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2. Thrombotic Features as the Primary Cause of SARS-CoV-2 Related Acute Abdomen in Children

Author

Amoroso, A, Di Stasio, F, Ranucci, G, Betalli, P, Cheli, M, Dalla Rosa, D, D'Anna, C, Gaglione, G, Giannotti, G, Licini, L, Mandato, C, Massazza, G, Orlando, F, Morotti, D, Rocco, M, Sonzogni, A, Tipo, V, Verdoni, L, D'Antiga, L, Norsa, L, Amoroso A., Di Stasio F., Ranucci G., Betalli P., Cheli M., Dalla Rosa D., D'anna C., Gaglione G., Giannotti G., Licini L., Mandato C., Massazza G., Orlando F., Morotti D., Rocco M., Sonzogni A., Tipo V., Verdoni L., D'antiga L., Norsa L., Amoroso, A, Di Stasio, F, Ranucci, G, Betalli, P, Cheli, M, Dalla Rosa, D, D'Anna, C, Gaglione, G, Giannotti, G, Licini, L, Mandato, C, Massazza, G, Orlando, F, Morotti, D, Rocco, M, Sonzogni, A, Tipo, V, Verdoni, L, D'Antiga, L, Norsa, L, Amoroso A., Di Stasio F., Ranucci G., Betalli P., Cheli M., Dalla Rosa D., D'anna C., Gaglione G., Giannotti G., Licini L., Mandato C., Massazza G., Orlando F., Morotti D., Rocco M., Sonzogni A., Tipo V., Verdoni L., D'antiga L., and Norsa L.

Abstract

Objectives: We performed a retrospective case control study to evaluate the histological characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive pediatric patients undergoing laparoscopic exploration for acute abdomen symptoms. To our knowledge this is the first study that analyzes histopathological characteristics of abdominal tissues in SARS-CoV-2 children. Study design: We enrolled 8 multisystem inflammatory syndrome in children (MIS-C) patients and 4 SARS-CoV-2 positive patients who underwent intestinal resection versus 36 control appendectomies from 2 pediatric tertiary referral centers between March 2020 and July 2021. Surgical resection samples were evaluated on several histological sections focusing on general inflammatory pattern and degree of inflammation. Peculiar histological features (endotheliitis and vascular thrombosis) were semi-quantitatively scored respectively in capillary, veins, and arteries. Results: All SARS-CoV-2 related surgical samples showed thrombotic patterns. Those patterns were significantly less frequent in SARS-CoV-2 negative appendectomies (P = 0.004). The semi-quantitative score of thrombosis was significantly higher (P = 0.002) in patients with SARS-CoV-2 related procedures. Conclusions: Our results showed that SARS-CoV-2 can cause thrombotic damage in abdominal tissues both in the acute phase of the infection (SARS-CoV-2 related appendectomies) and secondary to cytokine storm (MIS-C).

Published
2023

4. Children with special health care needs attending emergency department in Italy: analysis of 3479 cases

Author

Cianci, P, D'Apolito, V, Moretti, A, Barbagallo, M, Paci, S, Carbone, M, Lubrano, R, Urbino, A, Dionisi Vici, C, Memo, L, Zampino, G, La Marca, G, Villani, A, Corsello, G, Selicorni, A, Campania, A, Geremia, C, Castagno, E, Masi, S, Poggi, G, Vestri, M, Fossali, E, Rocchi, A, Dadalt, L, Arrighini, A, Chiappa, S, Renna, S, Piccotti, E, Borgna, C, Govoni, M, Biondi, A, Fossati, C, Iughetti, L, Bertolani, P, Salvatoni, A, Agosti, M, Fuca, F, Ilardi, A, Giuffrida, S, Diguardo, V, Boni, S, D'Antiga, L, Ruggeri, M, Chiaretti, A, Amarri, S, Peduto, A, Bernardi, F, Corsini, I, Deangelis, G, Ruberto, C, Zuccotti, G, Stringhi, C, Lombardi, G, Salladini, C, Dimichele, S, Parola, L, Porta, A, Biasucci, G, Bellini, M, Ortisi, M, Apuril, E, Midulla, F, Tarani, L, Parlapiano, G, Lietti, D, Sforzini, C, Marseglia, G, Savasta, S, Falsaperla, R, Vitaliti, M, Chiarelli, F, Rossi, N, Banderali, G, Giacchero, R, Bernardo, L, Pinto, F, Fabiani, E, Ficcadenti, A, Pellegrini, G, Giacoma, S, Biban, P, Spada, S, Tipo, V, Ghitti, C, Bolognini, S, Mariani, G, Russo, A, Colella, M, Verrico, A, Bruni, P, Poddighe, D, Cagnoli, G, Morandi, F, Gadaleta, A, Barbi, E, Bruno, I, Graziano, R, Sgaramella, P, Catalani, M, Baldoni, I, Colarusso, G, Galvagno, G, Barone, A, Longo, A, Nardella, G, Portale, G, Garigali, G, Bona, G, Erbela, M, Agostiniani, R, Nanni, L, Schieven, E, Dona, M, Varisco, T, Russo, F, Distefano, V, Dipietro, F, Tarallo, L, Imperato, L, Parisi, G, Salzano, R, Raiola, G, Talarico, V, Bellu, R, Cannone, A, Ferrante, P, Cianci P., D'Apolito V., Moretti A., Barbagallo M., Paci S., Carbone M. T., Lubrano R., Urbino A., Dionisi Vici C., Memo L., Zampino G., La Marca G., Villani A., Corsello G., Selicorni A., Campania A., Geremia C., Castagno E., Masi S., Poggi G., Vestri M., Fossali E., Rocchi A., DaDalt L., Arrighini A., Chiappa S., Renna S., Piccotti E., Borgna C., Govoni M. R., Biondi A., Fossati C., Iughetti L., Bertolani P., Salvatoni A., Agosti M., Fuca F., Ilardi A., Giuffrida S., DiGuardo V., Boni S., D'Antiga L., Ruggeri M., Chiaretti A., Amarri S., Peduto A., Bernardi F., Corsini I., DeAngelis G. L., Ruberto C., Zuccotti G. V., Stringhi C., Lombardi G., Salladini C., DiMichele S., Parola L., Porta A., Biasucci G., Bellini M., Ortisi M. T., Apuril E., Midulla F., Tarani L., Parlapiano G., Lietti D., Sforzini C., Marseglia G. L., Savasta S., Falsaperla R., Vitaliti M. C., Chiarelli F., Rossi N., Banderali G., Giacchero R., Bernardo L., Pinto F., Fabiani E., Ficcadenti A., Pellegrini G., Giacoma S., Biban P., Spada S., Tipo V., Ghitti C., Bolognini S., Mariani G., Russo A., Colella M. G., Verrico A., Bruni P., Poddighe D., Cagnoli G., Morandi F., Gadaleta A., Barbi E., Bruno I. I., Graziano R., Sgaramella P., Catalani M. P., Baldoni I., Colarusso G., Galvagno G., Barone A. P., Longo A., Nardella G., Portale G., Garigali G., Bona G., Erbela M., Agostiniani R., Nanni L., Schieven E., Dona M., Varisco T., Russo F., DiStefano V. A., DiPietro F., Tarallo L., Imperato L., Parisi G., Salzano R., Raiola G., Talarico V., Bellu R., Cannone A., Ferrante P., Cianci, P, D'Apolito, V, Moretti, A, Barbagallo, M, Paci, S, Carbone, M, Lubrano, R, Urbino, A, Dionisi Vici, C, Memo, L, Zampino, G, La Marca, G, Villani, A, Corsello, G, Selicorni, A, Campania, A, Geremia, C, Castagno, E, Masi, S, Poggi, G, Vestri, M, Fossali, E, Rocchi, A, Dadalt, L, Arrighini, A, Chiappa, S, Renna, S, Piccotti, E, Borgna, C, Govoni, M, Biondi, A, Fossati, C, Iughetti, L, Bertolani, P, Salvatoni, A, Agosti, M, Fuca, F, Ilardi, A, Giuffrida, S, Diguardo, V, Boni, S, D'Antiga, L, Ruggeri, M, Chiaretti, A, Amarri, S, Peduto, A, Bernardi, F, Corsini, I, Deangelis, G, Ruberto, C, Zuccotti, G, Stringhi, C, Lombardi, G, Salladini, C, Dimichele, S, Parola, L, Porta, A, Biasucci, G, Bellini, M, Ortisi, M, Apuril, E, Midulla, F, Tarani, L, Parlapiano, G, Lietti, D, Sforzini, C, Marseglia, G, Savasta, S, Falsaperla, R, Vitaliti, M, Chiarelli, F, Rossi, N, Banderali, G, Giacchero, R, Bernardo, L, Pinto, F, Fabiani, E, Ficcadenti, A, Pellegrini, G, Giacoma, S, Biban, P, Spada, S, Tipo, V, Ghitti, C, Bolognini, S, Mariani, G, Russo, A, Colella, M, Verrico, A, Bruni, P, Poddighe, D, Cagnoli, G, Morandi, F, Gadaleta, A, Barbi, E, Bruno, I, Graziano, R, Sgaramella, P, Catalani, M, Baldoni, I, Colarusso, G, Galvagno, G, Barone, A, Longo, A, Nardella, G, Portale, G, Garigali, G, Bona, G, Erbela, M, Agostiniani, R, Nanni, L, Schieven, E, Dona, M, Varisco, T, Russo, F, Distefano, V, Dipietro, F, Tarallo, L, Imperato, L, Parisi, G, Salzano, R, Raiola, G, Talarico, V, Bellu, R, Cannone, A, Ferrante, P, Cianci P., D'Apolito V., Moretti A., Barbagallo M., Paci S., Carbone M. T., Lubrano R., Urbino A., Dionisi Vici C., Memo L., Zampino G., La Marca G., Villani A., Corsello G., Selicorni A., Campania A., Geremia C., Castagno E., Masi S., Poggi G., Vestri M., Fossali E., Rocchi A., DaDalt L., Arrighini A., Chiappa S., Renna S., Piccotti E., Borgna C., Govoni M. R., Biondi A., Fossati C., Iughetti L., Bertolani P., Salvatoni A., Agosti M., Fuca F., Ilardi A., Giuffrida S., DiGuardo V., Boni S., D'Antiga L., Ruggeri M., Chiaretti A., Amarri S., Peduto A., Bernardi F., Corsini I., DeAngelis G. L., Ruberto C., Zuccotti G. V., Stringhi C., Lombardi G., Salladini C., DiMichele S., Parola L., Porta A., Biasucci G., Bellini M., Ortisi M. T., Apuril E., Midulla F., Tarani L., Parlapiano G., Lietti D., Sforzini C., Marseglia G. L., Savasta S., Falsaperla R., Vitaliti M. C., Chiarelli F., Rossi N., Banderali G., Giacchero R., Bernardo L., Pinto F., Fabiani E., Ficcadenti A., Pellegrini G., Giacoma S., Biban P., Spada S., Tipo V., Ghitti C., Bolognini S., Mariani G., Russo A., Colella M. G., Verrico A., Bruni P., Poddighe D., Cagnoli G., Morandi F., Gadaleta A., Barbi E., Bruno I. I., Graziano R., Sgaramella P., Catalani M. P., Baldoni I., Colarusso G., Galvagno G., Barone A. P., Longo A., Nardella G., Portale G., Garigali G., Bona G., Erbela M., Agostiniani R., Nanni L., Schieven E., Dona M., Varisco T., Russo F., DiStefano V. A., DiPietro F., Tarallo L., Imperato L., Parisi G., Salzano R., Raiola G., Talarico V., Bellu R., Cannone A., and Ferrante P.

