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1. Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group

Author

Giovanni Autore, Luca Bernardi, Filippo Ghidini, Claudio La Scola, Alberto Berardi, Giacomo Biasucci, Federico Marchetti, Andrea Pasini, Maria Elena Capra, Claudia Castellini, Vera Cioni, Sante Cantatore, Andrea Cella, Francesca Cusenza, Alessandro De Fanti, Elisa Della Casa Muttini, Margherita Di Costanzo, Alessandra Dozza, Claudia Gatti, Cristina Malaventura, Luca Pierantoni, Giovanni Parente, Gabriella Pelusi, Serafina Perrone, Laura Serra, Francesco Torcetta, Enrico Valletta, Gianluca Vergine, Francesco Antodaro, Andrea Bergomi, Jennifer Chiarlolanza, Laura Leoni, Franco Mazzini, Roberto Sacchetti, Agnese Suppiej, Lorenzo Iughetti, Andrea Pession, Mario Lima, Susanna Esposito, and The UTI-Ped-ER Study Group

Subjects
antibiotic prophylaxis, antibiotic resistance, obstructive uropathies, pediatrics, urinary tract infection, Therapeutics. Pharmacology, RM1-950
Abstract

Background: Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in children. To prevent recurrent infections and long-term complications, low-dose continuous antibiotic prophylaxis (CAP) has been used. However, the efficacy of CAP is controversial. The aim of this document was to develop updated guidelines on the efficacy and safety of CAP to prevent pediatric UTIs. Methods: A panel of experts on pediatric infectious diseases, pediatric nephrology, pediatric urology, and primary care was asked clinical questions concerning the role of CAP in preventing UTIs in children. Overall, 15 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results: The use of CAP is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder. CAP is suggested in children with significant obstructive uropathies until surgical correction. Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended. Conclusions: Our systematic review shows that CAP plays a limited role in preventing recurrences of UTI in children and has no effect on its complications. On the other hand, the emergence of new antimicrobial resistances is a proven risk.

Published
2023
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2. Home Management of Children With COVID-19 in the Emilia-Romagna Region, Italy

Author

Gianluca Vergine, Michela Fantini, Federico Marchetti, Marcello Stella, Enrico Valletta, Giacomo Biasucci, Marcello Lanari, Icilio Dodi, Maurizio Bigi, Anna Maria Magista, Francesca Vaienti, Andrea Cella, Paola Affanni, Maria Carla Re, Vittorio Sambri, Susanna Esposito, and The Regione Emilia-Romagna COVID-19 Pediatric Working Group (RERCOPed)

Subjects
community health service, COVID-19, home management, pediatric infectious diseases, SARS-COV-2, Pediatrics, RJ1-570
Abstract

In most children, coronavirus disease 2019 (COVID-19) is a mild or moderate disease. Moreover, in a relevant number of cases, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains totally asymptomatic. All these findings seem to suggest that otherwise healthy children with suspected COVID-19 might be managed in the community in most cases, thus avoiding hospital admission and closely related medical, social and economic problems, including overwhelming hospitals. Unfortunately, home management of children with suspected COVID-19 rarely occurs, and many children with suspected or laboratory-confirmed SARS-CoV-2 infection are frequently hospitalized irrespective of the severity of disease. To evaluate the role of community health houses (CHHs) in the management of children with COVID-19, 1,009 children with suspected SARS-CoV-2 infection were studied in Emilia-Romagna Region, Italy. Among them, 194 (19.2%) resulted positive for SARS-CoV-2. The majority (583, 58%) were tested at home by CHHs, while 426 (42%) were brought to the hospital for testing. The patients who were managed in the hospital had a significantly lower median age than those who were managed at home (2 vs. 12 years, p < 0.001). Exposure to SARS-CoV-2 cases within the family was significantly more frequent among those who were managed at home (82 vs. 46%, p < 0.05). The clinical findings were similar between the children who were managed at home and those who were managed in the hospital. Only one of the children managed at home (0.7%) required hospitalization; in comparison, 26 (48%) of those whose swab samples were taken at the hospital were hospitalized. Our research shows for the first time the importance of CHHs in the management of COVID-19 in children; because of the high frequency of mild to moderate cases, management by CHHs can reduce the care load in hospitals, providing enormous advantages on the familial, medical, social, and economic levels. These findings could be useful for suggesting a territorial rather than hospital-based strategy in pediatrics in the case of a new wave of the epidemic.

