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Di Pietro P, Della Casa Alberighi O, Silvestri M, Tosca MA, Ruocco A, Conforti G, Rossi GA, Castagnola E, Merlano MC, Zappettini S, Renna S. Monitoring adherence to guidelines of antibiotic use in pediatric pneumonia: the MAREA study. Ital J Pediatr 2017; 43:113. [PMID: 29273072 PMCID: PMC5741879 DOI: 10.1186/s13052-017-0432-2] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 11/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background Children are the most vulnerable population exposed to the use of antibiotics often incorrectly prescribed for the treatment of infections really due to viruses rather than to bacteria. We designed the MAREA study which consisted of two different studies: i) a surveillance study to monitor the safety/efficacy of the antibiotics for the treatment of pneumonia (CAP), pharyngotonsillitis and acute otitis media in children younger than 14 yrs old, living in Liguria, North-West Italy and ii) a pre−/post-interventional study to evaluate the appropriateness of antibiotic prescription for the treatment these infections. In this paper, we show only results of the appropriateness study about the antibiotic prescription for the treatment of pneumonia. Methods Patients included in this study met the following inclusion criteria: i) admission to the Emergency/Inpatient Dpt/outpatient clinic of primary care pediatricians for pneumonia requiring antibiotics, ii) informed written consent. The practice of prescribing antibiotics was evaluated before-and-after a 1 day-educational intervention on International/National recommendations. Results Global adherence to guidelines was fulfilled in 45%: main reason for discordance was duration (shorter than recommended). Macrolide monotherapy and cephalosporins were highly prescribed; ampicillin/amoxicillin use was limited. 61% of patients received >1 antibiotic; parenteral route was used in 33%. After intervention, i) in all CAP, cephalosporin prescription decreased (−23%) and the inappropriate macrolide prescriptions was halved and, ii) in not hospitalized CAP (notH-CAP), macrolides were prescribed less frequently (−25%) and global adherence to guidelines improved (+39%); and iii) in H-CAP antibiotic choice appropriateness increase. Conclusion Prescribing practices were sufficiently appropriate but widespread preference for multidrug empirical regimens or macrolide in monotherapy deserve closer investigation.
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Affiliation(s)
| | | | - Michela Silvestri
- Pediatric Pulmonology and Allergy Unit and Cystic Fibrosis Center - Istituto G, Gaslini, Genoa, Italy
| | - Maria Angela Tosca
- Pediatric Pulmonology and Allergy Unit and Cystic Fibrosis Center - Istituto G, Gaslini, Genoa, Italy
| | - Anna Ruocco
- Primary Care Pediatrician - FIMP Genoa, Genoa, Italy
| | | | - Giovanni A Rossi
- Pediatric Pulmonology and Allergy Unit and Cystic Fibrosis Center - Istituto G, Gaslini, Genoa, Italy
| | | | | | | | - Salvatore Renna
- Pediatric Emergency Department, Istituto G, Gaslini, Genoa, Italy.
