La Pediatria medica e chirurgica : Medical and surgical pediatrics
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Inhaled nitric oxide (NO) has been recently proposed as a new treatment in newborns and children with severe hypoxemic respiratory failure. Differently from other vasodilators, inhaled nitric oxide selectively lowers pulmonary vascular resistance and pulmonary arterial pressure, and improves the ventilation/perfusion matching by directing pulmonary blood flow toward better ventilated areas, ultimately improving systemic oxygenation. ⋯ Nonetheless, the underlying disease and the clinical conditions before NO treatment seem to maintain a crucial role in the ultimate prognosis of these patients. Further studies are needed in order to better define indications, dosages, and safety of nitric oxide treatment, and to verify its authentic prognostic value in neonates and children with acute respiratory failure.
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Pediatric intensive care units (PICUs) have been developed to provide intensive care for children between post-neonatal age and adolescence. These units have largely been developed in North America, mainly in tertiary hospitals. In Italy, critically ill children are still often nursed on adult ICU's, where medical and nursing staff often lack pediatric training. Here we report the first 5-year experience of the multidisciplinary PICU developed at the Department of Pediatrics, University of Padua, focusing on PICU and patients characteristics, as well as on the evaluation of outcome by means of the Pediatric Risk of Mortality (PRISM) score.
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Comparative Study
[Accidents in childhood. Experiences at the Emergency Department of the Bambino Gesù Hospital of Rome].
Considering the clinical and statistical data about injured children coming to the emergency department in the years between 1990 and 1995, the Authors hope better information, identification of risks, use of safety devices in order to successfully implement precautionary measures and the assistance in accidents which still are the first reason for death in children.
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In adult obese patients both an increase of aminotranspherase values and hepatic steatosis have been frequently showed. Conversely in childhood the existence of a liver's damage is often not investigated. To assess the prevalence of hepatic alterations in obese children, we studied 135 subjects, all affected by simple obesity, showing in a 20% of them the presence of ultrasonographic evidence of hepatic steatosis and/or hyperaminotransferasemia. Our study demonstrates the existence of silent hepatic alterations also in obese children and suggests to improve the treatment of obesity in childhood to prevent the progression of liver's damage.
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Case Reports Comparative Study
[Syncopal fainting episodes and gastroesophageal reflux].
Fainting syncopal events are caused by a transient functional neuronal paralysis. Reflex syncope happens for brainstem involving mediated by peripherical afferents. Sometimes gastroesophageal reflux (GER) has been implicated in the development of obstructive apnea. ⋯ The treatment with antiacid drugs was effectual and the infants did not present ALTE(s). The cases presented are in favour of a routine search of gastroesophageal reflux in infants presenting with one or recurrent ALTE(s). The identification of these infants will permitt to develop a correct strategy of treatment.