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Children
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Pediatric Emergency Medicine
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Pediatric Emergency Medicine

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Emergency Medicine & Intensive Care Medicine".

Deadline for manuscript submissions: closed (10 October 2024) | Viewed by 12015

Special Issue Editors

Dr. Claudia Bondone

E-Mail Website
Guest Editor
Department of Pediatric Emergency, Regina Margherita Children’s Hospital—A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
Interests: pediatric emergency; pediatric advanced life support; high-fidelity simulation; non-technical skills
Special Issues, Collections and Topics in MDPI journals
Dr. Emanuele Castagno

E-Mail Website
Guest Editor
Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Turin, Italy
Interests: interests: pediatric emergency; pediatric procedural sedation and pain management; pediatric bioethics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Over the past ten years, pediatric emergency medicine has deeply changed.

Sepsis, trauma, respiratory diseases and seizure management are still priorities in pediatric emergency departments, but the effects of the COVID-19 pandemic, global migrations, and actual social and cultural trends have had an impact on the epidemiology and etiology of such conditions. Moreover, these factors assisted in largely increasing the psychiatric burden in pediatric emergency departments worldwide.

From a global perspective, the crowding of pediatric emergency departments is a major patient safety concern and has consequences for healthcare providers regarding burnout and their well-being.

Simulation-based education and debriefing have emerged as effective strategies to improve the management of low-frequency/high-impact conditions like pediatric emergencies. More recently, such training programs have been also used to develop non-technical skills in critical situations.

This Special Issue will focus on actual challenges in pediatric emergency medicine. Special emphasis will be given to core pediatric emergency medicine skills, such as the management of medical and traumatic emergencies and procedural competences, but also the management of psychiatric diseases and non-technical skills, like crisis resource management, teamwork and communication. Papers that focus on simulation-based learning, debriefing and organizational strategies to manage crowding and help healthcare workers deal with burnout are welcome.

Dr. Claudia Bondone
Dr. Emanuele Castagno
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric emergency medicine
  • pediatric emergency department
  • psychiatric disorders
  • crowding
  • medical simulation
  • non-technical skills
  • children
  • adolescent

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Published Papers (7 papers)

