neurotrophic factor expression in three infants with Ondine's curse. Pediatr Neurol 2005; 33:331-6. [PMID: 16243220 DOI: 10.1016/j.pediatrneurol.2005.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Revised: 03/31/2005] [Accepted: 05/23/2005] [Indexed: 11/16/2022]
Abstract
This study investigates the expression of some neurotrophic factors (brain-derived neurotrophic factor, glial-derived neurotrophic factor, and nerve growth factor) in the cerebrospinal fluid of infants suffering from idiopathic congenital central hypoventilation syndrome and determines their correlations with this syndrome. Cerebrospinal fluid samples were collected from three infants suffering from idiopathic congenital central hypoventilation syndrome and 15 control subjects with obstructive hydrocephalus to measure the expression of brain-derived neurotrophic factor, glial-derived neurotrophic factor, and nerve growth factor using an immunoenzymatic assay. In the cerebrospinal fluid of patients, analysis of neurotrophic factors expression indicated a reduction, not statistically significant, of brain-derived neurotrophic factor compared with the mean level of the control group (1554 pg/mL, 1509 pg/mL, and 1582 pg/mL respectively, in comparison to 1954 +/- 103 pg/mL), whereas nerve growth factor and glial-derived neurotrophic factor did not undergo significant variations in either group. Neurotrophic factors, namely brain-derived neurotrophic factor, regulate the maturation and differentiation of respiratory neurons. The reduced expression of brain-derived neurotrophic factor in the cerebrospinal fluid samples of infants with Ondine's curse, although not statistically significant, is suggestive of a dysregulation in the brain-derived neurotrophic factor synthesis that could play an important role in the breathing disorders observed in patients with idiopathic congenital central hypoventilation syndrome.
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Affiliation(s)
- Antonio Chiaretti
- Pediatric Intensive Care Unit, Catholic University Medical School, Rome, Italy
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Pulitanò S, Viola L, Genovese O, Chiaretti A, Piastra M, Mariotti P, Di Rocco F, Polidori G, Di Rocco C. Miller-Fisher syndrome mimicking intracranial hypertension following head trauma. Childs Nerv Syst 2005; 21:473-6. [PMID: 15830202 DOI: 10.1007/s00381-005-1144-2] [Citation(s) in RCA: 13] [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] [Received: 12/04/2004] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Miller-Fisher syndrome (MFS) is a polyneuropathy with benign outcome characterized by ophthalmoplegia, limb ataxia and tendon areflexia. Impaired consciousness level and intracranial hypertension are very rare symptoms in MFS. CASE REPORT We describe the case of a 5-year-old girl who showed intracranial hypertension, transient coma and respiratory failure after mild head injury; moreover the patient showed mild ataxia, areflexia, ophthalmoplegia and autonomic disturbances. These symptoms were suggestive of MFS. Electrophysiologic studies and laboratory tests confirmed the diagnosis and immunoglobulins and steroids were given. The child showed a progressive clinical improvement and the final outcome was good. CONCLUSION This case, initially managed as trauma injury due to the presence of suggestive signs and clinical history, maskered an atypical presentation of Miller-Fisher syndrome, a rare disorder of central nervous system.
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Affiliation(s)
- S Pulitanò
- Pediatric Intensive Care Unit, Catholic University Medical School-Hospital A. Gemelli, Largo F. Vito, 8, 00168, Rome, Italy.
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Fundarò C, Pantanella A, Genovese O, Rando G, Pintus C. [Utility and safety endoscopic digestive procedure in pediatric age]. Pediatr Med Chir 2005; 27:99-102. [PMID: 16910459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
The aim of this study is to verify the utility and safety of endoscopic procedures in the evaluation of children with clinically-significant gastrointestinal symptomatology. We report our experience of 87 pediatric endoscopy procedures including esophagogastroduodenoscopy, colonoscopy and tissue biopsies performed in 85 infants, children and adolescent, 3 months-15 years old, over a two-year period, june 2002-november 2004 after complete history, physical examination and basic investigations. General anesthesia was used in all patients after informed consent obtained from parents. Non significant complications were observed in this series of patients. In 81 cases (92.5%) with clinical symptoms and laboratory indications for gastrointestinal disease, the endoscopy and bioptical samples confirmed the utility and safety of procedure. Coeliac disease (39 cases), gastritis (11 cases), esophagitis (6 cases) were the most common organic cause of upper gastrointestinal disease. Allergic and indeterminate colitis (7 cases) were the most common cause of lower gastrointestinal disease. In 4.7% the procedures appear to be particularly helpful in the diagnosis of inflammatory lesions of the esophagus and stomach. In summary, the data demonstrate that endoscopy techniques show low morbidity, provide important diagnostic informations in pediatric gastrointestinal diseases and can be done safely in patients over 3 months of age.
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Affiliation(s)
- C Fundarò
- Istituto di Clinica Pediatrica, Policlinico Universitario A Gemelli, Universita Cattolica del Sacro Cuore-Roma.
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Abel CG, Stein G, Pereyra S, Nano G, Arakaki T, Garreto N, Bueri JA, Adamo C, Arizaga R, Genovese O, Allegri RF, Sica REP. [Neuropsychological study of 12 patients with pure degenerative cerebellar disease]. Rev Neurol 2005; 40:465-72. [PMID: 15861327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
INTRODUCTION The cerebellum has been traditionally associated with motor control learning and performance. However, since 1970 a growing body of clinical and experimental evidences has suggested that the cerebellum may be involved in nonmotor cognitive functions as well. OBJECTIVE To explore the presence of eventual cognitive impairment in non-demented patients with isolated degenerative cerebellar diseases. PATIENTS AND METHODS Twelve patients with the diagnosis of selective degenerative cerebellar disorders, either inherited or sporadic, were selected (mean age: 40.42 +/- 13.49 years; mean education level: 9.92 +/- 3.99 years; duration of illness: 12.13 +/- 11.27 years, MMSE: 26.75 +/- 1.5) and evaluated through a standardized neuropsychological tests battery. Normalized Z scores were estimated and compared against 0, employing the t test for one sample. RESULTS Significant cognitive deficits were found in the following domains: executive, visuo-spatial, memory and attention functions. Performance on the Wisconsin test showed a significative number of perseverative errors. Memory deficits included verbal learning and free recall difficulties, with good recognition of the material presented. CONCLUSIONS The findings of this study are consistent with the role of the cerebellum as modulator of mental functions. The cognitive deficits resulting from cerebellar pathology may be related with the disruption of cerebello-cortical connexions involving a complex network which includes the prefrontal region, suggesting that the cerebellum may process cortical information coming from different areas linked with the control of cognition.
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Affiliation(s)
- C G Abel
- Servicio de Neurología, Hospital Ramos Mejía, Buenos Aires, Argentina.
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