Published
2020
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4. Rapunzel syndrome: an infrequent cause of severe iron deficiency anemia and abdominal pain presenting to the pediatric emergency department

Author

Giuseppe Cannalire, Luigi Conti, Maurizio Celoni, Carmine Grassi, Andrea Cella, Giulia Bensi, Patrizio Capelli, and Giacomo Biasucci

Subjects
Rapunzel syndrome, Abdominal pain, Iron deficiency anemia, PICA, Trichobezoar, Trichophagia, Pediatrics, RJ1-570
Abstract

Abstract Background Iron deficiency anemia (IDA) and abdominal pain are commonly seen in a pediatric emergency department (8 and 18% incidence respectively in our center). They are manifestations of a wide variety of diseases ranging from benign to immediately life-threatening. Trichobezoar is an under-diagnosed entity that has to be considered in children and adolescents, expecially female, suffering from trichotillomania (compulsion to pull hair) and trichophagy (compulsion to swallow hair). When undiagnosed, gastric bezoars may cause gastric ulceration, perforation, haemorrhage and obstruction. Case presentation To underline the importance of including this pathology in the differential diagnosis of IDA and abdominal pain, we present the case of a 14 year-old girl with a huge trichobezoar which completely filled the stomach and extended into the small bowel. Since trichobezoar has an extension to the small bowel, it is classified as Rapunzel syndrome. As the bezoar couldn’t be removed by endoscopy, the girl underwent surgical intervention. The patient passed through a gradual re-feeding, with iron and vitamins supplementation, and through a psychiatric counselling. Conclusion The Rapunzel syndrome is a rare entity that may be complicated by life-threatening events. A prompt diagnosis and an appropriate therapy can reduce comorbidities. Gradual re-feeding with supplementation of micronutrients allows adequate catch-up weight with normalization of haematochemical nutritional parameters. Since many of these patients suffer from psychiatric pathology such as PICA with emotional problems and mental retardation, psychological/psychiatric counselling plays an important role in order to prevent bezoar recurrence.

Published
2018
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5. The pandemic within the pandemic: the surge of neuropsychological disorders in Italian children during the COVID-19 era

Author

Elena, Bozzola, Pietro, Ferrara, Giulia, Spina, Alberto, Villani, Marco, Roversi, Massimiliano, Raponi, Giovanni, Corsello, Annamaria, Staiano, Francesco, Chiarelli, Federica, Cavallo, Farello, Giovanni, Nadia, Rossi, Carmela, Salladini, Sergio, Manieri, Mariapia, Mirauda, Giacomo, Biasucci, Andrea, Cella, Gianluca, Vergine, Angela, Troisi, Federico, Marchetti, Enrico, Valletta, Marcello, Stella, Marcello, Lanari, Duccio Maria Cordelli, Ilaria, Corsini, Jacopo, Pruccoli, Chiara, Ghizzi, Chiara, Franzonello, Egidio, Barbi, Alessandro, Amaddeo, Ilaria, Liguoro, Paola, Cogo, Giuliana, Morabito, Maria Rosaria Marchili, Carla, Brusco, Cristina, Mascolo, Riccardo, Borea, Emanuela, Piccotti, Tommaso, Bellini, Carlo, Agostoni, Raffaele, Badolato, Camilla, Dallavilla, Leonardo, Felici, Simone, Mattozzi, Guido, Pennoni, Elisabetta Mencaroni and, Bozzola E., Ferrara P., Spina G., Villani A., Roversi M., Raponi M., Corsello G., Staiano A., Chiarelli F., Cavallo F., Farello G., Rossi N., Salladini C., Manieri S., Mirauda M.P., Biasucci G., Cella A., Vergine G., Troisi A., Marchetti F., Valletta E., Stella M., Lanari M., Cordelli D.M., Corsini I., Pruccoli J., Ghizzi C., Franzonello C., Barbi E., Amaddeo A., Liguoro I., Cogo P., Morabito G., Marchili M.R., Brusco C., Mascolo C., Borea R., Piccotti E., Bellini T., Agostoni C., Badolato R., Dallavilla C., Felici L., Mattozzi S., Pennoni G., Mencaroni E., Bozzola, Elena, Ferrara, Pietro, Spina, Giulia, Villani, Alberto, Roversi, Marco, Raponi, Massimiliano, Corsello, Giovanni, and Staiano, Annamaria