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Maistrello I, Di Pietro P, Renna S, Febbrari MD, Natale L. The Drug Monitoring-Oriented Medical Record: A New Resource for Drug Surveillance. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009286159302700441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Italo Maistrello
- Giannina Gaslini Children's Hospital and Research Institute, Genoa, Italy
| | - Pasquale Di Pietro
- Giannina Gaslini Children's Hospital and Research Institute, Genoa, Italy
| | - Salvatore Renna
- Giannina Gaslini Children's Hospital and Research Institute, Genoa, Italy
| | | | - Lauro Natale
- Policlinico Ponte San Pietro Hospital, Bergamo, Italy
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Marchisio P, Pipolo C, Landi M, Consonni D, Mansi N, Di Mauro G, Salvatici E, Di Pietro P, Esposito S, Felisati G, Principi N. Cerumen: A fundamental but neglected problem by pediatricians. Int J Pediatr Otorhinolaryngol 2016; 87:55-60. [PMID: 27368443 DOI: 10.1016/j.ijporl.2016.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Under physiological conditions, cerumen (Ce) is regularly extruded from the ear canal by a self-cleaning mechanism. Failure of this mechanism leads to excessive accumulation or impaction of Ce. Limited data are available concerning the prevalence of cerumen in healthy and sick infants and children. We assessed the prevalence of Ce in a large population of infants and children and compared the Ce removal attitudes of paediatricians (PEDs) and otorhinolaryngologists (ENTs). METHODS Children seen in November 2014 for acute respiratory infections, including suspected acute otitis media, or well-being visits, were enrolled. The following data were recorded: presence, laterality, and amount of Ce; presenting complaints and final diagnosis; attempt to remove Ce during the visit; and type of physician. RESULTS Among 819 children aged 1 month to 12 years, Ce was present in 594 (72.5%), of whom 478 (80.5%) had bilateral Ce, and 261 (43.9%) had Ce in a relevant amount (cerumen obstructing at least 50% of the ear canal). Presence of Ce was more common in younger and in African or Asian children. PEDs were less likely to remove cerumen than ENTs (28.8% vs 91.0%, p < 0.001) irrespective of age, gender, race and reason for visit. Ce was removed by PEDs in less than one-third of sick children with a final diagnosis of acute otitis media (AOM) (31.6%) compared with almost all the children by ENTs (95.6%, p < 0.001). CONCLUSION Ce is highly prevalent in healthy and sick children but is quite neglected by PEDs. Educational programs to reinforce the importance of Ce removal and to improve the techniques for removal in case of suspected AOM should be implemented and rigorously evaluated in order to avoid incorrect diagnosis and erroneous treatments.
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Affiliation(s)
- Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Carlotta Pipolo
- Otolaryngology-Head and Neck Unit, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | | | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Mansi
- Department of Otolaryngology, Ospedale Santobono Pausilipon, Naples, Italy
| | | | - Elisabetta Salvatici
- Department of Pediatrics, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | | | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology-Head and Neck Unit, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Da Dalt L, Zerbinati C, Strafella MS, Renna S, Riceputi L, Di Pietro P, Barabino P, Scanferla S, Raucci U, Mores N, Compagnone A, Da Cas R, Menniti-Ippolito F. Henoch-Schönlein purpura and drug and vaccine use in childhood: a case-control study. Ital J Pediatr 2016; 42:60. [PMID: 27316345 PMCID: PMC4912703 DOI: 10.1186/s13052-016-0267-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Henoch-Schönlein purpura (HSP) is the most common vasculitis in childhood; nevertheless, its etiology and pathogenesis remain unknown despite the fact that a variety of factors, mainly infectious agents, drugs and vaccines have been suggested as triggers for the disease. The aim of this study was to estimate the association of HSP with drug and vaccine administration in a pediatric population. METHODS An active surveillance on drug and vaccine safety in children is ongoing in 11 clinical centers in Italy. All children hospitalized through the local Paediatric Emergency Department for selected acute clinical conditions of interest were enrolled in the study. Data on drug and vaccine use in children before the onset of symptoms leading to hospitalization were collected by parents interview. A case-control design was applied for risk estimates: exposure in children with HSP, included as cases, was compared with similar exposure in children with gastroduodenal lesions, enrolled as controls. HSP cases were validated according to EULAR/PRINTO/PRES criteria. Validation was conducted retrieving data from individual patient clinical record. RESULTS During the study period (November 1999-April 2013), 288 cases and 617 controls were included. No increased risk of HSP was estimated for any drug. Among vaccines, measles-mumps-rubella (MMR) vaccine showed an increased risk of HSP (OR 3.4; 95 % CI 1.2-10.0). CONCLUSIONS This study provides further evidence on the possible role of MMR vaccine in HSP occurrence.
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Affiliation(s)
- Liviana Da Dalt
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | | | | | | | | | | | | | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nadia Mores
- Pharmacology and Pediatrics, Università Cattolica S. Cuore, Rome, Italy
| | - Adele Compagnone
- Pharmacology and Pediatrics, Università Cattolica S. Cuore, Rome, Italy
| | - Roberto Da Cas
- National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Viale Regina Elena, 299 - 00161, Rome, Italy
| | - Francesca Menniti-Ippolito
- National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Viale Regina Elena, 299 - 00161, Rome, Italy.
