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A 16-years-old girl, with type 1 diabetes diagnosed elsewhere in 2000, was brought to our Departm... more A 16-years-old girl, with type 1 diabetes diagnosed elsewhere in 2000, was brought to our Department for a first routine visit in 2006, during which two yellow-brown, atrophic plaques surrounded by raised, violaceus rims on the right side of the lower abdomen (0.79 × 0.2 in and 1.38×0.79 cm, resp.) (Figure 1) were observed. Several other plaques had been observed on both legs (Figure 2). No other significant finding had been seen. A careful history revealed that she was on bad terms with her diabetes. Since diagnosis she had a multiple daily injections (MDIs) scheme for her insulin therapy (mean insulin requirement: 0.97 U/kg/day). Due to poor glycemic control she was switched to insulin pump therapy in 2006. Despite a slight improvement in glycemic values and reduction in insulin requirement (0.70 U/kg/day), her glycated hemoglobin (HbA1c) remained high (mean± SD: 12.9± 1.1), without any improvement of the skin lesions. In 2008 she returned to MDI, and her last HbA1c (December 2010...

Few epidemiological data are available since the introduction of 13-valent pneumococcal vaccine (... more Few epidemiological data are available since the introduction of 13-valent pneumococcal vaccine (PCV13) in 2010. We conducted a cross-sectional study to estimate the prevalence of Streptococcus pneumoniae (SP) nasopharyngeal carriage in healthy Italian infants and young children and to evaluate the impact of PCV13 on pneumococcal colonization. In the trimester September-December 2011 nasopharyngeal swabs were collected from healthy children aged 3-59 months presenting for routine well careat 16 primary care pediatricians in Milan. SP carriage isolates were serotyped and tested for antimicrobial resistance using EUCAST breakpoints. Among 1250 enrolled children, 618 had received at least 1 dose of PCV13, 292 at least 1 dose of PCV7, 94 a combination of the two vaccines and 246 were not vaccinated. The prevalence of SP carriage was 27% (95% confidence interval [CI] 25-30). At multivariable analysis, age≥25 months (prevalence ratio [PR]=0.74) and use of antibiotics in the previous 3 mon...

Acta Paediatrica, 2020

Post‐haemorrhagic ventricular dilatation (PHVD) still represents an important cause of brain inju... more Post‐haemorrhagic ventricular dilatation (PHVD) still represents an important cause of brain injury in premature infants. Intervention for PHVD is recommended once Ventricular Index (VI) crosses the 97th percentile + 4 mm line according to Levene.

Archives of Disease in Childhood - Fetal and Neonatal Edition, 2018

AimTo determine whether IntelliVue (ECG plus Masimo pulse oximeter (PO)) measures heart rate (HR)... more AimTo determine whether IntelliVue (ECG plus Masimo pulse oximeter (PO)) measures heart rate (HR) in low-risk newborns more quickly than Nellcor PO (PO alone).MethodsUnmasked parallel group randomised (1:1) study.ResultsWe studied 100 infants, 47 randomised to IntelliVue, 53 to Nellcor. Time to first HR was shorter with IntelliVue ECG than Nellcor (median (IQR) 24 (19, 39) vs 48 (36, 69) s, p<0.001). There was no difference in time to display both HR and SpO2 (52 (47, 76) vs 48 (36, 69) s, p=0.507). IntelliVue PO displayed initial bradycardia more often than the Nellcor (55% vs 6%). Infants monitored with IntelliVue were handled more frequently and for longer.ConclusionsIntelliVue ECG displayed HR more quickly than Nellcor PO. IntelliVue PO often displayed initial bradycardia. Infants monitored with IntelliVue were handled more often. Study of ECG in high-risk infants is warranted.

Archives of disease in childhood. Fetal and neonatal edition, Jan 25, 2018

Clinical assessment of an infant's heart rate (HR) in the delivery room (DR) has been reporte... more Clinical assessment of an infant's heart rate (HR) in the delivery room (DR) has been reported to be inaccurate. We compared auscultation of the HR using a stethoscope with electrocardiography (ECG) and pulse oximetry (PO) for determining the HR in 92 low-risk newborn infants in the DR. Caregivers auscultated the HR while masked to the HR on the monitor. Auscultation underestimated ECG HR (mean difference (95% CI) by -9 (-15 to -2) beats per minute (bpm)) and PO HR (mean difference (95% CI) by -5 (-12 to 2) bpm). The median (IQR) time to HR by auscultation was 14 (10-18) s. As HR was determined quickly and with reasonable accuracy by auscultation in low-risk newborns, study in high-risk infants is warranted.