Abstract

Background: Although children with special health care needs (CSHCN) represent a minority of the population, they go through more hospitalizations, more admissions to the Emergency Department (ED), and receive a major number of medical prescriptions, in comparison to general pediatric population. Objectives of the study were to determine the reasons for admission to the ED in Italian CSHCN, and to describe the association between patient’s demographic data, clinical history, and health services requirements. Methods: Ad hoc web site was created to collect retrospective data of 3479 visits of CSHCN to the ED in 58 Italian Hospitals. Results: Seventy-two percent of patients admitted to ED were affected by a previously defined medical condition. Most of the ED admissions were children with syndromic conditions (54%). 44.2% of the ED admissions were registered during the night-time and/or at the weekends. The hospitalization rate was of 45.6% among patients admitted to the ED. The most common reason for admission to the ED was the presence of respiratory symptoms (26.6%), followed by gastrointestinal problems (21.3%) and neurological disorders (18.2%). 51.4% of the access were classified as ‘urgent’, with a red/yellow triage code. Considering the type of ED, 61.9% of the visits were conducted at the Pediatric EDs (PedEDs), 33.5% at the Functional EDs (FunEDs) and 4.6% at the Dedicated EDs (DedEDs). Patients with more complex clinical presentation were more likely to be evaluated at the PedEDs. CSHCN underwent to a higher number of medical procedures at the PedEDs, more in comparison to other EDs. Children with medical devices were directed to a PedED quite exclusively when in need for medical attention. Subjects under multiple anti-epileptic drug therapy attended to PedEDs or FunEDs generally. Patients affected by metabolic diseases were more likely to look for medical attention at FunEDs. Syndromic patients mostly required medical attention at the DedEDs. Conclusions

Published
2020

5. Collateral effects of COVID-19 pandemic in pediatric hematooncology: Fatalities caused by diagnostic delay

Author

Parasole, R, Stellato, P, Conter, V, De Matteo, A, D'Amato, L, Colombini, A, Pecoraro, C, Bencivenga, C, Raimondo, M, Silvestri, S, Tipo, V, Annicchiarico Petruzzelli, L, Giagnuolo, G, Curatolo, A, Biondi, A, Menna, G, Parasole R., Stellato P., Conter V., De Matteo A., D'Amato L., Colombini A., Pecoraro C., Bencivenga C., Raimondo M., Silvestri S., Tipo V., Annicchiarico Petruzzelli L., Giagnuolo G., Curatolo A., Biondi A., Menna G., Parasole, R, Stellato, P, Conter, V, De Matteo, A, D'Amato, L, Colombini, A, Pecoraro, C, Bencivenga, C, Raimondo, M, Silvestri, S, Tipo, V, Annicchiarico Petruzzelli, L, Giagnuolo, G, Curatolo, A, Biondi, A, Menna, G, Parasole R., Stellato P., Conter V., De Matteo A., D'Amato L., Colombini A., Pecoraro C., Bencivenga C., Raimondo M., Silvestri S., Tipo V., Annicchiarico Petruzzelli L., Giagnuolo G., Curatolo A., Biondi A., and Menna G.

Published
2020

6. Children with special health care needs attending emergency department in Italy: analysis of 3479 cases

Author

Cianci, P., D'Apolito, V., Moretti, A., Barbagallo, M., Paci, S., Carbone, M. T., Lubrano, R., Urbino, A., Dionisi Vici, C., Memo, L., Zampino, G., La Marca, G., Villani, A., Corsello, G., Selicorni, A., Campania, A., Geremia, C., Castagno, E., Masi, S., Poggi, G., Vestri, M., Fossali, E., Rocchi, A., Dadalt, L., Arrighini, A., Chiappa, S., Renna, S., Piccotti, E., Borgna, C., Govoni, M. R., Biondi, A., Fossati, C., Iughetti, L., Bertolani, P., Salvatoni, A., Agosti, M., Fuca, F., Ilardi, A., Giuffrida, S., Diguardo, V., Boni, S., D'Antiga, L., Ruggeri, M., Chiaretti, A., Amarri, S., Peduto, A., Bernardi, F., Corsini, I., Deangelis, G. L., Ruberto, C., Zuccotti, G. V., Stringhi, C., Lombardi, G., Salladini, C., Dimichele, S., Parola, L., Porta, A., Biasucci, G., Bellini, M., Ortisi, M. T., Apuril, E., Midulla, F., Tarani, L., Parlapiano, G., Lietti, D., Sforzini, C., Marseglia, G. L., Savasta, S., Falsaperla, R., Vitaliti, M. C., Chiarelli, F., Rossi, N., Banderali, G., Giacchero, R., Bernardo, L., Pinto, F., Fabiani, E., Ficcadenti, A., Pellegrini, G., Giacoma, S., Biban, P., Spada, S., Tipo, V., Ghitti, C., Bolognini, S., Mariani, G., Russo, A., Colella, M. G., Verrico, A., Bruni, P., Poddighe, D., Cagnoli, G., Morandi, F., Gadaleta, A., Barbi, E., Bruno, I. I., Graziano, R., Sgaramella, P., Catalani, M. P., Baldoni, I., Colarusso, G., Galvagno, G., Barone, A. P., Longo, A., Nardella, G., Portale, G., Garigali, G., Bona, G., Erbela, M., Agostiniani, R., Nanni, L., Schieven, E., Dona, M., Varisco, T., Russo, F., Distefano, V. A., Dipietro, F., Tarallo, L., Imperato, L., Parisi, G., Salzano, R., Raiola, G., Talarico, V., Bellu, R., Cannone, A., Ferrante, P., Cianci, P, D'Apolito, V, Moretti, A, Barbagallo, M, Paci, S, Carbone, M, Lubrano, R, Urbino, A, Dionisi Vici, C, Memo, L, Zampino, G, La Marca, G, Villani, A, Corsello, G, Selicorni, A, Campania, A, Geremia, C, Castagno, E, Masi, S, Poggi, G, Vestri, M, Fossali, E, Rocchi, A, Dadalt, L, Arrighini, A, Chiappa, S, Renna, S, Piccotti, E, Borgna, C, Govoni, M, Biondi, A, Fossati, C, Iughetti, L, Bertolani, P, Salvatoni, A, Agosti, M, Fuca, F, Ilardi, A, Giuffrida, S, Diguardo, V, Boni, S, D'Antiga, L, Ruggeri, M, Chiaretti, A, Amarri, S, Peduto, A, Bernardi, F, Corsini, I, Deangelis, G, Ruberto, C, Zuccotti, G, Stringhi, C, Lombardi, G, Salladini, C, Dimichele, S, Parola, L, Porta, A, Biasucci, G, Bellini, M, Ortisi, M, Apuril, E, Midulla, F, Tarani, L, Parlapiano, G, Lietti, D, Sforzini, C, Marseglia, G, Savasta, S, Falsaperla, R, Vitaliti, M, Chiarelli, F, Rossi, N, Banderali, G, Giacchero, R, Bernardo, L, Pinto, F, Fabiani, E, Ficcadenti, A, Pellegrini, G, Giacoma, S, Biban, P, Spada, S, Tipo, V, Ghitti, C, Bolognini, S, Mariani, G, Russo, A, Colella, M, Verrico, A, Bruni, P, Poddighe, D, Cagnoli, G, Morandi, F, Gadaleta, A, Barbi, E, Bruno, I, Graziano, R, Sgaramella, P, Catalani, M, Baldoni, I, Colarusso, G, Galvagno, G, Barone, A, Longo, A, Nardella, G, Portale, G, Garigali, G, Bona, G, Erbela, M, Agostiniani, R, Nanni, L, Schieven, E, Dona, M, Varisco, T, Russo, F, Distefano, V, Dipietro, F, Tarallo, L, Imperato, L, Parisi, G, Salzano, R, Raiola, G, Talarico, V, Bellu, R, Cannone, A, Ferrante, P, Paola Cianci, Valeria D'Apolito, Alex Moretti, Massimo Barbagallo, Sabrina Paci, Maria Teresa Carbone, Riccardo Lubrano, Antonio Urbino, Carlo Dionisi Vici, Luigi Memo, Giuseppe Zampino, Giancarlo La Marca, Alberto Villani, Giovanni Corsello, Angelo Selicorni, Cianci, P., D'Apolito, V., Moretti, A., Barbagallo, M., Paci, S., Carbone, M. T., Lubrano, R., Urbino, A., Dionisi Vici, C., Memo, L., Zampino, G., La Marca, G., Villani, A., Corsello, G., Selicorni, A., Campania, A., Geremia, C., Castagno, E., Masi, S., Poggi, G., Vestri, M., Fossali, E., Rocchi, A., Dadalt, L., Arrighini, A., Chiappa, S., Renna, S., Piccotti, E., Borgna, C., Govoni, M. R., Biondi, A., Fossati, C., Iughetti, L., Bertolani, P., Salvatoni, A., Agosti, M., Fuca, F., Ilardi, A., Giuffrida, S., Diguardo, V., Boni, S., D'Antiga, L., Ruggeri, M., Chiaretti, A., Amarri, S., Peduto, A., Bernardi, F., Corsini, I., Deangelis, G. L., Ruberto, C., Zuccotti, G. V., Stringhi, C., Lombardi, G., Salladini, C., Dimichele, S., Parola, L., Porta, A., Biasucci, G., Bellini, M., Ortisi, M. T., Apuril, E., Midulla, F., Tarani, L., Parlapiano, G., Lietti, D., Sforzini, C., Marseglia, G. L., Savasta, S., Falsaperla, R., Vitaliti, M. C., Chiarelli, F., Rossi, N., Banderali, G., Giacchero, R., Bernardo, L., Pinto, F., Fabiani, E., Ficcadenti, A., Pellegrini, G., Giacoma, S., Biban, P., Spada, S., Tipo, V., Ghitti, C., Bolognini, S., Mariani, G., Russo, A., Colella, M. G., Verrico, A., Bruni, P., Poddighe, D., Cagnoli, G., Morandi, F., Gadaleta, A., Barbi, E., Bruno, I. I., Graziano, R., Sgaramella, P., Catalani, M. P., Baldoni, I., Colarusso, G., Galvagno, G., Barone, A. P., Longo, A., Nardella, G., Portale, G., Garigali, G., Bona, G., Erbela, M., Agostiniani, R., Nanni, L., Schieven, E., Dona, M., Varisco, T., Russo, F., Distefano, V. A., Dipietro, F., Tarallo, L., Imperato, L., Parisi, G., Salzano, R., Raiola, G., Talarico, V., Bellu, R., Cannone, A., and Ferrante, P.

Subjects
Male, Metabolic disease, Hospitalization rate, Congenital skeletal condition, Children with special health care needs, Emergency department, Isolated CNS malformation, Metabolic diseases, Multiple AED therapy, Neuromuscular diseases, Syndromic disorders, True isolated microcephaly, 0302 clinical medicine, Clinical history, Medicine, Child, education.field_of_study, Neuromuscular disease, Settore MED/38, Disabled Children, Hospitalization, Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA, Italy, Child, Preschool, Female, Children with special health care need, Emergency Service, Hospital, medicine.medical_specialty, Adolescent, Population, Triage Code, 03 medical and health sciences, Pharmacotherapy, 030225 pediatrics, Humans, Medical prescription, education, Retrospective Studies, Health Services Needs and Demand, Syndromic disorder, business.industry, Research, Infant, Newborn, Infant, 030208 emergency & critical care medicine, Children with special health care needs, Congenital skeletal conditions,Emergency department, Hospitalization rate, Isolated CNS malformation, Metabolic diseases, Multiple AED therapy, Neuromuscular diseases, Syndromic disorders, True isolated microcephaly, Family medicine, Chronic Disease, business, Facilities and Services Utilization
Abstract

Background Although children with special health care needs (CSHCN) represent a minority of the population, they go through more hospitalizations, more admissions to the Emergency Department (ED), and receive a major number of medical prescriptions, in comparison to general pediatric population. Objectives of the study were to determine the reasons for admission to the ED in Italian CSHCN, and to describe the association between patient’s demographic data, clinical history, and health services requirements. Methods Ad hoc web site was created to collect retrospective data of 3479 visits of CSHCN to the ED in 58 Italian Hospitals. Results Seventy-two percent of patients admitted to ED were affected by a previously defined medical condition. Most of the ED admissions were children with syndromic conditions (54%). 44.2% of the ED admissions were registered during the night-time and/or at the weekends. The hospitalization rate was of 45.6% among patients admitted to the ED. The most common reason for admission to the ED was the presence of respiratory symptoms (26.6%), followed by gastrointestinal problems (21.3%) and neurological disorders (18.2%). 51.4% of the access were classified as ‘urgent’, with a red/yellow triage code. Considering the type of ED, 61.9% of the visits were conducted at the Pediatric EDs (PedEDs), 33.5% at the Functional EDs (FunEDs) and 4.6% at the Dedicated EDs (DedEDs). Patients with more complex clinical presentation were more likely to be evaluated at the PedEDs. CSHCN underwent to a higher number of medical procedures at the PedEDs, more in comparison to other EDs. Children with medical devices were directed to a PedED quite exclusively when in need for medical attention. Subjects under multiple anti-epileptic drug therapy attended to PedEDs or FunEDs generally. Patients affected by metabolic diseases were more likely to look for medical attention at FunEDs. Syndromic patients mostly required medical attention at the DedEDs. Conclusions Access of CSHCN to an ED is not infrequent. For this reason, it is fundamental for pediatricians working in any kind of ED to increase their general knowledge about CHSCN and to gain expertise in the management of such patients and their related medical complexity.

