22 results on '"Verrillo, E."'
Search Results
2. Application of latent class analysis in assessing the awareness, attitude, practice and satisfaction of paediatricians on sleep disorder management in children in Italy
- Author
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Nosetti L, Paglietti MG, Brunetti L, Masini L, La Grutta S, Cilluffo G, Ferrante G, Zaffanello M, Verrillo E, Pavone M, Niespolo AC, Broggi G, Cutrera R, Diletta Valentini, Dominga Cardaropoli, Carolina De Chiara, Valentina Tranchino, Salvatore Iasevoli, Angela Salvatore, Amelia Balzarini, Valeria Spica Russotto, Stefania Porcu, Paolo Barracchini, Sinibaldo Iemboli, Giuseppe Rosselli, and Nosetti L, Paglietti MG, Brunetti L, Masini L, La Grutta S, Cilluffo G, Ferrante G, Zaffanello M, Verrillo E, Pavone M, Niespolo AC, Broggi G, Cutrera R, Diletta Valentini, Dominga Cardaropoli, Carolina De Chiara, Valentina Tranchino, Salvatore Iasevoli, Angela Salvatore, Amelia Balzarini, Valeria Spica Russotto, Stefania Porcu, Paolo Barracchini, Sinibaldo Iemboli, Giuseppe Rosselli
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Questionnaires ,European People ,Health Knowledge, Attitudes, Practice ,Medical Doctors ,Cross-sectional study ,Health Care Providers ,Pilot Projects ,Personal Satisfaction ,Practice Patterns ,Logistic regression ,Pediatrics ,Families ,latent class analysis, sleep disorder, children, paediatricians ,0302 clinical medicine ,Sleep-Disordered Breathing ,Surveys and Questionnaires ,Medicine and Health Sciences ,Ethnicities ,Medical Personnel ,Practice Patterns, Physicians' ,Child ,Transients and Migrants ,Sleep disorder ,Practice ,Multidisciplinary ,Health Knowledge ,Armenia ,Middle Aged ,Hospitals, Pediatric ,Latent class model ,Italian People ,Professions ,Health Education and Awareness ,Neurology ,Italy ,Research Design ,Respondent ,Practice Guidelines as Topic ,Pediatric Otolaryngology ,Medicine ,Job satisfaction ,Health education ,Female ,Sexual Health ,Research Article ,Adult ,medicine.medical_specialty ,Adolescent ,Science ,education ,Mothers ,Research and Analysis Methods ,03 medical and health sciences ,Young Adult ,Sleep Apnea Syndromes ,children ,030225 pediatrics ,Physicians ,medicine ,latent class analysis ,Humans ,Pediatricians ,Demography ,Survey Research ,Physicians' ,business.industry ,medicine.disease ,Health Surveys ,Health Care ,Cross-Sectional Studies ,Otorhinolaryngology ,Age Groups ,Family medicine ,Attitudes ,People and Places ,Population Groupings ,business ,Sleep Disorders ,030217 neurology & neurosurgery ,paediatricians - Abstract
Aim To identify subgroups regarding paediatricians’ awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA). Methods A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value
- Published
- 2020
3. Red Flags for early referral of people with symptoms suggestive of narcolepsy: a report from a national multidisciplinary panel
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Vignatelli, L., primary, Antelmi, E., additional, Ceretelli, I., additional, Bellini, M., additional, Carta, C., additional, Cortelli, P., additional, Ferini-Strambi, L., additional, Ferri, R., additional, Guerrini, R., additional, Ingravallo, F., additional, Marchiani, V., additional, Mari, F., additional, Pieroni, G., additional, Pizza, F., additional, Verga, M. C., additional, Verrillo, E., additional, Taruscio, D., additional, and Plazzi, Giuseppe, additional
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- 2018
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4. Red Flags for early referral of people with symptoms suggestive of narcolepsy: a report from a national multidisciplinary panel.
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Vignatelli, L., Antelmi, E., Ceretelli, I., Bellini, M., Carta, C., Cortelli, P., Ferini-Strambi, L., Ferri, R., Guerrini, R., Ingravallo, F., Marchiani, V., Mari, F., Pieroni, G., Pizza, F., Verga, M. C., Verrillo, E., Taruscio, D., and Plazzi, Giuseppe
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CATAPLEXY ,NARCOLEPSY ,PHYSICIANS ,MEDICAL specialties & specialists ,FLAGS ,GENERAL practitioners ,MEDICAL error statistics ,AGE distribution ,DIAGNOSIS ,DIFFERENTIAL diagnosis ,INTERPROFESSIONAL relations ,MEDICAL referrals - Abstract
Objective: Narcolepsy is a lifelong disease, manifesting with excessive daytime sleepiness and cataplexy, arising between childhood and young adulthood. The diagnosis is typically made after a long delay that burdens the disease severity. The aim of the project, promoted by the "Associazione Italiana Narcolettici e Ipersonni" is to develop Red Flags to detect symptoms for early referral, targeting non-sleep medicine specialists, general practitioners, and pediatricians.Materials and Methods: A multidisciplinary panel, including patients, public institutions, and representatives of national scientific societies of specialties possibly involved in the diagnostic process of suspected narcolepsy, was convened. The project was accomplished in three phases. Phase 1: Sleep experts shaped clinical pictures of narcolepsy in pediatric and adult patients. On the basis of these pictures, Red Flags were drafted. Phase 2: Representatives of the scientific societies and patients filled in a form to identify barriers to the diagnosis of narcolepsy. Phase 3: The panel produced suggestions for the implementation of Red Flags.Results: Red Flags were produced representing three clinical pictures of narcolepsy in pediatric patients ((1) usual sleep symptoms, (2) unusual sleep symptoms, (3) endocrinological signs) and two in adult patients ((1) usual sleep symptoms, (2) unusual sleep symptoms). Inadequate knowledge of symptoms at onset by medical doctors turned out to be the main reported barrier to diagnosis.Conclusions: This report will hopefully enhance knowledge and awareness of narcolepsy among non-specialists in sleep medicine in order to reduce the diagnostic delay that burdens patients in Italy. Similar initiatives could be promoted across Europe. [ABSTRACT FROM AUTHOR]- Published
- 2019
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5. A survey around the Italian pediatric units on current clinical practice for Sleep Disordered Breathing (SDB)
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L. Nosetti, M. G. Paglietti, L. Brunetti, L. Masini, S. La Grutta, G. Cilluffo, M. Zaffanello, E. Verrillo, M. Pavone, A. C. Niespolo, G. Broggi, R. Cutrera, the Italian Pediatric Respiratory Diseases Society (SIMRI) Sleep Disordered Breathing Working Group, Nosetti L., Paglietti M.G., Brunetti L., Masini L., La Grutta S., Cilluffo G., Zaffanello M., Verrillo E., Pavone M., Niespolo A.C., Broggi G., and Cutrera R.
