International Journal of Pediatrics and Child Health

Head Trauma in Paediatric Patients Referring to a Spoke Hospital

Neftj Ragusa — 2024-01-17

Introduction: Head trauma (HT) is a leading cause of morbidity and mortality in children worldwide. The primary aim of this study was to describe patients presenting to our first-level Emergency Department (ED) following a HT. The secondary aims were to compare both the epidemiology and the management of paediatric patients with literature data, analyzing the appropriateness of management of children’s traumatic brain injuries according to the current guidelines.

Methods: We conducted a retrospective review of medical records of patients aged < 14 years who attended our first-level ED due to head trauma from July 1, 2021, and June 30, 2022. Clinical data, including age, gender, injury mechanism, location of trauma, time from traumatic event and ED arrival, symptoms at first evaluation, physical examination findings, radiological investigation results, medications administered in ED and prescribed at home, and outcome were collected and compared with data available in literature and current guidelines.

Results: A total of 117 children aged < 14 years who attended our first-level ED due to head trauma from July 1, 2021, and June 30, 2022, were analyzed. Most of them were males aged 1-3 years. Frontal bone was the commonest side of trauma (43% of HT). Only eleven patients (9%) had a brain CT scan and 4 of them showed pathological findings. None had signs of bleeding. Four of the patients were transferred to a HUB hospital, provided with a paediatric neurosurgery and more important none of them has developed neurological sequelae or death.

Discussion: Our 1-year observation of HT showed how this is a frequent indication for ED referral, especially in young children. In our hands less than 10% of cases required CT scan that reported pathological cases in 4 patients only (3%). We can conclude that the reduction of ionizing radiation exposition can be obtained with skilled experienced physicians.

Neonatal Orthoptic Screening Battery (NOSB): Four-decade Experience of Orthoptic Best Practice

Mondelli Flora — 2024-02-27

The present study describes the neonatal orthoptic screening battery (NOSB), a comprehensive orthoptic screening, based on four decades of application, aimed at early identification of signs and symptoms of ocular pathology or functional disorders. The NOSB allows for verifying the integrity of ocular components and early detection of functional alterations in ocular movements that could lead to the development of amblyopia or strabismus. The NOSB is the result of 45 years of screening activity in a primary health center assured by the National Health System in the city of Ragusa – Italy. It aims to examine and assess the neonate within the first 3 days of extrauterine life to identify visual system issues as early as possible. The NOSB may be conducted by Orthoptists, healthcare professionals specializing in neonatal and pediatric visual prevention. The Neonatal Orthoptic Screening battery (NOSB) here reported is proposed as a standard suitable for widespread adoption to be considered a "Best Practice".

The Relationship between Autism Spectrum Disorder among Children and Perceived Functioning among Parents in Italy

Elsa Vitale — 2024-03-02

Aim: To evaluate how the life of a parent changes from a psychological, social and economic point of view and to investigate levels of anxiety and depression perceived from the moment of diagnosis of the child's Autism Spectrum Disorder (ASD).

Methods: From March to December 2021 an observational, cross sectional multicentre study was conducted.

Results: A total of 372 parents were recruited in this survey. From data collected, most of parents reported high depression than anxiety levels. Parents interviewed declared that in most of the life spheres, such as: social, working, family, the presence of their sons with ADS have importantly influenced their lives. No significant associations were recorded between the autistic child habits or behaviors and the presence of anxiety among participants. On the other hand, motor and vocalist which could create serious disturbance among neighborhood was significantly associated with depression condition (p=0.021).

Conclusions: It has been shown that social, psychological and economic support from institutions and professionals is still very low.

Difficulties and Psychological Experiences of Parents of Children with Autism Spectrum Disorders (ASD): A Cross-Sectional Study

Roberto Lupo — 2024-04-28

Introduction: Autism spectrum disorders are brain development disorders with multifactorial etiology, identified by difficulties in communication and social interrelation, like recurrent and stereotyped attitudes, activities, and interests. Families with children with developmental disorders may experience more difficulties than families with children without disorders. Therefore there is a need Finding ways to reduce or manage parental stress for improve the family's quality of life through the evaluation of the causes. This study aims to analyze the difficulties experienced by caregivers and the perceived inclusion and inclusion of parents and children with autism spectrum disorder (ASD) within the social fabric, thereby examining the difficulties parents face in daily life.

Materials and Methods: A cross-sectional study was conducted online through snowball sampling until data saturation from November 2020 - March 2023, through the administration of an online questionnaire made through a Google form and disseminated through social media. Data analysis using the Statistical Package for Social Science (SPSS) Software version 17.

