Children with multisystem inflammatory syndrome (MIS-C) tend to develop a clinical condition of fluid overload due both to contractile cardiac pump deficit and to endotheliitis with subsequent capillary leak syndrome. In this context, the ability of point-of-care ultrasound (PoCUS) to simultaneously explore multiple systems and detect polyserositis could promote adequate therapeutic management of fluid balance. We describe the PoCUS findings in a case-series of MIS-C patients admitted to the Emergency Department. At admission 10/11 patients showed satisfactory clinical condition without signs and symptoms suggestive for cardiovascular impairment/shock, but PoCUS showed pathological findings in 11/11 (100%). In particular, according to Rapid Ultrasound in SHock (RUSH) protocol, cardiac hypokinesis was detected in 5/11 (45%) and inferior vena cava dilatation in 3/11 (27%). Peritoneal fluid was reported in 6/11 cases (54%). Lung ultrasound (LUS) evaluation revealed an interstitial syndrome in 11/11 (100%), mainly localized in posterior basal lung segments. We suggest PoCUS as a useful tool in the first evaluation of children with suspected MIS-C for the initial therapeutic management and the following monitoring of possible cardiovascular deterioration.

Background We report a pediatric patient presenting in good general condition despite a hemoglobin value of 1,9 g/dL, which is normally regarded as life-threatening. Case presentation An African 5 years-old girl presented to our Emergency Department (ED) for worsening asthenia, within a clinical picture of good general condition. The hemoglobin value at admission was 1,9 g/dL. The subsequent diagnostic-therapeutic pathway highlighted the presence of two different causes, both well known to be responsible for chronic anemia (with slow reduction of hemoglobin values): iron deficiency anemia (IDA) due to a very low dietary intake of iron-rich foods, and homozygous sickle cell disease (HbSS). She received transfusions of packed red blood cells (overall 15 ml/kg) and subsequently intravenous iron preparations (total amount 200 mg) followed by oral iron supplements. The Hb value at discharge, 10 days after the admission, was 9.8 g/dL. Conclusions When approaching a picture of severe anemia, we suggest pediatricians take into consideration clinical conditions rather than laboratory values and to take advantage of detailed anamnestic data in order to make the diagnosis.

Background and AimsChronic intestinal failure (CIF) therapy changed significantly in recent decades, and both survival and complication rates improved over time. International guidelines claim that early referral of long-term home parenteral nutrition (HPN) patients to an expert center with specific standards of care may positively affect long-term outcomes. Herein, we retrospectively analyse the long-term outcomes of a cohort of pediatric patients with CIF followed-up since our Pediatric Intestinal Failure Unit foundation, in 1989.MethodsData of the 120 children followed up at Pediatric Intestinal Failure Unit during the last 28 years were retrospectively collected. Patients' and HPN characteristics, as well as dependence, survival, and complication rates, were described.ResultsIncidence and prevalence of CIF increased during the study period particularly due to the increase of HPN for non-digestive disease (NDD) CIF (47.5% of the study sample). Catheter-related bloodstream infection (CRBSI) rate decreased over the study period: 0.33 episodes/1,000 catheters days before 2011 and 0.19 episodes/1,000 catheters days afterwards. Only 1 patient out of 12 died because of HPN complications. The survival rate of patients with PDD was 98.4% at 1 year from the beginning of HPN, 96.5% at 2 years, and 93.8% from the fifth year onwards. Concerning the dependence rate, 70.6% of patients were still on HPN 1 year after the start of HPN, 63.7% at 2 years, 52.4% at 5 years, and 40.8% from the 9th year onwards, with no significant difference according to the underlying intestinal pathology. The survival rate of NDD patients was 91.2% at 1 year from the beginning of HPN, 87.4% at 2 years, and 81.9% from the third year onwards. For what concerns the enteral autonomy, it was regained by 56.7% 1 year after the start of HPN, 74.5% at 2 years, and 95.0% in the 5th year.ConclusionsOur data confirmed the importance of appropriate standards of care and suggest that applying a specific set of standards and protocols may further improve patients' outcomes and survival. Indeed, both primary and non-digestive diseases HPN showed good outcomes.

Venous thrombosis is a complication that mostly occurs in the paediatric patient with multiple comorbidities. In these cases, it is relatively simple for the paediatrician to suspect the presence of a thrombosis. On the contrary, due to the rarity of the pathology and the clinical presentation that can mimic other conditions, it could be difficult to recognize a thrombotic event in an extra-hospital context and in an "otherwise healthy" child. This article aims to examine how to diagnose and treat this rare paediatric condition promptly

Background: Kawasaki disease (KD) is an acute, self-limited febrile illness of unknown cause, that predominantly affects children < 5 years of age. The diagnosis is merely clinic, based on the identification of principal clinical findings and the exclusion of other clinically similar entities. Patients who do not fulfill the complete diagnostic criteria for KD are referred to as incomplete form. Lymphadenopathy is the least common symptom in patients with KD. The rate of cervical lymphadenopathy occurring as the initial presenting symptom is only approximately 12%. As a result, KD could be initially diagnosed as bacterial lymphadenitis and treated improperly with antibiotics.Case presentation: we describe the case of a 5 years-old girl of African origin presented to our emergency department with a two-day history of fever and left unilateral lymph node swelling. Persistent fever, unresponsiveness to broad-spectrum antibiotics therapy, the evidence on computerized-tomography (CT) scan of para-pharyngeal abscesses-like lesion and the onset of other characteristic clinical features that emerged gradually, provided support for a diagnosis of incomplete KD. The excellent response within 24 hours after administration of intravenous immunoglobulin (IVIG) and the rapid resolution of fever, confirmed the correct diagnosis of incomplete KD.Conclusions: from this case we need to realize that para-pharyngeal involvement with edema, cellulitis and abscess-like lesions is a rare, but possible initial manifestation of KD. To avoid delayed diagnosis, clinicians have to be alert to identifying head and neck manifestations as a possible early presentation of KD and include it as a routine differential diagnosis for suspected parapharyngeal abscesses.