Journal of paediatrics and child health, Jan 30, 2018

Chylothorax is a rare but life-threatening condition in newborns. Octreotide, a somatostatin anal... more Chylothorax is a rare but life-threatening condition in newborns. Octreotide, a somatostatin analogue, is widely used as a therapeutic option in neonates with congenital and acquired chylothorax, but its therapeutic role has not been clarified yet. We performed a systematic review to assess the efficacy and safety of octreotide in the treatment of congenital and acquired chylothorax in newborns. Comprehensive research, updated till 31 October 2017, was performed by searching in PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) databases using the MeSH terms 'octreotide' and 'chylothorax'. Both term and preterm newborns with congenital or acquired chylothorax treated with octreotide within the 30th day of life were included. Octreotide treatment was considered effective if a progressive reduction/ceasing in drained chylous effusion occurred. A total of 39 articles were included. Octreotide was effective in 47% of patients, with a...

Archives of Disease in Childhood - Fetal and Neonatal Edition, 2017

Studies report that ECG measures newborns’ heart rate (HR) more quickly1 ,2 and accurately3 than ... more Studies report that ECG measures newborns’ heart rate (HR) more quickly1 ,2 and accurately3 than pulse oximetry (PO) in the delivery room (DR). In these studies, separate ECG and PO monitors were applied. The Philips IntelliVue X2 monitor (Philips, Eindhoven, Netherlands) incorporates ECG and Masimo PO technology (Masimo, Irvine, California, USA) and has a portable unit that may be used in the DR. This monitor displays HR faster when the ECG leads are connected to the machine before application to the infant.4 We wished to determine whether the order of application of ECG and PO affected how quickly …

Archives of disease in childhood. Fetal and neonatal edition, 2017

The 2015 International Liaison Committee on Resuscitation1 treatment recommendations suggest that... more The 2015 International Liaison Committee on Resuscitation1 treatment recommendations suggest that ECG can be used to provide rapid and accurate estimation of the newly born infant’s heart rate (HR). Studies report that it provides HR quicker than pulse oximetry (PO) in the delivery room (DR).2 3 In addition, a DR study of 53 infants reported that HR measured with PO at birth was significantly lower than that measured with ECG with clinically important differences in the first minutes.4 Pulse oximeters display the HR more quickly when the sensor is applied to the infant before it is connected to the monitor.5 We wished to determine …

New England Journal of Medicine, 2012

n engl j med 366;26 nejm.org june 28, 2012 2502 A 37-year-old obese woman with poorly controlled ... more n engl j med 366;26 nejm.org june 28, 2012 2502 A 37-year-old obese woman with poorly controlled type 1 diabetes mellitus presented with pain in the right lower leg, which had a plaque measuring 18 by 8 cm, with central atrophy and ulcerations. The plaque had existed for more than 17 years but had become painful for at least the 4 preceding weeks, when the lesions had ulcerated. A biopsy was performed, and examination of the specimen confirmed a diagnosis of ulcerative necrobiosis lipoidica diabeticorum, with aggregates of lymphoid cells and palisading necrobiotic granuloma in the dermis. Necrobiosis lipoidica diabeticorum is a chronic granulomatous dermatitis of unknown cause that is most often associated with diabetes mellitus. However, in about 25% of patients with this condition, lesions develop before the onset of diabetes. The lesions appear as yellow-brown, telangiectatic plaques with central atrophy and raised violaceous borders. They occur most frequently on the shins or the dorsa of the feet. Ulcers, which exist in about 30% of lesions, are often induced by trauma. In rare cases squamous-cell carcinomas develop, typically in older, ulcerated lesions. Moist-wound therapy and débridement relieved this patient’s pain, but she was soon lost to follow-up.

Diabetes Research and Clinical Practice, 2014

Frontiers in Pediatrics, 2018