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1. Comparison of “IN-REC-SUR-E” and LISA in preterm neonates with respiratory distress syndrome: a randomized controlled trial (IN-REC-LISA trial)

Author

Vento, Giovanni, Paladini, Angela, Aurilia, C., Ozdemir, S. Alkan, Carnielli, V. P., Cools, F., Costa, S., Cota, F., Dani, C., Davis, P. G., Fattore, S., Fè, C., Finer, N., Fusco, F. P., Gizzi, C., Herting, E., Jian, M., Lio, A., Lista, G., Mosca, F., Nobile, S., Perri, A., Picone, S., Pillow, J. J., Polglase, G., Pasciuto, T., Pastorino, R., Tana, M., Tingay, D., Tirone, C., van Kaam, A. H., Ventura, M. L., Aceti, A., Agosti, M., Alighieri, G., Ancora, G., Angileri, V., Ausanio, G., Aversa, S., Balestri, E., Baraldi, E., Barbini, M. C., Barone, C., Beghini, R., Bellan, C., Berardi, A., Bernardo, I., Betta, P., Binotti, M., Bizzarri, B., Borgarello, G., Borgione, S., Borrelli, A., Bottino, R., Bracaglia, G., Bresesti, I., Burattini, I., Cacace, C., Calzolari, F., Campagnoli, M. F., Capasso, L., Capozza, M., Capretti, M. G., Caravetta, J., Carbonara, C., Cardilli, V., Carta, M., Castoldi, F., Castronovo, A., Cavalleri, E., Cavigioli, F., Cecchi, S., Chierici, V., Cimino, C., Cocca, F., Cocca, C., Cogo, P., Coma, M., Comito, V., Condò, V., Consigli, C., Conti, R., Corradi, M., Corsello, G., Corvaglia, L. T., Costa, A., Coscia, A., Cresi, F., Crispino, F., D’Amico, P., De Cosmo, L., De Maio, C., Del Campo, G., Di Credico, S., Di Fabio, S., Di Nicola, P., Di Paolo, A., Di Valerio, S., Distilo, A., Duca, V., Falcone, A., Falsaperla, R., Fasolato, V. A., Fatuzzo, V., Favini, F., Ferrarello, M. P., Ferrari, S., Nastro, F. Fiori, Forcellini, C. A., Fracchiolla, A., Gabriele, A., Galdo, F., Gallini, F., Gangemi, A., Gargano, G., Gazzolo, D., Gentile, M. P., Ghirardello, S., Giardina, F., Giordano, L., Gitto, E., Giuffrè, M., Grappone, L., Grasso, F., Greco, I., Grison, A., Guglielmino, R., Guidotti, I., Guzzo, I., La Forgia, N., La Placa, S., La Torre, G., Lago, P., Lanciotti, L., Lavizzari, A., Leo, F., Leonardi, V., Lestingi, D., Li, J., Liberatore, P., Lodin, D., Lubrano, R., Lucente, M., Luciani, S., Luvarà, D., Maffei, G., Maggio, A., Maggio, L., Maiolo, K., Malaigia, L., Mangili, G., Manna, A., Maranella, E., Marciano, A., Marcozzi, P., Marletta, M., Marseglia, L., Martinelli, D., Martinelli, S., Massari, S., Massenzi, L., Matina, F., Mattia, L., Mescoli, G., Migliore, I. V., Minghetti, D., Mondello, I., Montano, S., Morandi, G., Mores, N., Morreale, S., Morselli, I., Motta, M., Napolitano, M., Nardo, D., Nicolardi, A., Nider, S., Nigro, G., Nuccio, M., Orfeo, L., Ottaviano, C., Paganin, P., Palamides, S., Palatta, S., Paolillo, P., Pappalardo, M. G., Pasta, E., Patti, L., Paviotti, G., Perniola, R., Perotti, G., Perrone, S., Petrillo, F., Piazza, M. S., Piccirillo, A., Pierro, M., Piga, E., Pingitore, G. A., Pisu, S., Pittini, C., Pontiggia, F., Pontrelli, G., Primavera, A., Proto, A., Quartulli, L., Raimondi, F., Ramenghi, L., Rapsomaniki, M., Ricotti, A., Rigotti, C., Rinaldi, M., Risso, F. M., Roma, E., Romanini, E., Romano, V., Rosati, E., Rosella, V., Rulli, I., Salvo, V., Sanfilippo, C., Sannia, A., Saporito, A., Sauna, A., Scapillati, E., Schettini, F., Scorrano, A., Mantelli, S. Semeria, Sepporta, V., Sindico, P., Solinas, A., Sorrentino, E., Spaggiari, E., Staffler, A., Stella, M., Termini, D., Terrin, G., Testa, A., Tina, G., Tirantello, M., Tomasini, B., Tormena, F., Travan, L., Trevisanuto, D., Tuling, G., Tulino, V., Valenzano, L., Vedovato, S., Vendramin, S., Villani, P. E., Viola, S., Viola, V., Vitaliti, G., Vitaliti, M., Wanker, P., Yang, Y., Zanetta, S., and Zannin, E.

Published
2024
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2. 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

3. 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

4. Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program

Author

Carmelo Massimo Maida, Francesco Vitale, Aurora Aleo, Vincenzo Insinga, Grazia Rinaudo, Mario Giuffrè, Celestino Bonura, Emanuele Amodio, Vitaliti M, Giovanni Corsello, Giorgio Graziano, Federica Mescolo, Laura Saporito, Saporito L., Graziano G., Mescolo F., Amodio E., Insinga V., Rinaudo G., Aleo A., Bonura C., Vitaliti M., Corsello G., Vitale F., Maida C.M., and Giuffre M.

Subjects
0301 basic medicine, Microbiology (medical), Male, medicine.medical_specialty, Neonatal intensive care unit, 030106 microbiology, Extended spectrum β lactamases producing klebsiella pneumoniae, Context (language use), Drug resistance, Microbial Sensitivity Tests, Antimicrobial resistance, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, 0302 clinical medicine, Antibiotic resistance, Medical microbiology, Internal medicine, Drug Resistance, Multiple, Bacterial, Intensive Care Units, Neonatal, Gram-Negative Bacteria, medicine, Humans, Pharmacology (medical), lcsh:RC109-216, 030212 general & internal medicine, Cross Infection, Infection Control, Active surveillance program, business.industry, Research, Public Health, Environmental and Occupational Health, Infant, Newborn, Antimicrobial, Multi-drug resistant gram-negative bacteria, Electrophoresis, Gel, Pulsed-Field, Infectious Diseases, Carriage, Italy, Intervention strategy, Carrier State, Female, Sample collection, business, Gram-Negative Bacterial Infections
Abstract