Results: 404 parents of children with ASD 94.8% of whom are mothers with an average age of 40.23 years. The prevalence of parents correctly defined autism as "a neurodevelopmental disorder characterized by difficulties in social interaction and communication, limited interests, and repetitive behaviors". At final diagnosis, the study results reported for 87.9% of parents sadness and grief at diagnosis, followed by fear (83.9%).

Conclusions: Research in this area is critical as it can assist health care providers and scholars in understanding the unique issues parents face in raising a child with ASD, as well as support parents themselves in identifying factors that contribute to their stress level in order to take the right steps to reduce it and improve their overall well-being.

Understanding and Managing Inherited Platelet Disorders: A Case Study of Storage Pool Disease

Manuela Giuseppa Ingrascì — 2024-05-05

Inherited platelet disorders, including platelet storage pool diseases (SPDs), manifest in various bleeding symptoms, with severity often categorized based on their effects on either the surface receptors or internal structures of platelets [1]. This rare condition, characterized by defects in platelet granules, exhibits broad phenotypic variability, ranging from mild bruising to severe hemorrhages. Diagnosis involves specialized analyses such as platelet aggregation and genetic studies, necessitating a multidisciplinary approach for management [2]. Our case report describes a child with recurrent epistaxis, initially diagnosed with immune thrombocytopenia. Subsequent presentations led to suspicion of von Willebrand disease, but further examinations revealed a platelet function disorder. Genetic testing confirmed mutations associated with SPD. Treatment options include desmopressin, antifibrinolytic agents, and platelet transfusions, tailored to individual needs. The discussion underscores the diverse manifestations of SPD, emphasizing the importance of thorough diagnostic assessments. Treatment strategies aim to alleviate bleeding symptoms and mitigate associated risks, with a strong focus on personalized care. Challenges in managing SPD include missed diagnoses and the influence of genetic variations on disease severity. Ultimately, early detection and individualized therapies are essential for effectively managing SPD, underscoring the ongoing need for research to enhance outcomes for affected individuals.

Craniofacial Morphology and Knowledge of the Stability in Class III Malocclusion Growing Subjects

F.C. De Razza — 2024-05-07

Introduction: to investigate the palatal and craniofacial relationship in Class III growing patients between successful and failed treated groups.

Methods: Thirty-one patients treated with RME/FM/BB were enrolled (inclusion criteria: Caucasian ancestry, III Class malocclusion, maturation stage CS1-CS2, mixed dentition). Digital cast and cephalometric analysis were performed on pre-treatment and post-treatment records. Statistical analysis and a discriminant analysis was performed. GMM was used on digital dental casts with Procrustes analysis to assess the covariation between palatal and craniofacial morphology. Two groups (relapse, R, 19 and success S, 12) were identified.

Results: R group showed a greater maxillary-anterior transversal width at T0. At T1 R showed a shorter maxillary-anterior length than S. A larger maxillary-anterior and posterior-transversal widths was found in both groups. S had greater maxillary-anterior and posterior-sagittal length. A larger mandibular-anterior and posterior-transversal widths was shown in R, while S showed no differences in mandibula. Maxillary-anterior and maxillary-posterior length were two predictive variables found by discriminant analysis. The PC1 showed significant changes in the palatal morphology and revealed differences for the craniofacial vertical components. Palatal and craniofacial shapes showed a significant covariation, linking the palatal width to skeletal divergence.

Discussion: In Class III malocclusion increases in vertical divergence are correlated with a higher palatal vault and narrower width. A wider and shorter maxillary morphology could be a relapse factor for Class III orthopedic treatment, while the lack of mandibular modification could be predisposing for treatment success.

Pediatric Hearing Loss and the Multidisciplinary Approach. The Hearing Disability Team (HDT) Experience

Silvia Palma — 2024-05-13

Hearing loss is among the utmost common disorders in children and a late diagnosis can impact language and cognitive development. With the aim of implementing an early hearing detection program (EHDP), the Emilia Romagna region has officially approved, since 2012, a NHS program distinguishing well babies and NICU children. Aim of this study is to evaluate the results of the application of these regional guidelines through data flow from the Child and Adolescent Mental Health Services (CAMHS).

