Pediatric admissions to emergency departments of North-Western Italy during COVID-19 pandemic: A retrospective observational study.

BACKGROUND: COVID-19 pandemic caused huge decrease of pediatric admissions to Emergency Department (ED), arising concerns about possible delays in diagnosis and treatment of severe disorders. METHODS: Impact of COVID-19 on Pediatric Emergency Room (ICOPER) was a retrospective multicentre observational study including 23 Italian EDs.All the children <18 years admitted, between March 9th and May 3rd 2020 stratified by age, priority code, cause of admission and outcome have been included and compared to those admitted in the same period of 2019.Our objectives were to assess the characteristics of pediatric admissions to EDs since COVID-19 outbreak until the end of lockdown, and to describe the features of critical children. FINDINGS: 16,426 children were admitted in 2020, compared to 55,643 in 2019 (-70·48%). Higher reduction was reported in hospitals without Pediatric Intensive Care Unit (PICU) (-73·38%) than in those with PICU (-64·08%) (P<0·0001). Admissions with low priority decreased more than critical ones (-82·77% vs. 44·17% respectively; P<0·0001). Reduction of discharged patients was observed both in hospitals with (-66·50%) and without PICU (-74·65%) (P<0·0001). No difference in the duration of symptoms before admission was reported between 2019 and 2020, with the majority of children accessing within 24 h (55·08% vs. 57·28% respectively; P = 0·2344). INTERPRETATION: Admissions with low priority decreased significantly more than those with high priority; we suppose that the fear of being infected in hospital maybe overcame the concerns of caregivers. Compared to 2019, no significant referral delay by caregivers was reported. Our data suggest the need of adaptation of EDs and primary care services to different needs of children during COVID-9 pandemic.

Sleep-related risk and worrying behaviours: a retrospective review of a tertiary centre's experience.

This retrospective study aims at helping physicians select babies considered at risk for fatal events during sleep. It does so by describing the clinical features and outcome of worrying infants' behaviour during sleep, with the activation of an emergency medical service and/or emergency department, subsequently referred to the Centre for Paediatric Sleep Medicine and sudden infant death syndrome, Regina Margherita Children's Hospital, Turin, Italy. We analysed the medical records of infants < 12 months whose parents reported they had worrying behaviour during sleep in the period 1 January 2009- 31 December 2015. Regional guidelines suggest performing anamnesis and capillary blood gas analysis in case of apparent life-threatening events. There were 33 males, average age 55 ± 54.37 days. On arrival at the emergency medical service/emergency department 97 % infants were asymptomatic; 61 % patients had a capillary blood gas analysis as suggested by the regional guidelines. A clear acid-base disorder was observed in two infants, asymptomatic at medical evaluation, that had assumed an unsafe sleeping position. Two patients presented recurrence of the episode at 3 months.Conclusions: Most worrying infant behaviour during sleep can be related to paraphysiological phenomena; capillary blood gas analysis and anamnesis are pivotal to identify the cases at risk of fatal events.What is Known:• Events that happen during sleep often frighten the parents of newborns. This fear may be induced by the fact that Sudden Infant Death Syndrome typically occurs during sleep.• This tragic event is unpredictable by any clinical features or findings in instrumental examinations and cannot be prevented with an early resuscitation.What is New:• In our retrospective study, most worrying infant behaviour during sleep can be related to paraphysiological phenomena.• Capillary blood gas analysis and anamnesis collection were crucial to identify the only two life-threatening events.

Skin-to-skin contact and delivery room practices: a longitudinal survey conducted in Piedmont and the Aosta Valley.

BACKGROUND: Sudden unexpected postnatal collapse of presumably healthy neonates during early skin-to-skin contact is a rare, yet recognized occurrence, associated with a high risk of mortality and morbidity. A survey was conducted in 2012 in 30 delivery wards throughout Piedmont and the Aosta Valley to evaluate the environmental and logistical aspects that could be linked to SUPC. The survey was again conducted in 2016 in 28 delivery wards in Piedmont and the Aosta Valley in order to evaluate organizational improvements introduced after ministerial indications and recommendations by the Italian Society of Neonatology were published in 2014, in light of new findings regarding the phenomenon. METHODS: A questionnaire specifically asking about the organization of delivery wards, and surveillance or supervision during early skin-to-skin contact, was sent to all of the hospitals taking part in the survey in both 2012 and 2016. The collected data were elaborated anonymously and the statistical analysis was performed by using the two by two table. RESULTS: In 2012, 28 out of 30 delivery wards in Piedmont and Aosta, with a total of 31,074 newborns out of 35,435, were evaluated in all of the environmental and logistical aspects that might be cause for SUPC to occur. An identical survey was taken again in 2016; 26 out of 28 wards participated with a total of 27,484 newborns out of 30,339. In 2012, early skin-to-skin contact took place immediately in all the delivery rooms in 27 wards, and soon after in the post-partum room in one; in 11 out of 28 wards there was early skin-to-skin contact in the operating theater itself, following caesarean sections (11/26 in 2016). Routine newborn care was given after 3 h in 8 delivery wards (7/26 in 2016); after 2 h in 12 (7/26 in 2016); after 1 h in 2 (4/26 in 2016); after 30 min in 3 (2/26 in 2016); after 10 min in 1 (0/26 in 2016); after 1 or 2 min in 1 (0/26 in 2016) and at any time in one ward (6/26 in 2016). CONCLUSION: Periodic surveys of delivery wards are useful for the assessment of all the aspects and risk factors that need to be changed in order to implement safe early skin-to-skin contact.