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Research

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9 pages, 360 KiB  
Article
Effectiveness of Antiviral Treatment with Intravenous Peramivir and Oral Oseltamivir for Seasonal Influenza in Children
by Young-hoon Byun, Ji-Eun Kim, So-Hyun Paek, Min-Jung Kim, Soo Hyun Park, Ho-Young Song and Jaehyun Kwon
Children 2025, 12(1), 26; https://doi.org/10.3390/children12010026 - 27 Dec 2024
Viewed by 901
Abstract
Background/Objectives: Influenza poses significant risks in children, causing complications like febrile seizures and hospitalizations. Antiviral treatments include oseltamivir and peramivir, both FDA-approved neuraminidase inhibitors. This study aims to compare the effectiveness of intravenous peramivir and oral oseltamivir in pediatric patients presenting to an [...] Read more.
Background/Objectives: Influenza poses significant risks in children, causing complications like febrile seizures and hospitalizations. Antiviral treatments include oseltamivir and peramivir, both FDA-approved neuraminidase inhibitors. This study aims to compare the effectiveness of intravenous peramivir and oral oseltamivir in pediatric patients presenting to an emergency department, with a primary focus on the revisit rate within 72 h post-treatment. Methods: A retrospective study analyzed 1327 children aged 1–15 years diagnosed with influenza A or B between 1 January 2019 and 29 February 2020, at a single urban hospital. Patients were divided into oseltamivir (n = 1243) and peramivir (n = 84) groups. Data included demographics, clinical symptoms, emergency department stays, and revisit rates. Fisher’s exact test was used for analysis, with p-values < 0.05 considered significant. Results: A total of 1327 pediatric patients were included, with 1243 receiving oseltamivir and 84 receiving peramivir. Patients in the peramivir group were older (median age 5.88 years vs. 4.54 years, p = 0.002) and had higher rates of gastrointestinal symptoms. The emergency department length of stay was significantly longer in the peramivir group (167 min vs. 63 min, p < 0.001). The revisit rate within 3 days was 5.63% for oseltamivir and 9.52% for peramivir, with no statistically significant difference (p = 0.22). Conclusions: Peramivir presents as an effective alternative treatment for influenza in children, particularly in situations where oral administration is not feasible due to gastrointestinal intolerance, highlighting the importance of an alternative route of antiviral administration. Full article
(This article belongs to the Special Issue Pediatric Emergency Medicine)
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11 pages, 1158 KiB  
Article
Helmet Continuous Positive Airway Pressure for Acute Bronchiolitis Respiratory Failure in a Pediatric Ward: Is It a Replicable Experience?
by Anna Maria Musolino, Sabrina Persia, Maria Chiara Supino, Francesca Stoppa, Lelia Rotondi Aufiero, Raffaella Nacca, Laura Papini, Mara Pisani, Sebastian Cristaldi, Anna Chiara Vittucci, Livia Antilici, Corrado Cecchetti, Massimiliano Raponi, Vinay Nadkarni and Alberto Villani
Children 2024, 11(11), 1273; https://doi.org/10.3390/children11111273 - 22 Oct 2024
Viewed by 1108
Abstract
(1) Background: Helmet Continuous Positive Airway Pressure (H-CPAP) has primarily been used in intensive care settings to treat moderate-to-severe bronchiolitis in infants. We aim to report on the feasibility of H-CPAP for selected infants with bronchiolitis in a pediatric ward. (2) Methods: A [...] Read more.
(1) Background: Helmet Continuous Positive Airway Pressure (H-CPAP) has primarily been used in intensive care settings to treat moderate-to-severe bronchiolitis in infants. We aim to report on the feasibility of H-CPAP for selected infants with bronchiolitis in a pediatric ward. (2) Methods: A retrospective, observational, consecutive case series was studied of 26 patients who received H-CPAP on the pediatric ward from October 2022 to February 2023, including a description of patient outcomes and costs. (3) Results: Of 130 infants with bronchiolitis admitted to Bambino Gesù Hospital in Rome, 34 were hospitalized for moderate to severe bronchiolitis, and 26 began H-CPAP on the ward. Among the 26 pediatric patients who received H-CPAP on the ward, 4 out of 26 (15%) required transfer to the PICU within the first hours of care due to clinical deterioration. No problems with the H-CPAP interface or side effects attributable to H-CPAP were reported. Pharmacological sedation with a single dose of dexmedetomidine was required for 15/26 patients (57%) following failure of non-pharmacological anxiety reduction strategies. After introducing H-CPAP in our pediatric ward, we achieved total cost savings of approximately EUR 147,120. (4) Conclusions: Treatment with H-CPAP for infants with bronchiolitis may be feasible in non-intensive care settings with trained staff, appropriate monitoring, and rapid access to pediatric intensive care. Full article
(This article belongs to the Special Issue Pediatric Emergency Medicine)
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13 pages, 919 KiB  
Article
Experience of an Italian Pediatric Third Level Emergency Department during the 2022–2023 Bronchiolitis Epidemic: A Focus on Discharged Patients and Revisits
by Giovanna Iudica, Daniele Franzone, Marta Ferretti, Barbara Tubino, Stefania Santaniello, Giacomo Brisca, Clelia Formigoni, Erica Data and Emanuela Piccotti
Children 2024, 11(3), 268; https://doi.org/10.3390/children11030268 - 21 Feb 2024
Viewed by 1549
Abstract
The aim of this study was to describe the 2022–2023 bronchiolitis epidemic season (the second after COVID-19 pandemic and the first without social restriction), focusing on patients discharged home from a pediatric emergency department (PED) and on those revisited within 72 h. We [...] Read more.
The aim of this study was to describe the 2022–2023 bronchiolitis epidemic season (the second after COVID-19 pandemic and the first without social restriction), focusing on patients discharged home from a pediatric emergency department (PED) and on those revisited within 72 h. We performed a retrospective observational study in an Italian tertiary care children’s hospital, reviewing PED accesses from 1 October 2022 to 31 March 2023. The number of hospitalizations for bronchiolitis was extracted from hospital discharge forms. A total of 512 patients diagnosed with bronchiolitis were admitted to PED (2.8% of total admissions). Accesses increased sharply from November to January, with a peak in December, in both admissions and hospitalizations. More than half of the patients (55.5%) were safely discharged home, while 38 (13.4%) came back to PED for a revisit. Overall PED accesses and hospitalizations for bronchiolitis increased since the previous epidemic season, and particularly compared to the pandemic and pre-pandemic eras. Empowering the collaboration between all healthcare provisioners is fundamental to suitable management of patients. Monitoring the epidemiology and seasonality of bronchiolitis is a starting point for an effective internal organization of pediatric departments and to further evaluate its socio-economic burden. Full article
(This article belongs to the Special Issue Pediatric Emergency Medicine)
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12 pages, 980 KiB  
Article
Predictors of Urinary Abnormalities in Children Hospitalised for Their First Urinary Tract Infection
by Danilo Buonsenso, Giorgio Sodero, Anna Camporesi, Ugo Maria Pierucci, Francesca Raffaelli, Francesco Proli, Piero Valentini and Claudia Rendeli
Children 2024, 11(1), 55; https://doi.org/10.3390/children11010055 - 30 Dec 2023
Cited by 1 | Viewed by 1596
Abstract
We aimed to investigate if children with their first UTI and a concomitant positive blood culture have a higher risk of abnormalities. We performed a retrospective study of children younger than 18 years of age with their first UTI. Multivariate logistic regression and [...] Read more.
We aimed to investigate if children with their first UTI and a concomitant positive blood culture have a higher risk of abnormalities. We performed a retrospective study of children younger than 18 years of age with their first UTI. Multivariate logistic regression and receiver operating characteristic (ROC) curves were used to evaluate if positive blood cultures are associated with urinary abnormalities. After the screening process, we considered the enrolled 161 children with UTIs. The median age was three months, and 83 were females (43.2%). In multivariate analysis, age (p = 0.001, 95% CI 1.005–1.020), the presence of Pseudomonas aeruginosa or unusual germs in urine cultures (p = 0.002, 95% CI 2.18–30.36) and the positivity of blood cultures (p = 0.001, 95% CI 2.23–18.98) were significantly associated with urinary abnormalities. A model based on these parameters has an AUC of 0.7168 to predict urinary malformations (p = 0.0315). Conclusions include how greater age, a positive blood culture and the presence of Pseudomonas aeruginosa or unusual germs in urine culture in children hospitalised for their first episode of a UTI are factors associated with a significantly higher risk of urinary abnormalities. These data can guide the implementation of more personalized strategies to screen for urinary abnormalities that may be included in future guidelines. Full article
(This article belongs to the Special Issue Pediatric Emergency Medicine)
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10 pages, 542 KiB  
Article
Acute Pupillary Disorders in Children: A 10-Year Retrospective Study of 101 Patients
by Giacomo Garone, Marco Roversi, Mara Pisani, Francesco La Penna, Antonio Musolino, Sebastian Cristaldi, Anna Maria Musolino, Amanda Roberto, Gianni Petrocelli, Antonino Reale, Fabio Midulla, Alberto Villani and Umberto Raucci
Children 2023, 10(11), 1739; https://doi.org/10.3390/children10111739 - 26 Oct 2023
Cited by 1 | Viewed by 1291
Abstract
Background: To date, no study has specifically examined children with acute-onset pupillary motility disorders (APMD). Especially in the Emergency Department (ED), it is crucial to distinguish benign and transient conditions from life-threatening or urgent conditions (UCs). The aim of the study is to [...] Read more.
Background: To date, no study has specifically examined children with acute-onset pupillary motility disorders (APMD). Especially in the Emergency Department (ED), it is crucial to distinguish benign and transient conditions from life-threatening or urgent conditions (UCs). The aim of the study is to describe the clinical characteristics of children with APMD and their association with an increased risk of UCs. Methods: We conducted a pediatric retrospective study of APMD referred to ED over a 10-year period. We described the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we applied a logistic regression model to identify the variables predictive of LT condition. Results: We analyzed 101 patients. In 59.4%, the APMD was isolated. In patients with extra-ocular involvement, the most frequently associated features were altered consciousness, headache, and vomiting. Exposure to toxic agents was reported in 48.5%. Urgent conditions occurred significantly more frequently in older children, presenting bilateral APMD and/or other ocular or extra-ocular manifestations. Conclusions: Our study shows that UCs most commonly occur in patients presenting with bilateral APMD and other associated features. In unilateral/isolated APMD ophthalmological examination, exclusion of toxic exposure and observation until resolution of symptoms should be recommended. Full article
(This article belongs to the Special Issue Pediatric Emergency Medicine)
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Review