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Male ,medicine.medical_specialty ,Practice Patterns ,Polysomnography ,Children ,Italy ,Pediatric units ,Sleep disordered breathing ,Survey ,Child ,Female ,Humans ,Practice Patterns, Physicians' ,Sleep Apnea Syndromes ,Surveys and Questionnaires ,03 medical and health sciences ,Exploratory survey ,0302 clinical medicine ,Quality of life ,030225 pediatrics ,mental disorders ,medicine ,cardiovascular diseases ,030212 general & internal medicine ,Physicians' ,medicine.diagnostic_test ,Pediatric respiratory diseases ,business.industry ,Research ,lcsh:RJ1-570 ,lcsh:Pediatrics ,Pediatric age ,nervous system diseases ,respiratory tract diseases ,Northern italy ,Clinical Practice ,Emergency medicine ,business - Abstract
Background During recent years, interest on Sleep Disordered Breathing (SDB) in pediatric age has increased, due to the impact on quality of life, psycho-physical attitude and other serious morbidities if undiagnosed and untreated. Methods Italian Pediatric Respiratory Diseases Society (SIMRI) SDB-Working Group carried out an exploratory survey in Italy, from January to December 2016, to assess the diagnostic and therapeutic pathways, perception and relevance of SDB in Italian Hospitals. Results A questionnaire was sent to 180 Pediatric Units (PUs) distributed throughout the Italy; 102 Pediatric Units (PUs; 56.6%) answered and among them 57% dealt with SDB, and 94% recognized SDB as a major problem. Instrumental tests performed by the PUs were saturimetry (66%), nocturnal polygraphy with complete cardio-respiratory monitoring (46%) and full polysomnography (23%). In addition, hospital pediatricians reported that 54% of parents were unaware of the SDB and 84% did not know their complications. In the Northern Italy, the diagnosis was frequently performed with instrumental tools and the treatment was often surgical. In the Southern Italy the diagnosis was clinical, and the treatment was usually with drugs. Conclusions The results of our study showed a heterogeneity in the diagnosis and treatment of SDB throughout Italy. Parents know little about SDB and their complications. The operator satisfaction was associated with the availability of tools for diagnosing SDB. Electronic supplementary material The online version of this article (10.1186/s13052-019-0658-2) contains supplementary material, which is available to authorized users.
- Published
- 2019
6. Red Flags for early referral of people with symptoms suggestive of narcolepsy: a report from a national multidisciplinary panel
- Author
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Renzo Guerrini, Luca Vignatelli, Raffaele Ferri, G. Pieroni, Francesco Mari, Francesca Ingravallo, M. Bellini, Claudio Carta, Valentina Marchiani, Elisabetta Verrillo, Giuseppe Plazzi, Fabio Pizza, M. C. Verga, I. Ceretelli, Luigi Ferini-Strambi, Pietro Cortelli, Domenica Taruscio, Elena Antelmi, Vignatelli, L., Antelmi, E., Ceretelli, I., Bellini, M., Carta, C., Cortelli, P., Ferini-Strambi, L., Ferri, R., Guerrini, R., Ingravallo, F., Marchiani, V., Mari, F., Pieroni, G., Pizza, F., Verga, M. C., Verrillo, E., Taruscio, D., Plazzi, G., Verga, M.C., and Plazzi, Giuseppe
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Adult ,medicine.medical_specialty ,Neurology ,Delayed Diagnosis ,Diagnostic criteria ,Cataplexy ,Excessive daytime sleepiness ,Dermatology ,Disease ,Review Article ,Sleep medicine ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Medicine ,Humans ,030212 general & internal medicine ,Young adult ,Psychiatry ,Child ,Referral and Consultation ,Narcolepsy ,Red flags ,business.industry ,Age Factors ,Burden of disease ,General Medicine ,Diagnostic delay ,2708 ,Neurology (clinical) ,Psychiatry and Mental Health ,medicine.disease ,Psychiatry and Mental health ,Italy ,Interdisciplinary Communication ,Red flag ,Neurosurgery ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Objective Narcolepsy is a lifelong disease, manifesting with excessive daytime sleepiness and cataplexy, arising between childhood and young adulthood. The diagnosis is typically made after a long delay that burdens the disease severity. The aim of the project, promoted by the “Associazione Italiana Narcolettici e Ipersonni” is to develop Red Flags to detect symptoms for early referral, targeting non-sleep medicine specialists, general practitioners, and pediatricians. Materials and methods A multidisciplinary panel, including patients, public institutions, and representatives of national scientific societies of specialties possibly involved in the diagnostic process of suspected narcolepsy, was convened. The project was accomplished in three phases. Phase 1: Sleep experts shaped clinical pictures of narcolepsy in pediatric and adult patients. On the basis of these pictures, Red Flags were drafted. Phase 2: Representatives of the scientific societies and patients filled in a form to identify barriers to the diagnosis of narcolepsy. Phase 3: The panel produced suggestions for the implementation of Red Flags. Results Red Flags were produced representing three clinical pictures of narcolepsy in pediatric patients ((1) usual sleep symptoms, (2) unusual sleep symptoms, (3) endocrinological signs) and two in adult patients ((1) usual sleep symptoms, (2) unusual sleep symptoms). Inadequate knowledge of symptoms at onset by medical doctors turned out to be the main reported barrier to diagnosis. Conclusions This report will hopefully enhance knowledge and awareness of narcolepsy among non-specialists in sleep medicine in order to reduce the diagnostic delay that burdens patients in Italy. Similar initiatives could be promoted across Europe. Electronic supplementary material The online version of this article (10.1007/s10072-018-3666-x) contains supplementary material, which is available to authorized users.