BackgroundAntimicrobial resistance in neonatal intensive care unit (NICU) patients is a threat, due to the frequent use of antimicrobial treatment and invasive devices in fragile babies. Since 2014 an active surveillance program of multidrug-resistant Gram-negative bacteria (MDR-GNB) carriage has been in place in the five NICUs of Palermo, Italy. In 2017 an increase in the prevalence of MDR-GNB, and in particular of extended-spectrum β-lactamases-producingKlebsiella pneumoniae(ESBL-KP), was observed in “Civico” hospital NICU.AimTo assess the impact of a coordinated intervention strategy in achieving long-lasting reduction of MDR-GNB prevalence in the NICU.MethodsRectal swabs were obtained monthly and processed to detect MDR-GNB using standard methods. MDR-GNB were characterized by pulsed-field gel electrophoresis (PFGE). Since November 2017 the following intervention measures were applied: (a) two-months intensification of sample collection; (b) stakeholders meetings; (c) improvement of prevention measures and antimicrobial policies.FindingsDuring the intensified microbiological surveillance MDR-GNB and ESBL-KP were detected in rectal swabs (34.8%; 23.2%), nasal swabs (24.6%; 14.5%), oral swabs (14.5%; 5.4%), milk samples (32.1%; 17.9%), pacifiers swabs (30.8%; 17.9%) and from sub-intensive room surfaces. Thirteen ESBL-KP strains isolated from clinical and environmental samples showed identical PFGE patterns. The prevalence of MDR-GNB and ESBL-KP carriage significantly decreased in the year after intervention compared to the previous year (20.6% vs 62.2%;p p p ConclusionsMDR-GNB broadly circulate in NICU setting, they can colonize different body sites and spread through various vehicles. A coordinated strategy of multiple interventions with active cooperation between epidemiologists and clinicians in the NICU can effectively reduce their circulation and in particular the carriage of the most dangerous ESBL-KP strains.

Published
2021

5. Caution advised regarding lung recruitment before surfactant – Authors’ reply

Author

Vento, Giovanni, Ventura, M. L., Pastorino, Roberta, van Kaam, A. H., Carnielli, V., Cools, F., Dani, C., Mosca, F., Polglase, G., Tagliabue, P., Boni, L., Cota, Francesco, Tana, Milena, Tirone, Chiara, Aurilia, Claudia, Lio, Alessandra, Cost, S., D'Andrea, Vito, Lucente, Monica Christine, Nigro, G., Giordano, Lucia, Roma, V., Villani, P., Fusco, Francesca Paola, Fasolato, V., Colnaghi, M. R., Matassa, P. G., Vendettuoli, V., Poggi, C., Del Vecchi, A., Petrillo, F., Betta, P., Mattia, C., Garani, G., Solinas, A., Gitto, E., Salvo, V., Gargano, G., Balestri, E., Sandri, F., Mescoli, G., Martinelli, Silvia, Ilardi, L., Ciarmoli, E., Di Fabio, S., Maranella, E., Grassia, C., Ausanio, G., Rossi, V., Motta, A., Tina, L. G., Maiolo, K., Nobile, Stefano, Messner, H., Staffler, Alex, Ferrero, F., Stasi, I., Pieragostini, L., Mondello, I., Haass, C., Consigli, C., Vedovato, S., Grison, A., Maffei, G., Presta, G., Perniola, R., Vitaliti, M., Re, M. P., De Curtis, M., Cardilli, V., Lago, P., Tormena, F., Orfeo, L., Gizzi, C., Massenzi, L., Gazzolo, D., Strozzi, M. C. M., Bottino, R., Pontiggia, F., Berardi, A., Guidotti, I., Cacace, C., Meli, V., Quartulli, L., Scorrano, A., Casati, A., Grappone, L., Pillow, J. J., Vento G. (ORCID:0000-0002-8132-5127), Pastorino R. (ORCID:0000-0001-5013-0733), Cota F. (ORCID:0000-0002-9009-3997), Tana M., Tirone C., Aurilia C., Lio A., D'Andrea V. (ORCID:0000-0002-0980-799X), Lucente M., Giordano L., Fusco F. P., Martinelli S., Nobile S. (ORCID:0000-0002-5304-1485), Staffler A., Vento, Giovanni, Ventura, M. L., Pastorino, Roberta, van Kaam, A. H., Carnielli, V., Cools, F., Dani, C., Mosca, F., Polglase, G., Tagliabue, P., Boni, L., Cota, Francesco, Tana, Milena, Tirone, Chiara, Aurilia, Claudia, Lio, Alessandra, Cost, S., D'Andrea, Vito, Lucente, Monica Christine, Nigro, G., Giordano, Lucia, Roma, V., Villani, P., Fusco, Francesca Paola, Fasolato, V., Colnaghi, M. R., Matassa, P. G., Vendettuoli, V., Poggi, C., Del Vecchi, A., Petrillo, F., Betta, P., Mattia, C., Garani, G., Solinas, A., Gitto, E., Salvo, V., Gargano, G., Balestri, E., Sandri, F., Mescoli, G., Martinelli, Silvia, Ilardi, L., Ciarmoli, E., Di Fabio, S., Maranella, E., Grassia, C., Ausanio, G., Rossi, V., Motta, A., Tina, L. G., Maiolo, K., Nobile, Stefano, Messner, H., Staffler, Alex, Ferrero, F., Stasi, I., Pieragostini, L., Mondello, I., Haass, C., Consigli, C., Vedovato, S., Grison, A., Maffei, G., Presta, G., Perniola, R., Vitaliti, M., Re, M. P., De Curtis, M., Cardilli, V., Lago, P., Tormena, F., Orfeo, L., Gizzi, C., Massenzi, L., Gazzolo, D., Strozzi, M. C. M., Bottino, R., Pontiggia, F., Berardi, A., Guidotti, I., Cacace, C., Meli, V., Quartulli, L., Scorrano, A., Casati, A., Grappone, L., Pillow, J. J., Vento G. (ORCID:0000-0002-8132-5127), Pastorino R. (ORCID:0000-0001-5013-0733), Cota F. (ORCID:0000-0002-9009-3997), Tana M., Tirone C., Aurilia C., Lio A., D'Andrea V. (ORCID:0000-0002-0980-799X), Lucente M., Giordano L., Fusco F. P., Martinelli S., Nobile S. (ORCID:0000-0002-5304-1485), and Staffler A.

