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1. Implementation of the WHO Standards to assess the quality of paediatric care using health workers as source of data: findings of a multicentre study (CHOICE) in Italy

Author

Egidio Barbi, Silvia Bressan, Stefano Masi, Marzia Lazzerini, Paola Cogo, Vanna Graziani, Federico Marchetti, Ilaria Mariani, Valentina Baltag, Ilaria Liguoro, Francesca Tirelli, Chiara Stefani, Sarah Contorno, Stefano Martelossi, Alessia Marcellino, Riccardo Lubrano, Enrico Felici, Annunziata Lucarelli, Gian Luca Trobia, Elia Balestra, Benmario Castaldo, Alice Del Colle, Chiara Pilotto, Paola Moras, Marcella Massarotto, Paola Crotti, Benedetta Ferro, Riccardo Pavanello, Silvia Fasoli, Chiara Grisaffi, Idanna Sforzi, Rosa Santangelo, Andrea Iuorio, Vanessa Martucci, Mariateresa Sanseviero, Roberta Parrino, Giuseppina de Rosa, Vita Antonella Di Stefano, Francesca Patané, Marta Minute, Fabio Cardinale, Alessandra Iacono, Marta Arrabito, Paolo Dalena, Massimo Dagnelut, Maristella Toniutti, Silvia Galiazzo, Maria Luisa Casciana, Marta Gagliardi, Kevin Valentino, Lucia Grazia Tricarico, Mariateresa De Sario, Alessandra Pisani, Maria Carla Finocchiaro, Laura Portale, Marco Greco, Emiliano Talanti, Anna Madera, Paola Stillo, Nicolò Chiti, Silvia Bloise, Silvia Sordelli, Mariangela Labruzzo, Massimo Lo Verde, Domenico Cipolla, Carlotta Farneti, Francesco Oppido, Giulia Sansovini, Giada Sartor, Marta Magnolato, Michele Maiola, Michela Pandullo, Sara Rivellini, Sara Dal Bo, Giuseppina De Rosa, Dal Bo Sara, Troisi Angela, Cozzi Giorgio, and Amaddeo Alessandro

Subjects
Pediatrics, RJ1-570
Published
2024
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7. Increase of pyogenic bacterial infections after relaxation of social distancing measures linked to COVID‐19 pandemic.

Author

Rossetti, Vanessa, Amaddeo, Alessandro, Vanz, Daniele, Boscarelli, Alessandro, Minute, Marta, and Cozzi, Giorgio

Subjects
BACTERIAL diseases, ELECTRONIC health records, CENTRAL nervous system, EMPYEMA, PEDIATRIC emergencies, BRAIN abscess
Abstract

Aim: After the relaxation of COVID‐19 mitigation measures, we observed a dramatic increase in pyogenic infections. Based on this observation, we retrospectively analysed all cases of invasive bacterial infections of brain, lung and complicated ear–nose–throat (ENT) infections, in the period from 1 August to 31 March from the years 2018–2019 to 2022–2023. Methods: The study was conducted in two Paediatric Emergency Departments, at IRCCS 'Burlo Garofolo' of Trieste and at Treviso Hospital. Electronic medical records were searched for all cases with a definitive diagnosis at discharge of mastoiditis, suppurative cervical lymphadenitis, retropharyngeal, parapharyngeal and peritonsillar abscess (ENT group), bacterial brain abscesses, epidural empyema, subdural empyema (central nervous system group), thoracic empyema and necrotising pneumonia (lung group). Results: In 2022–2023, we observed an increase in infections compared to the previous years. Total number of cases were 22, 29, 8, 27 and 63 in 2018–2019, 2019–2020, 2020–2021, 2021–2022 and 2022–2023, respectively. The greater increase occurred in thoracic empyema, with a peak incidence of +120% in 2022–2023 in respect of 2021–2022. Conclusion: We reported an important increase in paediatric bacterial complicated infections in two North East Italian regions, possibly correlated with the relaxation of COVID‐19 social distancing measures. [ABSTRACT FROM AUTHOR]

Published
2024
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13. Neuron‐Derived Extracellular Vesicles miRNA Profiles Identify Children Who Experience Adverse Events after Ketamine Administration for Procedural Sedation.

