Background: Prolonged mechanical ventilation in preterm infants may cause complications. We aimed to analyze the variables affecting extubation outcomes in preterm infants at high risk of extubation failure. Methods: This was a single-center, observational, retrospective study. Extubation failure was defined as survival with the need for reintubation within 72 h. Successfully extubated neonates (group 1) were compared to those with failed extubation (group 2). Multivariate logistic regression analysis evaluated factors that predicted extubation outcomes. Results: Eighty infants with a birth weight under 1000 g and/or gestational age (GA) under 28 weeks were included. Extubation failure occurred in 29 (36.2%) and success in 51 (63.8%) neonates. Most failures (75.9%) occurred within 24 h. Pre-extubation inspired oxygen fraction (FiO2) of 27% had a sensitivity of 58.6% and specificity of 64.7% for extubation failure. Post-extubation FiO2 of 32% had a sensitivity of 65.5% and specificity of 62.8% for failure. Prolonged membrane rupture (PROM) and high GA were associated with extubation success in multivariate logistic regression analysis. Conclusions: High GA and PROM were associated with extubation success. Pre- and post-extubation FiO2 values were not significantly predictive of extubation failure. Further studies should evaluate if overall assessment, including ventilatory parameters and clinical factors, can predict extubation success in neonates.

Background: Neonatal encephalopathy due to perinatal asphyxia is one of the leading causes of neonatal death and morbidity worldwide. The neurodevelopmental outcomes of asphyxiated neonates have considerably improved after therapeutic hypothermia (TH). The current challenge is to identify all newborns with encephalopathy at risk of cerebral lesions and subsequent disability within 6 h of life and who may be within the window period for treatment with TH. This study evaluated the neurodevelopmental outcomes in surviving asphyxiated neonates who did and did not receive TH, based on clinical and polygraphic electroencephalographic (p-EEG) criteria. Methods: The study included 139 asphyxiated newborns divided into two groups: 82 who received TH and 57 who were not cooled. TH was administered to asphyxiated newborns (gestational age ≥ 35 weeks, birth weight ≥ 1800 g) with encephalopathy of any grade and moderate-to-severe p-EEG abnormalities or seizures. Neurodevelopmental outcomes between the groups at 24 months of life and the risk factors for severe outcomes were assessed. Results: Severe neurodevelopmental impairment occurred in 10 (7.2%) out of the 139 enrolled neonates. Nine out of the 82 cooled neonates (11.0%) had severe neurodevelopmental impairment. All but one neonate (98.2%) who did not receive TH had normal outcomes. The multivariate logistic regression analysis showed that abnormal p-EEG patterns (OR: 27.6; IC: 2.8–267.6) and general movements (OR: 3.2; IC: 1.0–10.0) were significantly associated with severe neurodevelopmental impairment (area under ROC curve: 92.7%). Conclusion: The combination of clinical and p-EEG evaluations in hypoxic–ischemic encephalopathy contributed to a more accurate selection of patients treated with therapeutic hypothermia. When administered to infants with moderate to severe p-EEG abnormalities, TH prevents approximately 90% of severe neurodevelopmental impairment after any grade of hypoxic–ischemic encephalopathy.

Background Pediatricians play a crucial role in the identification and management of child abuse and neglect (CAN) but they often don’t have a formal specialized training. Methods We analysed retrospectively data about patients, 0 - 18 years of age, victims of CAN between 1 April 2005 and 30 April 2015. The aim of the study was to evaluate the effect of a multidisciplinary educational program, “CAN: prevention strategies, individuation and treatment”, on the knowledge, case recognition, treatment and follow-up of physicians of Gemelli University Hospital in Rome, regarding physical, sexual abuse and neglect. This program, in 3 different editions biannually, respectively in May-July 2010, November-January 2012 and February-May 2014, was based on 4 sessions, each one of 2 days. Results Considering the number of victims of CAN between 2005 and 2015 we observed 66 cases of maltreatment. We divided the study population in 2 groups: group A, before the educational programs, patients evaluated from 1 April 2005 to 30 July 2010; group B, after the educational program from 1 August 2010 to 30 April 2015. We observed 23 children in group A and 43 children in group B with an improvement of 87%. Analyzing our data about sex, nationality, type of perpetrators, we found that: 37/66 (56%) of children were females compared to 29/66 (44%) males; 41/66 (62%) of children came from Italy compared to 25/66 (38%) of foreign children; 52/66 (79%) of the perpetrators of abuse were parents or family members compared to acquaintances 10/66 (15%) and to strangers 4/66 (6%). Conclusions Considering the prevalence of CAN, the need to develop clinically competent clinicians and the improving of residency education in child maltreatment is imperative. Improving the clinical skills of pediatricians to identify and evaluate CAN may lead to reduce morbidity and mortality of these children.