Abstract

N/A

Published
2021

6. Lung recruitment before surfactant administration in extremely preterm neonates with respiratory distress syndrome (IN-REC-SUR-E): a randomised, unblinded, controlled trial

Author

Vento, Giovanni, Ventura, M. L., Pastorino, Roberta, van Kaam, A. H., Carnielli, V., Cools, F., Dani, C., Mosca, F., Polglase, G., Tagliabue, P., Boni, L., Cota, Francesco, Tana, Milena, Tirone, Chiara, Aurilia, Claudia, Lio, Alessandra, Costa, Simonetta, D'Andrea, Vito, Lucente, M., Nigro, G., Giordano, Liliana, Roma, V., Villani, P. E., Fusco, Francesca Paola, Fasolato, V., Colnaghi, M. R., Matassa, P. G., Vendettuoli, V., Poggi, C., Del Vecchio, Arianna, Petrillo, F., Betta, P., Mattia, C., Garani, G., Solinas, A., Gitto, E., Salvo, V., Gargano, G., Balestri, E., Sandri, F., Mescoli, G., Martinelli, S., Ilardi, L., Ciarmoli, E., Di Fabio, S., Maranella, E., Grassia, C., Ausanio, G., Rossi, V., Motta, Alessandro, Tina, L. G., Maiolo, K., Nobile, Stefano, Messner, H., Staffler, Alex, Ferrero, Mattia Francesco, Stasi, I., Pieragostini, L., Mondello, I., Haass, C., Consigli, C., Vedovato, S., Grison, A., Maffei, G., Presta, G., Perniola, R., Vitaliti, M., Re, M. P., De Curtis, M., Cardilli, V., Lago, P., Tormena, F., Orfeo, L., Gizzi, C., Massenzi, L., Gazzolo, D., Strozzi, M. C. M., Bottino, R., Pontiggia, F., Berardi, A., Guidotti, I., Cacace, C., Meli, V., Quartulli, L., Scorrano, A., Casati, A., Grappone, L., Pillow, J. J., Vento G. (ORCID:0000-0002-8132-5127), Pastorino R. (ORCID:0000-0001-5013-0733), Cota F. (ORCID:0000-0002-9009-3997), Tana M., Tirone C., Aurilia C., Lio A., Costa S., D'Andrea V. (ORCID:0000-0002-0980-799X), Giordano L., Fusco F. P., Del Vecchio A., Motta A., Nobile S. (ORCID:0000-0002-5304-1485), Staffler A., Ferrero F., Vento, Giovanni, Ventura, M. L., Pastorino, Roberta, van Kaam, A. H., Carnielli, V., Cools, F., Dani, C., Mosca, F., Polglase, G., Tagliabue, P., Boni, L., Cota, Francesco, Tana, Milena, Tirone, Chiara, Aurilia, Claudia, Lio, Alessandra, Costa, Simonetta, D'Andrea, Vito, Lucente, M., Nigro, G., Giordano, Liliana, Roma, V., Villani, P. E., Fusco, Francesca Paola, Fasolato, V., Colnaghi, M. R., Matassa, P. G., Vendettuoli, V., Poggi, C., Del Vecchio, Arianna, Petrillo, F., Betta, P., Mattia, C., Garani, G., Solinas, A., Gitto, E., Salvo, V., Gargano, G., Balestri, E., Sandri, F., Mescoli, G., Martinelli, S., Ilardi, L., Ciarmoli, E., Di Fabio, S., Maranella, E., Grassia, C., Ausanio, G., Rossi, V., Motta, Alessandro, Tina, L. G., Maiolo, K., Nobile, Stefano, Messner, H., Staffler, Alex, Ferrero, Mattia Francesco, Stasi, I., Pieragostini, L., Mondello, I., Haass, C., Consigli, C., Vedovato, S., Grison, A., Maffei, G., Presta, G., Perniola, R., Vitaliti, M., Re, M. P., De Curtis, M., Cardilli, V., Lago, P., Tormena, F., Orfeo, L., Gizzi, C., Massenzi, L., Gazzolo, D., Strozzi, M. C. M., Bottino, R., Pontiggia, F., Berardi, A., Guidotti, I., Cacace, C., Meli, V., Quartulli, L., Scorrano, A., Casati, A., Grappone, L., Pillow, J. J., Vento G. (ORCID:0000-0002-8132-5127), Pastorino R. (ORCID:0000-0001-5013-0733), Cota F. (ORCID:0000-0002-9009-3997), Tana M., Tirone C., Aurilia C., Lio A., Costa S., D'Andrea V. (ORCID:0000-0002-0980-799X), Giordano L., Fusco F. P., Del Vecchio A., Motta A., Nobile S. (ORCID:0000-0002-5304-1485), Staffler A., and Ferrero F.

Abstract

Background: The importance of lung recruitment before surfactant administration has been shown in animal studies. Well designed trials in preterm infants are absent. We aimed to examine whether the application of a recruitment manoeuvre just before surfactant administration, followed by rapid extubation (intubate-recruit-surfactant-extubate [IN-REC-SUR-E]), decreased the need for mechanical ventilation during the first 72 h of life compared with no recruitment manoeuvre (ie, intubate-surfactant-extubate [IN-SUR-E]). Methods: We did a randomised, unblinded, controlled trial in 35 tertiary neonatal intensive care units in Italy. Spontaneously breathing extremely preterm neonates (24 + 0 to 27 + 6 weeks' gestation) reaching failure criteria for continuous positive airway pressure within the first 24 h of life were randomly assigned (1:1) with a minimisation algorithm to IN-REC-SUR-E or IN-SUR-E using an interactive web-based electronic system, stratified by clinical site and gestational age. The primary outcome was the need for mechanical ventilation in the first 72 h of life. Analyses were done in intention-to-treat and per-protocol populations, with a log-binomial regression model correcting for stratification factors to estimate adjusted relative risk (RR). This study is registered with ClinicalTrials.gov, NCT02482766. Findings: Of 556 infants assessed for eligibility, 218 infants were recruited from Nov 12, 2015, to Sept 23, 2018, and included in the intention-to-treat analysis. The requirement for mechanical ventilation during the first 72 h of life was reduced in the IN-REC-SUR-E group (43 [40%] of 107) compared with the IN-SUR-E group (60 [54%] of 111; adjusted RR 0·75, 95% CI 0·57–0·98; p=0·037), with a number needed to treat of 7·2 (95% CI 3·7–135·0). The addition of the recruitment manoeuvre did not adversely affect the safety outcomes of in-hospital mortality (19 [19%] of 101 in the IN-REC-SUR-E group vs 37 [33%] of 111 in the IN-SUR-E group), pneumothorax (