- Published
- 2018
7. The Efficacy of Noninvasive Ventilation in Patients Affected by Rett Syndrome With Hypoventilation.
- Author
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Peri F, Cherchi C, Chiarini Testa MB, Pavone M, Verrillo E, and Cutrera R
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- Humans, Female, Retrospective Studies, Adolescent, Child, Young Adult, Oximetry, Child, Preschool, Polysomnography, Treatment Outcome, Rett Syndrome complications, Rett Syndrome therapy, Rett Syndrome physiopathology, Noninvasive Ventilation, Hypoventilation therapy, Hypoventilation etiology
- Abstract
Background: Rett syndrome is a progressive neurological disorder associated to several comorbidities that contribute significantly to impair lung function. Respiratory morbidity represents a major cause of death in this population. Little is known about the benefit of noninvasive ventilation., Methods: We retrospectively enrolled patients with Rett syndrome who underwent a pneumological evaluation combined with a cardiorespiratory polygraphy and/or a pulse oximetry and capnography from 2012 to 2022., Results: Medical records of 11 patients with Rett syndrome, mean age 13 ± 6 years, were evaluated. Most patients presented with both epilepsy and scoliosis. Five patients showed a pathologic sleep study and/or impaired night gas exchange: mean obstructive apnea-hypopnea index was 4 ± 3 events/hour; mean and minimal SpO
2 were, respectively, 93% ± 2% and 83% ± 6%, while mean and maximal transcutaneous carbon dioxide monitoring (PtcCO2 ) were, respectively, 51 ± 5 mm Hg and 55 ± 8 mm Hg; and mean oxygen desaturation index was 13 ± 11 events/hour. These patients started noninvasive ventilation with clinical benefit and improved gas exchange mostly in terms of PtcCO2 (mean PtcCO2 51 ± 5 mm Hg before and 46 ± 6 mm Hg after noninvasive ventilation)., Conclusions: Noninvasive ventilation is a suitable option for patients with Rett syndrome., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)- Published
- 2024
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8. Sleep architecture and Nusinersen therapy in children with Spinal Muscular Atrophy type 1.
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Verrillo E, Pavone M, Bruni O, Ferri R, Chiarini Testa MB, Cherchi C, D'Amico A, and Cutrera R
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- Male, Female, Humans, Child, Oligonucleotides adverse effects, Sleep physiology, Spinal Muscular Atrophies of Childhood drug therapy, Spinal Muscular Atrophies of Childhood complications, Muscular Atrophy, Spinal drug therapy, Muscular Atrophy, Spinal chemically induced, Muscular Atrophy, Spinal complications
- Abstract
Background: Spinal muscular atrophy (SMA) is a severe neuromuscular disorder, the phenotype of the disease is caused by the mutation of the SMN1 (survival motor neuron 1) gene which encodes for the SMN protein. Innovative treatments for SMA have become available and the first molecule approved is Nusinersen, an antisense oligonucleotide that increases the production of SMN protein. Nusinersen has been shown to be associated with a significant motor improvement and an increase of the event-free survival. For these reasons the aim of the present study is to assess if Nusinersen is able modify sleep architecture and microstructure and to improve sleep structure in these patients., Methods: Sixteen patients affected by SMA1 were enrolled in the study (4 boys, 12 girls; median age 72.5 months, intelligence quotient range 24-84). All patients underwent complete nocturnal PSG before the start of the treatment trough intrathecal injections with Nusinersen (T0) and after the fifth infusion (day 180, T180). PSG recordings were visually scored and interpreted according to the indications of the American Academy of Sleep Medicine (AASM) and and microstructure by means of the Cyclic Alternating Pattern (CAP)., Results: After 6 months therapy we found a significantly reduced sleep latency and a significantly increased sleep efficiency. Regarding sleep microstructure parameters (CAP), we did not find any significant change after therapy however, it is worth mentioning that a moderate effect size was observed for the increase in CAP A3 index., Conclusions: We observed short-term effects of Nusinersen on sleep with an improvement in sleep efficiency and reduction in sleep onset latency; regarding sleep microstructure, a moderate effect size was found for the number of CAP A3 subtypes that slightly increased, possibly indicating a slightly higher arousability. This finding points at a probably overall better sleep pattern organization associated with the treatment, but they need to be confirmed by larger studies with patients treated earlier in life and for a longer period., Competing Interests: Declaration of competing interest Authors declare none., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2023
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9. Telemedicine in children with medical complexity on home ventilation during the COVID-19 pandemic.
