1,721,053 research outputs found
Head trauma: clinical and diagnostic factors in pediatric emergency,Il trauma cranico: aspetti diagnostico-terapeutici nell'emergenza-urgenza pediatrica
No full textThe Authors describe the clinical spectrum of head trauma. The importance of history (the way the trauma occurred) and of the intrinsic dynamics of the lesions are emphasized, as is their role for the outcome. They delineate the major intervention the pediatrician should perform in emergency, and the diagnostic and therapeutical approach. In particular, recommendations are made about the best neuroradiological test which should be done
Vasopressin and terlipressin in neonates and children with refractory septic shock
No full textVasopressin and its analogue terlipressin are potent vasopressors which have been recently proposed in the treatment of catecholamine-resistant septic shock. We review the physiology, metabolism and pharmacology of vasopressin and terlipressin, as well as the available data on their efficacy and safety in neonates and children with septic shock. In adults, vasopressin deficiency can contribute to refractory shock states associated with sepsis. Differently, in children with septic shock vasopressin levels may be normal or even augmented. Nevertheless, low doses of vasopressin and terlipressin seem to have the potential to restore vasomotor tone in conditions refractory to catecholamines, improving organ perfusion with preservation of renal blood flow, while decreasing catecholamine requirements. Vasopressin and terlipressin produce vasoconstriction via stimulation of V1-receptors. In particular, terlipressin has a higher selectivity for V1-receptors and a longer half-life when compared to vasopressin, allowing for intermittent bolus doses. However, the pharmacology of vasopressin/terlipressin in newborns and children has not been sufficiently investigated and data on potential short and long-term adverse effects are still lacking. Further clinical, pharmacokinetic and pharmacodynamic studies are needed to better define the role of vasopressin and terlipressin in septic shock, as well as to prove their effectiveness and safety in infants and children
Unexpected death due to refractory metabolic acidosis and massive hemolysis in a young infant with Prader-Willi
Full text linkTo our knowledge, massive acute hemolysis has not yet reported among the catastrophic events related to the demise of patients with PWS. We believe that this phenomenon might have played a decisive role in the terminal course of our patient, even though the causative mechanism remains unclear. While further studies are needed in order to better clarify this issue, we suggest a close surveillance of these patients during acute diseases such as gastroenteritis and upper respiratory tract infections or when anticonvulsant treatment must be provide
Fathers’ experiences of nurses’ roles and care practices during their preterm infant's stay in the neonatal intensive care unit
No full textIntroduction: Neonatal intensive care unit (NICU) nurses play a crucial role in providing infant care, as well as in bridging the communication gap with parents. Aim: Explore fathers’ perceptions and interactions with nurses during their preterm infants’ stay in a NICU. Design: Qualitative study using ethnographic data collection techniques. Methods: Twenty fathers of preterm infants were purposively sampled in a level III NICU in Italy. Data collection comprised 120 h of participant observation, 68 informal conversations, and 20 semi-structured interviews. Data analysis was performed using reflexive thematic analysis. Results: Analysis revealed five primary themes: (i) communication and clarity about infants’ health condition and progress, (ii) inclusiveness and guidance from nurses, (iii) fathers’ satisfaction with nurses’ support for mother, (iv) nurses’ personal attention to the babies, and (v) nurses’ varied personalities. Conclusion: Nurses are crucial in facilitating father-infant bonding in the NICU. Although the content of nurse communication is critical for fathers, the delivery style becomes especially relevant during their infant's hospitalization. Discrepancies in messages and guidance can negatively impact fatherly confidence and their ability to care for their preterm infants and support partners. Thus, training that emphasizes the recognition of the unique ways that fathers exhibit distress is crucial. Relevance to Clinical Practice: Nurses play a critical role in shaping the fathers’ experiences in NICU. Emphasizing clear communication and individualized care is vital. To strengthen father support in NICU settings, recommended approaches include regular training, holistic care, fostering inclusivity, emotional support, and improving bonding opportunities. Reporting Method: Adherence to the COREQ guidelines
Acute onset of bilateral visual loss during sildenafil therapy in a young infant with congenital heart disease
Full text linkWe report a case of posterior non-arteritic ischaemic optic neuropathy (NAION) causing bilateral visual loss in a 7-month-old female infant, after a therapeutic course with sildenafil, a phosphodiesterase type 5 inhibitors (PDE5i). The patient was affected by a complex cyanotic congenital heart defect and had undergone cavopulmonary anastomosis (Glenn operation) 3 months ago. After 2 months of recurring chylothorax, a course of oral sildenafil was administered, with the hypothesis that pulmonary vascular resistances were increased. Approximately 4 weeks later the acute onset of visual worsening and poor pupillary light reflex prompted the diagnosis of posterior NAION. Despite a rapid cessation of PDE5i and systemic treatment with corticosteroids, no visual recovery was noticed at 2-year follow-up. NAION has been associated with PDE5i therapy in adults, but to the best of our knowledge it is almost unheard of in children. We suggest close monitoring of visual function in children undergoing treatment with sildenafil
Effect of antibiotic therapy on nasal nitric oxide concentration in children with acute sinusitis.