Published
2020

7. Caution advised regarding lung recruitment before surfactant – Authors’ reply

Author

Vento, Giovanni, primary, Ventura, M L, additional, Pastorino, R, additional, van Kaam, A H, additional, Carnielli, V, additional, Cools, F, additional, Dani, C, additional, Mosca, F, additional, Polglase, G, additional, Tagliabue, P, additional, Boni, L, additional, Cota, F, additional, Tana, M, additional, Tirone, C, additional, Aurilia, C, additional, Lio, A, additional, Cost, S, additional, D'Andrea, V, additional, Lucente, M, additional, Nigro, G, additional, Giordano, L, additional, Roma, V, additional, Villani, P, additional, Fusco, F P, additional, Fasolato, V, additional, Colnaghi, M R, additional, Matassa, P G, additional, Vendettuoli, V, additional, Poggi, C, additional, Del Vecchi, A, additional, Petrillo, F, additional, Betta, P, additional, Mattia, C, additional, Garani, G, additional, Solinas, A, additional, Gitto, E, additional, Salvo, V, additional, Gargano, G, additional, Balestri, E, additional, Sandri, F, additional, Mescoli, G, additional, Martinelli, S, additional, Ilardi, L, additional, Ciarmoli, E, additional, Di Fabio, S, additional, Maranella, E, additional, Grassia, C, additional, Ausanio, G, additional, Rossi, V, additional, Motta, A, additional, Tina, L G, additional, Maiolo, K, additional, Nobile, S, additional, Messner, H, additional, Staffler, A, additional, Ferrero, F, additional, Stasi, I, additional, Pieragostini, L, additional, Mondello, I, additional, Haass, C, additional, Consigli, C, additional, Vedovato, S, additional, Grison, A, additional, Maffei, G, additional, Presta, G, additional, Perniola, R, additional, Vitaliti, M, additional, Re, M P, additional, De Curtis, M, additional, Cardilli, V, additional, Lago, P, additional, Tormena, F, additional, Orfeo, L, additional, Gizzi, C, additional, Massenzi, L, additional, Gazzolo, D, additional, Strozzi, M C M, additional, Bottino, R, additional, Pontiggia, F, additional, Berardi, A, additional, Guidotti, I, additional, Cacace, C, additional, Meli, V, additional, Quartulli, L, additional, Scorrano, A, additional, Casati, A, additional, Grappone, L, additional, and Pillow, J J, additional

Published
2021
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9. A Snapshot on MRSA Epidemiology in a Neonatal Intensive Care Unit Network, Palermo, Italy

Author

GERACI, Daniela Maria, GIUFFRE, Mario, BONURA, Celestino, GRAZIANO, Giorgio, ALEO, Aurora, VECCHIO, Davide, MAMMINA, Caterina, SAPORITO, Laura, Insinga, V., Rinaudo, G., Ciofalo, A., Vitaliti, M., Lunetta, F., Sulliotti, G., Pinna, G., Pomo, R., Rizzo, A., Sepporta, V., Geraci, D., Giuffrè, M., Bonura, C., Graziano, G., Saporito, L., Insinga, V., Rinaudo, G., Aleo, A., Vecchio, D., Mammina, C., Ciofalo, A., Vitaliti, M., Lunetta, F., Sulliotti, G., Pinna, G., Pomo, R., Rizzo, A., and Sepporta, V.

Subjects
0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Neonatal intensive care unit, health care facilities, manpower, and services, 030106 microbiology, lcsh:QR1-502, MRSA, Microbiology, lcsh:Microbiology, 03 medical and health sciences, Internal medicine, Epidemiology, Medicine, Infection control, network approach, Original Research, NICu, Active surveillance, Molecular typing, Network approach, business.industry, MRSA colonization, active surveillance, molecular typing, Sequence types, Variable number tandem repeat, 030104 developmental biology, Multilocus sequence typing, University teaching, business
Abstract

Objectives. We performed a one-year prospective surveillance study on MRSA colonization within the five NICUs of the metropolitan area of Palermo, Italy. The purpose of the study was to assess epidemiology of MRSA in NICU from a network perspective. Methods. Transfer of patients between NICUs during 2014 was traced based on the annual hospital discharge records. In the period February 2014 – January 2015, in the NICU B, at the University teaching hospital, nasal swabs from all infants were collected weekly, whereas in the other four NICUs (A, C, D, E) at four week-intervals of time. MRSA isolates were submitted to antibiotic susceptibility testing, SCCmec typing, PCR to detect lukS-PV and lukF-PV (lukS/F-PV) genes and the gene encoding the toxic shock syndrome toxin (TSST-1), multilocus variable number tandem repeat fingerprinting (MLVF) and multilocus sequence typing (MLST). Results. In the period under study, 587 nasal swabs were obtained from NICU B, whereas 218, 180, 157 and 95 from NICUs A, C, D and E, respectively. Two groups of NICUs at high prevalence and low prevalence of MRSA colonization were recognized. Overall, 113 isolates of MRSA were identified from 102 infants. Six MLVF types (A-F) were detected, with type C being subdivided into five subtypes. Five sequence types (STs) were found with ST22-IVa being the most frequent type in all NICUs. All the MRSA molecular subtypes, except for ST1-IVa, were identified in NICU B. Conclusions. Our findings support the need to approach surveillance and infection control in NICU in a network perspective, prioritizing referral healthcare facilities.

Published
2016
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10. MECASERMIN TREATMENT OF A CHILD WITH CONGENITAL HYPERINSULINISM LINKED TO INS-R MUTATION

Author

Maggio, M. C., Vitaliti, M., Vitaliti, G., Fabrizio Barbetti, Corsello, G., and Maria Cristina Maggio, Marcello Vitaliti, Giuliana Vitaliti, Fabrizio Barbetti, Giovanni Corsello

Subjects
Mecasermin, IGF1,Leprechaunism, Donohue syndrome
Abstract

Objectives: Mecasermin is recombinant human insulin-like growth factor 1 (IGF1) which is approved for the treatment of short stature in children with documented primary IGF1 deficiency. Leprechaunism, also known as Donohue syndrome, is a severe disease, secondary to a severe congenital insulin resistance, with prenatal and neonatal growth retardation, typical dysmorphic features, glycaemic dysregulation characterized by hyperinsulinemia and hyperandrogenism. These patients have a poor prognosis with death in the first year of life. Methods: We describe the case of a 3.5 years child, born at 35,4 weeks, with severe fetal growth restriction (weight 1149 gr; length: 38 cm; cranial circumference: 28 cm), typical facial features with low implant ears, low implant hairs, hypertrichosis, hypertrophic external genitalia, postnatal growth failure, and severe hyperglycaemia (327 mg/dl) alternated with hypoglycaemia (10 mg/dl) also during i.v. infusion of glucose; significant hyperinsulinism (1000 mcU/dl) with elevated C peptide levels (43,41 ng/ml), persistent hypertension (113/74 mmHg). He has consanguineous parents (cousins) and the mother underwent abortions before the baby was born. Results: A treatment with diazoxide (5 mg/kg/day) was tried with limited efficacy. He was treated with ACE-inhibitor (Captopril) at the dose of 0,02 mg/kg/day with a low response. The Captopril dose was increased at 0,04 mg/kg/day with a regulation of the blood pressure (76/54 mmHg). The genetic study of INS-R was showed a homozygote mutation in the insulin receptor (INS-R) gene. The mutation reported was c.3289C>T (CAG->TAG) p.Gln1097Stop (Q1097X). For the growth delay and the hypotrophic muscular masses he started a off-label treatment with mecasermin at increasing doses. He had no adverse events linked to the treatment. Otherwise, he improved growth and muscular strength. Conclusions: The singular case is of relieve for the rarity of the disease and for the good response to the treatment with mecasermin, the real opportunity for these children with a severe disease otherwise with a poor prognosis.