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Onofri A, Pavone M, De Santis S, Verrillo E, Caggiano S, Ullmann N, and Cutrera R
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- Adolescent, Child, Child, Preschool, Chronic Disease, Female, Home Care Services, Hospitalization, Humans, Male, Pandemics, COVID-19 epidemiology, COVID-19 prevention & control, Respiration, Artificial, SARS-CoV-2, Telemedicine
- Abstract
Children with medical complexity (CMC) are patients with one or more complex chronic conditions dependent on medical technologies. In our unit (Pediatric Pulmonology and Respiratory Intermediate Care Unit, Department of Pediatrics, "Bambino Gesù" Children's Hospital and Research Institute), we regularly follow-up CMC patients, particularly children on long-term, invasive (IMV) or noninvasive (NIV), ventilation. Children suffering from chronic diseases and with medical complexity have lost the possibility to go to the hospital during the COVID-19 pandemic. The aim of this article is to describe our experience with telemedicine (teleconsultation [TC] and telemonitoring of ventilator [TM]) in CMC on ventilation. We presented 21 children on long-term ventilation (NIV or IMV) whose planned hospital admission was postponed due to lockdown. A total of 12 healthcare problems were detected during scheduled TCs. Only one problem was not solved by our remote intervention. Specifically, TM has allowed us to change the ventilator parameters and to monitor patients on ventilation remotely. In conclusion, the use of telemedicine in CMC ventilated patients resulted in a feasible tool to avoid in-person visits during the pandemic., (© 2021 Wiley Periodicals LLC.)
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- 2021
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10. Built-in software in children on long-term ventilation in real life practice.
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Onofri A, Pavone M, De Santis S, Verrillo E, Caggiano S, Ullmann N, Paglietti MG, Chiarini Testa B, and Cutrera R
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- Adolescent, Child, Child, Preschool, Female, Home Care Services, Humans, Infant, Infant, Newborn, Patient Compliance, Sleep, Noninvasive Ventilation instrumentation, Software, Ventilators, Mechanical
- Abstract
Information gathered with built-in software (BIS) on new ventilators allow clinicians to access long-term noninvasive ventilation (LTNIV) data. Nevertheless, few evidence are available in literature that highlight potential strengths and disadvantages of using BIS in pediatrics. We aim to evaluate the use of BIS in a cohort of 90 children on LTNIV in our unit, focusing mainly on adherence, air leaks, and residual sleep events. We found that caregivers' perception of ventilator use is independent from objective adherence (P = .137). Furthermore, we failed to find any predictors of adherence. As regards air leaks, we found that pre-scholars' (0-6 years old) total air leaks are lower than teenagers' (more than 12 years old) (P < .05). Multiple regressive analysis showed that age at the beginning of therapy is a predictor of total air leaks: prescholars are associated with lower values (P < .05), while scholars (6-12 years old) are associated with higher values (P < .05). Finally, we explored the validity of BIS automatic scoring of sleep events (AHI
BIS ) as compared with the manual scoring of polygraphy (AHIPG ). AHIBIS is within a range of 3.98 from AHIPG in 95% of cases, with a 64% of sensitivity and a 67% of specificity in identifying a pathological state. The disagreement between the two methods seems to increase for high AHI values. In conclusion, data gathered by BIS are a useful support tool for the clinician in assessing the course of LTNIV. However, clinicians must be aware of the several limitations of built-in software, especially in pediatrics., (© 2020 Wiley Periodicals LLC.)- Published
- 2020
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11. Ventilators and Ventilatory Modalities.
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Pavone M, Verrillo E, Onofri A, Caggiano S, and Cutrera R
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Non-invasive ventilation is increasingly used in children for acute and chronic respiratory failure. Ventilators available for clinical use have different levels of complexity, and clinicians need to know in detail their characteristics, setting variables, and performances. A wide range of ventilators are currently used in non-invasive ventilation including bi-level ventilators, intermediate ventilators, and critical care ventilators. Simple or advanced continuous positive airway pressure devices are also available. Differences between ventilators may have implications on the development of asynchronies and air leaks and may be associated with discomfort and poor patient tolerance. Although pressure-targeted (controlled) mode is preferable in children because of barotrauma concerns, volume-targeted (controlled) ventilators are also available. Pressure support ventilation represents the most used non-invasive ventilation mode, as it is more physiological. The newest ventilators allow the clinicians to use the hybrid modes that combine the advantages of volume- and pressure-targeted (controlled) ventilation while limiting their drawbacks. The use of in-built software may help clinicians to optimize the ventilator setting as well as to objectively monitor patient adherence to the treatment. The present review aims to help the clinician with the choice of the ventilator and its ventilation modalities to ensure a successful non-invasive ventilation program., (Copyright © 2020 Pavone, Verrillo, Onofri, Caggiano and Cutrera.)
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- 2020
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12. Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome.