Author

Lucafò, Marianna, Bidoli, Carlotta, Franzin, Martina, Eitan, Erez, Rau, Sara, Amaddeo, Alessandro, Fachin, Alice, d'Adamo, Adamo Pio, Decorti, Giuliana, Stocco, Gabriele, Barbi, Egidio, and Cozzi, Giorgio

Abstract

Ketamine provides the highest safety profile among sedatives for procedural sedation and analgesia in the pediatric emergency setting. However, it can cause vomiting and recovery agitation. No studies have examined epigenetic factors, such as microRNAs, for predicting the occurrence of these adverse events. Neuronal‐derived extracellular vesicle microRNA profiles were studied to predict the occurrence of ketamine‐induced vomiting and recovery agitation in children. For this aim, a single‐center prospective pharmacoepigenetic study was performed and 50 children who underwent procedural sedation with intravenous ketamine as the only sedative drug were enrolled between October 2019 and November 2022. MiRNA profiling in plasma neural‐derived extracellular vesicles was analyzed through next‐generation sequencing and measured before treatment with ketamine. Twenty‐two patients experienced vomiting or recovery agitation. Among the 16 differentially expressed microRNAs, the upregulated miR‐15a‐5p and miR‐484 targeted genes related to N‐methyl‐D‐aspartate (NMDA) receptor activity, including glutamate ionotropic receptor NMDA type subunit 2A (GRIN2A). Preliminary data confirmed lower GRIN2A levels in patients who developed these events. Downregulated miR‐126‐3p and miR‐24‐3p targeted AMPA receptor‐associated genes. Functional analyses of gene targets revealed the enrichment of glutamatergic and neurotrophins signaling. Recovery agitation was associated with this network. Vomiting was related to dopaminergic and cholinergic systems. Three miRNAs (miR‐18a‐3p, miR‐484, and miR‐548az‐5p) were identified as predictive biomarkers (AUC 0.814; 95% CI: 0.632–0.956) for ketamine‐induced vomiting and recovery agitation. MicroRNA profiles can predict the development of ketamine‐induced vomiting or recovery agitation in children. This study contributes to the understanding of the mechanisms underlying ketamine‐induced adverse events. [ABSTRACT FROM AUTHOR]

Published
2025
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14. Management of neonatal head injuries: A retrospective cohort study.

Author

Parri, Niccolò, Giacalone, Martina, Greco, Marco, Aceti, Arianna, Lucenteforte, Ersilia, Corsini, Iuri, Sarli, Walter Maria, D'Anna, Carolina, Tipo, Vincenzo, Cristaldi, Sebastian, Musolino, Anna Maria, Tibaldi, Jessica, Parodi, Alessandro, Bondone, Claudia, Vasarri, Pier Luigi, Bechi, Francesca, Chiaretti, Antonio, Bertolozzi, Giuseppe, Cozzi, Giorgio, and D'Aiuto, Francesca

Subjects
BRAIN injuries, HEAD injuries, COMPUTED tomography, PEDIATRIC emergencies, NEWBORN infants
Abstract