Published
2020

7. Treatment of Multisystem Inflammatory Syndrome in Children

Author

McArdle A. J., Vito O., Patel H., Seaby E. G., Shah P., Wilson C., Broderick C., Nijman R., Tremoulet A. H., Munblit D., Ulloa-Gutierrez R., Carter M. J., De T., Hoggart C., Whittaker E., Herberg J. A., Kaforou M., Cunnington A. J., Levin M., Vazquez J. A., Carmona R., Perez L., Rubinos M., Veliz N., Yori S., Haerynck F., Hoste L., Leal I. A., Da Silva A. R. A., Silva A. E. A., Barchik A., Barreiro S. T. A., Cochrane N., Teixeira C. H., Arauj J. M., Ossa R. A. P. -D. L., Vieira C. S., Dimitrova A., Ganeva M., Stefanov S., Telcharova-Mihaylovska A., Biggs C. M., Scuccimarri R., Withington D., Raul B. B., Ampuero C., Aravena J., Casanova D., Cruces P., Diaz F., Garcia-Salum T., Godoy L., Medina R. A., Galaz G. V., Avila-Aguero M. L., Brenes-Chacon H., Ivankovich-Escoto G., Yock-Corrales A., Badib A., Badreldin K., Elkhashab Y., Heshmat H., Heinonen S., Angoulvant F., Belot A., Ouldali N., Beske F., Heep A., Masjosthusmann K., Reiter K., Heuvel I. V. D., Both U. V., Agrafiotou A., Antachopoulos C., Eleftheriou I., Farmaki E., Fotis L., Kafetzis D., Lampidi S., Liakopoulou T., Maritsi D., Michailidou E., Milioudi M., Mparmpounaki I., Papadimitriou E., Papaevangelou V., Roilides E., Tsiatsiou O., Tsolas G., Tsolia M., Vantsi P., Pineda L. Y. B., Aguilar K. L. B., Quintero E. M. C., Ip P., Kwan M. Y. W., Kwok J., Lau Y. L., To K., Wong J. S. C., David M., Farkas D., Kalcakosz S., Szekeres K., Zsigmond B., Aslam N., Andreozzi L., Bianco F., Bucciarelli V., Buonsenso D., Cimaz R., D'Argenio P., Dellepiane R. M., Fabi M., Mastrolia M. V., Mauro A., Mazza A., Romani L., Simonini G., Tipo V., Valentini P., Verdoni L., Reel B., Pace D., Torpiano P., Flores M. F., Dominguez M. G., Vargas A. L. G., Hernandez L. L., Figueroa R. P. M., Gaxiola G. P., Valadez J., Klevberg S., Knudsen P. K., Maseide P. H., Carrera J. M., Castano E. G., Timana C. A. D., Leon T. D., Estripeaut D., Levy J., Norero X., Record J., Rojas-Bonilla M., Iramain R., Hernandez R., Huaman G., Munaico M., Peralta C., Seminario D., Yarleque E. H. Z., Gadzinska J., Mandziuk J., Okarska-Napierala M., Alacheva Z. A., Alexeeva E., Ananin P. V., Antsupova M., Bakradze M. D., Bobkova P., Borzakova S., Chashchina I. L., Fisenko A. P., Gautier M. S., Glazyrina A., Kondrikova E., Korobyants E., Korsunskiy A. A., Kovygina K., Krasnaya E., Kurbanova S., Kurdup M. K., Mamutova A. V., Mazankova L., Mitushin I. L., Nargizyan A., Orlova Y. O., Osmanov I. M., Polyakova A. S., Romanova O., Samitova E., Sologub A., Spiridonova E., Tepaev R. F., Tkacheva A. A., Yusupova V., Zholobova E., Grasa C. D., Segura N. L., Martinon-Torres F., Melendo S., Echevarria A. M., Guzman J. M. M., Argueta J. R. P., Rivero-Calle I., Riviere J., Rodriguez-Gonzalez M., Rojo P., Manubens J. S., Soler-Palacin P., Soriano-Arandes A., Tagarro A., Villaverde S., Altman M., Brodin P., Horne A., Palmblad K., Brotschi B., Sauteur P. M., Schmid J. P., Prader S., Relly C., Schlapbach L. J., Seiler M., Truck J., Wutz D., Ketharanathan N., Vermont C., Ozkan E. A., Erdeniz E. H., Borisova G., Boychenko L., Diudenko N., Kasiyan O., Katerynych K., Melnyk K., Miagka N., Teslenko M., Trykosh M., Volokha A., Akomolafe T., Al-Abadi E., Alders N., Avram P., Bamford A., Bank M., Roy R. B., Beattie T., Boleti O., Broad J., Carrol E. D., Chandran A., Cooper H., Davies P., Emonts M., Evans C., Fidler K., Foster C., Gong C., Gongrun B., Gonzalez C., Grandjean L., Grant K., Hacohen Y., Hall J., Hassell J., Hesketh C., Hewlett J., Hnieno A., Holt-Davis H., Hossain A., Hudson L. D., Johnson M., Johnson S., Jyothish D., Kampmann B., Kavirayani A., Kelly D., Kucera F., Langer D., Lillie J., Longbottom K., Lyall H., MacKdermott N., Maltby S., McLelland T., McMahon A. -M., Miller D., Morrison Z., Mosha K., Muller J., Myttaraki E., Nadel S., Osaghae D., Osman F., Ostrzewska A., Panthula M., Papachatzi E., Papadopoulou C., Penner J., Polandi S., Prendergast A. J., Ramnarayan P., Rhys-Evans S., Riordan A., Rodrigues C. M. C., Romaine S., Seddon J., Shingadia D., Srivastava A., Struik S., Taylor A., Tran S., Tudor-Williams G., Van Der Velden F., Ventilacion L., Wellman P. A., Yanney M. P., Yeung S., Badheka A., Badran S., Bailey D. M., Burch A. K., Burns J. C., Cichon C., Cirks B., Dallman M. D., Delany D. R., Fairchok M., Friedman S., Geracht J., Langs-Barlow A., Mann K., Padhye A., Quade A., Ramirez K. A., Rockett J., Sayed I. A., Shahin A. A., Umaru S., Widener R., Angela M. H., Kandawasvika G., McArdle A.J., Vito O., Patel H., Seaby E.G., Shah P., Wilson C., Broderick C., Nijman R., Tremoulet A.H., Munblit D., Ulloa-Gutierrez R., Carter M.J., De T., Hoggart C., Whittaker E., Herberg J.A., Kaforou M., Cunnington A.J., Levin M., Vazquez J.A., Carmona R., Perez L., Rubinos M., Veliz N., Yori S., Haerynck F., Hoste L., Leal I.A., Da Silva A.R.A., Silva A.E.A., Barchik A., Barreiro S.T.A., Cochrane N., Teixeira C.H., Arauj J.M., Ossa R.A.P.-D.L., Vieira C.S., Dimitrova A., Ganeva M., Stefanov S., Telcharova-Mihaylovska A., Biggs C.M., Scuccimarri R., Withington D., Raul B.B., Ampuero C., Aravena J., Casanova D., Cruces P., Diaz F., Garcia-Salum T., Godoy L., Medina R.A., Galaz G.V., Avila-Aguero M.L., Brenes-Chacon H., Ivankovich-Escoto G., Yock-Corrales A., Badib A., Badreldin K., Elkhashab Y., Heshmat H., Heinonen S., Angoulvant F., Belot A., Ouldali N., Beske F., Heep A., Masjosthusmann K., Reiter K., Heuvel I.V.D., Both U.V., Agrafiotou A., Antachopoulos C., Eleftheriou I., Farmaki E., Fotis L., Kafetzis D., Lampidi S., Liakopoulou T., Maritsi D., Michailidou E., Milioudi M., Mparmpounaki I., Papadimitriou E., Papaevangelou V., Roilides E., Tsiatsiou O., Tsolas G., Tsolia M., Vantsi P., Pineda L.Y.B., Aguilar K.L.B., Quintero E.M.C., Ip P., Kwan M.Y.W., Kwok J., Lau Y.L., To K., Wong J.S.C., David M., Farkas D., Kalcakosz S., Szekeres K., Zsigmond B., Aslam N., Andreozzi L., Bianco F., Bucciarelli V., Buonsenso D., Cimaz R., D'Argenio P., Dellepiane R.M., Fabi M., Mastrolia M.V., Mauro A., Mazza A., Romani L., Simonini G., Tipo V., Valentini P., Verdoni L., Reel B., Pace D., Torpiano P., Flores M.F., Dominguez M.G., Vargas A.L.G., Hernandez L.L., Figueroa R.P.M., Gaxiola G.P., Valadez J., Klevberg S., Knudsen P.K., Maseide P.H., Carrera J.M., Castano E.G., Timana C.A.D., Leon T.D., Estripeaut D., Levy J., Norero X., Record J., Rojas-Bonilla M., Iramain R., Hernandez R., Huaman G., Munaico M., Peralta C., Seminario D., Yarleque E.H.Z., Gadzinska J., Mandziuk J., Okarska-Napierala M., Alacheva Z.A., Alexeeva E., Ananin P.V., Antsupova M., Bakradze M.D., Bobkova P., Borzakova S., Chashchina I.L., Fisenko A.P., Gautier M.S., Glazyrina A., Kondrikova E., Korobyants E., Korsunskiy A.A., Kovygina K., Krasnaya E., Kurbanova S., Kurdup M.K., Mamutova A.V., Mazankova L., Mitushin I.L., Nargizyan A., Orlova Y.O., Osmanov I.M., Polyakova A.S., Romanova O., Samitova E., Sologub A., Spiridonova E., Tepaev R.F., Tkacheva A.A., Yusupova V., Zholobova E., Grasa C.D., Segura N.L., Martinon-Torres F., Melendo S., Echevarria A.M., Guzman J.M.M., Argueta J.R.P., Rivero-Calle I., Riviere J., Rodriguez-Gonzalez M., Rojo P., Manubens J.S., Soler-Palacin P., Soriano-Arandes A., Tagarro A., Villaverde S., Altman M., Brodin P., Horne A., Palmblad K., Brotschi B., Sauteur P.M., Schmid J.P., Prader S., Relly C., Schlapbach L.J., Seiler M., Truck J., Wutz D., Ketharanathan N., Vermont C., Ozkan E.A., Erdeniz E.H., Borisova G., Boychenko L., Diudenko N., Kasiyan O., Katerynych K., Melnyk K., Miagka N., Teslenko M., Trykosh M., Volokha A., Akomolafe T., Al-Abadi E., Alders N., Avram P., Bamford A., Bank M., Roy R.B., Beattie T., Boleti O., Broad J., Carrol E.D., Chandran A., Cooper H., Davies P., Emonts M., Evans C., Fidler K., Foster C., Gong C., Gongrun B., Gonzalez C., Grandjean L., Grant K., Hacohen Y., Hall J., Hassell J., Hesketh C., Hewlett J., Hnieno A., Holt-Davis H., Hossain A., Hudson L.D., Johnson M., Johnson S., Jyothish D., Kampmann B., Kavirayani A., Kelly D., Kucera F., Langer D., Lillie J., Longbottom K., Lyall H., MacKdermott N., Maltby S., McLelland T., McMahon A.-M., Miller D., Morrison Z., Mosha K., Muller J., Myttaraki E., Nadel S., Osaghae D., Osman F., Ostrzewska A., Panthula M., Papachatzi E., Papadopoulou C., Penner J., Polandi S., Prendergast A.J., Ramnarayan P., Rhys-Evans S., Riordan A., Rodrigues C.M.C., Romaine S., Seddon J., Shingadia D., Srivastava A., Struik S., Taylor A., Tran S., Tudor-Williams G., Van Der Velden F., Ventilacion L., Wellman P.A., Yanney M.P., Yeung S., Badheka A., Badran S., Bailey D.M., Burch A.K., Burns J.C., Cichon C., Cirks B., Dallman M.D., Delany D.R., Fairchok M., Friedman S., Geracht J., Langs-Barlow A., Mann K., Padhye A., Quade A., Ramirez K.A., Rockett J., Sayed I.A., Shahin A.A., Umaru S., Widener R., Angela M.H., Kandawasvika G., Pediatric Surgery, Pediatrics, University of Zurich, National Institute of Health and Medical Research, Wellcome Trust, Medical Research Foundation, Shah, Priyen [0000-0001-9164-8862], Ulloa-Gutierrez, Rolando [0000-0002-9157-9227], Herberg, Jethro A [0000-0001-6941-6491], Cunnington, Aubrey J [0000-0002-1305-3529], Levin, Michael [0000-0003-2767-6919], and Apollo - University of Cambridge Repository

Subjects
Inotrope, Male, medicine.medical_treatment, 2700 General Medicine, 030204 cardiovascular system & hematology, Antibodies, Viral, Medical and Health Sciences, Cohort Studies, 0302 clinical medicine, Glucocorticoid, hemic and lymphatic diseases, Medicine and Health Sciences, 030212 general & internal medicine, Viral, Child, 11 Medical and Health Sciences, OUTCOMES, Respiration, Immunoglobulins, Intravenous, General Medicine, Systemic Inflammatory Response Syndrome, 3. Good health, Hospitalization, Treatment Outcome, Child, Preschool, Combination, Artificial, Regression Analysis, Drug Therapy, Combination, Female, Original Article, Intravenous, Life Sciences & Biomedicine, Cohort study, Human, medicine.medical_specialty, BATS Consortium, Adolescent, Immunoglobulins, 610 Medicine & health, Regression Analysi, Antibodies, Immunomodulation, 03 medical and health sciences, Medicine, General & Internal, Pharmacotherapy, Drug Therapy, Clinical Research, Internal medicine, General & Internal Medicine, medicine, MANAGEMENT, Confidence Intervals, Humans, Preschool, Propensity Score, Glucocorticoids, Mechanical ventilation, Science & Technology, business.industry, SARS-CoV-2, Inflammatory and immune system, COVID-19, Odds ratio, medicine.disease, Respiration, Artificial, Confidence interval, KAWASAKI-LIKE DISEASE, COVID-19 Drug Treatment, Systemic inflammatory response syndrome, 10036 Medical Clinic, Immunoglobulins, Intravenou, Propensity score matching, Cohort Studie, business, ACUTE RESPIRATORY SYNDROME, Confidence Interval, TOXIC-SHOCK-SYNDROME
Abstract

BackgroundEvidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2.MethodsWe performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation.ResultsData were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups.ConclusionsWe found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue. (Funded by the European Union's Horizon 2020 Program and others; BATS ISRCTN number, ISRCTN69546370.).

