Children's Hospital Management in the COVID-19 Era: The Reorganization of a Tertiary Care Pediatric Emergency Department in Northern Italy.

In the Veneto Region, an exponential spread of patients affected by 2019 novel Coronavirus disease (COVID-19) has been observed after February 21st. Since then, we have been evaluating children suspected or confirmed for SARS-CoV-2 infection. A protocol for pediatric hospital reorganization and children management has been developed, since the beginning of the epidemic. A pre-triage area has been created at the immediate entrance of the pediatric emergency room, for all uncritical pediatric patients. According to the epidemiologic and clinical risk factors, all children/adolescents have been addressing to one of the four different pathways created. The strict application of this protocol has been leading to quickly identification, isolation, and management of all positive children, preventing SARS-CoV-2 intrahospital spread.

COVID-19 Pandemic: Perspective of an Italian Tertiary Care Pediatric Center.

Since February 2020, Italy has been faced with the dramatic spread of novel Coronavirus SARS-CoV-2. This impetuous pandemic infection forced many hospitals to reorganize their healthcare systems. Predicting a rapid spread of the SARS-CoV-2 virus within our region, the Department for Women's and Children's Health promptly decided (i) to revise the distribution of the clinical areas in order to create both designated COVID-19 and COVID-19-free areas with their own access, (ii) to reinforce infection prevention control (IPC) measures for all healthcare workers and administrative staff and (iii) to adopt the new "double-gate approach": a phone call pre-triage and nasopharyngeal swab for SARS-CoV-2 detection before the admission of all patients and caregivers. Between 21 February 2020 till 04 May 2020, only seven physicians, two nurses and two of the administrative staff resulted positive, all during the first week of March. No other cases of intra-department infection were documented among the healthcare workers since all the preventive procedures described above were implemented. It is predicted that similar situations can happen again in the future, and thus, it is necessary to be more prepared to deal with them than we were at the beginning of this COVID-19 pandemic.

Special Immunization Service: A 14-year experience in Italy.

BACKGROUND: Concerns regarding vaccine safety are increasing along with lack of compliance to vaccination schedules. This study aimed to assess vaccination-related risks and the impact of a Special Immunization Service (SIS) at the Pediatric Emergency Department (PED) of Padua on vaccination compliance among participants. MATERIALS AND METHODS: This retrospective cohort study included all children attending the SIS from January 1st 2002 to December 31st 2015. The Service is divided into a clinic (SIS-C) where all referred children undergo a pre-vaccination visit and an area within the Pediatric Emergency Department (SIS-PED) where children are vaccinated if indicated. During each SIS-C visit, age, gender, admission criteria and scheduled vaccinations were recorded, with any vaccine-related adverse events captured during SIS-PED visits. Follow-up was conducted to evaluate vaccination plan completion. RESULTS: 359 children received 560 vaccine administrations (41.3% MMR/MMRV, 17.5% hexavalent) at the SIS during the 14 year study. Admission criteria were adverse events after previous vaccination (immediate, IgE/not IgE mediated, and late) in 27.2% of cases, non-anaphylactic allergies (mostly egg allergy) in 42.7% and anaphylaxis in 10.3%. After vaccination, 15/560 (2.7%) mild adverse events were observed. 96.3% of children vaccinated at least once at the SIS-PED and available for follow-up completed their vaccination plan, in contrast to 55.5% of children referred to the SIS-C who were not vaccinated in SIS-PED. CONCLUSIONS: For children referred to SIS-C and available for follow-up, vaccination in SIS-PED was associated with more frequent completion of vaccination plans, indicating a benefit of the service to vaccine coverage. The low number and mild severity of adverse events reported after vaccination of high-risk children in SIS-PED attest to the safety of the service.

Reflex anal dilatation: An observational study on non-abused children.

OBJECTIVES: Reflex anal dilatation (RAD) is considered as a possible sign of anal abuse,however studies evaluating its prevalence in non-abused children are limited. The aim of this study was to evaluate the prevalence of RAD in a convenience sample of children with no suspicion of abuse admitted to a Pediatric Emergency Department (PED). METHODS: Prospective observational study including children admitted to the PED of Padova, Italy, between January and June 2011. Patients with no suspicion of abuse and for whom ano-genital examination was part of their medical evaluation were included. Children were excluded if in critical clinical conditions or if any suspicion of abuse arose during medical evaluation. Presence/absence of RAD and of factors favoring its appearance were recorded for each patient. RESULTS: Two-hundred and thirty children (median age of 12 months, interquartile range 5-35 months) were finally included. A positive RAD was reported in 14 (6.1%, CI 95% 3.4-10). Only 3 patients (1.3%, CI 95% 0.3-3.7) showed a positive RAD in the absence of any predisposing factor. CONCLUSIONS: RAD is an infrequent sign in non-abused children and it is particularly rare in the absence of any predisposing factor. Case-control studies are necessary to better clarify its diagnostic relevance.

Bacteremia in feverish children presenting to the emergency department: a retrospective study and literature review.

AIM: To evaluate the incidence of bacteremia, and the isolated pathogens, in well-appearing children with fever without source (FWS) presenting to the pediatric emergency department (PED), after pneumococcal conjucate vaccine - 7 valent (PCV-7) widespread introduction in the Veneto region of north-eastern Italy, and to review the main literature contributions on the subject. METHODS: Blood cultures performed at the PED of Padova from 1 June 2006 to 31 January 2009 in febrile children aged 1-36 months were retrospectively retrieved. Medical records of previously healthy well-appearing children with FWS were identified and reviewed. RESULTS: The study finally included 392 patients. Bacteremia rate was 0.34% (95% CI 0-1) in the age group 3-36 months and 2% (95% CI 0-4.7) in infants 1-3 months. No Streptococcus pneumoniae was isolated. The literature review identified 10 relevant studies carried out in the USA and Spain showing an overall bacteremia rate <1% for feverish children aged 3-36 months, with values <0.5% in settings with high PCV-7 coverage. CONCLUSION: Overall bacteremia rate is currently <0.5% in well-appearing children aged 3-36 months with FWS attending the PED in areas with PCV-7 widespread vaccination and is sufficiently low to preclude laboratory testing in favour of close follow-up. Further research is needed to evaluate a more conservative approach in infants 2-3 months of age.

A delayed methadone encephalopathy: clinical and neuroradiological findings.

Several studies on opiates demonstrated that selected brain areas as cerebellum and limbic system have the greatest density of opioid receptors. Recently, few cases of severe cerebellitis following methadone poisoning have been reported in children. We present the case of a 30-month-old girl who developed a delayed encephalopathy after methadone intoxication. She was admitted to our emergency department in coma, and after naloxone infusion, she completely recovered. Five days after intoxication, she developed psychomotor agitation, slurred speech, abnormal movements, and ataxia despite a negative neuroimaging finding. A repeat magnetic resonance imaging (MRI) performed 19 days after the intoxication for persistent symptoms showed signal abnormalities in the temporomesial regions, basal ganglia, and substantia nigra. To our knowledge, this is the first report of these delayed MRI findings associated with synthetic opioid intoxication.