Caterina Agosto

Evaluating pain induced by venipuncture in pediatric patients with developmental delay

Objectives:Little attention has been paid to the assessment of pain in children with developmental delay. The aim of this study was to explore several methods for assessing pain during venipuncture in this population of children, using classic and modified scales to evaluate the children’s response to simplified tools. Methods:Sixteen children with mild or moderate developmental delay were evaluated using three standard self-rating scales (Visual Analog Scale [VAS], Eland Scale, and Faces Scale) and three modified methods (Cube Test, Modified Eland Scale, and Modified Faces Scale), recording subjective self-ratings and behavioral expressions of pain during a venipuncture procedure, apart from the initial fear. The children’s pain and reaction time were assessed by an outside observer, while their pain and fear were also evaluated by the parents. Results:The VAS was used without difficulty by all the children and revealed a good consistency with the Cube Test. The parents’ and neutral observer’s indirect pain assessment was also consistent with the child’s evaluations. The Eland Scale proved difficult to use, especially for Down’s syndrome children, while its modified version was easier. Results emerging from the original and modified Faces Scales were inconsistent. Frightened children attributed higher pain scores, demonstrating that negative emotions exacerbate the experience of pain in developmentally delayed children. The patients showed a limited capacity for verbal and behavioral expression in reaction to the painful stimulus (especially the Down’s cases). Discussion:These findings support the conviction that even developmentally delayed children can use self-rating methods effectively. This sector demands further, more extensive study, including the development of simplified tools, to ensure an adequate pain assessment and optimal antalgic approach to this particular pediatric population.

Safety and efficacy of propofol administered by paediatricians during procedural sedation in children.

The aim of this study was to determine the safety and the efficacy of paediatrician‐administered propofol in children undergoing different painful procedures.

Congenital central hypoventilation syndrome and hypoglycaemia.

Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder typically presenting in infants with an impaired automatic control of breathing, particularly during sleep, and often associated with variable patterns of autonomic nervous system dysregulations. We studied three children who had CCHS associated with episodes of severe hypoglycaemia and hyperinsulinaemia; we discuss the possible relationship with impaired dopamine‐beta‐hydroxylase function.

The management of procedural pain at the Italian Centers of Pediatric Hematology-Oncology: state-of-the-art and future directions.

PurposeThe quality of life of children with cancer can be affected by the experience of cancer-related pain, treatment-related pain, procedural pain, generalized pain, and long-term chronic pain, and the consequences may be permanent. Treatment-related pain and procedural pain are often reportedly the most painful experiences relating to their illness. Procedural pain treatment is therefore now considered essential. This multicenter survey investigated how procedural pain is managed at Italian Pediatric Hematology–Oncology Centers.MethodsFrom April to October 2010, questionnaires were collected from the directors and/or referent of the Italian Centers of Pediatric Hematology–Oncology about the management of lumbar punctures, bone marrow aspirates, and biopsies.ResultsWe received responses from 67% of the centers (which performed a total of 13,271 procedures per year). Fifty percent of the procedures were performed in the operating room. The sedation–analgesia was provided “almost always” for 84% of procedures. Non-pharmacological treatments were used in 55% of the centers. The specialist who practiced analgesia was the anesthetist in 83.3% of the cases.ConclusionsA nationwide multicentre survey has been conducted for the first time to verify the management of procedural pain in Pediatric Hematology–Oncology patients. The results indicate that many aspects in the management of procedural pain appear consistent with the international guidelines. Some problems still remain, including the inability to ensure adequate sedation–analgesia in all the patients—often due to the lack of adequate staff, the frequent use of the operating room, and an underdeveloped use of non-pharmacological therapies.

Pain management of arteriovenous fistula cannulation in haemodialysis children: efficacy of EMLA anaesthetic cream.

The aim of the present study was to evaluate the efficacy of EMLA cream (containing a eutectic mixture of local anaesthetics) in controlling pain due to arteriovenous fistula cannulation in teenagers undergoing chronic haemodialysis. The study was conducted in two phases, one prospective, the other a blind randomized trial, at the Paediatric Haemodialysis service of the Paediatrics Department of Padua University, Italy. It involved six teenagers, aged 12–18 years. Pain was measured using the visual analogue scale, indirect evaluation by nurses and a four‐category verbal rating scale.

Successful use of extracorporeal membrane oxygenation for severe interstitial lung disease in a child with dermatomyositis

Juvenile dermatomyositis (JDM) is a multisystemic disease of children that affects primarily muscle and skin. The prevalence of pulmonary involvement is not well known but seems to be rarer than in adult patients with dermatomyositis/polymyositis (DM/PM) [1–3]. A wide spectrum of clinical presentations have been described, ranging from asymptomatic patients with merely abnormal pulmonary function tests [4] to severe, potentially fatal cases refractory to immunosuppressive and supportive therapy [5-9]. Here we present the case of a child with JDM and severe interstitial lung disease (ILD) successfully treated with immunosuppressive drugs and extracorporeal membrane oxygenation (ECMO).

Effect of Administering Low-Dose Fentanyl Infusion on Respiratory Dynamics in the Premature Ventilated for Respiratory Distress Syndrome-A Randomized Double-Blind Trial

Effect of Administering Low-Dose Fentanyl Infusion on Respiratory Dynamics in the Premature Ventilated for Respiratory Distress Syndrome-A Randomized Double-Blind Trial

Use of Scrambler Therapy in Acute Paediatric Pain: A Case Report and Review of the Literature.

We report our clinical experience on the effect of Scrambler Therapy (ST) for a child with acute mixed pain refractory to pharmacological treatment. ST, recently proposed as an alternative treatment for chronic neuropathic pain in adults, is a noninvasive approach to relieve pain, by changing pain perception at brain level. It is safe and has no side effects. Further research is needed to assess its efficacy for acute pain and for paediatric population.

Use of Zoledronic Acid in Paediatric Craniofacial Fibrous Dysplasia

We describe a case of a paediatric patient affected by mandibular fibrous dysplasia (FD) with severe and chronic pain who was successfully treated with zoledronic acid (ZOL): a third-generation bisphosphonate. Further research is needed to assess its safety and efficacy as a treatment option for FD in the paediatric population.

Symptom management and psychological support for families are the cornerstones of end-of-life care for children with spinal muscular atrophy type 1

This study described end‐of‐life care for children affected by spinal muscular atrophy type 1 (SMA1), which is characterised by progressive muscle weakness and develops in the first six months of life.