Published
2017

11. Caution advised regarding lung recruitment before surfactant – Authors’ reply

Author

Ventura, M L, Pastorino, R, van Kaam, A H, Carnielli, V, Cools, F, Dani, C, Mosca, F, Polglase, G, Tagliabue, P, Boni, L, Cota, F, Tana, M, Tirone, C, Aurilia, C, Lio, A, Cost, S, D'Andrea, V, Lucente, M, Nigro, G, Giordano, L, Roma, V, Villani, P, Fusco, F P, Fasolato, V, Colnaghi, M R, Matassa, P G, Vendettuoli, V, Poggi, C, Del Vecchi, A, Petrillo, F, Betta, P, Mattia, C, Garani, G, Solinas, A, Gitto, E, Salvo, V, Gargano, G, Balestri, E, Sandri, F, Mescoli, G, Martinelli, S, Ilardi, L, Ciarmoli, E, Di Fabio, S, Maranella, E, Grassia, C, Ausanio, G, Rossi, V, Motta, A, Tina, L G, Maiolo, K, Nobile, S, Messner, H, Staffler, A, Ferrero, F, Stasi, I, Pieragostini, L, Mondello, I, Haass, C, Consigli, C, Vedovato, S, Grison, A, Maffei, G, Presta, G, Perniola, R, Vitaliti, M, Re, M P, De Curtis, M, Cardilli, V, Lago, P, Tormena, F, Orfeo, L, Gizzi, C, Massenzi, L, Gazzolo, D, Strozzi, M C M, Bottino, R, Pontiggia, F, Berardi, A, Guidotti, I, Cacace, C, Meli, V, Quartulli, L, Scorrano, A, Casati, A, Grappone, L, Pillow, J J, and Vento, Giovanni

Published
2021
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12. Iperinsulinismo congenito da mutazione in omozigosi di INS-R: descrizione di un caso

Author

Vitaliti M, Grasso V, Vitaliti G, Maresi MR, Mascellino E, Mancuso D, Barbetti F., MAGGIO, Maria Cristina, RINAUDO, Grazia, CORSELLO, Giovanni, Vitaliti M, Maggio MC, Grasso V, Vitaliti G, Maresi MR, Rinaudo G, Mascellino E, Mancuso D, Corsello G, and Barbetti F

Subjects
Settore MED/38 - Pediatria Generale E Specialistica, Iperinsulinismo congenito, omozigosi, INS-r
Published
2014

13. Congenital Hyperinsulinism Linked to INS-R Mutation: Case Report

Author

Vitaliti M, Vitaliti G, Grasso V, Ciofalo A, Rinaudo G, Tranchina E, Costantino G, Fabrizio Barbetti, MAGGIO, Maria Cristina, CORSELLO, Giovanni, Vitaliti M, Maggio MC, Vitaliti G, Grasso V, Ciofalo A, Rinaudo G, Tranchina E, Costantino G, Corsello G, and Fabrizio Barbetti

Subjects
Settore MED/38 - Pediatria Generale E Specialistica, Congenital Hyperinsulinism, INS-R Mutation
Published
2014

14. Efficacy of a new technique - INtubate-RECruit-SURfactant-Extubate - 'IN-REC-SUR-E' - in preterm neonates with respiratory distress syndrome: study protocol for a randomized controlled trial.

Author

Vento, Giovanni, Pastorino, Roberta, Boni, L, Cota, Francesco, Carnielli, V, Cools, F, Dani, C, Mosca, F, Pillow, J, Polglase, G, Tagliabue, Roberta Piera, van Kaam, Ah, Ventura, Ml, Tana, Milena, Tirone, Chiara, Aurilia, Claudia, Lio, Alessandra, Ricci, C, Gambacorta, Maria Antonietta, Consigli, C, D'Onofrio, D, Gizzi, C, Massenzi, L, Cardilli, V, Casati, A, Bottino, R, Pontiggia, Federico, Ciarmoli, E, Martinelli, S, Ilardi, L, Colnaghi, M, Matassa, Piero Giuseppe, Vendettuoli, Valentina, Villani, P, Fusco, Francesca Paola, Gazzolo, D, Ricotti, A, Ferrero, F, Stasi, I, Magaldi, R, Maffei, G, Presta, G, Perniola, R, Messina, F, Montesano, G, Poggi, C, Giordano, L, Roma, E, Grassia, C, Ausanio, G, Sandri, F, Mescoli, G, Giura, F, Garani, G, Solinas, A, Lucente, Michele, Nigro, G, Del Vecchio, Angela Maria, Petrillo, F, Orfeo, L, Grappone, L, Quartulli, L, Scorrano, Antonio, Messner, H, Staffler, Alex, Gargano, G, Balestri, E, Nobile, Stefano, Cacace, C, Meli, V, Dallaglio, S, Pasqua, B, Mattia, L, Gitto, E, Vitaliti, M, Re, Mp, Vedovato, S, Grison, A, Berardi, A, Torcetta, F, Guidotti, I, di Fabio, S, Maranella, E, Mondello, I, Visentin, S, Tormena, F., Vento, Giovanni (ORCID:0000-0002-8132-5127), Pastorino, Roberta (ORCID:0000-0001-5013-0733), Cota, Francesco (ORCID:0000-0002-9009-3997), Gambacorta, Maria Antonietta (ORCID:0000-0001-5455-8737), Nobile, S (ORCID:0000-0002-5304-1485), Vento, Giovanni, Pastorino, Roberta, Boni, L, Cota, Francesco, Carnielli, V, Cools, F, Dani, C, Mosca, F, Pillow, J, Polglase, G, Tagliabue, Roberta Piera, van Kaam, Ah, Ventura, Ml, Tana, Milena, Tirone, Chiara, Aurilia, Claudia, Lio, Alessandra, Ricci, C, Gambacorta, Maria Antonietta, Consigli, C, D'Onofrio, D, Gizzi, C, Massenzi, L, Cardilli, V, Casati, A, Bottino, R, Pontiggia, Federico, Ciarmoli, E, Martinelli, S, Ilardi, L, Colnaghi, M, Matassa, Piero Giuseppe, Vendettuoli, Valentina, Villani, P, Fusco, Francesca Paola, Gazzolo, D, Ricotti, A, Ferrero, F, Stasi, I, Magaldi, R, Maffei, G, Presta, G, Perniola, R, Messina, F, Montesano, G, Poggi, C, Giordano, L, Roma, E, Grassia, C, Ausanio, G, Sandri, F, Mescoli, G, Giura, F, Garani, G, Solinas, A, Lucente, Michele, Nigro, G, Del Vecchio, Angela Maria, Petrillo, F, Orfeo, L, Grappone, L, Quartulli, L, Scorrano, Antonio, Messner, H, Staffler, Alex, Gargano, G, Balestri, E, Nobile, Stefano, Cacace, C, Meli, V, Dallaglio, S, Pasqua, B, Mattia, L, Gitto, E, Vitaliti, M, Re, Mp, Vedovato, S, Grison, A, Berardi, A, Torcetta, F, Guidotti, I, di Fabio, S, Maranella, E, Mondello, I, Visentin, S, Tormena, F., Vento, Giovanni (ORCID:0000-0002-8132-5127), Pastorino, Roberta (ORCID:0000-0001-5013-0733), Cota, Francesco (ORCID:0000-0002-9009-3997), Gambacorta, Maria Antonietta (ORCID:0000-0001-5455-8737), and Nobile, S (ORCID:0000-0002-5304-1485)

