• Anxiety and fear caused by medical procedures exacerbate children's pain and may interfere with the procedure. • To reduce anxiety, fear, and pain and to facilitate patient's evaluation, different non-pharmacological approaches have been proposed and positive effects of laughter and humor have been reported. What is New: • The presence of clowns in the waiting room and in the ED during medical evaluation and painful procedures helps to reduce children's anxiety.

This study highlighted that somatic pain was a significant contributor to paediatric emergency room visits and should be suspected and diagnosed in children reporting pain.

Hepatic veno-occlusive disease (VOD) is a frequent and severe complication of hematopoietic stem cell transplantation (HSCT) affecting 9.6-17.3 % of cases. 200 HSCT, performed between January 1995 and March 2013 in our Paediatric HSCT Centre in Trieste, were retrospectively analysed to evaluate the frequency of VOD and to identify the associated risk factors. The frequency of VOD according to the Seattle criteria was 17 %, within the range reported in literature. The mortality rate was 37.5 % (75 out of 200 transplantations) in the general population and 73.5 % (25 out of 34) in VOD patients (p < 0.05). Veno-occlusive disease significantly decreased from 38 % (1995-2000) to 8 % (2007-2013) p < 0.05. Univariate and multivariate analyses identified sepsis and pre-transplant ferritin levels above 1000 ng/ml as two significant risk factors for VOD, while the use of tacrolimus appeared to be associated with a lower VOD risk. Veno-occlusive disease still remains an important cause of transplant-related mortality even if it appears to have decreased over the last few years.

BackgroundBronchiolitis is the leading acute respiratory tract infection in infants during the winter season. Since the beginning of the SARS-CoV-2 pandemic, a reduction in the number of bronchiolitis diagnoses has been registered.ObjectiveThe present study aimed to describe the incidence and clinical features of bronchiolitis during the 2020–2021 winter season in a large cohort of children in Europe and Israel, and to clarify the role of SARS-CoV-2.Setting, patients, interventionsWe conducted a multicentre observational cross-sectional study in 23 paediatric emergency departments in Europe and Israel. Clinical and demographic data about all the cases of infants diagnosed with bronchiolitis from 1 October 2020 to 30 April 2021 were collected. For each enrolled patient, diagnostic tests, treatments and outcomes were reported.Main outcome measuresThe main outcome was the prevalence of SARS-CoV-2-positive bronchiolitis.ResultsThree hundred and fourteen infants received a diagnosis of bronchiolitis during the study period. Among 535 infants who tested positive for SARS-CoV-2, 16 (3%) had bronchiolitis. Median age, male sex predominance, weight, history of prematurity and presence of comorbidities did not differ between the SARS-CoV-2-positive and SARS-CoV-2-negative groups. Rhinovirus was the most common involved pathogen, while respiratory syncytial virus (RSV) was detected in one case. SARS-CoV-2 bronchiolitis had a mild clinical course, with one patient receiving oxygen supplementation and none requiring paediatric or neonatal intensive care unit admission.ConclusionsDuring the SARS-CoV-2 pandemic, a marked decrease in the number of bronchiolitis diagnoses and the disappearance of the RSV winter epidemic were observed. SARS-CoV-2-related bronchiolitis was rare and mostly displayed a mild clinical course.

In this study, EMLA use did not interfere with the success of venipuncture or venous cannulation in children.