Subjects
Adolescent, COVID19, Neuropsychological disorder, COVID-19, General Medicine, Settore MED/38, Mental Health, Italy, Quarantine, Children, Neuropsychological disorders, Humans, COVID19, Children, Neuropsychological disorders, Child, Pandemics, Human
Abstract

Background Quarantine and isolation measures during COVID-19 pandemic may have caused additional stress and challenged the mental health of the youth. Aim of the study is to investigate the COVID-19 pandemic impact on neuropsychological disorders (NPD) of Italian children and adolescents to provide general pediatric recommendations. Material and methods A retrospective multicenter observational study was planned by the Italian Pediatric Society (SIP) to explore the impact of COVID-19 on the access of children to pediatric Emergency Departments (pED) for the evaluation of neuropsychological symptoms, collecting the classification codes of diagnoses between March 1, 2019 and March 2, 2021. The period study was split into two sub-periods: a pre COVID-19 period (from March 1 2019 to March 1, 2020) and a COVID-19 period (from March 2, 2020 to March 2, 2021). As additional information, data on NPD hospitalizations in any pediatric department of the involved centers were recorded. Results During the study period, a total of 533,318 children were admitted to the pED involved in the study. Despite a 48.2% decline of pED admissions, there was a significant increase (83.1%) in patient admissions for NPD. The most frequent NPD conditions which increased during the COVID-19 pandemic were suicidal ideation (+ 147%), depression (+ 115%), eating disorder (+ 78.4%), and psychosis (+ 17.2%). During the pandemic period, a 39.5% increase in NPD hospitalizations was observed as well. The NPD disorders that mostly required hospitalizations were suicidal ideation (+ 134%), depression (+ 41.4%), eating disorder (+ 31.4%), and drug abuse (+ 26.7%). COVID-19 pandemic had a major impact on children's health, mainly on their NPD development. Neuropsychological assessment should be required at the primary level, in the pediatrician's office, to facilitate early capture of the sign of impairment and provide an adequate treatment. Conclusion SIP underlines the psychological consequences of COVID 19 pandemic on the youngest and recommends an early identification of NPD in the pediatric population to avoid other serious consequences for children's physical and mental health.

Published
2022

6. Diagnosis and management of urinary tract infections in children aged 2 months to 3 years in the Italian emergency units: the ItaUTI study