Apparent Life-Threatening Events: Helping Infants Help Themselves.

OBJECTIVES: Apparent life-threatening event (ALTE) refers to a constellation of unexpected events suddenly occurring in infants that extremely alarm the observers. The objectives of this study were to evaluate 1) intervention of Emergency Service (ES) at home, 2) parental behavior before ES intervention, 3) patients' outcome at follow-up of a minimum of 6 months. METHODS: Retrospective study of infants younger than 12 months whose parents called ES and were evaluated for ALTE from 2005 to 2014. Tactile stimulation (TS) was defined as any maneuver performed by parents or ES staff aimed at rescuing patients without cardiopulmonary resuscitation attempts. Cardiopulmonary resuscitation was defined according to American Heart Association Guidelines 2010. RESULTS: One hundred eighty-eight patients were eligible. Emergency Service provided intervention for 178 infants (10 were assisted only by phone). All patients received TS by parents before ES arrival. Mean time for ES to reach patient location was 15 ± 10 minutes. On examination, 136 patients (76.5%) seemed normal and 42 symptomatic. One hundred sixty-three patients were brought to the emergency department where 23 patients were found symptomatic. One hundred six of 163 patients underwent capillary blood gas determination and, in 28 (26%) of 106, alterations were found. No infant had subsequent cardiopulmonary arrest or clinically evident adverse neurological outcome. Six were found to be epileptic. No infant died during the episode or during follow-up. CONCLUSIONS: Our findings suggest that ALTE is an alarming but self-limiting phenomenon that can be resolved either spontaneously or by simple TS in most cases. Emergency Service should solicit patients' physiological responses through TS first while considering a cardiopulmonary resuscitation maneuver.

Hypotonic-hyporesponsive episodes after administration of hexavalent DTP-based combination vaccine: A description of 12 cases.

Hypotonic-hyporesponsive (HHE) episodes are known and recognized phenomena, which typically occur within 48 hours of immunisation..Our aim is to describe 12 cases of HHE brought to the Center of Pediatric Sleep Medicine, with attention to the clinical features of the episode and their follow-up. Medical charts of infants visited between 2005-2015 were reviewed. Twelve infants showed a HHE using HHE using Brighton Collaboration Criteria. All infants received a Hexavalent diphtheria -tetanus -pertussis acellular component -hepatitis B-,inactivated poliovirus- Haemophilus influenzae type-b conjugate vaccine. Five out of 12 were brought to Emergency Department, where 2 were symptomatic (one was hyporeactive, the other had fever). No infant died during the episode, or the follow-up, nor developed neurological disease after subsequent vaccinations. HHE are confirmed as benign events, even after administration of hexavalent vaccination, devoid of negative neuropsychomotor outcome.

Apparent life-threatening events could be a wake-up call for sleep disordered breathing.

INTRODUCTION: Polysomnographic recordings of children with an apparent life-threatening event (ALTE) have often displayed signs of partial or complete obstruction during sleep. Various studies have focused on facial dysmorphia in infants with ALTE and tried to establish a correlation between ALTE and obstructive sleep apnoea. Our study evaluates the phenotypic characteristics and the presence of sleep disorders in pre-school children who had at least one ALTE in the first year of life. MATERIALS AND METHODS: We analyzed a group of pre-school children (mean age 5.21 ± 0.90 years) who were referred for an ALTE between 2008 and 2010. Children with no history of ALTEs were recruited as a control group. A detailed personal and family history was obtained for all the participants. Moreover, all the children underwent a general clinical examination and an ear, nose, and throat and orthodontic assessment. A clinical score was calculated according to the previously validated Sleep Clinical Record (SCR). RESULTS: In the ALTE group (n = 107), snoring (25.2% vs. 6.1%), apnoeas (19.6% vs. 4.3%), restless sleep (31.7% vs. 6.1%), and habitual mouth breathing (35.5% vs. 12.2%, P < 0.05) were significantly more common (P < 0.05) than in the control group (n = 115). The ALTE group also displayed a higher frequency of Angle class II (27.1% vs. 15.7%, P < 0.05), narrow palate (72.9% vs. 51.3%, P < 0.05), and Friedman palate position (grades III-IV) (31.7% vs. 16.6%, P < 0.05) than the control group. Moreover, 38/107 (35.5%) children in the ALTE group had a positive SCR score compared with 14/115 controls (12.2%) (P < 0.05). CONCLUSIONS: Pre-school age children with previous ALTE had a higher frequency of sleep disordered breathing and malocclusion phenotypes. The occurrence of ALTEs may be predictive of the development of sleep disordered breathing and highlight the importance of a long-term follow-up. Pediatr Pulmonol. 2016;51:1403-1408. © 2016 Wiley Periodicals, Inc.