Published
2021

10. Treatment of Multisystem Inflammatory Syndrome in Children

Author

McArdle, A.J. Vito, O. Patel, H. Seaby, E.G. Shah, P. Wilson, C. Broderick, C. Nijman, R. Tremoulet, A.H. Munblit, D. Ulloa-Gutierrez, R. Carter, M.J. De, T. Hoggart, C. Whittaker, E. Herberg, J.A. Kaforou, M. Cunnington, A.J. Levin, M. Vazquez, J.A. Carmona, R. Perez, L. Rubinos, M. Veliz, N. Yori, S. Haerynck, F. Hoste, L. Leal, I.A. Da Silva, A.R.A. Silva, A.E.A. Barchik, A. Barreiro, S.T.A. Cochrane, N. Teixeira, C.H. Arauj, J.M. Ossa, R.A.P.-D.L. Vieira, C.S. Dimitrova, A. Ganeva, M. Stefanov, S. Telcharova-Mihaylovska, A. Biggs, C.M. Scuccimarri, R. Withington, D. Raul, B.B. Ampuero, C. Aravena, J. Casanova, D. Cruces, P. Diaz, F. Garcia-Salum, T. Godoy, L. Medina, R.A. Galaz, G.V. Avila-Aguero, M.L. Brenes-Chacon, H. Ivankovich-Escoto, G. Yock-Corrales, A. Badib, A. Badreldin, K. Elkhashab, Y. Heshmat, H. Heinonen, S. Angoulvant, F. Belot, A. Ouldali, N. Beske, F. Heep, A. Masjosthusmann, K. Reiter, K. Heuvel, I.V.D. Both, U.V. Agrafiotou, A. Antachopoulos, C. Eleftheriou, I. Farmaki, E. Fotis, L. Kafetzis, D. Lampidi, S. Liakopoulou, T. Maritsi, D. Michailidou, E. Milioudi, M. Mparmpounaki, I. Papadimitriou, E. Papaevangelou, V. Roilides, E. Tsiatsiou, O. Tsolas, G. Tsolia, M. Vantsi, P. Pineda, L.Y.B. Aguilar, K.L.B. Quintero, E.M.C. Ip, P. Kwan, M.Y.W. Kwok, J. Lau, Y.L. To, K. Wong, J.S.C. David, M. Farkas, D. Kalcakosz, S. Szekeres, K. Zsigmond, B. Aslam, N. Andreozzi, L. Bianco, F. Bucciarelli, V. Buonsenso, D. Cimaz, R. D'Argenio, P. Dellepiane, R.M. Fabi, M. Mastrolia, M.V. Mauro, A. Mazza, A. Romani, L. Simonini, G. Tipo, V. Valentini, P. Verdoni, L. Reel, B. Pace, D. Torpiano, P. Flores, M.F. Domínguez, M.G. Vargas, A.L.G. Hernandez, L.L. Figueroa, R.P.M. Gaxiola, G.P. Valadez, J. Klevberg, S. Knudsen, P.K. Maseide, P.H. Carrera, J.M. Castano, E.G. Timana, C.A.D. Leon, T.D. Estripeaut, D. Levy, J. Norero, X. Record, J. Rojas-Bonilla, M. Iramain, R. Hernandez, R. Huaman, G. Munaico, M. Peralta, C. Seminario, D. Yarleque, E.H.Z. Gadzinska, J. Mandziuk, J. Okarska-Napierała, M. Alacheva, Z.A. Alexeeva, E. Ananin, P.V. Antsupova, M. Bakradze, M.D. Bobkova, P. Borzakova, S. Chashchina, I.L. Fisenko, A.P. Gautier, M.S. Glazyrina, A. Kondrikova, E. Korobyants, E. Korsunskiy, A.A. Kovygina, K. Krasnaya, E. Kurbanova, S. Kurdup, M.K. Mamutova, A.V. Mazankova, L. Mitushin, I.L. Nargizyan, A. Orlova, Y.O. Osmanov, I.M. Polyakova, A.S. Romanova, O. Samitova, E. Sologub, A. Spiridonova, E. Tepaev, R.F. Tkacheva, A.A. Yusupova, V. Zholobova, E. Grasa, C.D. Segura, N.L. Martinon-Torres, F. Melendo, S. Echevarria, A.M. Guzman, J.M.M. Argueta, J.R.P. Rivero-Calle, I. Riviere, J. Rodriguez-Gonzalez, M. Rojo, P. Manubens, J.S. Soler-Palacin, P. Soriano-Arandes, A. Tagarro, A. Villaverde, S. Altman, M. Brodin, P. Horne, A. Palmblad, K. Brotschi, B. Sauteur, P.M. Schmid, J.P. Prader, S. Relly, C. Schlapbach, L.J. Seiler, M. Truck, J. Wutz, D. Ketharanathan, N. Vermont, C. Ozkan, E.A. Erdeniz, E.H. Borisova, G. Boychenko, L. Diudenko, N. Kasiyan, O. Katerynych, K. Melnyk, K. Miagka, N. Teslenko, M. Trykosh, M. Volokha, A. Akomolafe, T. Al-Abadi, E. Alders, N. Avram, P. Bamford, A. Bank, M. Roy, R.B. Beattie, T. Boleti, O. Broad, J. Carrol, E.D. Chandran, A. Cooper, H. Davies, P. Emonts, M. Evans, C. Fidler, K. Foster, C. Gong, C. Gongrun, B. Gonzalez, C. Grandjean, L. Grant, K. Hacohen, Y. Hall, J. Hassell, J. Hesketh, C. Hewlett, J. Hnieno, A. Holt-Davis, H. Hossain, A. Hudson, L.D. Johnson, M. Johnson, S. Jyothish, D. Kampmann, B. Kavirayani, A. Kelly, D. Kucera, F. Langer, D. Lillie, J. Longbottom, K. Lyall, H. MacKdermott, N. Maltby, S. McLelland, T. McMahon, A.-M. Miller, D. Morrison, Z. Mosha, K. Muller, J. Myttaraki, E. Nadel, S. Osaghae, D. Osman, F. Ostrzewska, A. Panthula, M. Papachatzi, E. Papadopoulou, C. Penner, J. Polandi, S. Prendergast, A.J. Ramnarayan, P. Rhys-Evans, S. Riordan, A. Rodrigues, C.M.C. Romaine, S. Seddon, J. Shingadia, D. Srivastava, A. Struik, S. Taylor, A. Taylor, A. Taylor, A. Tran, S. Tudor-Williams, G. Van Der Velden, F. Ventilacion, L. Wellman, P.A. Yanney, M.P. Yeung, S. Badheka, A. Badran, S. Bailey, D.M. Burch, A.K. Burns, J.C. Cichon, C. Cirks, B. Dallman, M.D. Delany, D.R. Fairchok, M. Friedman, S. Geracht, J. Langs-Barlow, A. Mann, K. Padhye, A. Quade, A. Ramirez, K.A. Rockett, J. Sayed, I.A. Shahin, A.A. Umaru, S. Widener, R. Angela, M.H. Kandawasvika, G. BATS Consortium

Subjects
hemic and lymphatic diseases
Abstract

BACKGROUND Evidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2. METHODS We performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation. RESULTS Data were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups. CONCLUSIONS We found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue. Copyright © 2021 Massachusetts Medical Society.

Published
2021

11. Concomitant SARS‐CoV‐2 infection and crusted scabies in a 4‐month infant.

Author

Giannattasio, A., Rosa, M., Esposito, S., Di Mita, O., Angrisani, F., Acierno, S., D'Anna, C., Barbato, F., Tipo, V., and Ametrano, O.

Subjects
SCABIES, SARS-CoV-2, INFANTS
Abstract

A diagnosis of CS was made, while mother received diagnosis of ordinary scabies. (b) Complete resolution of cutaneous lesions during the post-discharge follow-up. (c) Laboratory investigation during the observation. gl This history and the characteristics of lesions drew our attention to a possible skin infestation. As for treatment, oral ivermectin is reserved for recurrent, difficult-to-treat cases, or CS.8 Due to severe presentation and to the refractoriness of the condition with topical treatment, our patient required this off-label treatment. [Extracted from the article]

Published
2022
Full Text
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12. Drug use and upper gastrointestinal complications in children: A case-control study

Author

Bianciotto, M, Chiappini, E, Raffaldi, I, Gabiano, C, Tovo, P, Sollai, S, De Martino, M, Mannelli, F, Tipo, V, Da Cas, R, Traversa, G, Mores, Nadia, Romagnoli, Costantino, Chiaretti, Antonio, Bersani, Giulia, De Nisco, Alessia, Riccardi, Riccardo, Italian, Multicenter Study Group For Drug And Vaccine Safety In Children, Bianciotto, M, Chiappini, E, Raffaldi, I, Gabiano, C, Tovo, Pa, Sollai, S, de Martino, M, Mannelli, F, Tipo, V, Da Cas, R, Traversa, G, Menniti Ippolito, F, Capuano, Annalisa, and Rafaniello, Concetta

Subjects
Male, Pediatrics, Gastrointestinal Diseases, Anti-Inflammatory Agents, Logistic regression, THERAPY, Upper Gastrointestinal Tract, Adrenal Cortex Hormones, PEPTIC-ULCER DISEASE, gastrointestinal complications, drug use, adverse events, case-control study, Medicine, Prospective Studies, Prospective cohort study, Child, media_common, RISK, Anti-Inflammatory Agents, Non-Steroidal, NONSTEROIDAL ANTIINFLAMMATORY DRUGS, ASSOCIATION, Anti-Bacterial Agents, Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA, Italy, Child, Preschool, ANTIBIOTIC-ASSOCIATED HYPOPROTHROMBINEMIA, SAFETY, Population study, Female, medicine.symptom, Non-Steroidal, Drug, medicine.medical_specialty, Settore BIO/14 - FARMACOLOGIA, media_common.quotation_subject, TOLERABILITY, IBUPROFEN, Drug Therapy, Melena, Humans, Adverse effect, Preschool, Acetaminophen, business.industry, Case-control study, Infant, Logistic Models, Concomitant, Case-Control Studies, Pediatrics, Perinatology and Child Health, business
Abstract

Objective: To evaluate the risk of upper gastrointestinal complications (UGIC) associated with drug use in the paediatric population. Methods: This study is part of a large Italian prospective multicentre study. The study population included children hospitalised for acute conditions through the emergency departments of eight clinical centres. Patients admitted for UGIC (defined as endoscopically confirmed gastroduodenal lesions or clinically defined haematemesis or melena) comprised the case series; children hospitalised for neurological disorders formed the control group. Information on drug and vaccine exposure was collected through parental interview during the children's hospitalisation. Logistic regression was used to estimate ORs for the occurrence of UGIC associated with drug use adjusted for age, clinical centre and concomitant use of any drug. Results: 486 children hospitalised for UGIC and 1930 for neurological disorders were enrolled between November 1999 and November 2010. Drug use was higher in cases than in controls (73% vs 54%; p

Published
2013

13. Effectiveness and safety of the A-H1N1 vaccine in children: a hospital-based case-control study

Author

Menniti Ippolito F, Da Cas R, Sagliocca L, Traversa G, Ferrazin F, Santuccio C, Tartaglia L, Trotta F, Di Pietro P, Renna S, Rossi R, Domenichini B, Gamba S, Trovato F, Tovo P, Bianciotto M, Calitri C, Gabiano C, Raffaldi I, Urbino A, Da Dalt L, Bavero V, Giordano L, Baraldi M, Bertuola F, Lorenzon E, Parata F, Perilongo G, Vendramin S, Frassineti M, Calvani AM, Chiappini E, De Martino M, Fancelli C, Mannelli F, Mazzantini R, Sollai S, Venturini E, Pirozzi N, Rauchi U, Reale A, Mores N, Bersani G, De Nisco A, Chiaretti A, Riccardi R, Romagnoli C, Tipo V, Dinardo M, Pisapia T, RAFANIELLO, Concetta, Fucà F, Di Rosa E., CAPUANO, Annalisa, PARRETTA, Elisabetta, Menniti Ippolito, F, Da Cas, R, Sagliocca, L, Traversa, G, Ferrazin, F, Santuccio, C, Tartaglia, L, Trotta, F, Di Pietro, P, Renna, S, Rossi, R, Domenichini, B, Gamba, S, Trovato, F, Tovo, P, Bianciotto, M, Calitri, C, Gabiano, C, Raffaldi, I, Urbino, A, Da Dalt, L, Bavero, V, Giordano, L, Baraldi, M, Bertuola, F, Lorenzon, E, Parata, F, Perilongo, G, Vendramin, S, Frassineti, M, Calvani, Am, Chiappini, E, De Martino, M, Fancelli, C, Mannelli, F, Mazzantini, R, Sollai, S, Venturini, E, Pirozzi, N, Rauchi, U, Reale, A, Mores, N, Bersani, G, De Nisco, A, Chiaretti, A, Riccardi, R, Romagnoli, C, Tipo, V, Dinardo, M, Pisapia, T, Capuano, Annalisa, Parretta, Elisabetta, Rafaniello, Concetta, Fucà, F, and Di Rosa, E.

