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1.
Ital J Pediatr ; 50(1): 114, 2024 Jun 09.
Article in English | MEDLINE | ID: mdl-38853266

ABSTRACT

BACKGROUND: The aim of this exploratory survey is to describe the current state of US (ultrasound) technique across different pediatric settings nationwide. METHODS: A questionnaire was emailed to all members of the Italian Society of Pediatrics, including pediatric residents. The survey was open from December 2021 to March 2022. RESULTS: There were 1098 respondents. Seven hundred and seven pediatricians (84.1%) reported any use of US, while 51 (44.3%) residents denied it. The majority of participants (n = 956, 87.1%) reported to have a US machine available within the department, mostly cart-based (n = 516, 66.9%) and provided from 1 to 5 years prior to the survey (n = 330, 42.8%). Lung and neonatal cerebral regions were the most frequently scanned (n = 289, 18.7% and n = 218, 14.1%, respectively). The suspicion of pneumonia or respiratory distress represented the main reasons for performing US in emergency room (n = 390, 78% and n = 330, 66%, respectively). The majority of family pediatricians reported to scan lung and kidney/urinary tract regions (n = 30, 16.9%, and n = 23,12.9%, respectively). Regarding US training, the majority of respondents (n = 358, 34.6%) declared an experience-based education, with a deficient certification enabling the use of US in 71.6% (n = 552) of cases. The most common barriers included the lack of a well-defined training program (n = 627, 57.1%), unavailability of the US machine (n = 196, 17.9%) and legal responsibility concern (n = 175, 15.9%). CONCLUSIONS: Despite the growing interest on pediatric US nationally, significant barriers still limit widespread adoption. These obstacles may be addressed through the dissemination of a specific US education plan and providing additional resources.


Subject(s)
Pediatrics , Practice Patterns, Physicians' , Ultrasonography , Italy , Humans , Surveys and Questionnaires , Practice Patterns, Physicians'/statistics & numerical data , Female , Male , Child , Pediatricians
2.
Eur J Pediatr ; 183(8): 3397-3405, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38767693

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.


Subject(s)
COVID-19 , Lung , Ultrasonography , Humans , COVID-19/diagnostic imaging , COVID-19/therapy , Male , Child , Female , Child, Preschool , Ultrasonography/methods , Prospective Studies , Lung/diagnostic imaging , Infant , Adolescent , SARS-CoV-2 , Prognosis
3.
Diagnostics (Basel) ; 13(17)2023 Aug 28.
Article in English | MEDLINE | ID: mdl-37685319

ABSTRACT

BACKGROUND: Alterations in plantar soft tissues are often reported in adults with diabetes, whereas data on children are conflicting. Also, the extent of foot damage caused by excess body fat in children has not been fully characterized yet. This study aimed to address the relationship between body mass and structural changes of the foot in children and adolescents with and without diabetes. METHODS: In a case-control study, 43 participants (age 13 ± 2.6 years) were recruited, 29 (67%) with type 1 diabetes (T1D) and 14 (33%) controls. Anthropometric parameters [body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR)], foot posture index-6 (FPI-6) for static foot posture, and navicular drop test (NDT) for medial longitudinal arch height (MLA) were measured in all participants. The thickness of the midfoot plantar fascia (MPF) and medial midfoot fat pad (MMFP) were quantified using ultrasound. RESULTS: No differences in clinical and ultrasonographical parameters were observed between the study groups. MMFP thickness was correlated with MPF thickness (p = 0.027). MMFP and MPF thicknesses were positively associated with BMI (p < 0.001 and p = 0.013, respectively), WC (p < 0.001 and p = 0.013), and WHtR (p < 0.001 and p = 0.026). The NDT measured on the right and left foot correlated with WHtR (p = 0.038 and p = 0.009, respectively), but not with WC and BMI. CONCLUSIONS: Children with T1D show structural alterations of plantar soft tissues which seem related to body mass increase rather than diabetes pathology. Ultrasound is a valuable tool to assess early structural changes of the foot in young people with an elevated BMI.