Aim: The aim of this study is to describe circumstances, management and short‐term outcomes of neonatal head trauma, and adherence to the Paediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rule for children under 2 years. Methods: Multicentre retrospective cohort study of neonates (<29 days) with head trauma across 25 emergency departments (ED) from January 2017 to June 2021. Results: A total of 492 neonates (median age 17 days, range 0–28 days) with non‐trivial head trauma were enrolled. Falls were the most common injury mechanism (375/492, 76.2%). Imaging was performed in 150/492 (30.5%) neonates. Clinically important traumatic brain injury (ciTBI), defined as death, neurosurgery, prolonged intubation, or extended hospitalisation from injury, occurred in 7/492 (1.4%) cases. Notably, 286/492 (58.1%) neonates were managed by short‐term observation (<48 h), and 126/492 (25.6%) were admitted. Among high‐risk neonates per PECARN criteria, 17/21 (80.9%) did not undergo recommended head CT scans but were observed within ED short observation units or underwent alternative imaging, with no ciTBI diagnoses among those discharged without CT. Conclusion: Severe neonatal head injuries are rare, and most neonatal head injuries have a favourable outcome, making observation a suitable approach, while remaining vigilant for signs of non‐accidental injuries. [ABSTRACT FROM AUTHOR]

Published
2025
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16. Continuous Infusion of Dexmedetomidine for Maintenance of Sedation in an Aggressive Adolescent with Autism Spectrum Disorder in the Emergency Department.

Author

Cozzi, Giorgio, Zago, Alessandro, Poropat, Federico, Rabach, Ingrid, Barbi, Egidio, and Amaddeo, Alessandro

Subjects
ACADEMIC medical centers, PATIENT safety, AUTISM, HOSPITAL emergency services, TREATMENT effectiveness, AGITATION (Psychology), TERTIARY care, CHILDREN'S hospitals, INTRAVENOUS therapy, AGGRESSION (Psychology), MEDICAL records, ACQUISITION of data, DRUG efficacy, INTENSIVE care units, ASPERGER'S syndrome, IMIDAZOLES, ADOLESCENCE
Abstract

Background: The treatment of aggressive behavior and agitation in pediatric patients with autism spectrum disorder (ASD) in the emergency department is topical and challenging. Case Presentation: We described an adolescent with autism spectrum disorder treated ten times in the pediatric emergency department for severe episodes of aggressiveness and agitation. After resolving the acute phase of these behavioural crises, sedation was maintained with a continuous infusion of dexmedetomidine to prevent the resurgence of agitation and to organize discharge properly, considering the family's needs. The continuous infusion of dexmedetomidine allowed the patient to remain asleep most of the time during his stay at the emergency department. No adverse events were recorded. Conclusions: The continuous infusion of dexmedetomidine could represent a safe and valuable tool to facilitate the permanence of the patient in the PED. [ABSTRACT FROM AUTHOR]

Published
2024
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40. Child with fern-like skin lesion

Author

Malni, Irene, Pintaldi, Stefano, Rabach, Ingrid, Amaddeo, Alessandro, Barbi, Egidio, Cozzi, Giorgio, Malni, Irene, Pintaldi, Stefano, Rabach, Ingrid, Amaddeo, Alessandro, Barbi, Egidio, and Cozzi, Giorgio

Subjects
Pediatrics, Perinatology and Child Health, Fern-lijke skin lesion, lighthning injury
Abstract

N/A

Published
2023

41. Screening del funzionamento psicologico: l’ottavo segno

Author

Ghirigato, Elena, Corona, Federica, Cozzi, Giorgio, Carucci, Sara, Barbi, Egidio, Ghirigato, Elena, Corona, Federica, Cozzi, Giorgio, Carucci, Sara, and Barbi, Egidio

Subjects
Children, Somatic symptom disorder, school absenteism, suicide, depression, anxiety
Abstract

Mental health problems are a significant cause of disability in children and adolescents. The most common are anxiety, depression, eating disorders and somatic symptom disorder. All these disorders have a negative impact on the child/adolescent functioning and they may lead to more severe psychiatric illnesses. For these reasons, paediatricians should be able to identify the patients with high risk of psychological dysfunction, by knowing the right questions to ask and using some simple psychological assessment tools (Paediatric symptom checklist, Strengths and Difficulties Questionnaire, HEADS-ED) that can help patients to receive the psychological/neuropsychiatric support they need as soon as possible.