Congenital hyperinsulinism (CHI) due to diffuse involvement of the pancreas is a challenging and severe illness in children. Its treatment is based on chronic therapy with diazoxide and/or octreotide, followed by partial pancreatectomy, which is often not resolutive. Sirolimus, a mammalian target of rapamycin inhibitor, was reported to be effective in treating CHI in infants. We report here the case of an 8-year-old boy affected by a severe form of CHI due to a biallelic heterozygous ABCC8 mutation who responded to sirolimus with a dramatic improvement in his glucose blood level regulation and quality of life, with no serious adverse events after 6 months of follow-up. To the best of our knowledge, this is the first report of a successful intervention in an older child. It provides a promising basis for further studies comparing sirolimus with other treatments, particularly in older children.Congenital hyperinsulinism (CHI) is a condition characterized by severe hypoglycemia related to inappropriate insulin secretion by pancreatic b cells. Its typical presentation is the presence of seizures in infants, and it is associated with the risk of brain damage. 1 The most common causes of CHI are mutations in the ABCC8 and KCNJ11 genes, which encode the sulfonylurea receptor (SUR1) and the inwardly rectifying potassium subunit (Kir6.2) of the pancreatic adenosine triphosphate-sensitive potassium channel (KATP). 2 CHI can manifest as either focal or diffuse: 18 F-Ldihydroxyphenylalanine positron emission tomography allows for differentiation between the 2 to choose the correct treatment strategy. 3 The management of diffuse, severe CHI is challenging: diazoxide (administered in doses of 10-15 mg/kg per day) is the drug of choice, 4 followed by octreotide; when medical therapy is ineffective, subtotal pancreatectomy should be considered to ensure normoglycemia, even if there is a high risk of postoperative diabetes mellitus or persistent hyperinsulinemic hypoglycemia. 5 The successful use of the mammalian target of rapamycin (mTOR) inhibitor sirolimus has been recently reported to be effective and safe for the severe, diffuse form of CHI. 6 We report the case of an 8-year-old white boy with severe diffuse CHI due to a biallelic heterozygous ABCC8 gene mutation who was successfully treated with sirolimus. CASE REPORTWe present the case of an 8-year-old white boy affected by CHI that was diagnosed in the first days of life due to severe and persistent hypoglycemia (35 mg/dL; 1.94 mmol/L) and high insulin blood levels (25 mU/mL; 166.7 pmol/L). The patient was born at 36 weeks' gestational age, after a pregnancy complicated by insulinindependent maternal diabetes, and

Riassuntole procedure di venipuntura ed incannulamento venoso sono la causa più comune di dolore e distress nel bambino. ridurre il dolore e l'ansia ad esse correlati potrebbe essere importante per prevenire le reazioni di distress in corso di ulteriori procedure, soprattutto per quei bambini con patologia cronica che necessitano di controlli o ricoveri multipli. l'obiettivo di questo trial randomizzato controllato, condotto in aperto, è stato quello di valutare nel bambino l'efficacia dell'aggiunta di una strategia di distrazione attiva (videogame) sul dolore procedurale da venipuntura.Metodi: Sono stati reclutati 109 bambini di età compresa tra i 4 e i 10 anni; di questi 97 sono stati randomizzati e suddivisi in due gruppi: un gruppo di controllo (CC) che ha ricevuto solo le cure convenzionali, ovvero la premedicazione con eMlA, e un gruppo sperimentale (Ad) in cui alle cure convenzionali è stata aggiunta la distrazione attiva con videogame. gli outcomes valutati sono stati il dolore riferito dal bambino, per mezzo della scala di autovalutazione FPS-r; la reazione comportamentale al dolore valutata da un osservatore secondo la scala FlACC; il numero di tentativi necessari per il successo delle procedure di venipuntura o incannulamento venoso. Risultati: in entrambi i gruppi la mediana dei punteggi FPS-r è stata 0, con un dolore significativo (FPS-r>4) riportato dal 9% dei soggetti. la mediana per quel che riguarda la scala FlACC è stata pari a 1 in entrambi i gruppi, mentre la percentuale di bambini con dolore grave (FlACC>4) è stata del 18% nel gruppo di controllo e del 9% in quello sperimentale; tale differenza non è statisticamente significativa (p=0.2). la mediana dei tentativi necessari è stata pari a 1 in entrambi i gruppi, con un range interquartile compreso tra 1 e 2. la distrazione attiva è stata applicata con facilità ed accettata molto bene sia dai bambini sia dagli operatori.Conclusioni: la distrazione attiva non migliora l'analgesia già fornita con eMlA per quel che riguarda le procedure di venipuntura ed incannulamento venoso, ciò nonostante è risultata essere facilmente applicabile e apprezzata dai bambini. Potrebbe essere utile indagare questa tecnica di distrazione in corso di altre procedure dolorose. AbstractBackground: needle-related procedures (venipuncture, intravenous cannulation) are the most common source of pain and distress for children. reducing needle related pain and anxiety could be important in order to prevent further distress, especially for children needing multiple hospital admissions. the aim of the present open randomized controlled trial was to investigate the efficacy of adding an active distraction strategy (videogame) to eMlA premedication in needle-related pain in children. Methods: one-hundred and nine children (4 -10 years of age) were prospectively recruited to enter in the study. ninety-seven were randomized in two groups: CC group (conventional care: eMlA only) as control group and Ad group (active distraction: eMlA plus videogame) as intervention group. outcome ...

Although both DT and GT had good specificity and positive predictive value compared with MT, GT had higher sensitivity and a lower rate of false-negative rates. Galinstan thermometer is more accurate in the measurement of body temperature compared with DT or MT.