4.
J Clin Med ; 11(14)2022 Jul 21.
Article in English | MEDLINE | ID: mdl-35887997

ABSTRACT

There is increasing recognition of the role of lung ultrasound (LUS) to assess bronchiolitis severity in children. However, available studies are limited to small, single-center cohorts. We aimed to assess a qualitative and quantitative LUS protocol to evaluate the course of bronchiolitis at diagnosis and during follow-up. This is a prospective, multicenter study. Children with bronchiolitis were stratified according to clinical severity and underwent four LUS evaluations at set intervals. LUS was classified according to four models: (1) positive/negative; (2) main LUS pattern (normal/interstitial/consolidative/mixed) (3) LUS score; (4) LUS score with cutoff. Two hundred and thirty-three children were enrolled. The baseline LUS was significantly associated with bronchiolitis severity, using both the qualitative (positive/negative LUS p < 0.001; consolidated/normal LUS pattern or mixed/normal LUS p < 0.001) and quantitative models (cutoff score > 9 p < 0.001; LUS mean score p < 0.001). During follow-up, all LUS results according to all LUS models improved (p < 0.001). Better cut off value was declared at a value of >9 points. Conclusions: Our study supports the role of a comprehensive qualitative and quantitative LUS protocol for the identification of severe cases of bronchiolitis and provides data on the evolution of lung aeration during follow-up.

5.
J Ultrasound Med ; 41(10): 2637-2641, 2022 Oct.
Article in English | MEDLINE | ID: mdl-34964991

ABSTRACT

With the emergence of the Covid-19 pandemic, pleuropulmonary ultrasound has become a very common tool in clinical practice, even in the pediatric field. Therefore, the clinicians' need to speak a common ultrasound language becomes increasingly necessary. The Italian scientific society AdET (Academy of Thoracic Ultrasound) has been carrying out the study and dissemination of pulmonary ultrasound in medical practice in Italy for years. With this article, the pediatric AdET group wants to propose a report model of pediatric pulmonary ultrasound as a useful tool in daily clinical practice to interpret the images and reach a diagnostic conclusion, aiming to share a standardized approach that may also support the sharing of research findings.


Subject(s)
COVID-19 , Pediatrics , Child , Humans , Lung/diagnostic imaging , Pandemics , Ultrasonography
6.
J Pediatr ; 159(1): 127-132.e1, 2011 Jul.
Article in English | MEDLINE | ID: mdl-21349541

ABSTRACT

OBJECTIVE: To assess the outcome of giant cell hepatitis combined with autoimmune hemolytic anemia in early childhood. STUDY DESIGN: We report on 16 children with this disease evaluated over a 28-year period. RESULTS: Children (nine boys; median age, 6 months) presented with jaundice, hepatomegaly, elevated aminotransferases, a positive Coombs test, and diffuse giant-cell transformation of hepatocytes on histology. Treatment with prednisone and azathioprine, plus, in three children, cyclosporine, resulted in complete remission in eight, partial remission in six, and failure in two. Relapses of hepatitis and/or anemia occurred in 11 and 10 children, respectively, requiring prolonged high levels of immunosuppression, and splenectomy or Rituximab, respectively. Treatment was stopped after a mean duration of 6 years, with no relapse, in seven children, with a median follow-up of 14 years. One child is alive 9 years after liver transplantation. Four children died of sepsis or multiple organ failure. CONCLUSIONS: Giant cell hepatitis combined with autoimmune hemolytic anemia requires rigorous treatment. Immunosuppressive therapy results in remission in most cases. A complete cure can be expected after several years of intensive treatment. Liver transplantation may be associated with prolonged survival.


Subject(s)
Anemia, Hemolytic, Autoimmune/complications , Anemia, Hemolytic, Autoimmune/therapy , Giant Cells/pathology , Hepatitis/complications , Hepatitis/therapy , Liver/pathology , Anemia, Hemolytic, Autoimmune/mortality , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Azathioprine/therapeutic use , Bilirubin/blood , Coombs Test , Cyclosporine/therapeutic use , Female , Follow-Up Studies , Glucocorticoids/therapeutic use , Hepatitis/mortality , Hepatocytes/pathology , Hepatomegaly/etiology , Humans , Immunologic Factors/therapeutic use , Immunosuppressive Agents/therapeutic use , Infant , Jaundice/etiology , Liver Transplantation , Male , Multiple Organ Failure/mortality , Prednisone/therapeutic use , Recurrence , Remission Induction , Rituximab , Sepsis/mortality , Splenectomy , Splenomegaly/etiology , Transaminases/blood , Treatment Outcome , gamma-Globulins/analysis
8.
Pediatr Infect Dis J ; 25(1): 90-1, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16395116

ABSTRACT

This is the first report of Guillain-Barré syndrome (GBS) related to Bartonella henselae infection. A 10-year-old girl had difficulty walking and marked myalgia. The search for all causes known to trigger GBS was negative. She was treated with intravenous immunoglobulins and recovered. Because she lived in a rural area and had a history of kitten contact, a specific serology for B. henselae infection was performed and confirmed an ongoing infection. She did not show any clinical typical feature of cat-scratch disease. B. henselae infection should be considered in the wide etiologic spectrum of GBS.