Published
2023

42. COVID-19 was mild in hospitalised infants younger than 90 days

Author

Servidio, Alessia Giuseppina, Visentin, Giacomo, Conti, Rosaura, Cozzi, Giorgio, Travan, Laura, Bua, Jenny, Barbi, Egidio, Amaddeo, Alessandro, Servidio, Alessia Giuseppina, Visentin, Giacomo, Conti, Rosaura, Cozzi, Giorgio, Travan, Laura, Bua, Jenny, Barbi, Egidio, and Amaddeo, Alessandro

Subjects
Covid 19, Infants
Abstract

N/A

Published
2023
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45. SARS-CoV-2-related bronchiolitis: a multicentre international study

Author

Cozzi, Giorgio, primary, Sovtic, Aleksandar, additional, Garelli, Davide, additional, Krivec, Uros, additional, Silvagni, Davide, additional, Corsini, Ilaria, additional, Colombo, Marco, additional, Giangreco, Manuela, additional, Giannattasio, Antonietta, additional, Milani, Gregorio Paolo, additional, Minute, Marta, additional, Marchetti, Federico, additional, Gatto, Antonio, additional, Debbia, Carla, additional, Gortan, Anna Jolanda, additional, Massaro, Marta, additional, Hatziagorou, Elpis, additional, Ravidà, Domenico, additional, Diamand, Raz, additional, Jones, Elizabeth, additional, Visekruna, Jelena, additional, Zago, Alessandro, additional, Barbi, Egidio, additional, Amaddeo, Alessandro, additional, and Cortellazzo Wiel, Luisa, additional

Published
2023
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48. Mixed hemodiafiltration reduces erythropoiesis stimulating agents requirement in dialysis patients: a prospective randomized study

Author

Pedrini, Luciano A., Comelli, Mario, Ruggiero, Pio, Feliciani, Annalisa, Manfrini, Vania, Cozzi, Giorgio, Castellano, Angelo, Pezzotta, Mauro, Gatti, Guido, Arazzi, Marta, Auriemma, Laura, di Benedetto, Attilio, and Stuard, Stefano

Abstract

Background: Improved responsiveness to erythropoiesis stimulating agents (ESAs) in patients on on-line post-dilution hemodiafiltration (Post-HDF) compared with conventional hemodialysis (HD) was reported by some authors but challenged by others. This prospective, cross-over randomized study tested the hypothesis that an alternative infusion modality of HDF, mixed-dilution HDF (Mixed HDF), could further reduce ESAs requirement in dialysis patients compared to the traditional Post-HDF. Methods: One-hundred-twenty prevalent patients from 6 Dialysis Centers were randomly assigned to two six-months treatment sequences: A–B and B–A (A, Mixed HDF; B, Post-HDF). Primary outcome was comparative evaluation of ESA (darbepoetin alfa) requirement and ESA resistance. Treatments efficiency, iron and vitamins status, inflammation and nutrition parameters were monitored. Results: In sequence A, darbepoetin requirement decreased during Mixed HDF from 29.5 to 23.7 µg/month and increased significantly during Post-HDF (32.3 µg/month at 6th month) while, in sequence B, it increased during Post-HDF from 38.2 to 43.7 µg/month and decreased during Mixed HDF (23.9 µg/month at 6th month). Overall, EPO doses at 6 months on Mixed and Post-HDF were 23.8 and 38.4 µg/month, respectively, P &lt; 0.01. A multiple linear model confirmed that Mixed HDF vs Post-HDF reduced significantly ESA requirement and ESA resistance (P &lt; 0.0001), by a mean of 29% (CI 23–35%) in the last three months of the observation periods. Conclusions: Mixed HDF decreased darbepoetin-alfa requirement in dialysis patients. This might help preventing the untoward side effects of high ESA doses, besides having a remarkable economic impact. Additional evidence is needed to confirm this potential benefit of Mixed-HDF.

Published
2024
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