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Fontanazza S, Piccotti E, Sartini M, Cristina ML, Spagnolo AM, Palmieri A, Di Pietro P. Development of stratification criteria of green codes in a pediatric emergency department: a pilot study. Minerva Pediatr 2016; 71:21-27. [PMID: 27163394 DOI: 10.23736/s0026-4946.16.04471-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to find stratification criteria in a group of children assigned to the green triage category at an emergency department (ED). METHODS We analyzed a sample of patients admitted to the ED of Gaslini Children's Hospital in Genoa between February 2014 and January 2015 who had been given a green code on triage. We analyzed the following parameters: age, sex, nationality, reason for admission, number and type of the procedures performed, length of stay in the ED, destination on discharge, color code and diagnosis on discharge. RESULTS Of the 2875 patients enrolled, 258 (8.97%) were hospitalized, 135 (4.70%) were placed in short intensive observation, 1609 (55.97%) were discharged from the ED without any intervention, 829 (28.83%) were discharged after undergoing procedures (blood tests, microbiology investigation, imaging, specialist evaluation) and 44 (1.5%) spontaneously left the ED. Among the patients who were hospitalized and those kept under short intensive observation, the most frequent discharge diagnosis was gastrointestinal disease; among those patients discharged with and without undergoing procedures, the most frequent diagnosis was respiratory disease. The mean age of patients admitted to hospital and of those discharged without undergoing procedures was 46 months, while the mean ages of patients kept under short intensive observation and of those discharged after undergoing procedures were 54 and 61 months, respectively. CONCLUSIONS These preliminary results suggest that one of the main criteria of stratification of green codes on triage is the association between 2 variables: age and pathology.
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Affiliation(s)
- Silvia Fontanazza
- Department of Pediatric Emergency, "G. Gaslini" Children's Hospital, Genoa, Italy
| | - Emanuela Piccotti
- Department of Pediatric Emergency, "G. Gaslini" Children's Hospital, Genoa, Italy
| | - Marina Sartini
- Department of Health Sciences, University of Genoa, Genoa, Italy -
| | - Maria L Cristina
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Anna M Spagnolo
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Antonella Palmieri
- Department of Pediatric Emergency, "G. Gaslini" Children's Hospital, Genoa, Italy
| | - Pasquale Di Pietro
- Department of Pediatric Emergency, "G. Gaslini" Children's Hospital, Genoa, Italy
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6
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Azzari C, Moriondo M, Di Pietro P, Di Bari C, Resti M, Mannelli F, Esposito S, Castelli-Gattinara G, Campa A, de Benedictis FM, Bona G, Comarella L, Holl K, Marchetti F. The burden of bacteremia and invasive diseases in children aged less than five years with fever in Italy. Ital J Pediatr 2015; 41:92. [PMID: 26589787 PMCID: PMC4654905 DOI: 10.1186/s13052-015-0189-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 10/12/2015] [Indexed: 11/29/2022] Open
Abstract
Background Invasive diseases (ID) caused by Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae (H. influenzae), and Neisseria meningitidis are a major public health problem worldwide. Comprehensive data on the burden of bacteremia and ID in Italy, including data based on molecular techniques, are needed. Methods We conducted a prospective, multi-centre, hospital-based study (GSK study identifier: 111334) to assess the burden of bacteremia and ID among children less than five years old with a fever of 39 °C or greater. Study participation involved a single medical examination, collection of blood for polymerase chain reaction (PCR) and blood culture, and collection of an oropharyngeal swab for colonization analysis by PCR. Results Between May 2008 and June 2009, 4536 patients were screened, 944 were selected and 920 were enrolled in the study. There were 225 clinical diagnoses of ID, 9.8 % (22) of which were bacteremic. A diagnosis of sepsis was made for 38 cases, 5.3 % (2) of which were bacteremic. Among the 629 non-ID diagnoses, 1.6 % (10) were bacteremic. Among the 34 bacteremic cases, the most common diagnoses were community-acquired pneumonia (15/34), pleural effusion (4/34) and meningitis (4/34). S. pneumoniae was the most frequently detected bacteria among bacteremic cases (29/34) followed by H. influenzae (3/34). Ninety percent (27/30) of bacteremic patients with oropharyngeal swab results were colonized with the studied bacterial pathogens compared to 46.1 % (402/872) of non-bacteremic cases (p < 0.001). PCV7 (7-valent pneumococcal conjugate vaccine) vaccination was reported for 55.9 % (19/34) of bacteremic cases. S. pneumoniae serotypes were non-vaccine serotypes in children who had been vaccinated. Mean duration of hospitalization was longer for bacteremic cases versus non-bacteremic cases (13.6 versus 5.8 days). Conclusions These results confirm that S. pneumoniae is one of the pathogens frequently responsible for invasive disease.