Author

Francesca, Cenzato, Milani, Gregorio P., Angela, Amigoni, Francesca, Sperotto, Bianchetti, Mario G., Carlo, Agostoni, Giovanni, Montini, Farello, Giovanni, Francesco, Chiarelli, Greco, Rita, Franco Di Lollo, Fabio Rocco Forte, Sergio, Manieri, Luigi, Carpino, Mimma, Caloiero, Anastasia, Cirisano, Salvatore, Bragh(`(o)), Roberto Della Casa, Felice, Nunziata, Carmine, Pecoraro, Rosario, Pacifico, Marcello, Lanari, Chiara, Ghizzi, Laura, Serra, Marcello, Stella, Giuseppe, Maggiore, Roberto, Fiorini, Icilio, Dodi, Andrea, Morelli, Lorenzo, Lughetti, Andrea, Cella, Gianluca, Vergine, Alessandro De Fanti, Danica, Dragovic, Daniele, Santori, Giorgio, Cozzi, Paola, Cogo, Marilena, Raponi, Riccardo, Lubrano, Mauro de Martinis, Antonio, Gatto, Maria Antonietta Barbieri, Antonino, Reale, Giorgio, Bracaglia, Emanuela, Piccotti, Riccardo, Borea, Alberto, Gaiero, Laura, Martelli, Alberto, Arrighini, Paola, Cianci, Claudio, Cavalli, Leonardina De Santis, Benedetta Chiara Pietra, Andrea, Biondi, Marco, Sala, Pogliani, Laura M., Simonetta, Cherubini, Marta, Bellini, Paola, Bruni, Giovanni, Traina, Paola, Tommasi, Paolo Del Barba, Sergio, Arrigoni, Salvini, Filippo M., Luca, Bernardo, Giuseppe, Bertolozzi, Silvia, Fasoli, Gian Luigi Marseglia, Emilio, Palumbo, Annalisa, Bosco, Gianpaolo, Mirri, Elisabetta, Fabiani, Ermanno, Ruffini, Luisa, Pieragostini, Martina, Fornaro, Gabriele, Ripanti, Donnina, Pannoni, Felici, Enrico, Anna, Perona, Eleonora, Tappi, Oscar Nis Haitink, Ivana, Rabbone, Pina Teresa Capalbo, Antonio, Urbino, Andrea, Guala, Gianluca, Cosi, Maria Gabriella Barracchia, Baldassarre, Martire, Fabio, Cardinale, Fulvio, Moramarco, Carmelo, Perrone, Angelo, Campanozzi, Valerio, Cecinati, Alessandro, Canetto, Ciro, Clemente, Antonio, Cualbu, Fabio, Narducci, Giuseppina, Mula, Pasquale, Bulciolu, Roberto, Antonucci, Giuseppe, Gramaglia, Giuseppe, Cavaleri, Carmelo, Salpietro, Giovanni, Corsello, Rosario, Salvo, Marcello, Palmeri, Maria Assunta Vitale, Ambra, Morgano, Susanna, Falorni, Diego, Peroni, Stefano, Masi, Alessio, Bertini, Angelina, Vaccaro, Pierluigi, Vasarri, Petra, Reinstadler, Massimo, Soffiati, Maurizio, Stefanelli, VERROTTI di PIANELLA, Alberto, Catherine, Bertone, Stefano, Marzini, Liviana Da Dalt, Simone, Rugolotto, Floriana, Scozzola, Luca Ecclesio Livio, Mauro, Cinquetti, Davide, Silvagni, Massimo Bellettato and, Cenzato F., Milani G.P., Amigoni A., Sperotto F., Bianchetti M.G., Agostoni C., Montini G., Farello G., Chiarelli F., Greco R., Di Lollo F., Rocco Forte F., Manieri S., Carpino L., Caloiero M., Cirisano A., Bragho S., Della Casa R., Nunziata F., Pecoraro C., Pacifico R., Lanari M., Ghizzi C., Serra L., Stella M., Maggiore G., Fiorini R., Dodi I., Morelli A., Lughetti L., Cella A., Vergine G., De Fanti A., Dragovic D., Santori D., Cozzi G., Cogo P., Raponi M., Lubrano R., de Martinis M., Gatto A., Barbieri M.A., Reale A., Bracaglia G., Piccotti E., Borea R., Gaiero A., Martelli L., Arrighini A., Cianci P., Cavalli C., De Santis L., Pietra B.C., Biondi A., Sala M., Pogliani L.M., Cherubini S., Bellini M., Bruni P., Traina G., Tommasi P., Del Barba P., Arrigoni S., Salvini F.M., Bernardo L., Bertolozzi G., Fasoli S., Marseglia G.L., Palumbo E., Bosco A., Mirri G., Fabiani E., Ruffini E., Pieragostini L., Fornaro M., Ripanti G., Pannoni D., Enrico F., Perona A., Tappi E., Nis Haitink O., Rabbone I., Capalbo P.T., Urbino A., Guala A., Cosi G., Barracchia M.G., Martire B., Cardinale F., Moramarco F., Perrone C., Campanozzi A., Cecinati V., Canetto A., Clemente C., Cualbu A., Narducci F., Mula G., Bulciolu P., Antonucci R., Gramaglia G., Cavaleri G., Salpietro C., Corsello G., Salvo R., Palmeri M., Vitale M.A., Morgano A., Falorni S., Peroni D., Masi S., Bertini A., Vaccaro A., Vasarri P., Reinstadler P., Soffiati M., Stefanelli M., Verrotti di Pianella A., Bertone C., Marzini S., Da Dalt L., Rugolotto S., Scozzola F., Ecclesio Livio L., Cinquetti M., Silvagni D., and Bellettato M.