Abstract

BACKGROUND: Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is not successful in all preterm neonates with respiratory distress syndrome, with a reported failure rate ranging from 19 to 69 %. One of the possible mechanisms responsible for the unsuccessful IN-SUR-E method, requiring subsequent re-intubation and mechanical ventilation, is the inability of the preterm lung to achieve and maintain an "optimal" functional residual capacity. The importance of lung recruitment before surfactant administration has been demonstrated in animal studies showing that recruitment leads to a more homogeneous surfactant distribution within the lungs. Therefore, the aim of this study is to compare the application of a recruitment maneuver using the high-frequency oscillatory ventilation (HFOV) modality just before the surfactant administration followed by rapid extubation (INtubate-RECruit-SURfactant-Extubate: IN-REC-SUR-E) with IN-SUR-E alone in spontaneously breathing preterm infants requiring nasal continuous positive airway pressure (nCPAP) as initial respiratory support and reaching pre-defined CPAP failure criteria. METHODS/DESIGN: In this study, 206 spontaneously breathing infants born at 24(+0)-27(+6) weeks' gestation and failing nCPAP during the first 24 h of life, will be randomized to receive an HFOV recruitment maneuver (IN-REC-SUR-E) or no recruitment maneuver (IN-SUR-E) just prior to surfactant administration followed by prompt extubation. The primary outcome is the need for mechanical ventilation within the first 3 days of life. Infants in both groups will be considered to have reached the primary outcome when they are not extubated within 30 min after surfactant administration or when they meet the nCPAP failure criteria after extubation. DISCUSSION: From all available data no definitive evidence exists about a positive effect of recruitment before surfactant instillation, but a rationale exists for testing the following h

Published
2016

15. UNA STRANA FORMA DI PSEUDOCCLUSIONE INTESTINALE

Author

VITALITI M, LIOTTA A, CASTIGLIONE A, MAGGIO, Maria Cristina, CORSELLO, Giovanni, MAGGIO, Claudia, VITALITI M, LIOTTA A, CASTIGLIONE A, MAGGIO MC, CORSELLO G, and Maggio, C.

Published
2007

16. Il dolore da procedura in età neonatale

Author

CORSELLO, Giovanni, MANZO, Vincenza, LO CURTO, Margherita, VITALITI M, ZUCCARELLO L, COSTA A, MARTINES M, MESSINA S, CARMINA M, CORSELLO G, VITALITI M, ZUCCARELLO L, COSTA A, MANZO V, MARTINES M, MESSINA S, CARMINA M, and LO CURTO M

Published
2006

18. Lung Recruitment Before Surfactant Administration in Extremely Preterm Neonates: 2-Year Follow-Up of a Randomized Clinical Trial.

Author

Gallini F, De Rose DU, Iuliano R, Romeo DM, Tana M, Paladini A, Fusco FP, Nobile S, Cota F, Tirone C, Aurilia C, Lio A, Esposito A, Costa S, D'Andrea V, Ventura ML, Carnielli V, Dani C, Mosca F, Fumagalli M, Scarpelli G, Giordano L, Fasolato V, Petrillo F, Betta P, Solinas A, Gitto E, Gargano G, Mescoli G, Martinelli S, Di Fabio S, Bernardo I, Tina LG, Staffler A, Stasi I, Mondello I, Scapillati E, Vedovato S, Maffei G, Bove A, Vitaliti M, Terrin G, Lago P, Gizzi C, Strozzi C, Villani PE, Berardi A, Cacace C, Bracaglia G, Pascucci E, Cools F, Pillow JJ, Polglase G, Pastorino R, van Kaam AH, Mercuri E, Orfeo L, Vento G, Malguzzi S, Rigotti C, Cecchi A, Nigro G, Costabile CD, Roma E, Sindico P, Venafra R, Mattia C, Conversano M, Ballardini E, Manganaro A, Balestri E, Gallo C, Catenazzi P, Astori MG, Maranella E, Grassia C, Maiolo K, Castellano D, Massenzi L, Chiodin E, Gallina MR, Consigli C, Sorrentino E, Bonato S, Mancini M, Perniola R, Giannuzzo S, Tranchina E, Cardilli V, Dito L, Regoli D, Tormena F, Battajon N, Arena R, Allais B, Guidotti I, Roversi F, Meli V, Tulino V, and Casati A

Subjects
Humans, Male, Female, Infant, Newborn, Follow-Up Studies, High-Frequency Ventilation methods, Child, Preschool, Intensive Care Units, Neonatal statistics & numerical data, Treatment Outcome, Italy, Infant, Pulmonary Surfactants administration & dosage, Pulmonary Surfactants therapeutic use, Infant, Extremely Premature, Respiratory Distress Syndrome, Newborn therapy, Respiratory Distress Syndrome, Newborn drug therapy
Abstract

Importance: A multicenter randomized clinical trial (RCT) showed a lung recruitment maneuver using high-frequency oscillatory ventilation just before surfactant administration (ie, intubate-recruit-surfactant-extubate [IN-REC-SUR-E]) improved the efficacy of treatment compared with the standard intubate-surfactant-extubate (IN-SUR-E) technique without increasing the risk of adverse neonatal outcomes., Objective: To examine follow-up outcomes at corrected postnatal age (cPNA) 2 years of preterm infants previously enrolled in an RCT and treated with IN-REC-SUR-E or IN-SUR-E in 35 tertiary neonatal intensive care units., Design, Setting, and Participants: This was a follow-up study of infants recruited into the primary RCT from 2015 to 2018 at 35 tertiary neonatal intensive care units (NICUs) in Italy. Follow-up examinations included neurodevelopmental, growth, and respiratory outcomes of these children at cPNA 2 years. Participants included spontaneously breathing extremely preterm neonates (24 0/7 to 27 6/7 weeks' gestation) reaching failure criteria for continuous positive airway pressure within the first 24 hours of life. Data were analyzed from April 2023 to January 2024., Intervention: Infants were randomly assigned (1:1) to IN-REC-SUR-E or IN-SUR-E and then followed up., Main Outcomes and Measures: The primary outcome was the occurrence of death after discharge or major disability at cPNA 2 years. Secondary outcomes were neurodevelopmental outcomes (major disability, cerebral palsy, cognitive impairment, visual deficit, or auditory deficit), anthropometric measurements (weight, length, and head circumference), and recurrent respiratory infections and hospitalizations because of respiratory causes at 2y cPNA., Results: A total of 137 extremely preterm infants (median [IQR] gestational age, 26.5 [25.3-27.5] weeks and 75 [54.7%] female), initially enrolled in the original RCT, were followed up at cPNA 2 years, including 64 infants in the IN-SUR-E group and 73 infants in the IN-REC-SUR-E group. There were no significant differences in the occurrence of death after discharge or major disability at cPNA 2 years (IN-SUR-E: 13 children [20.3%] vs IN-REC-SUR-E: 10 children [13.7%]; P = .36). There were no significant differences in incidence of disability, cerebral palsy, or cognitive impairment in the IN-REC-SUR-E group compared with the IN-SUR-E group. There were no significant differences in anthropometric measurements (weight, length, and head circumference) between groups. There were no significant differences in the incidence of recurrent respiratory infections or in hospitalizations because of respiratory causes between groups., Conclusions and Relevance: In this RCT of lung recruitment before surfactant vs standard care there were no significant differences between the 2 groups in death, neurodevelopmental outcomes, anthropometric measurements, or recurrent respiratory infections at the 2-year follow-up. These findings can aid clinicians in decision-making for the best strategy to administer surfactant, considering long-term outcomes.

