Discomfort relief after paracetamol administration in febrile children admitted to a third level paediatric emergency department

Backgroundinternational guidelines recommend treating fever in children not at a predefined body temperature limit but based on the presence of discomfort. However few studies evaluated discomfort relief after administration of antipyretics in children.MethodsBetween 1st January and 30th September 2021 a single-center prospective observational study was performed in febrile children consecutively admitted to a pediatric emergency department and treated with paracetamol orally. For each child, body temperature, presence and severity of discomfort, defined using a previously published semiquantitative likert scale, were evaluated at baseline and 60 min after administration of paracetamol, and differences were analyzed.Results172 children (males: 91/172; 52.9%; median age: 41.7 months) were included. Significant reductions in body temperature (median body temperature at T0: 38.9 °C; IQR: 38.3–39.4, median body temperature at T60: 36.9 °C; IQR: 36.4–37.5; P Conclusionsparacetamol in febrile children is associated not only with significantly reduction in body temperature but also with discomfort relief.</p

Procalcitonin performance in detecting serious and invasive bacterial infections in children with fever without apparent source: a systematic review and meta-analysis

<p><b>Introduction</b>: The management of children with fever without apparent sources (FWAS) is difficult. This study aimed to evaluate the diagnostic accuracy of procalcitonin (PCT) in detecting serious or invasive bacterial infection (SBI or IBI) in children with FWAS.</p> <p><b>Areas covered</b>: A systematic review of literature from 2007 to 2017 was performed on Medline. Twelve studies were included, involving 7,260 children with FWAS and analyzing the diagnostic performance of PCT. Four meta-analyses were performed to calculate pooled sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve for PCT in detecting SBI and IBI, at two different thresholds. Considering IBI, PCT sensitivity and specificity at a threshold of 0.5 ng/mL were 0.82 and 0.86, respectively; at a threshold of 2 ng/mL sensitivity and specificity were 0.61 and 0.94, respectively. In detecting SBI, PCT performance was lower, with 55% sensitivity and 85% specificity at a threshold of 0.5 ng/mL, and 30% sensitivity and 95% specificity at a threshold of 2 ng/mL.</p> <p><b>Expert commentary</b>: Considering IBI, results showed high diagnostic accuracy for PCT. Conversely, PCT performance in diagnosis of SBI was poor. These findings suggest that PCT level determination could be helpful in detecting meningitis, bacteremia and sepsis in children with FWAS.</p

Characteristics of the 962 internationally adopted children included in the study.

<p>Characteristics of the 962 internationally adopted children included in the study.</p

Serum 25(OH)D levels [median (IQR)] and vitamin D status related to presumed risk factors for hypovitaminosis D.

<p>Serum 25(OH)D levels [median (IQR)] and vitamin D status related to presumed risk factors for hypovitaminosis D.</p

Vitamin D status in internationally adopted children divided for country of origin.

<p>Vitamin D status in internationally adopted children divided for country of origin.</p

Cases of tuberculosis in Tuscan population, 1997–2011: age-stratified female:male annual incidence rate ratios and 95% confidence intervals.

<p>* Average annual population during the analysed period.</p><p>** TB incidence rates were calculated as cases per 100,000 population.</p><p>Cases of tuberculosis in Tuscan population, 1997–2011: age-stratified female:male annual incidence rate ratios and 95% confidence intervals.</p

Female incidence rate ratios for each age group (using male gender as a reference) in all the observed population (2003–2011).

<p>Female incidence rate ratios for each age group (using male gender as a reference) in all the observed population (2003–2011).</p

Tuberculosis cases in the Tuscan population differentiated by disease site and gender (1997–2011).

<p>Tuberculosis cases in the Tuscan population differentiated by disease site and gender (1997–2011).</p

Female incidence rate ratios for each age group (using male gender as a reference) in the Italian observed population (2003–2011).

<p>Female incidence rate ratios for each age group (using male gender as a reference) in the Italian observed population (2003–2011).</p

A receiver operator characteristic (ROC) plot is shown, illustrating sensitivity and specificity of AlaDH IFN-γ and IL-2 ELISpot results in discriminating children with latent (n = 21) and overt (n = 25) tuberculosis.

<p>Area under the ROC curve was 0.700 (95%IC: 0.547-0.853; p = 0.021 <i>vs.</i> the identity - diagonal - line) considering IFN-γ ELISpot and 0,896 (95%IC: 0.785–1.008; p<0.0001 <i>vs.</i> the identity - diagonal - line) for IL-2 ELISPOT.</p