Subjects
Catheter, Urinary tract, Emergency department, Pediatrics, Perinatology and Child Health, Guidelines, Infants, Infection, Survey, Urine, Infant, Guideline
Abstract

Urinary tract infections (UTIs) are among the most frequent bacterial diseases in infants and children. Physician adherence to recommendations is notoriously often poor, but no data are available on UTIs management in the emergency setting. In this multicenter national study, we investigated the policies regarding UTIs management in children aged 2 months to 3 years in Italian emergency units. Between April and June 2021, directors of the emergency units were invited to answer an online survey on the following items: diagnostic approach to children with fever without an apparent source, therapeutic approach to UTIs, the use of kidney and urinary tract ultrasound, and the criteria for hospitalization. A total of 121 (89%) out of 139 of invited units participated in the study. Overall, units manage children with a suspected or confirmed UTI according to available recommendations for most of the items. However, in almost 80% (n = 94) of units, a sterile perineal bag is used to collect urine for culture. When urine is collected by cathether, heterogeneity exists on the threshold of bacterial load considered for UTI diagnosis. Conclusions: Available recommendations on UTIs in children are followed by Italian emergency units for most of the items. However, the methods to collect urine specimens for culture, one of the crucial steps of the diagnostic work-up, often do not align with current recommendations and CFU thresholds considered for diagnosis largely vary among centers. Efforts should be addressed to validate and implement new child and family friendly urine collection techniques. What is Known:• Several guidelines are published on the management of children with suspected or confirmed urinary tract infection.• No data are available on the management of pediatric urinary tract infections in the emergency setting. What is New:• Almost 80% of the Italian emergency units employ a sterile perineal bag to collect urine for culture.• Diagnostic CFU thresholds largely vary among centers.

Published
2022

7. Assessment and pain management during the triage phase of children with extremity trauma. A retrospective analysis in a Pediatric Emergency Room after the introduction of the PIPER recommendations

Author

Carlotta, Granata, Massimo, Guasconi, Francesca, Ruggeri, Marina, Bolzoni, Cinzia Franca, Grossi, Giacomo, Biasucci, and Andrea, Cella

Subjects
Original Article: Assessment and Care of Pediatric Patients, Pain, Extremities, PIPER, nurses, Pediatric Emergency Room, extremity trauma, Italy, children, Humans, Pain Management, Triage, Child, Emergency Service, Hospital, Retrospective Studies
Abstract

Background and aim of the work: Pain is one of the most common symptoms in children who access the Pediatric Emergency Room (PER). However, many studies show that it is poorly evaluated and treated during the triage phase and that in many cases algometric scales aren’t used for its evaluation. Faced with this, the Piacenza PER (Italy) implemented the Pain in Pediatric Emergency Room (PIPER) recommendations for the assessment and management of pain from the 1st July 2017. The aim of this study was to detect the possible differences in the trend of the outcomes for the detection and treatment of pain in July-October 2016, 2017, 2018. Methods: A retrospective observational study was chosen. 811 discharge letters of extremity traumatized children aged 0-9 years were analyzed, of which 309 referred to the 2016 quarter, 243 to the 2017 quarter and 259 to the 2018 quarter. Results: In 2016, the pain of 12 patients was assessed out of a total of 309, in 2017 of 227 out of 243 and in 2018 of 245 out of 259. The Chi Square test about assessed and not assessed pain, gave statistically significant value (p = 1.36E-98), comparing 2016vs2017 and gave not significant value comparing 2017vs2018 (p = 0.58). 4 patients were treated during the triage phase in 2016, 68 in 2017 and 70 in 2018. Conclusions: Recommendations introduction has increased the frequency of pain algometric measurements during the triage phase by leading to an improvement in the nursing care outcomes in terms of pediatric pain management. (www.actabiomedica.it)

Published
2020

8. Rapunzel syndrome: an infrequent cause of severe iron deficiency anemia and abdominal pain presenting to the pediatric emergency department

Author

Giacomo Biasucci, Patrizio Capelli, Andrea Cella, Luigi Conti, Maurizio Celoni, Carmine Grassi, Giuseppe Cannalire, and Giulia Bensi