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18 pages, 343 KiB  
Review
Antimicrobial Stewardship in Pediatric Emergency Medicine: A Narrative Exploration of Antibiotic Overprescribing, Stewardship Interventions, and Performance Metrics
by Kevin Meesters and Danilo Buonsenso
Children 2024, 11(3), 276; https://doi.org/10.3390/children11030276 - 23 Feb 2024
Cited by 5 | Viewed by 3128
Abstract
Antibiotic overprescribing is prevalent in pediatric emergency medicine, influenced by clinician–caregiver dynamics and diagnostic uncertainties, and poses substantial risks such as increasing antibacterial resistance, adverse drug reactions, and increased healthcare expenditures. While antimicrobial stewardship programs have proven effective in optimizing antibiotic use within [...] Read more.
Antibiotic overprescribing is prevalent in pediatric emergency medicine, influenced by clinician–caregiver dynamics and diagnostic uncertainties, and poses substantial risks such as increasing antibacterial resistance, adverse drug reactions, and increased healthcare expenditures. While antimicrobial stewardship programs have proven effective in optimizing antibiotic use within inpatient healthcare settings, their implementation in pediatric emergency medicine presents specific challenges. Existing biomarkers like white blood cell count, C-reactive protein, procalcitonin, and presepsin have limitations in their ability to distinguish (serious) bacterial infections from other etiologies of fever. Furthermore, rapid antigen detection tests and guidelines aimed at guiding antibiotic prescriptions for children have not consistently reduced unnecessary antibiotic use. To improve antibiotic prescribing practices, potential strategies include the utilization of decision support tools, audit and feedback, establishing follow-up procedures, implementing safety netting systems, and delivering comprehensive training and supervision. Notably, host genome signatures have also gained attention for their potential to facilitate rapid and precise diagnoses of inflammatory syndromes. Standardized metrics are crucial for evaluating antimicrobial use within pediatric healthcare settings, enabling the establishment of benchmarks for assessing antibiotic utilization, quality enhancement initiatives, and research endeavors. Full article
(This article belongs to the Special Issue Pediatric Emergency Medicine)