Published
2024
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19. Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program.

Author

Saporito L, Graziano G, Mescolo F, Amodio E, Insinga V, Rinaudo G, Aleo A, Bonura C, Vitaliti M, Corsello G, Vitale F, Maida CM, and Giuffrè M

Subjects
Carrier State microbiology, Cross Infection microbiology, Cross Infection prevention & control, Electrophoresis, Gel, Pulsed-Field, Female, Gram-Negative Bacteria isolation & purification, Gram-Negative Bacterial Infections epidemiology, Humans, Infant, Newborn, Italy, Male, Microbial Sensitivity Tests, Carrier State diagnosis, Drug Resistance, Multiple, Bacterial, Gram-Negative Bacterial Infections prevention & control, Infection Control methods, Intensive Care Units, Neonatal
Abstract

Background: Antimicrobial resistance in neonatal intensive care unit (NICU) patients is a threat, due to the frequent use of antimicrobial treatment and invasive devices in fragile babies. Since 2014 an active surveillance program of multidrug-resistant Gram-negative bacteria (MDR-GNB) carriage has been in place in the five NICUs of Palermo, Italy. In 2017 an increase in the prevalence of MDR-GNB, and in particular of extended-spectrum β-lactamases-producing Klebsiella pneumoniae (ESBL-KP), was observed in "Civico" hospital NICU., Aim: To assess the impact of a coordinated intervention strategy in achieving long-lasting reduction of MDR-GNB prevalence in the NICU., Methods: Rectal swabs were obtained monthly and processed to detect MDR-GNB using standard methods. MDR-GNB were characterized by pulsed-field gel electrophoresis (PFGE). Since November 2017 the following intervention measures were applied: (a) two-months intensification of sample collection; (b) stakeholders meetings; (c) improvement of prevention measures and antimicrobial policies., Findings: During the intensified microbiological surveillance MDR-GNB and ESBL-KP were detected in rectal swabs (34.8%; 23.2%), nasal swabs (24.6%; 14.5%), oral swabs (14.5%; 5.4%), milk samples (32.1%; 17.9%), pacifiers swabs (30.8%; 17.9%) and from sub-intensive room surfaces. Thirteen ESBL-KP strains isolated from clinical and environmental samples showed identical PFGE patterns. The prevalence of MDR-GNB and ESBL-KP carriage significantly decreased in the year after intervention compared to the previous year (20.6% vs 62.2%; p < 0.001 and 11.1% vs 57.8%; p < 0.001). MDR-GNB were not detected at all for three months and ESBL-KP for five months. Multivariate analysis of the principal exposure variables showed that admission in the post-intervention period significantly reduced the risk of MDR-GNB carriage (adj-OR = 0.21, 95% CI = 0.076-0.629; p < 0.001)., Conclusions: MDR-GNB broadly circulate in NICU setting, they can colonize different body sites and spread through various vehicles. A coordinated strategy of multiple interventions with active cooperation between epidemiologists and clinicians in the NICU can effectively reduce their circulation and in particular the carriage of the most dangerous ESBL-KP strains.

Published
2021
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20. Lung recruitment before surfactant administration in extremely preterm neonates with respiratory distress syndrome (IN-REC-SUR-E): a randomised, unblinded, controlled trial.

Author

Vento G, Ventura ML, Pastorino R, van Kaam AH, Carnielli V, Cools F, Dani C, Mosca F, Polglase G, Tagliabue P, Boni L, Cota F, Tana M, Tirone C, Aurilia C, Lio A, Costa S, D'Andrea V, Lucente M, Nigro G, Giordano L, Roma V, Villani PE, Fusco FP, Fasolato V, Colnaghi MR, Matassa PG, Vendettuoli V, Poggi C, Del Vecchio A, Petrillo F, Betta P, Mattia C, Garani G, Solinas A, Gitto E, Salvo V, Gargano G, Balestri E, Sandri F, Mescoli G, Martinelli S, Ilardi L, Ciarmoli E, Di Fabio S, Maranella E, Grassia C, Ausanio G, Rossi V, Motta A, Tina LG, Maiolo K, Nobile S, Messner H, Staffler A, Ferrero F, Stasi I, Pieragostini L, Mondello I, Haass C, Consigli C, Vedovato S, Grison A, Maffei G, Presta G, Perniola R, Vitaliti M, Re MP, De Curtis M, Cardilli V, Lago P, Tormena F, Orfeo L, Gizzi C, Massenzi L, Gazzolo D, Strozzi MCM, Bottino R, Pontiggia F, Berardi A, Guidotti I, Cacace C, Meli V, Quartulli L, Scorrano A, Casati A, Grappone L, and Pillow JJ

Subjects
Female, Humans, Infant, Extremely Premature, Infant, Newborn, Intensive Care Units, Neonatal, Italy, Lung physiopathology, Male, Respiration, Artificial statistics & numerical data, Treatment Outcome, Airway Extubation methods, Critical Care methods, Intubation, Intratracheal methods, Pulmonary Surfactants therapeutic use, Respiratory Distress Syndrome, Newborn therapy
Abstract