Subjects
Abdominal pain, Pediatrics, medicine.medical_specialty, Adolescent, Duodenum, Perforation (oil well), Case Report, Bezoars, Diagnosis, Differential, Trichotillomania, 03 medical and health sciences, 0302 clinical medicine, Rapunzel syndrome, PICA, medicine, Humans, Trichophagia, Pica (disorder), Ultrasonography, Anemia, Iron-Deficiency, business.industry, Stomach, lcsh:RJ1-570, lcsh:Pediatrics, Syndrome, Trichobezoar, medicine.disease, Iron-deficiency anemia, Iron deficiency anemia, 030220 oncology & carcinogenesis, Pediatrics, Perinatology and Child Health, Bezoar, Female, 030211 gastroenterology & hepatology, Differential diagnosis, medicine.symptom, Emergency Service, Hospital, Tomography, X-Ray Computed, business
Abstract

Background Iron deficiency anemia (IDA) and abdominal pain are commonly seen in a pediatric emergency department (8 and 18% incidence respectively in our center). They are manifestations of a wide variety of diseases ranging from benign to immediately life-threatening. Trichobezoar is an under-diagnosed entity that has to be considered in children and adolescents, expecially female, suffering from trichotillomania (compulsion to pull hair) and trichophagy (compulsion to swallow hair). When undiagnosed, gastric bezoars may cause gastric ulceration, perforation, haemorrhage and obstruction. Case presentation To underline the importance of including this pathology in the differential diagnosis of IDA and abdominal pain, we present the case of a 14 year-old girl with a huge trichobezoar which completely filled the stomach and extended into the small bowel. Since trichobezoar has an extension to the small bowel, it is classified as Rapunzel syndrome. As the bezoar couldn’t be removed by endoscopy, the girl underwent surgical intervention. The patient passed through a gradual re-feeding, with iron and vitamins supplementation, and through a psychiatric counselling. Conclusion The Rapunzel syndrome is a rare entity that may be complicated by life-threatening events. A prompt diagnosis and an appropriate therapy can reduce comorbidities. Gradual re-feeding with supplementation of micronutrients allows adequate catch-up weight with normalization of haematochemical nutritional parameters. Since many of these patients suffer from psychiatric pathology such as PICA with emotional problems and mental retardation, psychological/psychiatric counselling plays an important role in order to prevent bezoar recurrence.

Published
2018

9. Italian COVID-19 epidemic: effects on paediatric emergency attendance—a survey in the Emilia Romagna region

Author

Lorenzo Iughetti, Giulia Graziani, Alessandro De Fanti, Anna Rita Di Biase, Giacomo Biasucci, Andrea Cella, Enrico Valletta, L. Viola, Gianluca Vergine, Francesca Vaienti, and Federico Marchetti

Subjects
medicine.medical_specialty, data collection, Coronavirus disease 2019 (COVID-19), business.industry, Attendance, Health services research, Disease, adolescent health, Triage, Pediatrics, health services research, RJ1-570, General Paediatrics, Pediatrics, Perinatology and Child Health, Epidemiology, Emergency medicine, Medicine, epidemiology, Pediatrics, Perinatology, and Child Health, business, Paediatric emergency, Adolescent health
Abstract

ObjectiveTo evaluate the effect of the COVID-19 epidemic on paediatric emergency department (ED) attendance in a region of Northern Italy.MethodsA survey was proposed to six out of nine paediatric EDs in the Emilia Romagna region to evaluate attendance data, distribution by age and gender, triage code score, outcome of clinical course, number of hospitalisations and the distribution of patients by disease. Data were collected during March 2020 and compared with that of March 2019.ResultsA drop in paediatric ED attendance of more than 83.8% was observed, with a higher percentage of infants and severe triage scores. The proportion of patients hospitalised was significantly higher in 2020 than in 2019 (p value: ConclusionsOur survey suggests that in the first month of the COVID-19 epidemic in Italy, there has been an increase in delayed attendance and provision of care of potentially severe diseases in paediatric EDs. Hospital and community paediatricians should be aware of this phenomenon and adopt appropriate strategies to prevent this danger, as it may affect children more seriously than COVID-19 itself.

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