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Affiliation(s)
- Chiara Azzari
- Division of Pediatric Immunology, Department of Health Sciences, University of Florence and Anna Meyer Children's University Hospital, Florence, Italy.
| | - Maria Moriondo
- Division of Pediatric Immunology, Department of Health Sciences, University of Florence and Anna Meyer Children's University Hospital, Florence, Italy.
| | - Pasquale Di Pietro
- Istituto Giannina Gaslini, Ospedale Pediatrico IRCCS, Via Gerolamo Gaslini 5, 16148, Genoa, Italy.
| | - Cesare Di Bari
- Azienda Ospedaliera Universitaria, Policlinico Consorziale di Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Massimo Resti
- Anna Meyer Children's University Hospital, Florence, Italy.
| | | | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Guido Castelli-Gattinara
- Paediatric Division, Bambino Gesù Children Hospital, v. Aurelia Km.30, 00100 Palidoro, Rome, Italy.
| | - Antonio Campa
- Ospedale Santobono, Via Fiore Mario 6, 80129, Naples, Italy.
| | | | - Gianni Bona
- Azienda Ospedaliera Maggiore della Carita', Corso Mazzini, n. 18, Novara, 28100, Italy.
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Menniti-Ippolito F, Da Cas R, Traversa G, Santuccio C, Felicetti P, Tartaglia L, Trotta F, Di Pietro P, Barabino P, Renna S, Riceputi L, Tovo PA, Gabiano C, Urbino A, Baroero L, Le Serre D, Virano S, Perilongo G, Daverio M, Gnoato E, Maretti M, Galeazzo B, Rubin G, Scanferla S, Da Dalt L, Stefani C, Zerbinati C, Chiappini E, Sollai S, De Martino M, Mannelli F, Becciani S, Giacalone M, Montano S, Remaschi G, Stival A, Furbetta M, Abate P, Leonardi I, Pirozzi N, Raucci U, Reale A, Rossi R, Russo C, Mancinelli L, Manuela O, Carlo C, Mores N, Romagnoli C, Chiaretti A, Compagnone A, Riccardi R, Delogu G, Sali M, Prete V, Tipo V, Dinardo M, Auricchio F, Polimeno T, Sodano G, Maccariello A, Rafaniello C, Fucà F, Di Rosa E, Altavilla D, Mecchio A, Arrigo T. Vaccine effectiveness against severe laboratory-confirmed influenza in children: results of two consecutive seasons in Italy. Vaccine 2014; 32:4466-4470. [PMID: 24962760 DOI: 10.1016/j.vaccine.2014.06.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/20/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of seasonal influenza vaccine in preventing Emergency Department (ED) visits and hospitalisations for influenza like illness (ILI) in children. METHODS We conducted a test negative case-control study during the 2011-2012 and 2012-2013 influenza seasons. Eleven paediatric hospital/wards in seven Italian regions participated in the study. Consecutive children visiting the ED with an ILI, as diagnosed by the doctor according to the European Centre for Disease Control case definition, were eligible for the study. Data were collected from trained pharmacists/physicians by interviewing parents during the ED visit (or hospital admission) of their children. An influenza microbiological test (RT-PCR) was carried out in all children. RESULTS Seven-hundred and four children, from 6 months to 16 years of age, were enrolled: 262 children tested positive for one of the influenza viruses (cases) and 442 tested negative (controls). Cases were older than controls (median age 46 vs. 29 months), though with a similar prevalence of chronic conditions. Only 25 children (4%) were vaccinated in the study period. The overall age-adjusted vaccine effectiveness (VE) was 38% (95% confidence interval -52% to 75%). A higher VE was estimated for hospitalised children (53%; 95% confidence interval -45% to 85%). DISCUSSION This study supports the effectiveness of the seasonal influenza vaccine in preventing visits to the EDs and hospitalisations for ILI in children, although the estimates were not statistically significant and with wide confidence intervals. Future systematic reviews of available data will provide more robust evidence for recommending influenza vaccination in children.