Other

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8 pages, 550 KiB  
Case Report
Pediatric Post-Pump Chorea: Case Report and Implications for Differential Diagnosis
by Elisa Rossi, Concetta Strano, Ilaria Cortesia, Francesca Torta, Mirella Davitto Bava, Irene Tardivo and Marco Spada
Children 2024, 11(9), 1060; https://doi.org/10.3390/children11091060 - 29 Aug 2024
Viewed by 1317
Abstract
Background: Chorea is a neurological disorder characterized by random, fluid movements that may affect the limbs, trunk, neck, or face. In children, Sydenham’s chorea (SC) is the most common cause of acute chorea, mainly following group A beta-hemolytic streptococcal (GABHS) infection. Other autoimmune [...] Read more.
Background: Chorea is a neurological disorder characterized by random, fluid movements that may affect the limbs, trunk, neck, or face. In children, Sydenham’s chorea (SC) is the most common cause of acute chorea, mainly following group A beta-hemolytic streptococcal (GABHS) infection. Other autoimmune and metabolic disorders may also cause chorea. Case presentation: We report the case of a 6-year-old girl who developed chorea following cardiac surgery for mitral insufficiency. One week after discharge, the patient presented with right-sided hyposthenia, slower speech, mild dysarthria, and sialorrhea. Brain MRI and intracranial MRI angiography revealed a small vascular lesion consistent with a microembolic event. Extensive diagnostic investigations, including serum panels for autoimmune encephalitis, neurotropic viruses, and metabolic disorders, were negative. Conclusions: Considering the patient’s history, clinical course, and the exclusion of other potential causes, a diagnosis of post-pump chorea was made. This case underlines the importance of a thorough differential diagnosis in pediatric chorea and highlights post-pump chorea as a significant postoperative complication in pediatric cardiac surgery. The patient’s motor symptoms improved with symptomatic treatment, and follow-up showed good recovery without neurological sequelae. Full article
(This article belongs to the Special Issue Pediatric Emergency Medicine)
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