Results: A total of 2109 neonates were enrolled; the median age was 6 days and 55.7% were males. More than half the newborns (67.5%) visited the ED out of hours, and 99% were nonreferral. The frequency of multiparity and cesarean delivery were 48.9% and 57.4%, respectively. The most common complaints were jaundice (66.3%), irritability (9.3%), vomiting (3.4%), and fever (2.6%). While the hospitalization rate was 13%, 12.8% had a serious illness (sepsis, pneumonia, bronchiolitis, etc.). Serious diseases and hospitalization rates were higher among neonates with low birth weight and prematurity (P < .005, P < .001). Mothers who were primiparous and had their pregnancy at a younger age (<21 years) used EDs frequently for nonserious conditions (P < .05, P < .05, respectively). Early postpartum discharge, admission out of hours, age ≤ 7 days, residence in proximity to the hospital, and primiparity were significantly associated with readmission to the ED within 24 hours (P = .001, P < .001, P < .001, P = .014 and P < .001, respectively).
Italy is one of the few countries in the world where pediatric neuropsychiatry is still a united discipline not following the separation that has been underway for several years between adulthood neurology and psychiatry. However, in practice, many pediatric neuropsychiatrists here operate as if this separation was present, dealing with either neurologic or psychiatric pathologies of the developmental age. Indeed, due to the increasing hyperspecialization of skills, there are some pediatric neuropsychiatrists, in the field of neurology, who deal almost only with epilepsy or neuromuscular diseases, while there are others, in the field of psychiatry, who deal almost only with autism spectrum disorder (ASD). At least partially, this trend towards the hyperspecialization of skills is inevitable due to the recent great progress of neurosciences, but at the same time, this situation entails serious risks for adequate patient care. Each individual, particularly during development, should be considered as a single entity both in physiologic and pathologic situations. A clear distinction between normal neurologic and psychic development is very difficult and probably pointless, especially in the earliest stages of life. This distinction becomes almost impossible when, for some reason, the development of the individual shows domain-specific or global deficits. In this regard, there would be innumerable examples of pathologic conditions whose clinical picture at onset may appear misleading and requires a global neuropsychiatric approach; here we will mention only a few. The first example: a child aged around 2 years showing language delay, potentially the prelude to a specific language disorder, who unfortunately in the following months begins to present a series of signs such as epileptic seizures, ataxia, as well as cognitive, motor, and visual deterioration, leading then, based on the results of instrumental tests, to a diagnosis of neuronal ceroid lipofuscinosis type 2 disease. It is known that the first sign of this disease can be language delay (1). The second example: a boy aged 15 months presenting a mild motor developmental delay, but who after a few months starts to show the classic signs of ASD. A consistent series of data shows that, in ASD, motor type signs, including a delay in the gross motor and fine motor acquisitions, may occur even before the impairment of social communication skills (2, 3). The third example: a girl aged 18 months showing an apparently non-specific global developmental delay, whose clinical picture subsequently becomes more complicated following the loss of acquired skills and the appearance of symptoms including handwashing stereotypies, breathing abnormalities during wakefulness (hyperventilation alternating with apnea), and others, leading to a diagnosis of atypical Rett syndrome, whose onset is often difficult to identify (4, 5). These examples highlight that an overall picture of the developing individual, through a global approach combining both the neurologic and psychiatric perspective, facilitates an adequate diagnostic framework and therefore a correct management. The fact that pediatric neuropsychiatry remains a united discipline is not a legacy of the past, but reflects a modern way of dealing with the neuropsychiatric disorders of the developing individual.
Congenital factor VII (FVII) deficiency is a rare bleeding disorder inherited autosomal recessively (1, 2). It is the most common congenital rare factor deficiency in the world. The clinical picture is variable; it may be asymptomatic or may lead to critical bleeding (3). There is a weak correlation between FVII activity and clinical findings (1, 4). Mucocutaneous bleeding is observed predominantly. Bleeding such as hematoma and hemarthrosis occur rarely compared to patients with haemophilia (1, 3, 4). The clinical picture and follow-up of patients who present with hemarthrosis is similiar to patients with haemophilia. Development of a target joint and subsequent chronic synovitis and arthropathy may be observed. Use of radioisotope synovectomy (RS), which is known to have successful outcomes in patients with haemophilia with secondary prophylaxis and surgical interventions, is limited in patients with FVII deficiency. Here, we share our experience of radioisotope synovectomy in the ankle joint in a patient with congenital FVII deficiency who developed a target joint and chronic synovitis.
Coronavirus disease-2019 (COVID-19) has affected nearly 2 million people and caused up to 100,000 people death worldwide until today. This severe disease has seen less in children than adults. This may be due to the fact that cytokine storm in children is milder, viral load exposure is less than in adults, and angiotensin converting enzyme receptor levels are different from adults. It should be kept in mind that COVID-19 may cause severe illness in infants under 1 year old and in children with chronic diseases such as chronic kidney disease undergoing dialysis, sickle cell disease, chronic liver disease, endocrine disorders, chronic lung disease, cardiovascular disease, immune deficiency, and severe obesity. Fever and cough are the most common symptoms in COVID-19, and children can also be asymptomatic. Laboratory findings are variable in children. Ground-glass opacity, consolidation, patchy shadowing, halo sign, and interstitial anomalies can be detected in lung computed tomography, or it can be normal. In this review, the frequency of COVID-19 in children, differences between adults, the course of pregnancy and newborn, clinical and laboratory findings, and treatment options are reviewed.
The child healthcare system in Ukraine is coordinated and managed at a central level by the Ministry of Health and at a local level by the regional health authorities. The Ministry of Health has executive the power for the implementation of state health policies and controls and manages state-owned health facilities. The system of public funding for the pediatric healthcare system is divided into two sources: central and local. Primary healthcare is organized by the National Health Service of Ukraine. Secondary level healthcare is mostly organized by the Ministry of Health, which gives money for hospitals and medical centers. Since 2014, due to reform and decentralization in Ukraine, local, regional, and city administrations received money from the Ukrainian government for the formation of decentralized budgets.