Hyperleukocytosis has a high morbidity index. The involvement of the respiratory or central nervous system and the metabolic derangements accompanying tumor lysis are responsible for early mortality. Standard care for acute hyperleukocytosis must include cytoreduction, proper supportive care, and prevention of tumor lysis. Hydration, alkalization, allopurinol, or urate oxidase should be started immediately. In patients with low platelet count of less than 20,000/mm3, platelet transfusions should be given to prevent cerebral hemorrhage, as platelets do not add substantially to blood viscosity. Packed red blood cells must be given with caution as they can significantly increase blood viscosity. If the patient is hemodynamically stable, packed red transfusions should be planned when the hemoglobin level is less than 7–8 g/dl, avoiding post-transfusional levels above 10 g/dl. Coagulation abnormalities should be corrected. Leukapheresis has been advocated to correct metabolic abnormalities and to decrease viscosity by reducing the peripheral white blood count. However, leukapheresis may fail to decrease the leukocyte count substantially or may achieve only a transient tumor bulk reduction. The procedure is generally well tolerated but can involve problems such as the need for anticoagulation or difficulty of access, and limited availability in many institutions.

The number of refugees who attempt to reach Europe is increasing, and, as warned in an Editorial (Sept 12, p 1013),1The LancetAdapting to migration as a planetary force.Lancet. 2015; 386: 1013Summary Full Text Full Text PDF PubMed Scopus (26) Google Scholar decisive action is needed. European Union (EU) member states have to do more to ensure the care and protection of these vulnerable refugees, especially the children. Every day, children around the world are severely affected by crises and circumstances that are beyond their control. UNICEF reports an alarming situation in Europe—more than 106 000 children applied for asylum in the EU (between January–June, 2015).2UNICEFPlauso all'Europa, ma ora azioni concrete.http://www.unicef.it/doc/6422/unicef-plauso-a-europa-ma-ora-azioni-concrete.htmDate: Sept 11, 2015Google Scholar Since the beginning of 2015, more than 122 380 migrants have arrived in Italy, more than 12 120 of whom were children.3Save The Children ItaliaImmigrazione UE: Save the Children, necessario attivare subito un sistema di accoglienza e protezione europeo. Cinque priorità indicate dall'Organizzazione all'Europa.http://www.savethechildren.it/IT/Tool/Press/All/IT/Tool/Press/Single?id_press=944&year=2015Date: Sept 9, 2015Google Scholar Many of these children are alone. According to Save the Children Italy, 8715 children arrived in Italy without family or guardians since the start of the year.3Save The Children ItaliaImmigrazione UE: Save the Children, necessario attivare subito un sistema di accoglienza e protezione europeo. Cinque priorità indicate dall'Organizzazione all'Europa.http://www.savethechildren.it/IT/Tool/Press/All/IT/Tool/Press/Single?id_press=944&year=2015Date: Sept 9, 2015Google Scholar About a thousand people land on the Dodecanese islands every day.4Save The Children ItaliaGrecia, minori migranti: Save the Children, sono ad alto rischio di sfruttamento e abusi. Solo 1 centro di prima accoglienza funzionante come tale mentre gli altri più simili a centri di detenzione.http://www.savethechildren.it/IT/Tool/Press/All/IT/Tool/Press/Single?id_press=933&year=2015Date: Aug 6, 2015Google Scholar In June alone, 4270 children landed on the islands, and 86 of them were unaccompanied.4Save The Children ItaliaGrecia, minori migranti: Save the Children, sono ad alto rischio di sfruttamento e abusi. Solo 1 centro di prima accoglienza funzionante come tale mentre gli altri più simili a centri di detenzione.http://www.savethechildren.it/IT/Tool/Press/All/IT/Tool/Press/Single?id_press=933&year=2015Date: Aug 6, 2015Google Scholar Many of the children who travel unaccompanied come from Eritrea, Somalia, Egypt, and South Africa. These children are in serious danger once they arrive in Europe as they could disappear into criminal groups, become victims of child trafficking, or be forced into manual labour, domestic work, drug smuggling, or prostitution. For many migrants, Italy and Greece are a bridge into EU countries. However, the burden cannot fall on Italy and Greece alone: the EU bears collective responsibility for dealing with the crisis. The European nations have a collective role in ensuring that refugees and migrants are treated with dignity and that vulnerable children are protected. The EU has the duty to prevent children from being exploited by unscrupulous human traffickers and to give these children their unquestionable rights to health, safety, and wellbeing. EU member states can prevent children from becoming deprived of their childhood with all the psychological implications this could inflict on the rest of their lives. The European Academy of Paediatrics (EAP) urge all European medical societies to help find a humane solution to the current crisis. The EAP believes that it is necessary to create a platform for countries to discuss and share issues affecting paediatric services in Europe, provide medical and psychosocial support services for children, and to protect them. We call on EU member states to ensure that children gain access to legal services and school and are protected from from violence, abuse, and exploitation. Paediatricians should cooperate with schools to help these children receive health care (including mental health screening, and immunisations). The EAP advocates for medical care without barriers, inequities, and inequalities for all children in Europe and solicits governments of nations receiving migrants to protect and defend children's rights, without restrictions, because these children have the same rights to receive care as other European children. All children have the right to live in a safe environment where they can grow up and achieve their potential. There must not be a right or wrong place to be born. We declare no competing interests. Adapting to migration as a planetary forceThe spectre of hundreds of thousands of refugees crossing Europe and being turned away by nations, despite urgent and heart-rending appeals for safe haven, has disturbing historical echoes. In 1938, Hertha Nathorff, a Jewish physician living in Germany, wrote: “I'm counting the days until we come out of this living hell…Everyone has only one wish: to get out of this country. And they don't hesitate to say so openly.” During 1938 and 1939, the world, including the USA, Europe, and Latin America, was reluctant to admit escaping Jewish refugees—with, as we know, horrific consequences. Full-Text PDF