Published
2011

15. Definire i criteri organizzativi per l’istituzione di una struttura operativa sperimentale di 'Pianificazione delle attività di accettazione pediatrica inetgrata' in un’AORN Pediatrica

Author

TIPO V, GIORDANO V, BERNARDO A, DELLA VECCHIA A, BOTTA E, CACACE G, DI RESTA M, CAPPUCCIO A, NOCERINO A, CUCCARO, PATRIZIA, PAUDICE, ALESSANDRO, TRIASSI, MARIA, Tipo, V, Giordano, V, Bernardo, A, Cuccaro, Patrizia, DELLA VECCHIA, A, Paudice, Alessandro, Botta, E, Cacace, G, DI RESTA, M, Cappuccio, A, Nocerino, A, and Triassi, Maria

Published
2008

16. Vaccine effectiveness against severe laboratory-confirmed influenza in children: results of two consecutive seasons in Italy

Author

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, Pier Angelo, 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, Italian Multicentre Study Group for Drug, Vaccine Safety in Children, Menniti Ippolito, Francesca, Da Cas, Roberto, Traversa, Giuseppe, Santuccio, Carmela, Felicetti, Patrizia, Tartaglia, Loriana, Trotta, Francesco, Di Pietro, Pasquale, Barabino, Paola, Renna, Salvatore, Riceputi, Laura, Tovo, Pier Angelo, Gabiano, Clara, Urbino, Antonio, Baroero, Luca, Le Serre, Daniele, Virano, Silvia, Perilongo, Giorgio, Daverio, Marco, Gnoato, Elisa, Maretti, Michela, Galeazzo, Beatrice, Rubin, Giulia, Scanferla, Stefania, Da Dalt, Liviana, Stefani, Chiara, Zerbinati, Claudia, Chiappini, Elena, Sollai, Sara, De Martino, Maurizio, Mannelli, Francesco, Becciani, Sabrina, Giacalone, Martina, Montano, Simona, Remaschi, Giulia, Stival, Alessia, Furbetta, Mario, Abate, Piera, Leonardi, Ilaria, Pirozzi, Nicola, Raucci, Umberto, Reale, Antonino, Rossi, Rossella, Russo, Cristina, Mancinelli, Livia, Manuela, Onori, Carlo, Concato, Mores, Nadia, Romagnoli, Costantino, Chiaretti, Antonio, Compagnone, Adele, Riccardi, Riccardo, Delogu, Giovanni, Sali, Michela, Prete, Valentina, Tipo, Vincenzo, Dinardo, Michele, Auricchio, Fabiana, Polimeno, Teodoro, Sodano, Giuseppe, Maccariello, Alessandra, Rafaniello, Concetta, Fucà, Fortunata, Di Rosa, Eleonora, Altavilla, Domenica, Mecchio, Anna, and Arrigo, Teresa

Subjects
Male, Pediatrics, Laboratory-confirmed case, Emergency Medical Services, Immunology and Microbiology (all), Laboratory-confirmed cases, Case-control study, Children, Influenza vaccine effectiveness, Seasonal influenza, Influenza vaccine effectivene, Emergency medical services, Medicine, Child, Vaccine effectiveness, Vaccination, Hospitalization, Systematic review, Infectious Diseases, Treatment Outcome, Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA, Italy, Influenza Vaccines, Child, Preschool, Molecular Medicine, Veterinary (all), Female, Case-Control Studie, Influenza Vaccine, Settore BIO/19 - MICROBIOLOGIA GENERALE, Human, medicine.medical_specialty, Settore BIO/14 - FARMACOLOGIA, Adolescent, Settore MED/07 - MICROBIOLOGIA E MICROBIOLOGIA CLINICA, Immunology and Microbiology(all), Influenza, Human, Humans, Influenza-like illness, General Veterinary, General Immunology and Microbiology, business.industry, Emergency Medical Service, Public Health, Environmental and Occupational Health, Infant, Emergency department, veterinary(all), Confidence interval, Surgery, Case-Control Studies, Case-control study, Children, Influenza vaccine effectiveness, Laboratory-confirmed cases, influenza in children, business
Abstract

•Vaccine effectiveness in children visiting an Emergency Department for influenza.•Test negative case-control study in 11 paediatric centres in two influenza seasons.•Vaccine effectiveness in preventing ED visits: 38% (95% CI -52% to 75%).•Add information for recommendation for vaccination in children. 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. © 2014 The Authors.

Published
2013

17. Vaccine effectiveness against severe laboratory-confirmed influenza in children: results of two consecutive seasons in Italy.

Author

Mores, Nadia, Romagnoli, Costantino, Chiaretti, Antonio, Compagnone, Adele, Riccardi, Riccardo, Delogu, Giovanni, Sali, Michela, Menniti Ippolito, F, Da Cas, R, Traversa, G, Santuccio, C, Trotta, F, Felicetti, P, Tartaglia, L, Di Pietro, P, Barabino, P, Renna, S, Riceputi, L, Tovo, Pa, Gabiano, C, Baroero, L, Le Serre, D, Virano, S, Perilongo, G, Daverio, M, Gnoato, E, Maretti, M, Manuela, O, 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, Carlo, C, Prete, V, Tipo, V, Dinardo, M, Auricchio, F, Polimeno, T., Mores, Nadia (ORCID:0000-0002-4197-0914), Romagnoli, Costantino (ORCID:0000-0003-1176-2943), Chiaretti, Antonio (ORCID:0000-0002-9971-1640), Riccardi, Riccardo (ORCID:0000-0001-7515-6622), Delogu, Giovanni (ORCID:0000-0003-0182-8267), Sali, Michela (ORCID:0000-0003-3609-2990), Mores, Nadia, Romagnoli, Costantino, Chiaretti, Antonio, Compagnone, Adele, Riccardi, Riccardo, Delogu, Giovanni, Sali, Michela, Menniti Ippolito, F, Da Cas, R, Traversa, G, Santuccio, C, Trotta, F, Felicetti, P, Tartaglia, L, Di Pietro, P, Barabino, P, Renna, S, Riceputi, L, Tovo, Pa, Gabiano, C, Baroero, L, Le Serre, D, Virano, S, Perilongo, G, Daverio, M, Gnoato, E, Maretti, M, Manuela, O, 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, Carlo, C, Prete, V, Tipo, V, Dinardo, M, Auricchio, F, Polimeno, T., Mores, Nadia (ORCID:0000-0002-4197-0914), Romagnoli, Costantino (ORCID:0000-0003-1176-2943), Chiaretti, Antonio (ORCID:0000-0002-9971-1640), Riccardi, Riccardo (ORCID:0000-0001-7515-6622), Delogu, Giovanni (ORCID:0000-0003-0182-8267), and Sali, Michela (ORCID:0000-0003-3609-2990)

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.

Published
2014

18. Vaccine effectiveness against severe laboratory-confirmed influenza in children: results of two consecutive seasons in Italy

Author

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, P, 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, Nadia, Romagnoli, C, Chiaretti, Antonio, Compagnone, A, Riccardi, Riccardo, Delogu, Giovanni, Sali, Michela, 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., Mores, Nadia (ORCID:0000-0002-4197-0914), Chiaretti, A (ORCID:0000-0002-9971-1640), Riccardi, Riccardo (ORCID:0000-0001-7515-6622), Delogu, Giovanni (ORCID:0000-0003-0182-8267), Sali, Michela (ORCID:0000-0003-3609-2990), 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, P, 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, Nadia, Romagnoli, C, Chiaretti, Antonio, Compagnone, A, Riccardi, Riccardo, Delogu, Giovanni, Sali, Michela, 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., Mores, Nadia (ORCID:0000-0002-4197-0914), Chiaretti, A (ORCID:0000-0002-9971-1640), Riccardi, Riccardo (ORCID:0000-0001-7515-6622), Delogu, Giovanni (ORCID:0000-0003-0182-8267), and Sali, Michela (ORCID:0000-0003-3609-2990)

Abstract

To evaluate the effectiveness of seasonal influenza vaccine in preventing Emergency Department (ED) visits and hospitalisations for influenza like illness (ILI) in children.

Published
2014

19. A multicenter study on drug safety in children [Studio multicentrico sulla sicurezza dei farmaci in pediatria]

Author

Menniti-Ippolito, F., Da Cas, R., Bolli, M., Annalisa Capuano, Saglioca, L., Traversa, G., Messi, G., Marchetti, F., Lazzerini, M., Rovere, F., Tripaldi, E., Da Dalt, L., Bressan, E., Capretta, A., Falcon, E., Intini, F., Mongillo, B., Morando, C., Di Pietro, P., Rossi, R., Barbino, P., Bianchi, C., Renna, S., Dorozzi, N., Ceccheti, C., Iori, V., Lauri, M., Rauchi, U., Reale, A., Vetrano, F., Saggiamo, G., Giuliano, F. M., and Tipo, V.

Subjects
Hosptial admissions, Adverse drug reactions, Case-control study, Children
Published
2007

24. A multicenter study on drug safety in children,Studio multicentrico sulla sicurezza dei farmaci in pediatria

Author

Menniti-Ippolito, F., Da Cas, R., Bolli, M., Capuano, A., Saglioca, L., Traversa, G., Messi, G., Federico Marchetti, Lazzerini, M., Rovere, F., Tripaldi, E., Da Dalt, L., Bressan, E., Capretta, A., Falcon, E., Intini, F., Mongillo, B., Morando, C., Di Pietro, P., Rossi, R., Barbino, P., Bianchi, C., Renna, S., Dorozzi, N., Ceccheti, C., Iori, V., Lauri, M., Rauchi, U., Reale, A., Vetrano, F., Saggiamo, G., Giuliano, F. M., and Tipo, V.

25. Henoch-Schönlein purpura and drug and vaccine use in childhood: a case-control study

Author

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, Italian Multicenter Study Group for Drug, Vaccine Safety in Children including Menniti Ippolito, F, Traversa, G, Santuccio, C, Felicetti, P, Tartaglia, L, Trotta, F, Tovo, Pier Angelo, Gabiano, C, Urbino, A, Baroero, Luca, LE SERRE, Daniele, Virano, Silvia, Stefani, C, Perilongo, G, Daverio, M, Maretti, M, Galeazzo, B, Rubin, G, Chiappini, E, Sollai, S, De Martino, M, Becciani, S, Giacalone, M, Montano, S, Remaschi, G, Stival, A, Abate, P, Leonardi, I, Pirozzi, N, Reale, A, Rossi, R, Bersani, G, Chiaretti, A, Riccardi, R, Romagnoli, C, Tipo, V, Dinardo, M, Auricchio, F, Polimeno, T, Bonagura, M, Maccariello, A, Fucà, F, Di Rosa, E, Altavilla, D, Mecchio, A, and Arrigo, T.

Subjects
Male, Drug, Pediatrics, medicine.medical_specialty, Henoch-Schonlein purpura, Adolescent, Drug-Related Side Effects and Adverse Reactions, IgA Vasculitis, media_common.quotation_subject, Adverse drug reaction, Disease, MMR vaccine, Risk Assessment, Statistics, Nonparametric, 03 medical and health sciences, Age Distribution, 0302 clinical medicine, 030225 pediatrics, Confidence Intervals, medicine, Humans, Children, Henoch-Schönlein purpura, Vaccine, Pediatrics, Perinatology and Child Health, Sex Distribution, Child, media_common, 030203 arthritis & rheumatology, Chi-Square Distribution, business.industry, Incidence, Research, Case-control study, Reproducibility of Results, Perinatology and Child Health, medicine.disease, Italy, Pharmaceutical Preparations, Case-Control Studies, Child, Preschool, Etiology, Female, business, Vasculitis, Measles-Mumps-Rubella Vaccine, Follow-Up Studies
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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26. Immunodepression COVID-19-related as a promoting factor for severe Pseudomonas sepsis in an infant with not respiratory symptoms

Author

letizia zenzeri, Giannattasio, A., Zito Marinosci, G., Ponticiello, E., Iodice, Mr, Vitullo, Me, and Tipo, V.

Subjects
sepsis, fever, lcsh:R5-920, children, diarrhea, COVID-19, lcsh:Medicine (General)
Abstract

The outbreak of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 is a reason of concern worldwide. While a high proportion of adult patients have been severely ill, requiring intensive care assistance and mechanical ventilation, pediatric patients seem to have a less invasive clinical expression of the disease. Reasons for a milder disease in children compared to that seen in adults are yet to be elucidated. Nonetheless, severe and fatal cases have been reported in children and are expected to continue to increase with the growing community transmission and overall current disease prevalence. We report the first case of an infant with a very mild not-respiratory COVID- 19 infection and a concomitant invasive bacterial sepsis.