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Affiliation(s)
| | - Roberto Da Cas
- National Centre of Epidemiology, National Institute of Health, Roma, Italy
| | - Giuseppe Traversa
- National Centre of Epidemiology, National Institute of Health, Roma, Italy
| | | | | | | | | | | | | | | | | | | | - Clara Gabiano
- Regina Margherita Paediatric Hospital, Torino, Italy
| | | | - Luca Baroero
- Regina Margherita Paediatric Hospital, Torino, Italy
| | | | - Silvia Virano
- Regina Margherita Paediatric Hospital, Torino, Italy
| | | | - Marco Daverio
- Department of Paediatrics, University of Padova, Italy
| | - Elisa Gnoato
- Department of Paediatrics, University of Padova, Italy
| | | | | | - Giulia Rubin
- Department of Paediatrics, University of Padova, Italy
| | | | | | - Chiara Stefani
- Department of Paediatrics, Treviso Hospital, Treviso, Italy
| | | | | | - Sara Sollai
- Anna Meyer Children's University Hospital, Firenze, Italy
| | | | | | | | | | - Simona Montano
- Anna Meyer Children's University Hospital, Firenze, Italy
| | | | - Alessia Stival
- Anna Meyer Children's University Hospital, Firenze, Italy
| | - Mario Furbetta
- Department of Paediatrics, University Hospital, Perugia, Italy
| | - Piera Abate
- Department of Paediatrics, University Hospital, Perugia, Italy
| | - Ilaria Leonardi
- Department of Paediatrics, University Hospital, Perugia, Italy
| | - Nicola Pirozzi
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Umberto Raucci
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Antonino Reale
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Rossella Rossi
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Cristina Russo
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Livia Mancinelli
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Onori Manuela
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Concato Carlo
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Nadia Mores
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Costantino Romagnoli
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Antonio Chiaretti
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Adele Compagnone
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Riccardo Riccardi
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Giovanni Delogu
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Michela Sali
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Valentina Prete
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Vincenzo Tipo
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Michele Dinardo
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Fabiana Auricchio
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Teodoro Polimeno
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Giuseppe Sodano
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | | | | | - Fortunata Fucà
- Giovanni Di Cristina Paediatric Hospital, Palermo, Italy
| | | | - Domenica Altavilla
- Department of Paediatric, Gynecologic, Microbiologic and Biomedical Sciences, University Hospital, Messina, Italy
| | - Anna Mecchio
- Department of Paediatric, Gynecologic, Microbiologic and Biomedical Sciences, University Hospital, Messina, Italy
| | - Teresa Arrigo
- Department of Paediatric, Gynecologic, Microbiologic and Biomedical Sciences, University Hospital, Messina, Italy
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Renna S, Bergamino L, Pirlo D, Rossi A, Furione M, Piralla A, Mascaretti M, Cristina E, Marazzi MG, Di Pietro P. A case of neonatal human parechovirus encephalitis with a favourable outcome. Brain Dev 2014; 36:70-3. [PMID: 23347531 DOI: 10.1016/j.braindev.2012.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 12/14/2012] [Accepted: 12/16/2012] [Indexed: 11/16/2022]
Abstract
Human parechoviruses (HPeVs) are a new family of neurotropic viruses that cause central nervous system (CNS) infections similar to enterovirus (EVs) meningoencephalitis in the neonatal period, resulting in white matter lesions that can be visualized with cranial ultrasonography and magnetic resonance imaging, and correlated to a large spectrum of neurological outcomes. HPeV should be suspected in neonates with signs and symptoms of sepsis-like illness or CNS disease. We report a case of neonatal HPeV encephalitis, diagnosed on the basis of clinical and radiological findings and HPeV RT-PCR, with a good neurological outcome.