Subject(s)
Bartonella henselae/isolation & purification , Cat-Scratch Disease/complications , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Antibodies, Bacterial/blood , Bartonella henselae/immunology , Child , Female , Guillain-Barre Syndrome/physiopathology , Humans , Immunoglobulin G/blood , Immunoglobulin M , Immunoglobulins, Intravenous/administration & dosage , Immunoglobulins, Intravenous/therapeutic use , Movement Disorders , Polyradiculoneuropathy
9.
J Pediatr ; 148(1): 138-40, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16423615

ABSTRACT

In 3 children with chronic liver disease, although multiple studies of copper metabolism were normal, which made the diagnosis of Wilson disease unlikely, analysis of ATP7B gene showed disease causing mutations in all. Molecular diagnosis should be considered in children with enigmatic liver disease, especially those with features of nonalcoholic fatty liver disease.


Subject(s)
Adenosine Triphosphatases/genetics , Cation Transport Proteins/genetics , Hepatolenticular Degeneration/diagnosis , Mutation , Adolescent , Antidotes/therapeutic use , Child , Copper-Transporting ATPases , Female , Hepatolenticular Degeneration/drug therapy , Hepatolenticular Degeneration/genetics , Humans , Male , Mutation, Missense , Penicillamine/therapeutic use , Retrospective Studies , Sequence Deletion , Treatment Outcome
10.
Infect Dis Clin North Am ; 19(3): 691-711, 2005 Sep.
Article in English | MEDLINE | ID: mdl-16102656

ABSTRACT

Bartonella spp cause various clinical syndromes immunocompetent and immunocompromised hosts. Domestic cats are the natural reservoir, and vectors of B henselae. B henselae infection usually occurs early in childhood, is generally asymptomatic, and in most cases revolves spontaneously. It may, however, produce a wide spectrum of clinical symptoms, the most frequent feature being cat-scratch disease. Disseminated atypical B. henselae infection may follow cat-scratch disease alter a symptom-free period or may present de novo mimicking a wide range of clinical disorders. A careful clinical history researching an intimate contact with a kitten associated with a specific serology and an abdominal ultrasound for typical hepatosplenic involvement may follow a rapid and accurate diagnosis.


Subject(s)
Bartonella Infections , Cat-Scratch Disease , Animals , Bartonella Infections/drug therapy , Bartonella Infections/epidemiology , Bartonella Infections/physiopathology , Bartonella Infections/veterinary , Bartonella henselae/isolation & purification , Cat Diseases/epidemiology , Cat-Scratch Disease/complications , Cat-Scratch Disease/drug therapy , Cat-Scratch Disease/epidemiology , Cat-Scratch Disease/pathology , Cats , Child , Disease Vectors , Humans , Liver/pathology , Spleen/pathology
11.
Clin Infect Dis ; 38(1): 145-8, 2004 Jan 01.
Article in English | MEDLINE | ID: mdl-14679462

ABSTRACT

Few data are available on the seroprevalence of antibodies to Bartonella henselae among children. We retrospectively evaluated the presence of immunoglobulin G and M class antibodies to B. henselae in 508 children living in central Italy who were apparently free of any features suggesting B. henselae infection. We found that B. henselae infection is common among children in central Italy, occurs early in life, is in most cases asymptomatic, and resolves spontaneously.


Subject(s)
Antibodies, Bacterial/analysis , Bartonella henselae/immunology , Cat-Scratch Disease/epidemiology , Seroepidemiologic Studies , Adolescent , Bartonella henselae/isolation & purification , Child , Child, Preschool , Female , Humans , Immunoglobulin G/analysis , Immunoglobulin M/analysis , Infant , Italy/epidemiology , Male
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