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Pavone M, Verrillo E, Onofri A, Caggiano S, Chiarini Testa MB, and Cutrera R
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- Adolescent, Child, Child, Preschool, Chronic Disease, Female, Follow-Up Studies, Humans, Infant, Male, Retrospective Studies, Rome, Treatment Outcome, Respiration, Artificial methods, Respiratory Insufficiency therapy, Tertiary Care Centers
- Abstract
Background: Children with chronic respiratory failure and/or sleep disordered breathing due to a broad range of diseases may require long-term ventilation to be managed at home. Advances in the use of long-term non-invasive ventilation has progressively leaded to a reduction of the need for invasive mechanical ventilation through tracheostomy. In this study, we sought to characterize a cohort of children using long-term NIV and IMV and to perform an analysis of those children who showed significant changes in ventilatory support management., Methods: We performed a retrospective cohort study of pediatric (within 18 years old) patients using long-term, NIV and IMV, hospitalized in our center between January 1, 2000 and December 31, 2017. A total of 432 children were included in the study. Long Term Ventilation (LTV) was defined as IMV or NIV, performed on a daily basis, at least 6 h/day, for a period of at least 3 months., Results: 315 (72.9%) received non-invasive ventilation (NIV); 117 (27.1%) received invasive mechanical ventilation (IMV). Children suffered mainly from neuromuscular (30.6%), upper airway (24.8%) and central nervous system diseases (22.7%). Children on IMV were significantly younger when they start LTV [NIV: 6.4 (1.2-12.8) years vs IMV 2.1 (0.8-7.8) years] (p < 0.001)]. IMV was likely associated with younger age at starting ventilatory support (aOR 0.9428; p = 0.0220), and being a child with home health care (aOR 11.4; p < 0.0001). Overtime 39 children improved (9%), 11 children on NIV (3.5%) received tracheostomy; 62 children died (14.3%); and 74 children (17.1%) were lost to follow-up (17.8% on NIV, 15.4% on IMV)., Conclusions: Children on LTV suffered mainly from neuromuscular, upper airways, and central nervous system diseases. Children invasively ventilated usually started support younger and were more severely ills.
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- 2020
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13. Decannulation in children affected by congenital central hypoventilation syndrome: A proposal of an algorithm from two European centers.
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Paglietti MG, Porcaro F, Sovtic A, Cherchi C, Verrillo E, Pavone M, Bottero S, and Cutrera R
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- Bronchoscopy, Child, Child, Preschool, Female, Humans, Hypoventilation therapy, Male, Polysomnography, Respiration, Artificial methods, Retrospective Studies, Tracheostomy, Airway Extubation methods, Algorithms, Hypoventilation congenital, Noninvasive Ventilation, Sleep Apnea, Central therapy
- Abstract
Rationale: Long-life ventilatory assistance is necessary for survival in pediatric patients with congenital central hypoventilation syndrome (CCHS). Invasive mechanical ventilation (IMV) through tracheostomy is the most used method, especially in the first years of life when the central nervous system is maturing. Nevertheless, IMV via tracheostomy is not ideal because tracheostomy in children is associated with impaired speech and language development, also frequent infections of the lower airway tract occur., Objective: Only few reports describe the transition from IMV to the noninvasive method, ending with decannulation in CCHS affected patients. We aim to provide our experience regarding decannulation program in CCHS affected children and to describe a proposal of an algorithm concerning transition from invasive to noninvasive ventilation (NIV) in CCHS patients., Methods: The study has been conducted retrospectively. Four children from two European centers underwent tracheostomy removal and decannulation, upon request of patients and their families., Results: All children were trained to carry out tracheostomy capping before decannulation and underwent endoscopic assessment of upper and lower airway. Subsequently they started training to NIV at mean age of 106.25 months (±40.7 SD). Decannulation occurred 12 months after and no patients needed the reintroduction of tracheal cannula in either short or long term follow up., Conclusions: our study shows that effective liberation from IMV, the transition to NIV and decannulation are possible in CCHS affected children and offers a proposal of an algorithm which can be applied in selected centers., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2019
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14. Transition to adult care in young people with neuromuscular disease on non-invasive ventilation.
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Onofri A, Tan HL, Cherchi C, Pavone M, Verrillo E, Ullmann N, Testa MBC, and Cutrera R
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- Adolescent, Female, Health Services Needs and Demand, Humans, Italy, London, Male, Retrospective Studies, Neuromuscular Diseases, Noninvasive Ventilation, Transition to Adult Care
- Abstract
Background: Long-term mechanical ventilation (LTV) with non-invasive ventilation (NIV) prolongs survival in patients with Neuromuscular Diseases (NMDs). Transition from paediatric to adult healthcare system is an undervalued and challenging issue for children with chronic conditions on mechanical ventilation., Methods: this retrospective study aims to compare issues of young adults in age to transition to adult care (≥ 15 years old) affected by NMDs on NIV in two different Paediatric Respiratory Units in two different countries: Bambino Gesù Children's Hospital, Research Institute, (Rome, Italy) (BGCH) and the Paediatric Respiratory Unit of the Royal Brompton Hospital (London, UK) (RBHT)., Results: The median (min-max) age at starting ventilation was significantly different in the two groups (16 years old vs 12, p = 0.0006). We found significant difference in terms of median age at the time of observation (18 (15-22) vs 17 (15-19) years, p = 0.0294) and of type of referral (all the patients from the BGCH group were referred to paediatric services (n = 15, 100%), median age 18 (15-22); only 6 patients, in the RBHT group, with a median age 15.50 (15-17) years, were entirely referred to paediatric service). We found different sleep-disordered breathing assessments 6 full Polysomnographies, 7 Cardio-Respiratory Polygraphies and 2 oximetry with capnography (SpO
2 -tcCO2 ) studies in the BCGH group, while all patients of RBHT group were assessed with an SpO2 -tcCO2 study. All patients from both groups underwent multidisciplinary assessment., Conclusions: In conclusion, patients with NMDs on NIV in age to transition to adult require complex multidisciplinary management: significant efforts are needed to achieve the proper transition to adult care.- Published
- 2019
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15. Effects of long-term non-invasive ventilation on sleep structure in children with Spinal Muscular Atrophy type 2.