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Affiliation(s)
- Salvatore Renna
- Emergency Department of Paediatrics, G. Gaslini Children's Hospital, Genova, Italy
| | - Laura Bergamino
- Emergency Department of Paediatrics, G. Gaslini Children's Hospital, Genova, Italy.
| | - Daniela Pirlo
- Emergency Department of Paediatrics, G. Gaslini Children's Hospital, Genova, Italy
| | - Andrea Rossi
- Neuroradiology Department, G. Gaslini Children's Hospital, Genova, Italy
| | - Milena Furione
- Molecular Virology Unit, Virology and Microbiology Department, IRCCS San Matteo, Pavia, Italy
| | - Antonio Piralla
- Molecular Virology Unit, Virology and Microbiology Department, IRCCS San Matteo, Pavia, Italy
| | - Monica Mascaretti
- Child Neurology and Psychiatry Unit, G. Gaslini Children's Hospital, Genova, Italy
| | - Emilio Cristina
- Infectious Diseases Unit, G. Gaslini Children's Hospital, Genova, Italy
| | - Maria Grazia Marazzi
- Faculty of Medicine, University of Genova, Infectious Diseases Unit, G. Gaslini Children's Hospital, Genova, Italy.
| | - Pasquale Di Pietro
- Emergency Department of Paediatrics, G. Gaslini Children's Hospital, Genova, Italy
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9
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Bagnasco A, Tubino B, Piccotti E, Rosa F, Aleo G, Di Pietro P, Sasso L, Gambino L, Passalacqua D. Identifying and correcting communication failures among health professionals working in the Emergency Department. Int Emerg Nurs 2012. [PMID: 23207054 DOI: 10.1016/j.ienj.2012.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [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: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to identify effective corrective measures to ensure patient safety in the Paediatric Emergency Department (ED). METHODS In order to outline a clear picture of these risks, we conducted a Failure Mode and Effects Analysis (FMEA) and a Failure Mode, Effects, and Criticality Analysis (FMECA), at a Emergency Department of a Children's Teaching Hospital in Northern Italy. The Error Modes were categorised according to Vincent's Taxonomy of Causal Factors and correlated with the Risk Priority Number (RPN) to determine the priority criteria for the implementation of corrective actions. RESULTS The analysis of the process and outlining the risks allowed to identify 22 possible failures of the process. We came up with a mean RPN of 182, and values >100 were considered to have a high impact and therefore entailed a corrective action. CONCLUSIONS Mapping the process allowed to identify risks linked to health professionals' non-technical skills. In particular, we found that the most dangerous Failure Modes for their frequency and harmfulness were those related to communication among health professionals.
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Affiliation(s)
- Annamaria Bagnasco
- Health Sciences Department, University of Genoa, Via Pastore 1, 16132 Genova, Italy.
