Time needed to intubate and suction a manikin prior to instituting positive pressure ventilation: a simulation trial.

Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid (MSAF) is supposed to delay initiation of positive pressure ventilation (PPV), but the magnitude of such delay is unknown. To compare the time of PPV initiation when performing immediate laryngoscopy with intubation and suctioning vs. performing immediate PPV without intubation in a manikin model. Randomized controlled crossover (AB/BA) trial comparing PPV initiation with or without endotracheal suctioning in a manikin model of non-vigorous neonates born through MSAF. Participants were 20 neonatologists and 20 pediatric residents trained in advanced airway management. Timing of PPV initiation was longer with vs. without endotracheal suctioning in both pediatric residents (mean difference 13 s, 95% confidence interval 8 to 18 s; p < 0.0001) and neonatologists (mean difference 12 s, 95% confidence interval 8 to 16 s; p < 0.0001). The difference in timing of PPV initiation was similar between pediatric residents and neonatologists (mean difference - 1 s, 95% confidence interval - 7 to 6 s; p = 0.85).Conclusions: Performing immediate laryngoscopy with intubation and suctioning was associated with longer-but not clinically relevant-time of initiation of PPV compared with immediate PPV without intubation in a manikin model. While suggesting negligible delay in starting PPV, further studies in a clinical setting are warranted.Registration: clinicaltrial.gov NCT04076189. What is Known: • Management of the non-vigorous newborn delivered through meconium-stained amniotic fluid remains still controversial. • Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid is supposed to delay initiation of positive pressure ventilation, but the magnitude of such delay is unknown. What is New: • Performing immediate ventilation without intubation was associated with shorter-but not clinically relevant-time of initiation of ventilation compared to immediate laryngoscopy with intubation and suctioning in a manikin model. • Further studies in a clinical setting are warranted.

Clinical and Laboratory Features of 184 Italian Pediatric Patients Affected with Selective IgA Deficiency (SIgAD): a Longitudinal Single-Center Study.

PURPOSE: Selective IgA deficiency (SIgAD) is the most common humoral primary immunodeficiency. Long-term follow-up data in large cohort of pediatric patients are scarce. METHODS: We report on a single-center cohort of 184 pediatric patients affected with selective IgA deficiency and describe the characteristics at diagnosis and during follow-up. RESULTS: Respiratory infections were the most common clinical finding leading to the initial diagnosis (62%). Positive family history for antibody deficiencies (selective IgA deficiency, common variable immunodeficiency) led to SIgAD diagnosis in 16% of cases. During follow-up, while the incidence of respiratory infections was not particularly high, gastrointestinal symptoms were reported in 27% of patients. Allergic manifestations were found in 23% at diagnosis and an additional 16% of patients during follow-up, leading to a prevalence of atopy of 39% among SIgAD patients. Autoimmune manifestations, excluding celiac disease, were found in 9% of affected patients during follow-up. Celiac disease was found in a high prevalence (14%). Increase of serum IgA levels to partial deficiency (9%) and normal serum levels for age (4%) was observed during follow-up. A small percentage of patients (2%) progressed to common variable immunodeficiency (CVID). CONCLUSIONS: In conclusion, this is the first study to describe a large single-center pediatric cohort of patients affected with SIgAD, revealing that overall most patients do well with regard to infections. Many develop CD, at a rate much higher than the general population. A few normalize their IgA levels. A few progress to CVID. Thus, careful follow-up is suggested to diagnose and treat potential complications earlier for avoiding potential morbidities.

Meconium Aspiration Syndrome: A Narrative Review.

Meconium aspiration syndrome is a clinical condition characterized by respiratory failure occurring in neonates born through meconium-stained amniotic fluid. Worldwide, the incidence has declined in developed countries thanks to improved obstetric practices and perinatal care while challenges persist in developing countries. Despite the improved survival rate over the last decades, long-term morbidity among survivors remains a major concern. Since the 1960s, relevant changes have occurred in the perinatal and postnatal management of such patients but the most appropriate approach is still a matter of debate. This review offers an updated overview of the epidemiology, etiopathogenesis, diagnosis, management and prognosis of infants with meconium aspiration syndrome.

How patchy is patchy villous atrophy?: distribution pattern of histological lesions in the duodenum of children with celiac disease.

OBJECTIVES: In celiac disease (CD) the degree of histological damage in the duodenum may vary, but there is some controversy about the coexistence of villous atrophy and normal mucosa in different biopsy sites, i.e., patchy villous atrophy. We prospectively evaluated the degree, frequency, and distribution of histological lesions among different duodenal sites as well as within each duodenal biopsy. METHODS: Over the last 4 years, in each patient with suspected CD (positive anti-transglutaminase antibodies), four to five endoscopic biopsies were taken from the duodeno-jejunal flexure/distal duodenum (D3), intermediate duodenum (D2), proximal duodenum (D1), and duodenal bulb (B). Biopsies were subjected to hematoxylin/eosin staining and immunostaining with anti-CD3 monoclonal antibodies for intraepithelial lymphocyte (IEL) count. Duodenal lesions were classified according to Marsh-Oberhuber, and CD was diagnosed according to the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition criteria. RESULTS: Six hundred and eighty-six children did have CD. A degree of villous atrophy was found in 660/686 patients (96.2%), total villous atrophy was present in 550/686 (80.1%), and 320/686 (46.6%) had different lesions at different sites, but none of these patients had entirely normal biopsies. In all, 116 of 686 (16.9%) had variable lesions within the same biopsy, with grade 2+3A being the most frequent association (43%), followed by 2+3A+3B (27%) and 2+3A+3B+3C (22%). All these 116 patients also had histologically normal areas within the same biopsy, but anti-CD3 immunostaining showed that IELs were always increased in such areas. In all the cases, the severity of duodenal lesions significantly increased in an aborad manner (chi(2)=52.38 with alpha=0.01 and d.f.=12; P<0.0001). No correlation was found between type and distribution of histologic lesions and clinical presentation of CD. CONCLUSIONS: In newly diagnosed CD, some variability of histological lesions can be found, even within the same duodenal biopsy, in which areas of apparently normal mucosa with increased IEL number often exist. We also confirm our previous findings that duodenal lesions may vary among different biopsies; lesion severity has a proximal-to-distal gradient, but no patient has entirely normal duodenal biopsies. The awareness of such histological variability may help establish a correct diagnosis of CD.