Data of children born between 2012 and 2018 and admitted to the service in the same period were collected, 84 children (56 males,28 females) were enrolled; 65% of the children were taken in charge by CAMHS within the first year of life. Concerning the NHS results, 77 (91%) children resulted fail at the screening test (6 unilateral fails), while the result was not available in one case; 6 children resulted pass. Most cases, 79 (94%), presented bilateral hearing loss. In particular, 14 (17.8%) children had a profound hearing loss, 10 (12.6%) a severe hearing loss, 10 (12.6%) a mild hearing loss (6 were conductive), 22 (27.8%) a moderate hearing loss, and 23 (29.2%) a moderate/severe hearing loss. Finally, 5 resulted affected by unilateral hearing loss (2 profound hearing loss, 3 severe).

This study confirmed that regional recommendations about early diagnosis of hearing loss have been applied and most children accessed the CAMHS timely. To this aim synergism between hospital and territorial services, determining the implementation of the organization system was the keystone.

The Effectiveness of Glycopyrronium in Drooling Managment: A Scoping Review Protocol

Giovanni Battista Dell’Isola — 2024-05-15

The management of pediatric drooling presents challenges requiring tailored therapeutic approaches. This scoping review examines the efficacy and safety of glycopyrronium in addressing drooling across diverse pediatric populations. Glycopyrronium, an anticholinergic medication, inhibits salivary gland activity, offering promise in managing drooling. Clinical trials and observational studies consistently demonstrate its effectiveness, particularly in children with neurological disabilities like cerebral palsy. Notably, glycopyrronium exhibits efficacy even at lower dosages, emphasizing personalized treatment. However, potential side effects such as dry mouth and vision changes necessitate careful monitoring. Future research should explore predictors of treatment response and include diverse patient populations to optimize management strategies. Overall, glycopyrronium emerges as a valuable therapeutic option for pediatric drooling, improving quality of life for affected children. This review underscores the importance of tailored approaches and highlights the need for further research to enhance outcomes in pediatric drooling management.

Are Steroids Always Necessary in Multisystem Inflammatory Syndrome in Children (MIS-C)?

Anna Camporesi — 2024-06-13

Multisystem Inflammatory Syndrome in Children (MIS-C) treatment is still under debate and involves Intravenous Immunoglobulins (IVIG) and/or steroids. We retrospectively analysed data from the patients admitted to Our Institution during the year 2020 to investigate whether prompt IVIG treatment conditions cardiac dysfunction and need for support and if addition of steroids in different doses correlates with outcomes.

Days of fever, time between fever appearance and IVIG treatment, left ventricular ejection fraction (LVEF%) at admission and Cardiac Function Recovery Time (time between worst LVEF and resume of LVEF >55%) were used as outcomes.

38 patients were admitted with MIS-C. All except one received IVIG; 24 received also different Methylprednisolone dosages. Time to IVIG treatment, adjusted for age and sex, correlated with global duration of fever (Coefficient: 1.2; 95% CI:0.73-1.68) and with Vasoactive Inotropic Score (VIS) (Coefficient: 0.09; 95% CI 0.02-0.15), with pericardial effusion (Coefficient: 2.37; 95% CI: 0.45-4.2). Global duration of fever was associated with time to IVIG (Coefficient: 0.8; 95% CI :0.49-1.13) and positive Covid-19 swab (Coefficient: 1.71; 95% CI 0.21-3.22). Cardiac Function Recovery Time did not show differences with different steroid dose regimens. High-dose steroids did not show any benefit in our cohort.

Cold Agglutinin Urticaria Secondary to Mycoplasma Pneumoniae Infection in Childhood: A Case Report

Clelia Cusmano — 2024-06-14

This case report discusses a 13-year-old child presenting with bilateral middle-basal pneumonia attributed to Mycoplasma pneumoniae infection. Despite the absence of hemolysis, the patient exhibited symptoms consistent with cold agglutinin syndrome (CAS), including an erythematous-pomfoid urticaria-like rash. Laboratory analyses confirmed CAS with elevated cold agglutinin titers and a recent Mycoplasma pneumoniae infection. Treatment with clarithromycin resolved the pneumonia, and the rash spontaneously regressed. Additionally, hepatic steatosis was detected, likely associated with the patient's overweight status. This case highlights the importance of considering CAS in children with atypical symptoms following Mycoplasma pneumoniae infection.

Respiratory Follow-up in a Cohort of Children with Congenital Malformations Affecting Lung Development: A Cohort Study

Nicole Mussi — 2024-07-05

Background; Congenital malformations like oesophageal atresia (OA) and tracheo-esophageal fistula (TOF), congenital pulmonary airway malformations (CPAMs), congenital diaphragmatic hernia (CDH) and vascular rings (VRs) can influence lung development and respiratory function with significant impact on individuals, families, and health care system. This observational study outlines our multidisciplinary approach and respiratory follow-up for children with these congenital malformations.