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Marchetti F, Maestro A, Rovere F, Zanon D, Arrighini A, Bertolani P, Biban P, Da Dalt L, Di Pietro P, Renna S, Guala A, Mannelli F, Pazzaglia A, Messi G, Perri F, Reale A, Urbino AF, Valletta E, Vitale A, Zangardi T, Tondelli MT, Clavenna A, Bonati M, Ronfani L. Oral ondansetron versus domperidone for symptomatic treatment of vomiting during acute gastroenteritis in children: multicentre randomized controlled trial. BMC Pediatr 2011; 11:15. [PMID: 21310051 PMCID: PMC3045958 DOI: 10.1186/1471-2431-11-15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 02/10/2011] [Indexed: 12/05/2022] Open
Abstract
Background Vomiting in children with acute gastroenteritis (AG) is not only a direct cause of fluid loss but it is also a major factor of failure of oral rehydration therapy (ORT). Physicians who provide care to paediatric patients in the emergency department (ED) usually prescribe intravenous fluid therapy (IVT) for mild or moderate dehydration when vomiting is the major symptom. Thus, effective symptomatic treatment of vomiting would lead to an important reduction in the use of IVT and, consequently, of the duration of hospital stay and of frequency of hospital admission. Available evidence on symptomatic treatment of vomiting shows the efficacy of the most recently registered molecule (ondansetron) but a proper evaluation of antiemetics drugs largely used in clinical practice, such as domperidone, is lacking. Objectives To compare the efficacy of ondansetron and domperidone for the symptomatic treatment of vomiting in children with AG who have failed ORT. Methods/Design Multicentre, double-blind randomized controlled trial conducted in paediatric EDs. Children aged from 1 to 6 years who vomiting, with a presumptive clinical diagnosis of AG, and without severe dehydration will be included. After the failure of a initial ORS administration in ED, eligible children will be randomized to receive: 1) ondansetron syrup (0,15 mg/Kg of body weight); 2) domperidone syrup (0,5 mg/Kg of body weight); 3) placebo. The main study outcome will be the percentage of patients needing nasogastric or IVT after symptomatic oral treatment failure, defined as vomiting or fluid refusal after a second attempt of ORT. Data relative to study outcomes will be collected at 30 minute intervals for a minimum of 6 hours. A telephone follow up call will be made 48 hours after discharge. A total number of 540 children (i.e. 180 patients in each arm) will be enrolled. Discussion The trial results would provide evidence on the efficacy of domperidone, which is largely used in clinical practice despite the lack of proper evaluation and a controversial safety profile, as compared to ondansetron, which is not yet authorized in Italy despite evidence supporting its efficacy in treating vomiting. The trial results would contribute to a reduction in the use of IVT and, consequently, in hospital admissions in children with AG. The design of this RCT, which closely reflect current clinical practice in EDs, will allow immediate transferability of results. Trial Registration ClinicalTrials.gov: NCT01257672
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Affiliation(s)
- Federico Marchetti
- Department of Pediatrics and Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
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11
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Marangoni F, Poli A, Agostoni C, Di Pietro P, Cricelli C, Brignoli O, Fatati G, Giovannini M, Riva E, Marelli G, Porrini M, Rotella CM, Mele G, Iughetti L, Paoletti R. A consensus document on the role of breakfast in the attainment and maintenance of health and wellness. Acta Biomed 2009; 80:166-171. [PMID: 19848056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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12
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Grassino EC, Guidi C, Monzani A, Di Pietro P, Bona G. Access to paediatric emergency departments in Italy: a comparison between immigrant and Italian patients. Ital J Pediatr 2009; 35:3. [PMID: 19490660 PMCID: PMC2687543 DOI: 10.1186/1824-7288-35-3] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 02/22/2009] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of the study was to investigate whether access to paediatric emergency departments differed between foreign and Italian patients. Methods We performed a cross-sectional study between January-December 2007 to analyse attendance's characteristics in the paediatric emergency departments of ten Italian public hospitals. The study population included each foreign patient and the following Italian patient admitted to the same emergency department. All causes of admission of these subjects were evaluated, together with the child's age, gender, country of birth, parents' nationality, time of admission, severity code and discharge-related circumstances. Results We enrolled 4874 patients, 2437 foreign (M:F = 1409:1028) and 2437 Italian ones (M:F = 1368:1069). Most of foreign and Italian patients' admissions were sorted as green (72.5% and 87.8%, respectively) or white codes (25.2% and 9.8%, respectively). The most frequent causes for attendance concerned respiratory tract diseases, followed by gastroenteric ones and injuries in both groups. Conclusion In our survey immigrants didn't access to emergency departments more than Italian children. Both of them referred to emergency departments mainly for semi-urgent or non-urgent problems. Foreign and Italian patients suffered from the same pathologies. Infectious diseases traditionally thought to be a potential problem in immigrant populations actually seem to be quite infrequent.
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Affiliation(s)
- Erica Clara Grassino
- Department of Pediatrics, AOU Maggiore della Carit, University of Piemonte Orientale, Novara, Italy.