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Verrillo E, Pavone M, Bruni O, Ferri R, Caggiano S, Chiarini Testa MB, Cherchi C, and Cutrera R
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- Case-Control Studies, Child, Child, Preschool, Female, Humans, Male, Noninvasive Ventilation methods, Polysomnography methods, Sleep Arousal Disorders physiopathology, Sleep Stages physiology, Sleep, REM physiology, Spinal Muscular Atrophies of Childhood complications, Wakefulness physiology, Noninvasive Ventilation adverse effects, Sleep physiology, Spinal Muscular Atrophies of Childhood physiopathology, Spinal Muscular Atrophies of Childhood therapy
- Abstract
Objective: Changes of sleep architecture have been reported in children with Spinal Muscular Atrophy type 2 (SMA2), mainly represented by a decrease of arousability. No studies have evaluated the effect of long-term ventilation on sleep parameters in these children. The aim of this study was to evaluate the effects of long-term non-invasive positive pressure ventilation (LTNPPV) on sleep architecture and to assess the residual differences from normal controls., Methods: Nine consecutive children with SMA2 underwent two distinct polysomnographic (PSG) studies, one in spontaneous breathing, and subsequently after LTNPPV. The results were then compared to 15 age-matched controls., Results: SMA2 patients showed only slightly modified sleep architecture on LTNPPV: increased stage N2% and decreased number of awakenings, while several significant differences persisted between SMA2 patients on LTNPPV and controls (decreased total sleep time, number of awakenings, sleep efficiency, and percentage of REM sleep). Sleep microstructure, evaluated by means of the Cyclic alternating pattern (CAP) showed only marginal changes on LTNPPV (small shortening of CAP A1 subtype duration and small increase in CAP A3 index). Conversely, CAP parameters on LTNPPV showed significant differences between SMA2 patients vs. controls, with increased A1 subtype percentage and decreased percentage of A2 and A3 subtypes., Conclusions: This is the first study in children affected by SMA2 reporting data on sleep microstructure and their changes after LTNPPV. We found persisting, small but important changes in sleep microstructure during LTNPPV in these children, suggesting that this treatment only partially improves their arousability., (Copyright © 2019 Elsevier B.V. All rights reserved.)
- Published
- 2019
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16. Anti-Hypothalamus and Anti-Pituitary Auto-antibodies in ROHHAD Syndrome: Additional Evidence Supporting an Autoimmune Etiopathogenesis.
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Giacomozzi C, Guaraldi F, Cambiaso P, Niceta M, Verrillo E, Tartaglia M, and Cutrera R
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- Child, Preschool, Comparative Genomic Hybridization, Fatal Outcome, Female, Humans, Syndrome, Whole Genome Sequencing, Autoantibodies blood, Autoimmune Diseases blood, Autoimmune Diseases cerebrospinal fluid, Autoimmune Diseases genetics, Autoimmune Diseases therapy, Autonomic Nervous System Diseases blood, Autonomic Nervous System Diseases cerebrospinal fluid, Autonomic Nervous System Diseases genetics, Autonomic Nervous System Diseases therapy, Hypothalamic Diseases blood, Hypothalamic Diseases cerebrospinal fluid, Hypothalamic Diseases genetics, Hypothalamic Diseases therapy, Hypoventilation blood, Hypoventilation cerebrospinal fluid, Hypoventilation genetics, Hypoventilation therapy, Pediatric Obesity blood, Pediatric Obesity cerebrospinal fluid, Pediatric Obesity genetics, Pediatric Obesity therapy
- Abstract
Background: Rapid-onset Obesity with Hypothalamic dysfunction, Hypoventilation and Autonomic Dysregulation (ROHHAD) is a very rare and complex pediatric syndrome characterized by altered hypothalamic thermal regulation, pain threshold, and respiratory control, hyperphagia with rapid weight gain and, often, hypothalamic-pituitary dysfunction. Its etiopathogenesis remains undetermined. We investigated the presence of alterations to target genes and hypothalamic-pituitary autoimmunity in a patient with -ROHHAD syndrome., Methods: A 3-year-old girl presenting with obesity after rapid weight gain was diagnosed with ROHHAD syndrome based on clinical features and abnormal biochemical and functional testing results. Because of worsening of rapid symptoms and demonstration of oligoclonal bands on cerebrospinal fluid (CSF) analysis, she was treated with plasmapheresis, methylprednisolone, anti-CD20 monoclonal antibodies, and azathioprine. Despite initial partial clinical improvement, the patient soon died of cardiorespiratory arrest. Post-mortem, whole exome sequencing, high-resolution comparative genomic hybridization array, and optimized indirect immunofluorescence (IIF) analysis were performed on blood and CSF., Results: No putative causative genomic variants compatible with dominant or recessive inheritance nor clinically significant structural rearrangement were detected. IIF on serum and CSF demonstrated the presence of anti-pituitary and anti-hypothalamus autoantibodies., Conclusions: These findings support the involvement of autoimmunity in ROHHAD syndrome. However, response to immunosuppressive treatment was only transient and the patient died. Further cases are required to define the complex disease pathogenesis., (© 2019 S. Karger AG, Basel.)
- Published
- 2019
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17. Dynamic expiratory CT: An effective non-invasive diagnostic exam for fragile children with suspected tracheo-bronchomalacia.