Aim. School bullying is a proactive, intentional and repeated form of aggression. Approximately 20% of youths report being involved in bullying as perpetrators and/or victims. The purpose of this research was to investigate bullying prevalence in a sample of school Italian children in Rome.Methods. A total of 721 children from 6th and 8th grades completed a self-report anonymous questionnaire adapted from the Revised Olweus Bully/Victim Questionnaire, including specific items to investigate about children bullying involvement at school.Results. Prevalence of relational, physical and verbal bullying events resulted similar for 6th and 8th grades (5%, 3.6% and 3.9% versus 5.2%, 3% and 5.1% respectively). Boys compared to girls resulted more likely involved in bullying events, particularly in physical ones (4.9% versus 1.7%). The prevalence of both bullies and bully-victims was similar in boys and girls, regardless of age (53% and 47.4% among males versus 47% and 52.6% among females respectively). The 39.4% and 41.2% of students reported lack of intervention on victim's behalf by teachers and schoolmates respectively.Conclusion. Data from our study support the importance of further education to provide effective prevention programming. Pediatricians can play an important role in detection of potential victims limiting long-term psychosomatic and psychosocial sequelae.

BACKGROUND:To assess the prevalence of femicides in Italy over the last three years and the potential long lasting effects of these traumatic events for the children of a woman who dies a violent death.METHODS:The data used in this study come from an internet search for the number of femicides occurring in Italy between 1(st) January, 2012 and 31(st) October, 2014.RESULTS:The total number of femicides was 319; the average age of murdered women was 47.50 ± 19.26. Cold arms in the form of sharp object -mostly knives- have caused the death of 102/319 women; firearms were used in 87/319 cases; asphyxiation was the chosen method in 52/319 cases. About the place where the femicides occurred, 209/319 were committed inside the victim's house. Children of women who died a violent death were 417 with a total of 180 minors in less than three years. A total of 52/417 children were witness to the killing and, among these 30/52 were minors; in 18/417 cases, children were murdered together with their mother and among these 9/18 were minors.CONCLUSIONS:Long-term studies are needed to ascertain what happens to these children, to understand what are the most appropriate psychological treatments, the best decisions about the contact with their father and the best placement for these children.