27. Biomarkers of Endothelial Damage in Distinct Phases of Multisystem Inflammatory Syndrome in Children

Author

Monica Gelzo, Antonietta Giannattasio, Marco Maglione, Stefania Muzzica, Carolina D’Anna, Filippo Scialò, Thaililja Gagliardo, Michela Grieco, Vincenzo Tipo, Giuseppe Castaldo, Gelzo, M., Giannattasio, A., Maglione, M., Muzzica, S., D'Anna, C., Scialo, F., Gagliardo, T., Grieco, M., Tipo, V., Castaldo, G., Gelzo, Monica, Giannattasio, Antonietta, Maglione, Marco, Muzzica, Stefania, D'Anna, Carolina, Scialò, Filippo, Gagliardo, Thaililja, Grieco, Michela, Tipo, Vincenzo, and Castaldo, Giuseppe

Subjects
endothelial hyperinflammation, MCP-1, MIS-C, pANCA, vasculitis, VEGF-A, vasculiti, Endocrinology, Diabetes and Metabolism, Molecular Biology, Biochemistry
Abstract

Endothelial hyperinflammation and vasculitis are known hallmarks of acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C). They are due to the direct effect of the virus on endothelial cells enhanced by pro-inflammatory modulators and may cause venous/arterial thrombosis. Therefore, it is essential to identify patients with endothelial damage early in order to establish specific therapies. We studied the monocyte chemoattractant protein 1 (MCP-1), the perinuclear anti-neutrophil cytoplasmic antibodies (pANCA), and the vascular endothelial growth factor A (VEGF-A) in serum from 45 MIS-C patients at hospital admission and 24 healthy controls (HC). For 13/45 MIS-C patients, we measured the three serum biomarkers also after one week from hospitalization. At admission, MIS-C patients had significantly higher levels of MCP-1 and VEGF-A than the HC, but no significant differences were observed for pANCA. While after one week, MCP-1 was significantly lower, pANCA was higher and VEGF-A levels were not significantly different from the admission values. These findings suggest an involvement of epithelium in MIS-C with an acute phase, showing high MCP-1 and VEGF-A, followed by an increase in pANCA that suggests a vasculitis development. The serum biomarker levels may help to drive personalized therapies in these phases with anticoagulant prophylaxis, immunomodulators, and/or anti-angiogenic drugs.

Published
2022

28. Effects of Relaxed Lockdown on Pediatric ER Visits during SARS-CoV-2 Pandemic in Italy

Author

Matera, Luigi, Nenna, Raffaella, Ardenti Morini, Francesca, Banderali, Giuseppe, Calvani, Mauro, Calvi, Matteo, Cozzi, Giorgio, Falsaperla, Raffaele, Guidi, Roberto, Kantar, Ahmad, Lanari, Marcello, Lubrano, Riccardo, Messini, Beatrice, Niccoli, Antonio Augusto, Tipo, Vincenzo, Midulla, Fabio, On Behalf Of The Cicero Group, Null, Matera L., Nenna R., Morini F.A., Banderali G., Calvani M., Calvi M., Cozzi G., Falsaperla R., Guidi R., Kantar A., Lanari M., Lubrano R., Messini B., Niccoli A.A., Tipo V., and Midulla F.

Subjects
Pediatric emergency, Emergency rooms, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Health, Toxicology and Mutagenesis, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Lockdown measure, Article, lockdown measures, Air communicable infection, Retrospective Studie, Pandemic, Medicine, Humans, social activities reopening, Child, Pandemics, emergency rooms, Retrospective Studies, business.industry, SARS-CoV-2, pandemic, Public Health, Environmental and Occupational Health, COVID-19, Retrospective cohort study, Emergency room, air communicable infections, pediatric, Communicable Disease Control, Emergency Service, Hospital, Italy, Triage, Multicenter study, Emergency medicine, business, Human
Abstract

Previously, we demonstrated an 81% reduction in pediatric Emergency Room (ER) visits in Italy during the strict lockdown due to the SARS-CoV-2 pandemic. Since May 2020, lockdown measures were relaxed until 6 November 2020, when a strict lockdown was patchily reintroduced. Our aim was to evaluate the impact of the relaxed lockdown on pediatric ER visits in Italy. We performed a retrospective multicenter study involving 14 Italian pediatric ERs. We compared total ER visits from 24 September 2020 to 6 November 2020 with those during the corresponding timeframe in 2019. We evaluated 17 ER specific diagnoses grouped in air communicable and non-air communicable diseases. We recognized four different triage categories: white, green, yellow and red. In 2020 total ER visits were reduced by 51% compared to 2019 (16,088 vs. 32,568, respectively). The decrease in air communicable diseases was significantly higher if compared to non-air communicable diseases (−64% vs. −42%, respectively). ER visits in each triage category decreased in 2020 compared to 2019, but in percentage, white and red codes remained stable, while yellow codes slightly increased and green codes slightly decreased. Our results suggest that preventive measures drastically reduced the circulation of air communicable diseases even during the reopening of social activities but to a lesser extent with regard to the strict lockdown period (March–May 2020).

Published
2021

29. SARS-CoV-2 Pandemic Impact on Pediatric Emergency Rooms: A Multicenter Study

Author

Ahmad Kantar, Vincenzo Tipo, Matteo Calvi, Raffaella Nenna, Luigi Matera, Pietro Scoppi, Riccardo Lubrano, Fabio Midulla, Marcello Lanari, Valentina Rizzo, Giuseppe Banderali, Francesca Ardenti Morini, Antonio Augusto Niccoli, Raffaele Falsaperla, Giorgio Cozzi, Elisabetta Fabiani, Mauro Calvani, Beatrice Messini, Matera L., Nenna R., Rizzo V., Morini F.A., Banderali G., Calvani M., Calvi M., Cozzi G., Fabiani E., Falsaperla R., Kantar A., Lanari M., Lubrano R., Messini B., Niccoli A.A., Scoppi P., Tipo V., and Midulla F.

Subjects
Pediatric emergency, medicine.medical_specialty, Health, Toxicology and Mutagenesis, media_common.quotation_subject, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Lockdown measure, lcsh:Medicine, Primary care, Article, 03 medical and health sciences, Hospital, 0302 clinical medicine, lockdown measures, Air communicable infection, Retrospective Studie, Hygiene, 030225 pediatrics, Pandemic, medicine, Humans, 030212 general & internal medicine, Child, Pandemics, emergency rooms, media_common, Retrospective Studies, Emergency Service, business.industry, SARS-CoV-2, pandemic, lcsh:R, Public Health, Environmental and Occupational Health, COVID-19, Emergency room, Retrospective cohort study, Triage, air communicable infections, pediatric, Multicenter study, Italy, Emergency medicine, Communicable Disease Control, business, Emergency Service, Hospital, Human, Air communicable infections, Emergency rooms, Lockdown measures, Pediatric
Abstract

From March 9 to May 3, 2020, lockdown was declared in Italy due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Our aim was to evaluate how the SARS-CoV-2 pandemic and related preventive strategies affected pediatric emergency rooms (ERs) during this period. We performed a retrospective cohort multicenter study, comparing the lockdown period to the corresponding period in 2019. We examined 15 Italian pediatric ERs in terms of visit rates, specific diagnoses (grouped as air communicable diseases and non-air communicable diseases), and triage categories. During the lockdown period, ER admissions decreased by 81% compared to 2019 (52,364 vs. 10,112). All ER specific diagnoses decreased in 2020 and this reduction was significantly higher for air communicable diseases (25,462 vs. 2934, p &lt, 0.001). Considering the triage category, red codes remained similar (1% vs. 1%), yellow codes increased (11.2% vs. 22.3%), and green codes decreased (80.3% vs. 69.5%). We can speculate that social distancing and simple hygiene measures drastically reduced the spread of air communicable diseases. The increase in yellow codes may have been related to a delay in primary care and, consequently, in ER admissions.

Published
2020

30. Collateral effects of COVID-19 pandemic in pediatric hemato-oncology: fatalities caused by diagnostic delay

Author

Andrea Biondi, Luigi Annicchiarico Petruzzelli, Antonia De Matteo, Pio Stellato, Carmine Pecoraro, Valentino Conter, Luigia D'Amato, Giuseppe Menna, Giovanna Giagnuolo, Vincenzo Tipo, Agostino Curatolo, Rosanna Parasole, Carmela Bencivenga, Susanna Silvestri, Antonella Colombini, Marta Raimondo, Parasole, R, Stellato, P, Conter, V, De Matteo, A, D'Amato, L, Colombini, A, Pecoraro, C, Bencivenga, C, Raimondo, M, Silvestri, S, Tipo, V, Annicchiarico Petruzzelli, L, Giagnuolo, G, Curatolo, A, Biondi, A, and Menna, G

Subjects
2019-20 coronavirus outbreak, medicine.medical_specialty, Delayed Diagnosis, Coronavirus disease 2019 (COVID-19), Collateral, Pleural effusion, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, Atelectasis, Hematologic Neoplasms, Delayed diagnosis, Pediatrics, Tracheal deviation, Betacoronavirus, Intensive care, Cardiac tamponade, Pandemic, medicine, Humans, Pediatrics, Perinatology, and Child Health, Child, Letter to the Editor, Pandemics, Respiratory distress, SARS-CoV-2, business.industry, COVID-19, Hematology, Emergency department, Betacoronavirus, Child, Coronavirus Infections, Delayed Diagnosis, Survival Rate, Practice Guidelines as Topic, Pneumonia, Viral, Pediatrics, Pandemics, Hematologic Neoplasms, medicine.disease, Pediatric cancer, Survival Rate, Oncology, Anesthesia, Practice Guidelines as Topic, Pediatrics, Perinatology and Child Health, Emergency medicine, Coronavirus Infections, business
Abstract

Letter to the EditorCoronavirus disease COVID-19 has deeply modified national health services with a profound impact on hospital and in particular emergency and intensive care units (ICU) activities. As recently reported in Italy pediatric emergency accesses substantially decreased likely due to the instructions to prevent overcrowding in emergency rooms and spread of SARS-CoV-2 infection and to fear of the infection.1 At the Santobono-Pausilipon Hospital (Neaples), pediatric emergency accesses in March 2020 were only one fifth of those registered in 2019 in the same period. Likewhise a marked reduction of consultations occurred also in family pediatricians clinics.2We report here 3 children who arrived at hospital in life-threatening conditions at the onset of Acute Lymphoblastic Leukemia (ALL) between March 14 and April 10, 2020.First case: a 2-year-old-child arrived at the emergency department with a 15 days history of fatigue, pallor and dyspnea, in a comatose state, with severe anemia, respiratory distress, hematemesis and metabolic acidosis. Chest X-ray showed interstitial pneumonia. Blood tests showed: hemoglobin 2.7 gr/dL, WBC count 185.000/μl, platelets (PTL) 10.000/μl, LDH 3609 U/L. Peripheral blood was diagnostic for CD10, CD19 and CD58 positive ALL (B-lineage ALL). The patient, admitted at the ICU, intubated, transfused with RBC, PTL and plasma, died 12 hours after arrival at the hospital due to progressive worsening of clinical conditions. The nasal swab was negative for SARS-CoV-2 and positive for adenovirus.Second case: a 5-year-old-child arrived at the emergency department with a one month history of respiratory distress. Imaging showed a mediastinal mass compressing the brachiocephalic vein, the aorta, the pulmonary trunk and the left pulmonary artery, tracheal deviation, compression of the left main bronchus, left lung atelectasis and pleural effusion. Blood tests showed: hemoglobin 14.5 gr/dL, WBC count 37.000/μl, PTL 294.000/μl, LDH 6153 U/L, creatinine 1.9 mg/dl. Peripheral blood was diagnostic for CD5, CD7, CyCD3 and CD8 positive ALL (T-ALL). Steroid treatment was started. Clinical conditions deteriorated rapidly with cardiac and renal failure. The patient, admitted to ICU 2 hours after arrival at the hospital and intubated, died 24h later. The nasal swab was negative for SARS-CoV-2.Third Case: a 4-year-old child arrived at the hospital with one month history of fever, cough and shortness of breath treated at home with antibiotics and steroids without improvement. Imaging showed a mediastinal mass compressing the left brachiocephalic, azygos and superior cava veins, and right pulmonary artery and vein; mild tracheal deviation, compression of the left main bronchus; pericardial and pleural effusion; nephro-hepato-splenomegaly and ascites. Due to signs of cardiac tamponade, pericardiac and pleural drainage were placed and the patient was admitted at ICU and intubated. Blood tests showed: normal hemoglobin, WBC and PTL counts; LDH 2732 U/L, creatinine 2.98 mg/dl, K 8 mEq/L, Ca 5.4 mEq/L. Bone marrow was diagnostic for CD2, CD5, CD7, CD99 and CyCD3 positive ALL (T-ALL). Treatment with steroids was started. Due to progressive renal failure hemodialysis was performed for 9 days. Clinical conditions improved with rapid shrinking of mediastinal masses and resolution of pericardial and pleural effusion. The patient was thus extubated and treatment for ALL was instituted with good response to induction therapy. The nasal swab was negative for SARS-CoV-2.The 3 cases of ALL here described, 2 of them fatal, arrived at the hospital in critical conditions, most likely as a consequence of fear of COVID-19. Delay in diagnosis of neoplastic disease is a well-known problem in low-middle income countries (LMIC), but is quite rare in high-income countries (HIC). Actually, this combination of events never occurred in the past at the Santobono-Pausilipon Hospital, where, at the time of writing, no SARS-CoV-2 positive cases have been identified among children treated for cancer.Considering low prevalence of virus spreading in children and that SARS-CoV-2 positive children are generally asymptomatic or have a very mild course of the disease there is a substantial risk that collateral effects of COVID-19 pandemic, i.e. delays in diagnosis, chemotherapeutic treatments and treatment of chemotherapy complications, may be worse than those posed by the disease itself.3,4,7 Recently the major pediatric cancer scientific associations have expressed great concern on the risk that fear to access to medical care raised by Covid-19 may cause these delays not only in LMIC but also in HIC with dramatic consequences we are not used to face.5-6 Our experience confirms the occurrence of these collateral effects, indicating that there is a need of awareness of this risk and careful medical attention to assure timely diagnoses and adequate treatment adherence in childhood cancer.