- Author
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Ullmann N, Secinaro A, Menchini L, Caggiano S, Verrillo E, Santangelo TP, Cutrera R, and Tomà P
- Subjects
- Bronchi diagnostic imaging, Bronchoscopy, Child, Child, Preschool, Female, Humans, Infant, Male, Tomography, X-Ray Computed, Trachea diagnostic imaging, Tracheobronchomalacia diagnosis, Tracheobronchomalacia diagnostic imaging
- Abstract
Background: Tracheobronchomalacia, defined as variable collapse of the airways, has been recognized as an important cause of respiratory morbidity but still widely underdiagnosed. Bronchoscopy is still considered as the gold standard, but numerous limitations are known, especially for fragile sick children. Moreover, information on parenchymal lung disease cannot be described. There is a real need for a reliable, non-invasive test to help detection of airway and parenchymal malformations in children, specifically when bronchoscopy cannot be performed., Methods and Results: 34 paediatric patients underwent cine multidector CT for ongoing respiratory symptoms and were included. All CT images were of good quality and sedation was never needed. Airway disease such as trachea-broncomalacia with/without stenosis was described in 53% with the first being more frequent. Bronchomalacia alone was described in 10 patients and in 4 patients was associated with tracheomalacia. Moreover, CT allowed identification of parenchymal disease in 10 patients. Airways stenosis alone was detected in seven patients. The majority of patients (85%) underwent also bronchoscopy for clinical decision. The agreement between CT and bronchoscopy was explored. The two examinations did not agree only in two cases. CT dynamic showed an excellent sensitivity of 100% (81.47-100 %), a great specificity of 82% (48.22-97.72 %), NPV 100%, and PPV 90% (72-96.9 %)., Conclusion: Dynamic CT results an effective and highly sensitive diagnostic exam for children with tracheo-bronchomalacia. CT is especially indicated for those small and fragile patients that cannot undergo an invasive investigation. Moreover, CT allows a detailed evaluation both of the airways and the lungs which is useful for the clinical management., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2018
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18. Age and seasons influence on at-home pulse oximetry results in children evaluated for suspected obstructive sleep apnea.
- Author
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Pavone M, Verrillo E, Ullmann N, Caggiano S, Negro V, and Cutrera R
- Subjects
- Adolescent, Age Factors, Body Mass Index, Child, Child, Preschool, Cohort Studies, Female, Home Care Services, Humans, Logistic Models, Male, Predictive Value of Tests, Prevalence, Prognosis, Retrospective Studies, Risk Assessment, Severity of Illness Index, Sex Factors, Oximetry methods, Seasons, Sleep Apnea Syndromes diagnosis, Sleep Apnea Syndromes epidemiology
- Abstract
Background: Seasonal variability on obstructive sleep apnea has already been studied by polysomnography in children. Winter and spring season emerged as critical periods. No data are currently available for pulse oximetry performed at home. The aim of our study was to evaluate the effect of seasonality and age on the results of at-home pulse oximetry performed in children referred for suspected OSA., Methods: We retrospectively studied 781 children (64.3% Males), aged 4.9 ± 2.5 years. For all patients, we evaluated both pulse oximetry metrics and the McGill Oximetry Score. Variables for seasonal groups were assessed using Kruskal-Wallis test. A logistic regression model was performed to assess the relationship between patients' main characteristics, season period and the likelihood to have an abnormal McGill Oximetry Score., Results: Patients recorded during winter were significantly younger (p < 0.02), nadir SpO
2 was significantly lower (p < 0.002) and DI4 significantly higher than during others seasons (p < 0.005). Moreover, patients recorded during winter were nearly 2 times more likely to have an abnormal MOS (aOR 1.949). The logistic regression showed that also younger age (p < 0.0001) was associated with a higher risk to find an abnormal pulse oximetry., Conclusions: In our study, the winter season confirms to be a critical period for pulse-oximetry and it should be taken into account by clinicians for a correct interpretation of tests. Our data show that also younger age affects the prevalence of abnormal at-home pulse oximetry in children.- Published
- 2017
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19. Sleep in infants with congenital myasthenic syndromes.
- Author
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Caggiano S, Khirani S, Verrillo E, Barnerias C, Amaddeo A, Gitiaux C, Thierry B, Desguerre I, Cutrera R, and Fauroux B
- Subjects
- Female, Heart Rate, Humans, Infant, Male, Polysomnography, Myasthenic Syndromes, Congenital complications, Sleep Apnea Syndromes etiology, Sleep Apnea Syndromes physiopathology
- Abstract
Background and Objectives: Infants with congenital myasthenic syndrome (CMS) are at risk of brief resolved unexplained event (BRUE) and sleep-disordered breathing. The aim of the study was to explore sleep in infants with CMS with a particular focus on heart rate (HR) variability., Methods: Overnight polygraphy was performed and HR variations associated with respiratory events were analysed. Bradycardia and tachycardia were defined as a variation of HR of ±10 bpm from baseline and analysed as events/hour., Results: The data of 5 infants with CMS were analysed. Two patients had known mutations (COLQ and RAPSN). One patient had a tracheostomy. The apnoea-hypopnoea index (AHI) was abnormal in all the patients (range 2.8-47.7 events/h), with the highest AHI being observed in the 3 youngest infants. Nocturnal transcutaneous gas exchange was normal in all patients except the tracheostomised patient. Mean HR was 114 ± 23 bpm with a mean HR index of 4.5 ± 4.3 events/h. The amplitudes of HR variations (bradycardia or tachycardia) were around 15-20 bpm, regardless of the type of respiratory event, and comparable between patients. No correlations were found between HR indexes or variations and the type and mean duration of respiratory events. Ventilatory support was initiated in 3 infants immediately after the sleep study because of a high AHI and/or nocturnal hypoventilation., Conclusions: All 5 infants had an abnormal AHI with younger infants having the highest AHI. Three infants required ventilatory support after the polygraphy, underlining its clinical usefulness. No significant abnormalities of HR were observed during the sleep studies., (Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.)
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- 2017
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20. At-home pulse oximetry in children undergoing adenotonsillectomy for obstructive sleep apnea.