Methods; We collected clinical data of children followed at the Pediatric Respiratory Unit of Parma University Hospital (Italy) between January 2015 and May 2023.

Results; Thirty-five patients have been included. The most common anomalies were AE (n = 12) and CHD (n = 9), followed by CPAMs (n = 9) and VRs (n = 5). In 50% of patients, the diagnosis was made through prenatal ultrasound, particularly in almost all patients with CPAMs (88.8%) and CDH (77.7%), contrary to OE, diagnosed postnatally in the majority of patients (83%). Children underwent their first respiratory visit at an average age of 2.5 years, follow-up was conducted on average every 6 months. More than half of patients (54%) was hospitalized for lower respiratory tract infections, particularly those with OA and those aged <3 years. Eight out of the 16 children capable of performing spirometry showed abnormalities in lung function.

Conclusions; Children with congenital malformations are at risk of short and long-term respiratory complications. A personalized follow-up with close collaboration between pediatric pulmonologist, surgeon, neonatologist, physiotherapist is essential to optimize their management and improve their respiratory function.

Attention Deficit/Hyperactivity Disorder and Motor Planning Difficulties: A Confirmatory Study on the Overlap Between Neurodevelopmental Disorders

Valerio Zaccaria — 2024-10-22

Attention deficit/hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) represent two frequent neurodevelopmental disorders, which may be comorbid or have common characteristics with each other. The aim of the present study was to explore the presence of DCD or motor planning difficulties in children with behavioral disorders and/or ADHD, as already stated in the literature. Motor abilities were assessed in a sample of children which underwent a comprehensive neuropsychological evaluation. A total of 43 children were included in the study and were subdivided in three groups: those with ADHD and DCD, those with DCD, and those with ADHD but also presenting motor-praxic difficulties. The first group obtained clinical scores at the considered tests, with worse performances in the balance area; in the second and third groups lower scores were observed in the manual dexterity and balance, with more homogeneous profiles. Overall, 27.3% of ADHD subjects received a diagnosis of DCD as well, whereas 31.8% showed documented motor-praxic difficulties. Our results confirmed an increased prevalence of DCD or general motor difficulties in children with ADHD compared to the general population. Further research should investigate whether a poorer motor performance assessed by standardized tests could be either due to a comorbid neurodevelopmental condition or a direct consequence of the pivotal symptomatology of the disorder.

Internalizing Psychiatric Comorbidities Among Adolescents with Anorexia Nervosa

G. Fiacco — 2024-12-23

Anorexia Nervosa (AN) is a multifactorial psychiatric disorder classified among eating and feeding disorders and frequently associated with psychiatric comorbidities, particularly among adolescents. The main objective of the study was evaluating the psychiatric comorbidities associated with AN, analyzing how these conditions influence each other, triggering challenges in clinical management.

The study was conducted at the Child Neuropsychiatry Unit Clinic at Vanvitelli University and involved 60 AN inpatients. Retrospective data collection was obtained through analysis of several psychodiagnostic tests. The EAT-26 (Eating Attitude Test) was administered to assess the presence of dysfunctional eating behaviors, while the BUT (Body Uneasiness Test) was used to identify potential signs of body dysmorphic disorder. The SCARED (Screen for Child Anxiety Related Disorders) and CDI (Children’s Depression Inventory) were employed to investigate the presence of anxious and depressive symptoms. The WISC-IV (Wechsler Intelligence Scale for Children – Fourth Edition) was used to measure intellectual quotient and exclude the presence of intellectual disability. In addition, BMI at discharge of patients was evaluated as an outcome measure for treatment.

Results highlight a significant relationship between AN and psychiatric comorbidities, providing important insights for a deeper understanding of the psychiatric dynamics associated with AN. Pearson correlation analysis revealed a strong positive correlation between the scores of the Eating Attitude Test (EAT-26) and the Body Uneasiness Test (BUT) (r=0.730; p<0.001), suggesting that subjects with dysfunctional eating behaviors tend to exhibit high dissatisfaction with their body image. A moderate correlation between the EAT and the SCARED (Screen for Child Anxiety Related Emotional Disorders) (r=0.505; p<0.001) indicates that eating disorders are associated with elevated anxiety levels, while the EAT showed a moderate correlation with the Children’s Depression Inventory (CDI) (r=0.411; p=0.001), suggesting a relationship between dysfunctional eating behaviors and depressive symptoms.

Furthermore, the data show a significant increase in BMI during hospitalization, highlighting the importance of targeted therapeutic interventions.

These findings contribute to enhancing diagnostic and therapeutic strategies in the management of patients with AN.