No full textRecently, it has been demonstrated that paranasal sinuses are an important site of nitric oxide (NO) production in the upper airways. The aim of this study was to evaluate the NO nasal concentration in children with acute maxillary sinusitis before and after treatment with antibiotic therapy. We performed NO nasal measurements in 16 children 4 to 13 yr of age with acute maxillary sinusitis and compared values with 16 age- and sex-matched healthy control subjects. The diagnosis of acute sinusitis was done by clinical signs and symptoms in addition to radiographic examination. NO nasal concentrations were measured by a chemiluminescence analyzer. Nasal NO steady state during oral breathing was recorded. The mean +/- SEM NO nasal concentration in children with sinusitis was 70 +/- 8.7 parts per billion (ppb) and increased significantly to 220 +/- 15 ppb (p < 0.001) after antibiotic therapy (amoxicillin/clavulanate). NO values after recovery from sinusitis were similar to those of healthy control subjects (245 +/- 15 ppb, p = NS). NO nasal measurements were also performed before and after antibiotic treatment in nine children 4 to 12 yr of age with symptoms of upper respiratory tract infection but no symptoms of sinusitis. In these children NO nasal levels were 249 +/- 32 ppb and did not change (p = NS) after antibiotic therapy. We conclude that during acute maxillary sinusitis the concentration of nasal NO is largely decreased, probably because of an impaired flow of NO from the paranasal sinuses, and that NO returns to normal levels after antibiotic therapy
Prime forme di co-regolazione diadica con neonati pretermine in Terapia Intensiva Neonatale
No full textIntroduzione I neonati sono biologicamente equipaggiati per interagire con gli altri esseri umani. La nascita prematura pone però a rischio lo sviluppo di interazioni coordinate (Feldman, 2012; Provenzi et al., 2017) ̶cruciali per lo sviluppo delle capacità di auto- e co-regolazione ̶ poiché l’iniziale separazione forzata, l’irritabilità e la limitata responsività sociale del neonato dovute alla sua immaturità neurologica incrementano le difficoltà dei genitori già stressati a sintonizzarsi con il bambino. I risultati di ricerca si concentrano sulle interazioni dai 3 mesi di età; pochi studi hanno analizzato i comportamenti materni in interazione con il neonato in Terapia Intensiva Neonatale (TIN), senza però esplorare eventuali dinamiche di co-regolazione. Questo studio si propone di (a) esaminare se e a quali condizioni i comportamenti comunicativi del genitore e quelli del neonato pretermine in TIN sono regolati reciprocamente; (b) confrontare i comportamenti comunicativi materni e paterni e le connesse dinamiche di interazione. Metodo Venti diadi madre-neonato pretermine (< 34 sett.) in condizioni stabilizzate (e.pm. M=35.3 sett.) in TIN sono state videoregistrate durante la comunicazione spontanea faccia-a-faccia per almeno 3 min con il neonato in incubatrice in stato di veglia tranquilla. Dopo almeno 15 min in assenza di stimoli sociali, i neonati sono stati videoregistrati con i loro padri nelle medesime condizioni. I comportamenti dei genitori e dei neonati sono stati codificati microanaliticamente nelle categorie della Parent Engagement Scale e dell’Infant Engagement Scale (Lavelli & Beebe, 2016), ordinate per livello di qualità interattiva. Risultati L’analisi sequenziale condotta tra i comportamenti del genitore chinato sull’incubatrice scoperta e quelli del neonato prematuro rivela significative probabilità transizionali tra i comportamenti dei partner nei due versi (range 24-83, p<.01), indicative di prime forme di regolazione reciproca. Sia durante l’interazione madre-neonato che padre-neonato la presenza di Parental Affiliative Behavior al livello ottimale (co-occorrenza di Gaze On, Positive Affect, Affectionate Touch e Aff.Talk) richiama lo sguardo del neonato (infantGaze On) e questo, a sua volta, contribuisce a mantenere Affiliative Behavior. L’attivazione dello sguardo del neonato risulta associata bidirezionalmente anche ad Affectionate Touch materno e Affectionate Talk paterno quando co-occorrono con Gaze On+Positive Affect. Le durate di comportamenti capaci di attivare risposte nel neonato prematuro risultano però signif. maggiori per le madri, t(19)=2.43, p=.025, mentre Affectionate Touch+Neutral Affect, associato signif. a Gaze Off e occhi chiusi del neonato, signif. maggiore per i padri, t(19)=-2.56, p=.019. Conclusioni I risultati indicano che il neonato prematuro in incubatrice risponde con orientamento dello sguardo alla comunicazione affettuosa del genitore, e suggeriscono l’importanza di favorire tale comunicazione
Comment on "A new device for administration of continuous positive airway pressure in preterm infants" by Trevisanuto et al. [6]
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