- Author
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Pavone M, Ullmann N, Verrillo E, De Vincentiis G, Sitzia E, and Cutrera R
- Subjects
- Adolescent, Chi-Square Distribution, Child, Child, Preschool, Female, Humans, Infant, Logistic Models, Male, Polysomnography, Retrospective Studies, Sleep Apnea, Obstructive diagnosis, Surveys and Questionnaires, Heart Rate physiology, Oximetry methods, Predictive Value of Tests, Sleep Apnea, Obstructive surgery, Tonsillectomy statistics & numerical data
- Abstract
Nocturnal pulse oximetry has a high positive predictive value for polysomnographically diagnosed obstructive sleep apnoea (OSA) in children. When significant adenotonsillar hypertrophy is diagnosed, adenotonsillectomy (T&A) represents a common treatment for OSA in children. We investigated the role of pulse oximetry in predicting those patients, referred for suspected OSA, who subsequently needed T&A. At-home nocturnal pulse oximetry was performed on 380 children (65.7% males), median age 4.1(IRQ 3.0-5.6) years, referred for suspected OSA, and data were retrospectively analysed. For each recording McGill Oximetry Score (MOS) was categorized. Mean pulse rate (PR) z-score and pulse rate variability (PRV)-corrected (PRSD/meanPR) were significantly higher in children with abnormal MOS. Both parameters were significantly higher in subjects who underwent T&A compared with those not surgically treated. Both DI
4 and PRV corrected showed a negative correlation with the elapsed time between pulse oximetry recordings and T&A. The logistic regression model showed a strong effect of an abnormal MOS as a predicting factor for T&A (adjusted odds ratio 19.7)., Conclusions: In our study, children with OSA who subsequently needed T&A showed higher PRV compared to those without surgical indication. Children with abnormal MOS were nearly 20 times more likely to undergo T&A. What is Known: • Nocturnal pulse oximetry has a high positive predictive value for polysomnographically diagnosed obstructive sleep apnoea in children. • When significant adenotonsillar hypertrophy is diagnosed, adenotonsillectomy represents a common treatment for OSA in children. What is New: • An abnormal pulse oximetry highly predict the indication for adenotonsillectomy. • We suggest the use of at-home pulse oximetry as method to predict prescription of adenotonsillectomy, and this may be useful in contexts where polysomnography is not readily available.- Published
- 2017
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21. Sleep architecture in children with spinal muscular atrophy type 2.
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Verrillo E, Pavone M, Bruni O, Paglietti MG, Ferri R, Petreschi F, Chiarini Testa MB, and Cutrera R
- Subjects
- Child, Preschool, Electroencephalography methods, Female, Humans, Male, Polysomnography methods, Sleep physiology, Sleep Arousal Disorders physiopathology, Wakefulness physiology, Sleep Arousal Disorders etiology, Sleep Stages physiology, Spinal Muscular Atrophies of Childhood complications
- Abstract
Objective: There have been few published reports on the sleep patterns of patients with spinal muscular atrophy (SMA) type 2, and none on sleep microstructure. The aim of this study was to analyze sleep architecture and microstructure in a group of children with SMA type 2, compared with age-matched and sex-matched controls., Methods: Seventeen SMA type 2 children (seven males, mean age 4.2 years) and 12 controls (five males, mean age 5.0 years) underwent full polysomnography to evaluate sleep architecture and microstructure by means of the Cyclic Alternating Pattern (CAP)., Results: Compared with the control children, the SMA type 2 patients showed a mild increase in the apnea/hypopnea index. Sleep was characterized by a decrease in the number of sleep stage shifts per hour, of percentage of stage N3, of stage R, and of sleep efficiency. On the contrary, significant increases of awakenings per hour, wake after sleep onset, and percentage of stage N1 were found. The CAP analysis revealed a significant increase in the percentage of A1 CAP subtypes, a reduction of that of A3 subtypes, and of A2 and A3 indexes., Conclusions: The results indicated an abnormality of sleep macrostructure and microstructure in SMA type 2 patients, which was characterized by a reduction of A2 and A3 subtypes (low and high power arousals), supporting the concept of a decreased arousability in SMA type 2 patients. Similar to a previous report on SMA type 1, the findings might be additional proof of central nervous system involvement, although these alterations are less severe than those observed in infants with SMA type 1., (Copyright © 2016 Elsevier B.V. All rights reserved.)
- Published
- 2016
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22. Sleep architecture in infants with spinal muscular atrophy type 1.
- Author
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Verrillo E, Bruni O, Pavone M, Ferri R, Caldarelli V, Novelli L, Testa MB, and Cutrera R
- Subjects
- Case-Control Studies, Female, Humans, Infant, Male, Polysomnography, Sleep physiology, Sleep Arousal Disorders etiology, Sleep Arousal Disorders physiopathology, Sleep Deprivation etiology, Sleep Deprivation physiopathology, Sleep Wake Disorders physiopathology, Spinal Muscular Atrophies of Childhood physiopathology, Sleep Wake Disorders etiology, Spinal Muscular Atrophies of Childhood complications
- Abstract
Objective: Few reports on sleep patterns of patients with spinal muscular atrophy type 1 (SMA1) have been published and none on sleep microstructure. The aim of this study was to analyze sleep architecture and microstructure in a group of infants with SMA1, compared with age- and sex-matched controls., Methods: Twelve SMA1 patients (six males, mean age 5.9 months) and 10 controls (five males, mean age 4.8 months) underwent full polysomnography to evaluate their sleep architecture and microstructure by means of the cyclic alternating pattern (CAP)., Results: Compared with control children, SMA1 patients showed increased sleep latency and apnea/hypopnea index. CAP analysis revealed a significant increase in the percentage of A1 CAP subtypes, a reduction of that of A3 subtypes and of A2 and A3 indexes (number/h), indicating a dysfunction of the arousal system in these patients., Conclusion: The results indicate the presence of an abnormality of sleep microstructure in SMA1 patients, characterized by a reduction of A2 and A3 CAP subtypes. We hypothesize that SMA1 patients have reduced arousability during non-rapid eye movement sleep, which could be interpreted as additional evidence of central nervous system involvement in this disease., (Copyright © 2014 Elsevier B.V. All rights reserved.)
- Published
- 2014
- Full Text
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