Published
2020

31. Micturition Syncope in Childhood: How to Recognize and Manage It

Author

Andrea Apicella, Angela La Manna, Vincenzo Tipo, Laura Perrone, Emanuele Miraglia del Giudice, Cesare Polito, Pierluigi Marzuillo, Anna Grandone, Mario Diplomatico, Stefano Guarino, Marzuillo, P., Guarino, S., Tipo, V., Apicella, A., Grandone, A., Diplomatico, M., Polito, C., Miraglia Del Giudice, E., La Manna, A., and Perrone, L.

Subjects
Male, Pediatrics, medicine.medical_specialty, Supine position, situational syncope, Adolescent, media_common.quotation_subject, Population, Micturition syncope, 030204 cardiovascular system & hematology, Urination, Syncope, Diagnosis, Differential, 03 medical and health sciences, Orthostatic vital signs, 0302 clinical medicine, Behavior Therapy, Risk Factors, 030225 pediatrics, medicine, Humans, education, Child, micturition, media_common, education.field_of_study, Urinary bladder, biology, business.industry, Risk Factor, Syncope (genus), General Medicine, medicine.disease, biology.organism_classification, medicine.anatomical_structure, Pediatrics, Perinatology and Child Health, Emergency Medicine, Presentation (obstetrics), business, Human
Abstract

Frequently, general pediatricians could face a patient with syncope, which represents approximately 1% to 3% of emergency visits. Micturition syncope is a transient loss of consciousness with onset immediately before, during, or after micturition. Literature evidence indicates that healthy young men are a population with major risk for presenting micturition syncope, with a peak of incidence around 40 to 50 years of age. Usually, this syncope occurs in the morning, after wake-up, or, more generally, when the male patients assume the orthostatic position after a period of supine position in a warm bed. No information on micturition syncope clinical presentation and prevalence in childhood is available in the literature, and probably, this kind of syncope is unrecognized in childhood. We describe 4 unreported pediatric patients with a diagnosis of micturition syncope and well-defined clinical presentation. In all patients, the syncope has been presented in the same conditions: In the morning; after wake-up; in an orthostatic position; just before, after, or during urinary bladder voiding; and with spontaneous recovery in few minutes. Interestingly, 1 patient presented with the syncope during urinary bladder voiding by autocatheterization. In our patients, all investigations made as the first approach in the pediatric emergency department did not show any abnormal results, possibly underlying the syncope episodes. By describing our experience, we want to underline the clinical presentation of micturition syncope and give to the clinicians the elements to recognize and manage it easily in children.

Published
2017

32. Ventricular Tachycardia Induced by Propafenone Intoxication in a Pediatric Patient

Author

Vincenzo Tipo, Eduardo Ponticiello, Onorina Di Mita, Pierluigi Marzuillo, Margherita Rosa, Serena Pappacoda, Carolina DʼAnna, Rosa, M., Pappacoda, S., D'Anna, C., Di Mita, O., Ponticiello, E., Marzuillo, P., and Tipo, V.

Subjects
Tachycardia, Male, Bicarbonate, QT prolongation, Propafenone, 030204 cardiovascular system & hematology, Ventricular tachycardia, QT interval, 03 medical and health sciences, chemistry.chemical_compound, Electrocardiography, 0302 clinical medicine, intoxication, medicine, Humans, 030212 general & internal medicine, Sodium bicarbonate, medicine.diagnostic_test, business.industry, General Medicine, medicine.disease, Pediatric patient, Sodium Bicarbonate, chemistry, Anesthesia, Child, Preschool, Pediatrics, Perinatology and Child Health, Emergency Medicine, Tachycardia, Ventricular, Administration, Intravenous, medicine.symptom, business, Anti-Arrhythmia Agents, medicine.drug
Abstract

Unintentional poisonings are a global health problem frequently resulting in hospital admissions. Propafenone is a class 1C antiarrhythmic drug used in the second-line management of supraventricular and ventricular arrhythmias and, when unintentionally ingested, can lead to severe and life-threatening poisoning. We describe a case of a 3-year-old male patient unintentionally ingesting 300 mg (20 mg/kg) of propafenone and presenting with ventricular tachycardia with QT prolongation. Two boli of intravenous hypertonic sodium bicarbonate (total amount of 3 mEq/kg), followed by 3-hours continuous infusion of 1 mEq kg-1 h-1 sodium bicarbonate, were able to restore the clinical conditions of the patient. With this case report, we aim to highlight the existing challenge in the therapeutic management of propafenone intoxication that finds intravenous hypertonic bicarbonate to be a useful tool also in pediatric population.

Published
2017

33. Pneumo-orbita mimicking hordeolum

Author

Ferdinando Aliberti, Pierluigi Marzuillo, Vincenzo Tipo, Marzuillo, P., Aliberti, F., and Tipo, V.

Subjects
Facial trauma, Male, medicine.medical_specialty, Sneeze, genetic structures, Adolescent Health, Pain, Physical examination, Diagnosis, Differential, 03 medical and health sciences, Hyperaemia, 0302 clinical medicine, Martial Art, medicine, Orbital Diseases, Humans, Child, Crepitus, medicine.diagnostic_test, Skull Fractures, business.industry, Orbital Disease, Ethmoid bone, 030206 dentistry, Anatomy, medicine.disease, eye diseases, Subcutaneous Emphysema, Surgery, Ophthalmology, Ethmoid Bone, Skull Fracture, Pediatrics, Perinatology and Child Health, 030221 ophthalmology & optometry, sense organs, Stye, medicine.symptom, Hordeolum, business, Tomography, X-Ray Computed, Subcutaneous emphysema, Martial Arts, Human
Abstract

A healthy 12-years-old boy presented with right ocular pain with oedema and hyperaemia of the upper right eyelid, previously misdiagnosed as a stye (figure 1). The symptoms started with a sneeze, 2 days after facial trauma during a karate match. Clinical examination revealed crepitus of the upper right eyelid. Ocular motility and visual function were preserved. Ocular CT showed a fracture of the ethmoidal lamina papyracea (figure …

Published
2016

34. A revealing forehead cutaneuos lesion: Pott’s 'puffy' tumor

Author

Ferdinando Aliberti, Vincenzo Tipo, Pierluigi Marzuillo, Marzuillo, P., Aliberti, F., and Tipo, V.

Subjects
medicine.medical_specialty, business.industry, medicine.disease, Dermatology, Lesion, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030225 pediatrics, Pediatrics, Perinatology and Child Health, Forehead, medicine, Pott's puffy tumor, medicine.symptom, business, Letter to the Editor, 030217 neurology & neurosurgery
Published
2017

36. Serum endocan (ESM-1) as diagnostic and prognostic biomarker in Multisystem inflammatory syndrome in children (MIS-C).

Author

Cannavo A, Gelzo M, Vinciguerra C, Corbi G, Maglione M, Tipo V, Giannattasio A, and Castaldo G

Abstract

Endothelial-cell-specific molecule-1 (ESM-1) also called endocan is a well-known biomarker for detecting inflammation, endothelial dysfunction (ED), and cardiovascular (CV) risk in COVID-19 patients. Upon SARS-CoV-2 infection, a small percentage of children develop Multisystem Inflammatory Syndrome in children (MIS-C). Whether endocan can be used as a biomarker of MIS-C is unknown. In this study, we assessed ESM-1 levels in MIS-C (n = 19) and healthy controls (HC; n = 17). We observed a significant increase in serum ESM-1 levels in MIS-C vs HC (p = 0.0074). In addition, ROC curve analysis demonstrated that this factor has a reasonable discriminatory power between MIS-C patients and HC (AUC of 0.7585). Notably, after one week of hospitalization and care, ESM-1 levels decreased, and this reduction was observed also for other inflammatory and pro-thrombotic markers like C-reactive protein, procalcitonin, fibrinogen, D-dimer, and ferritin, suggesting a general recovery trend in MIS-C patients. In fact, we observed that serum ESM-1 levels positively correlated with procalcitonin (PCT) (r = 0.468; p = 0.043). Finally, logistic regression analysis demonstrated an association between endocan levels and cardiac complications like myocarditis. Therefore, this study suggests that ESM-1 is a valuable diagnostic and prognostic biomarker in patients with MIS-C that may help identify those MIS-C patients at higher risk for cardiovascular complications and guide treatment strategies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Published
2024
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38. The lung ultrasound in children with SARS-COV-2 infection: a national multicenter prospective study.

Author

Supino MC, Buonsenso D, Agostiniani R, Gori L, Tipo V, Morello R, Del Monaco G, Falsaperla R, Biagi C, Cazzato S, Villani A, and Musolino AM

Subjects
Humans, Male, Child, Female, Child, Preschool, Prospective Studies, Infant, Adolescent, SARS-CoV-2, Prognosis, COVID-19 diagnostic imaging, COVID-19 therapy, Ultrasonography methods, Lung diagnostic imaging
Abstract

Coronavirus disease-19 (COVID-19) caused hospitalizations, severe disease, and deaths in any age, including in the youngest children. The aim of this multicenter national study is to characterize the clinical and the prognostic role of lung ultrasound (LU) in children with COVID-19. We enrolled children between 1 month and 18 years of age with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection who underwent a LU within 6 h from the first medical evaluation. A total of 213 children were enrolled, 51.6% were male, median age was 2 years and 5 months (interquartile range (IQR) 4 months -11 years and 4 months). One hundred and forty-eight (69.4%) children were admitted in hospital, 9 (6.1%) in pediatric intensive care unit. We found an inverse correlation between the lung ultrasound score (LUS) and the oxygen saturation at the first clinical evaluation (r = -0.16; p = 0.019). Moreover, LUS was significantly higher in patients requiring oxygen supplementation (8 (IQR 3-19) vs 2 (IQR 0-4); p = 0.001). Among LU pathological findings, irregular pleural lines, subpleural consolidations, and pleural effusions were significantly more frequent in patients needing oxygen supplementation (p = 0.007, p = 0.006, and p = 0.001, respectively).  Conclusion: This multicenter study showed that LU in children with COVID-19 can highlight pleural line irregularities, vertical artifacts, and subpleural consolidation. Notably, children with higher LUS have a higher risk of hospitalization and need for oxygen supplementation, supporting LU as a valid and safe point-of-care first level tool for the clinical evaluation of children with COVID-19. What is Known: • Few children infected with SARS-CoV-2 develop a severe disease and need oxygen therapy. • Lung ultrasound can easily detect low respiratory tract infection during SARS-CoV-2. What is New: • Children with higher lung ultrasound score have a higher risk of need for oxygen supplementation. • Irregular pleural line, sub-pleural consolidations and pleural effusions were significantly more frequent in patients needing oxygen supplementation., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2024
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39. The diagnostic and therapeutic challenge of atrial flutter in children: a case report.