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13
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Defilippi A, Silvestri M, Tacchella A, Giacchino R, Melioli G, Di Marco E, Cirillo C, Di Pietro P, Rossi GA. Epidemiology and clinical features of Mycoplasma pneumoniae infection in children. Respir Med 2008; 102:1762-8. [DOI: 10.1016/j.rmed.2008.06.022] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 06/27/2008] [Accepted: 06/30/2008] [Indexed: 11/28/2022]
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Defilippi AC, Silvestri M, Giacchino R, Di Pietro P, Rossi GA. Changes in blood eosinophil numbers during Mycoplasma pneumoniae infection in wheezing and non-wheezing, atopic and non-atopic children. Pediatr Int 2008; 50:718-21. [PMID: 19261132 DOI: 10.1111/j.1442-200x.2008.02720.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Losurdo G, Giacchino R, Castagnola E, Gattorno M, Costabel S, Rossi A, Amato S, Di Pietro P, Molinari AC. Cerebrovascular disease and varicella in children. Brain Dev 2006; 28:366-70. [PMID: 16376509 DOI: 10.1016/j.braindev.2005.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 10/26/2005] [Accepted: 11/11/2005] [Indexed: 11/17/2022]
Abstract
Varicella-associated stroke has been reported with increasing frequency in recent years. In many cases, diagnosis is difficult because of the late onset of manifestations after the acute infectious episode. Four cases of cerebrovascular disease after varicella infection were observed. Three children presented hemiparesis and one facial paresis. The neuroradiological findings comprised stenosis/occlusion of middle cerebral artery or nucleo capsular signal alteration. Because, several pathogenetic mechanisms have been proposed as the cause of stroke, the relationship between prothrombotic conditions, antipospholipid antibodies and stroke in these patients is discussed. The difficulty in defining the pathogenesis of the ischemic episode is related to problems in the choice of antithrombotic treatment, which is still not standardized and must be decided on individual basis. In the event of rapid onset of stroke after exanthem high dose antiviral therapy seems to be justified. On the basis of our experience and of literature data on varicella-associated stroke, we recommend that VZV infection be taken into account in every episode of stroke in children.
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Affiliation(s)
- Giuseppe Losurdo
- Infectious Diseases Unit, G. Gaslini Children's Hospital, Largo G. Gaslini 5, 16147 Genoa, Italy
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Villa G, Lattere M, Rossi A, Di Pietro P. Acute onset of abducens nerve palsy in a child with prior history of otitis media: a misleading sign of Gradenigo syndrome. Brain Dev 2005; 27:155-9. [PMID: 15668058 DOI: 10.1016/j.braindev.2004.02.003] [Citation(s) in RCA: 16] [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: 07/14/2003] [Revised: 02/02/2004] [Accepted: 02/16/2004] [Indexed: 10/26/2022]
Abstract
Gradenigo syndrome in children during otitis media is a very rare complication since the use of antibiotics: nevertheless, it must be taken into account in case of otitis media, abducens nerve paralysis and facial pain in regions innervated by the first and second division of trigeminal nerve. We report the case of a 4-year-old boy whose neurological signs and clinical history prompted us to entertain a diagnosis of Gradenigo syndrome, which was not confirmed by CT and MRI findings, revealing otomastoiditis and sinus thrombosis.
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Affiliation(s)
- Giovanna Villa
- Emergency Department of Paediatrics G. Gaslini Children's Hospital Largo G. Gaslini, 5 16147 Genova, Italy.
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Abstract
This case report describes a lipoma located in the pre-mamillary area that appeared in a 5-year-old child. The first symptom was very deep, transient hypothermia. Laboratory exams were normal. Diagnosis of a lipoma situated in the hypothalamic-mamillary area was made by brain MRI. The lipoma showed no signs of growth and hypothermia disappeared over the following 2 years. It is an unusual case of the body adapting to a new anatomic situation.
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Affiliation(s)
- Pasquale Di Pietro
- Emergency Department, 'G. Gaslini', Children's Institute, L. go G. Gaslini 5, Genoa, Italy.
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