Background: The importance of lung recruitment before surfactant administration has been shown in animal studies. Well designed trials in preterm infants are absent. We aimed to examine whether the application of a recruitment manoeuvre just before surfactant administration, followed by rapid extubation (intubate-recruit-surfactant-extubate [IN-REC-SUR-E]), decreased the need for mechanical ventilation during the first 72 h of life compared with no recruitment manoeuvre (ie, intubate-surfactant-extubate [IN-SUR-E])., Methods: We did a randomised, unblinded, controlled trial in 35 tertiary neonatal intensive care units in Italy. Spontaneously breathing extremely preterm neonates (24 + 0 to 27 + 6 weeks' gestation) reaching failure criteria for continuous positive airway pressure within the first 24 h of life were randomly assigned (1:1) with a minimisation algorithm to IN-REC-SUR-E or IN-SUR-E using an interactive web-based electronic system, stratified by clinical site and gestational age. The primary outcome was the need for mechanical ventilation in the first 72 h of life. Analyses were done in intention-to-treat and per-protocol populations, with a log-binomial regression model correcting for stratification factors to estimate adjusted relative risk (RR). This study is registered with ClinicalTrials.gov, NCT02482766., Findings: Of 556 infants assessed for eligibility, 218 infants were recruited from Nov 12, 2015, to Sept 23, 2018, and included in the intention-to-treat analysis. The requirement for mechanical ventilation during the first 72 h of life was reduced in the IN-REC-SUR-E group (43 [40%] of 107) compared with the IN-SUR-E group (60 [54%] of 111; adjusted RR 0·75, 95% CI 0·57-0·98; p=0·037), with a number needed to treat of 7·2 (95% CI 3·7-135·0). The addition of the recruitment manoeuvre did not adversely affect the safety outcomes of in-hospital mortality (19 [19%] of 101 in the IN-REC-SUR-E group vs 37 [33%] of 111 in the IN-SUR-E group), pneumothorax (four [4%] of 101 vs seven [6%] of 111), or grade 3 or worse intraventricular haemorrhage (12 [12%] of 101 vs 17 [15%] of 111)., Interpretation: A lung recruitment manoeuvre just before surfactant administration improved the efficacy of surfactant treatment in extremely preterm neonates compared with the standard IN-SUR-E technique, without increasing the risk of adverse neonatal outcomes. The reduced need for mechanical ventilation during the first 72 h of life might facilitate implementation of a non-invasive respiratory support strategy., Funding: None., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Published
2021
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21. Efficacy of a new technique - INtubate-RECruit-SURfactant-Extubate - "IN-REC-SUR-E" - in preterm neonates with respiratory distress syndrome: study protocol for a randomized controlled trial.

Author

Vento G, Pastorino R, Boni L, Cota F, Carnielli V, Cools F, Dani C, Mosca F, Pillow J, Polglase G, Tagliabue P, van Kaam AH, Ventura ML, Tana M, Tirone C, Aurilia C, Lio A, Ricci C, Gambacorta A, Consigli C, D'Onofrio D, Gizzi C, Massenzi L, Cardilli V, Casati A, Bottino R, Pontiggia F, Ciarmoli E, Martinelli S, Ilardi L, Colnaghi M, Matassa PG, Vendettuoli V, Villani P, Fusco F, Gazzolo D, Ricotti A, Ferrero F, Stasi I, Magaldi R, Maffei G, Presta G, Perniola R, Messina F, Montesano G, Poggi C, Giordano L, Roma E, Grassia C, Ausanio G, Sandri F, Mescoli G, Giura F, Garani G, Solinas A, Lucente M, Nigro G, Del Vecchio A, Petrillo F, Orfeo L, Grappone L, Quartulli L, Scorrano A, Messner H, Staffler A, Gargano G, Balestri E, Nobile S, Cacace C, Meli V, Dallaglio S, Pasqua B, Mattia L, Gitto E, Vitaliti M, Re MP, Vedovato S, Grison A, Berardi A, Torcetta F, Guidotti I, di Fabio S, Maranella E, Mondello I, Visentin S, and Tormena F

Subjects
Caffeine administration & dosage, Central Nervous System Stimulants administration & dosage, Citrates administration & dosage, Continuous Positive Airway Pressure, Female, Humans, Infant, Newborn, Male, Time Factors, Treatment Outcome, Airway Extubation methods, Biological Products administration & dosage, High-Frequency Ventilation methods, Infant, Premature, Intubation, Intratracheal methods, Phospholipids administration & dosage, Pulmonary Surfactants administration & dosage, Respiratory Distress Syndrome, Newborn therapy
Abstract

Background: Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is not successful in all preterm neonates with respiratory distress syndrome, with a reported failure rate ranging from 19 to 69 %. One of the possible mechanisms responsible for the unsuccessful IN-SUR-E method, requiring subsequent re-intubation and mechanical ventilation, is the inability of the preterm lung to achieve and maintain an "optimal" functional residual capacity. The importance of lung recruitment before surfactant administration has been demonstrated in animal studies showing that recruitment leads to a more homogeneous surfactant distribution within the lungs. Therefore, the aim of this study is to compare the application of a recruitment maneuver using the high-frequency oscillatory ventilation (HFOV) modality just before the surfactant administration followed by rapid extubation (INtubate-RECruit-SURfactant-Extubate: IN-REC-SUR-E) with IN-SUR-E alone in spontaneously breathing preterm infants requiring nasal continuous positive airway pressure (nCPAP) as initial respiratory support and reaching pre-defined CPAP failure criteria., Methods/design: In this study, 206 spontaneously breathing infants born at 24(+0)-27(+6) weeks' gestation and failing nCPAP during the first 24 h of life, will be randomized to receive an HFOV recruitment maneuver (IN-REC-SUR-E) or no recruitment maneuver (IN-SUR-E) just prior to surfactant administration followed by prompt extubation. The primary outcome is the need for mechanical ventilation within the first 3 days of life. Infants in both groups will be considered to have reached the primary outcome when they are not extubated within 30 min after surfactant administration or when they meet the nCPAP failure criteria after extubation., Discussion: From all available data no definitive evidence exists about a positive effect of recruitment before surfactant instillation, but a rationale exists for testing the following hypothesis: a lung recruitment maneuver performed with a step-by-step Continuous Distending Pressure increase during High-Frequency Oscillatory Ventilation (and not with a sustained inflation) could have a positive effects in terms of improved surfactant distribution and consequent its major efficacy in preterm newborns with respiratory distress syndrome. This represents our challenge., Trial Registration: ClinicalTrials.gov identifier: NCT02482766 . Registered on 1 June 2015.

Published
2016
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22. Fatal biphasic brainstem and spinal leptomeningitis with Cryptococcus neoformans in a non-immunocompromised child.

Author

Ruggieri M, Polizzi A, Vitaliti MC, Magro G, and Musumeci S

Subjects
Child, Fatal Outcome, Humans, Magnetic Resonance Imaging, Male, Arachnoid microbiology, Brain Stem microbiology, Brain Stem pathology, Cryptococcosis complications, Cryptococcus neoformans isolation & purification, Meningitis, Fungal immunology, Meningitis, Fungal microbiology, Meningitis, Fungal pathology, Spinal Cord microbiology, Spinal Cord pathology
Abstract

Cryptococcal meningitis is one of the most common life-threatening, invasive fungal infections of the central nervous system in patients with defective T-lymphocyte function. It is, however, unusual in children. We report on a non-immunocompromised 10-y-old boy without evidence of immunological abnormality who developed headache, vomiting, disturbances of consciousness and areflexia. Magnetic resonance imaging of the brain and the spinal cord revealed enlargement of the ventricles and high signal lesions in the leptomeninges at the level of the cerebral peduncles and the cervical and thoracic cord. Cerebrospinal fluid analysis was positive for Cryptococcus neoformans. He was treated with amphotericin B and was symptom-free within 1 wk. Despite an extended course of therapy his symptoms suddenly relapsed and he succumbed to the medical complications of cardiac and respiratory failure. Central nervous system appearances at postmortem were those of cryptococcal leptomeningitis.

Published
1999
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