Author

De Nigris A, Arenella M, Di Nardo G, Marco GMD, Mormile A, Lauretta D, De Simone C, Pepe A, Cosimi R, Vastarella R, Giannattasio A, Salomone G, Perrotta S, Cioffi S, Marzuillo P, Tipo V, and Martemucci L

Subjects
Male, Adult, Child, Humans, Anti-Arrhythmia Agents therapeutic use, Adenosine therapeutic use, Atrial Flutter diagnosis, Atrial Flutter drug therapy, Atrial Fibrillation drug therapy, Tachycardia, Supraventricular diagnosis
Abstract

Background: Palpitations represent a common cause for consultation in the pediatric Emergency Department (ED). Unlike adults, palpitations in children are less frequently dependent from the heart, recognizing other causes., Case Presentation: A 11-year-old male came to our pediatric ED for epigastric pain, vomiting and palpitations. During the previous 6 month the patient was affected by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus). Electrocardiogram (ECG) revealed supraventricular tachycardia. Therefore, adenosine was administered unsuccessfully. The administration of adenosine, however, allowed us to make diagnosis of atypical atrial flutter. Multiple attempts at both electrical cardioversion, transesophageal atrial overdrive, and drug monotherapy were unsuccessful in our patient. Consequently, a triple therapy with amiodarone, flecainide, and beta-blocker was gradually designed to control the arrhythmic pattern with the restoration of a left upper atrial rhythm. There was not any evidence of sinus rhythm in the patient clinical history., Conclusions: The present study underlines the rarity of this type of dysrhythmia in childhood and the difficulties in diagnosis and management, above all in a patient who has never showed sinus rhythm. Raising awareness of all available treatment options is essential for a better management of dysrhythmia in children., (© 2023. Società Italiana di Pediatria.)

Published
2023
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40. Thrombotic Features as the Primary Cause of SARS-CoV-2 Related Acute Abdomen in Children.

Author

Amoroso A, Di Stasio F, Ranucci G, Betalli P, Cheli M, Dalla Rosa D, D'Anna C, Gaglione G, Giannotti G, Licini L, Mandato C, Massazza G, Orlando F, Morotti D, Rocco M, Sonzogni A, Tipo V, Verdoni L, D'Antiga L, and Norsa L

Subjects
Child, Humans, SARS-CoV-2, Retrospective Studies, Case-Control Studies, COVID-19 complications, Abdomen, Acute etiology, Abdomen, Acute surgery, Thrombosis etiology
Abstract

Objectives: We performed a retrospective case control study to evaluate the histological characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive pediatric patients undergoing laparoscopic exploration for acute abdomen symptoms. To our knowledge this is the first study that analyzes histopathological characteristics of abdominal tissues in SARS-CoV-2 children., Study Design: We enrolled 8 multisystem inflammatory syndrome in children (MIS-C) patients and 4 SARS-CoV-2 positive patients who underwent intestinal resection versus 36 control appendectomies from 2 pediatric tertiary referral centers between March 2020 and July 2021. Surgical resection samples were evaluated on several histological sections focusing on general inflammatory pattern and degree of inflammation. Peculiar histological features (endotheliitis and vascular thrombosis) were semi-quantitatively scored respectively in capillary, veins, and arteries., Results: All SARS-CoV-2 related surgical samples showed thrombotic patterns. Those patterns were significantly less frequent in SARS-CoV-2 negative appendectomies ( P = 0.004). The semi-quantitative score of thrombosis was significantly higher ( P = 0.002) in patients with SARS-CoV-2 related procedures., Conclusions: Our results showed that SARS-CoV-2 can cause thrombotic damage in abdominal tissues both in the acute phase of the infection (SARS-CoV-2 related appendectomies) and secondary to cytokine storm (MIS-C)., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer on behalf of European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Published
2023
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41. Simple febrile seizures: new cut off for the duration of the crises.

Author

Falsaperla R, Marino S, Vitaliti G, Bonadies A, Marino SD, Pavone P, Romano C, Savoia F, Calì C, Ruggieri M, Lubrano R, and Tipo V

Subjects
Child, Humans, Infant, Retrospective Studies, Fever, Hospitals, University, Seizures, Febrile diagnosis, Seizures, Febrile epidemiology, Epilepsy epidemiology
Abstract

Background: Our study aimed to identify a new cut-off for febrile seizure (FS) with a good prognosis, thereby replacing the 15 min described in the standard definition of simple febrile seizure (SFS)., Methods: Our study was a retrospective observational study (from January 2018 to December 2018) on children admitted to the Pediatric emergency room of the Santobono-Pausilipon Hospital, Naples, Italy, Pediatric Unit of Latina, Rome, Italy, and Policlinico-Vittorio-Emanuele University Hospital, Catania, Italy, for fever, which developed SFS during the hospitalization. All included patients had their seizures classified as SFS according to the international criteria for epilepsy. We assumed a duration cut-off, and we analyzed the EEG results, neurological follow-up at 12 months, and the recurrence of the febrile seizures the following year. Then, with another calculation, we identify an optimal cut-off of 6 min. Finally, we divided the population into two groups: children with seizures having a duration greater than or less than 6 min., Results: We found that the population with FS with a duration greater than 6 min presented EEG alteration at follow-up visits, neurological disorders, and a recurrence of FS during the following year., Conclusions: We suggest to introduce a new cut-off for the duration of FS that better represents the benign nature of a simple febrile event., (© 2023. The Author(s) under exclusive licence to Belgian Neurological Society.)

Published
2023
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42. Incomplete Kawasaki Disease with Peripheral Facial Nerve Palsy and Lung Nodules: A Case Report and Literature Review.

Author

Maglione M, Barlabà A, Grieco M, Cosimi R, Di Nardo G, Di Marco GM, Gelzo M, Castaldo G, Tucci C, Iodice RM, Lonardo MC, Tipo V, and Giannattasio A

Abstract

The diagnosis of Kawasaki disease (KD) is challenging and often delayed mainly in case of young infants and in presence of an incomplete disease and atypical features. Facial nerve palsy is one of the rare neurologic symptoms of KD, associated with a higher incidence of coronary arteries lesions and may be an indicator of a more severe disease. Here, we describe a case of lower motor neuron facial nerve palsy complicating KD and perform an extensive literature review to better characterize clinical features and treatment of patients with KD-associated facial nerve palsy. The patient was diagnosed at the sixth day of disease and presented extensive coronary artery lesions. A prompt treatment with intravenous immunoglobulins, aspirin and steroids obtained a good clinical and laboratory response, with resolution of facial nerve palsy and improvement of coronary lesions. The incidence of facial nerve palsy is 0.9-1.3%; it is often unilateral, transient, more frequent on the left and seemingly associated with coronary impairment. Our literature review showed coronary artery involvement in the majority of reported cases (27/35, 77%) of KD with facial nerve palsy. Unexplained facial nerve palsy in young children with a prolonged febrile illness should prompt consideration of echocardiography to exclude KD and start the appropriate treatment.

Published
2023
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45. Seizures in Children with SARS-CoV-2 Infection: Epidemiological, Clinical and Neurophysiological Characterization.

Author

Pascarella A, Maglione M, Lenta S, Sciorio E, Mancusi R, Tucci C, Angrisani F, Acierno S, Calì C, Tipo V, and Giannattasio A

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present with a wide variety of symptoms, including neurological manifestations. We investigated clinical, demographic, laboratory, neurophysiological and imaging characteristics of SARS-CoV-2-positive children with seizures and analyzed differences between children admitted during the periods with prevalent circulation of the Alpha/Delta and Omicron variants, respectively. Patients' characteristics were analyzed according to the presence or absence of seizures and then according to the SARS-CoV-2 variants. Five-hundred and four SARS-CoV-2-positive patients were included: 93 (18.4%) with seizures and 411 (81.6%) without. Patients with seizures were older, had more commonly an underlying epilepsy and had more frequently altered C-reactive protein than those without seizures. Electroencephalography was abnormal in 5/38 cases. According to the SARS-CoV-2 variant, seizures were recorded in 4.7% of the total number of hospitalized patients during the Alpha/Delta period, and in 16.9% of patients admitted during the Omicron period. During the Alpha/Delta variants, seizures were more commonly observed in patients with epilepsy compared to those observed during the Omicron period. Our findings suggest that although SARS-CoV-2 may potentially trigger seizures, they are generally not severe and do not require intensive care admission.

Published
2022
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46. MIS-C: A COVID-19-as sociated condition between hypoimmunity and hyperimmunity.

Author

Gelzo M, Castaldo A, Giannattasio A, Scalia G, Raia M, Esposito MV, Maglione M, Muzzica S, D'Anna C, Grieco M, Tipo V, La Cava A, and Castaldo G

Subjects
Child, Humans, Interleukin-10, SARS-CoV-2, Interleukin-17, Interleukin-6, RNA, Viral, Cytokines metabolism, Biomarkers, Autoantigens, Guanine Nucleotide Exchange Factors, COVID-19, Immunologic Deficiency Syndromes, Autoimmune Diseases
Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a rare, severe complication of COVID-19. A better knowledge of immunological, cellular, and genetic characteristics of MIS-C could help better understand the pathogenesis of the disease and contribute to identifying specific diagnostic biomarkers and develop targeted therapies. We studied 37 MIS-C children at hospital admission and 24 healthy controls analyzing serum cytokines (IFN-α, IFN-β, IFN-γ, IL-6, IL-10, IL-17A, IL-12p70 and TNF), lymphocyte populations by flow cytometry and 386 genes related to autoimmune diseases, autoinflammation and primary immunodeficiencies by NGS. MIS-C patients showed a significant increase of serum IFNγ (despite a significant reduction of activated Th1) and ILs, even if with a great heterogeneity among patients, revealing different pathways involved in MIS-C pathogenesis and suggesting that serum cytokines at admission may help to select the inflammatory pathways to target in each patient. Flow cytometry demonstrated a relevant reduction of T populations while the percentage of B cell was increased in agreement with an autoimmune pathogenesis of MIS-C. Genetic analysis identified variants in 34 genes and 83.3% of patients had at least one gene variant. Among these, 9 were mutated in more patients. Most genes are related to autoimmune diseases like ATM , NCF1 , MCM4 , FCN3 , and DOCK8 or to autoinflammatory diseases associated to the release of IFNγ like PRF1 , NOD2 , and MEF . Thus, an incomplete clearance of the Sars-CoV2 during the acute phase may induce tissue damage and self-antigen exposure and genetic variants can predispose to hyper-reactive immune dysregulation events of MIS-C-syndrome. Type II IFN activation and cytokine responses (mainly IL-6 and IL-10) may cause a cytokine storm in some patients with a more severe acute phase of the disease, lymphopenia and multisystemic organ involvement. The timely identification of such patients with an immunocytometric panel might be critical for targeted therapeutic management., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gelzo, Castaldo, Giannattasio, Scalia, Raia, Esposito, Maglione, Muzzica, D’Anna, Grieco, Tipo, La Cava and Castaldo.)

Published
2022
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49. Changing Epidemiology of Acute Viral Respiratory Infections in Hospitalized Children: The Post-Lockdown Effect.

Author

Maglione M, Pascarella A, Botti C, Ricci G, Morelli F, Camelia F, Micillo A, Calì C, Savoia F, Tipo V, and Giannattasio A

Abstract

Several reports highlighted how public health measures aimed at limiting severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) circulation have likely contributed to reducing the circulation of other respiratory viruses, particularly during the first year of the COVID-19 pandemic. We evaluated the epidemiology of acute respiratory infections in a large cohort of hospitalized children during the third year of the pandemic (2021−2022). We retrospectively analyzed data from the health records of children (<14 years) hospitalized for acute respiratory infections between 1 July 2021 and 31 March 2022. A total of 1763 respiratory panels were collected. Overall, 1269 (72%) panels hadpositive results for at least one pathogen. Most positive panels (53.8%) belonged to patients aged 1−12 months. The most detected pathogen was respiratory syncytial virus (RSV) (57.8% of positive panels). The RSV peak occurred in November 2021. Nine hundred and forty-five (74.5%) panels were positive for one pathogen while three hundred and twenty-four (25.5%) showed multiple infections. Patients with multiple infections were significantly older than those with a single infection. The 2021−2022 peak of RSV infection in Italy occurred earlier than in the previous pre-pandemic seasons. A high number of children have been hospitalized because of acute viral infections also due to less aggressive viruses.

Published
2022
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50. Biomarkers of Endothelial Damage in Distinct Phases of Multisystem Inflammatory Syndrome in Children.

Author

Gelzo M, Giannattasio A, Maglione M, Muzzica S, D'Anna C, Scialò F, Gagliardo T, Grieco M, Tipo V, and Castaldo G

Abstract

Endothelial hyperinflammation and vasculitis are known hallmarks of acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C). They are due to the direct effect of the virus on endothelial cells enhanced by pro-inflammatory modulators and may cause venous/arterial thrombosis. Therefore, it is essential to identify patients with endothelial damage early in order to establish specific therapies. We studied the monocyte chemoattractant protein 1 (MCP-1), the perinuclear anti-neutrophil cytoplasmic antibodies (pANCA), and the vascular endothelial growth factor A (VEGF-A) in serum from 45 MIS-C patients at hospital admission and 24 healthy controls (HC). For 13/45 MIS-C patients, we measured the three serum biomarkers also after one week from hospitalization. At admission, MIS-C patients had significantly higher levels of MCP-1 and VEGF-A than the HC, but no significant differences were observed for pANCA. While after one week, MCP-1 was significantly lower, pANCA was higher and VEGF-A levels were not significantly different from the admission values. These findings suggest an involvement of epithelium in MIS-C with an acute phase, showing high MCP-1 and VEGF-A, followed by an increase in pANCA that suggests a vasculitis development. The serum biomarker levels may help to drive personalized therapies in these phases with anticoagulant prophylaxis, immunomodulators, and/or anti-angiogenic drugs.

Published
2022
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