Ital J Pediatr [JOURNAL]
Sun
200 papers
Causal inference between neurodevelopmental disorders and brain structure among individuals with congenital heart disease: Insights from meta-analysis and Mendelian randomization.
An J, Du X, Ye M … +4 more , Bai Z, Yang F, Yu D, Mo X
Ital J Pediatr · 2026 Mar · PMID 41882777 · Full text
BACKGROUND: To systematically review and meta-analyze the evidence on neurodevelopmental outcomes from infancy to adolescence among patients with congenital heart disease (CHD) and to explore the causal relationships amo...
BACKGROUND: To systematically review and meta-analyze the evidence on neurodevelopmental outcomes from infancy to adolescence among patients with congenital heart disease (CHD) and to explore the causal relationships among CHD, neurodevelopmental (ND) and brain structure. METHODS: The PubMed, Embase, and Web of Science databases were searched for relevant studies. Genetic variants from genome-wide association studies (GWASs) were used to elucidate the causal relationships between CHD, ND, and brain structure. RESULTS: A total of 5824 studies were initially retrieved; ultimately, 23 studies were included (2069 CHD cases). Nine studies used the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) to assess language, motor and cognitive skills; 10 studies used the Wechsler Intelligence Scale (WIS) to assess the intelligence quotient (IQ); 3 studies used the Social Reactive Score (SRS) to assess social communication; and 1 study used both the SRS and the WIS. We found that the CHD group had worse language (mean 94.40, 95% CI 92.98–95.81) and motor (mean 95.35, 95% CI 92.11–98.59) skills during infancy as well as lower IQ (mean 95.94, 95% CI 93.59 ~ 98.29) and worse social communication abilities (mean 53.82, 95% CI 51.75–55.90) in the preschool and adolescence periods than did the age-matched healthy group. There were no significant genetic associations between CHD, ND and brain structure. We observed causal links between brain structure and both cognitive function and behavioral functions. CONCLUSION: ND delay is common among non-genetic CHD patients from infancy to young adulthood.
Bridging eosinophilic esophagitis: healthcare transition from pediatric to adult patients.
Savarino EV, Giodice R, Morani M … +14 more , Bonfanti M, Fardella M, Bilò MB, De Bortoli N, Di Sabatino A, Penagini R, Rea F, Renzo S, Romano C, Sarnelli G, Spinelli I, Strisciuglio C, Vespa E, Oliva S
Ital J Pediatr · 2026 Mar · PMID 41877249 · Full text
Eosinophilic esophagitis (EoE) is a chronic and progressive type 2 immune-mediated disease resulting in esophageal dysfunction. As with other chronic conditions, therapeutic continuity is crucial to ensure patient benefi...
Eosinophilic esophagitis (EoE) is a chronic and progressive type 2 immune-mediated disease resulting in esophageal dysfunction. As with other chronic conditions, therapeutic continuity is crucial to ensure patient benefits, particularly during the transition of patients with EoE from pediatric to adult care. This investigation aimed to establish an algorithm to assist healthcare providers in optimizing the healthcare transition pathway through a multistep collaborative process that encompassed an initial analysis of the three principal currently available guidelines, the formulation of recommendations by a steering committee, and their validation through deliberation with a panel of 11 Italian EoE experts. Three essential criteria have been elucidated to define the healthcare transition pathway for pediatric patients with EoE to adulthood: readiness to transition, patient’s age, and disease control (from clinical, endoscopic, and histological perspectives). The algorithm incorporates the utilization of the STARx questionnaire as an efficacious instrument to assess patient’s readiness to transition, identifies the optimal age for this phase within the range of 14–18 years, and considers clinical, endoscopic, and histological control maintained for a minimum of 6 months. The availability of a standardized and well-defined pathway supporting healthcare professionals during the transition process of pediatric EoE patients to adulthood is associated with therapeutic continuity, enhancement of clinical outcomes, and prevention of long-term fibrostenotic complications, which may result in economic benefits for the Italian health system.
Anemia in children with congenital heart disease and its association with postoperative prognosis.
Zhou Y, Chen C, Wang J … +4 more , Zhai B, Feng R, Wang P, Yan H
Ital J Pediatr · 2026 Mar · PMID 41877191 · Full text
BACKGROUND: This study aimed to investigate the prevalence and influencing factors of preoperative anaemia in Chinese children with congenital heart disease (CHD), as well as its implications for clinical management and...
BACKGROUND: This study aimed to investigate the prevalence and influencing factors of preoperative anaemia in Chinese children with congenital heart disease (CHD), as well as its implications for clinical management and postoperative outcomes. METHODS: A cross-sectional study was performed using a pediatric CHD database from Central China. We calculated the prevalence and proportion of anaemia in different subgroups and genders. A visualization of the distribution of hemoglobin in males and females of different age groups was then plotted. Multivariate logistic regression model and forest plots were used to identify influencing factors (presenting odds ratios [OR] and 95% confidence intervals [CI]), and the relationship between preoperative anaemia and postoperative prognosis was evaluated. RESULTS: A total of 12,294 CHD patients were included, with an overall anaemia prevalence of 41.5%. The neonate was the most critical period (52.5% prevalence), and higher rates were observed in complex CHD (47.2%), low birth weight (LBW, 69.1%), and rural patients (45.3% vs. 37.1% in urban areas). Double-outlet right ventricle (DORV) was most strongly associated with anaemia. Median hemoglobin levels in both genders were below age-specific standards. Preoperative anemia was associated with adverse postoperative outcomes. CONCLUSIONS: Preoperative anaemia is highly prevalent in Chinese CHD children, particularly in high-risk subgroups. These findings emphasize the clinical necessity of early screening and targeted intervention to improve postoperative outcomes and quality of life. Future prospective longitudinal studies are warranted to comprehensively elucidate the long-term association between anaemia and CHD across the lifespan.
Development and validation of a clinical prediction model for neonatal seizures among neonates admitted to public health hospitals in Northwest Ethiopia: retrospective follow-up study.
Tsega TD, Yeshiwas AG, Ayele WM … +22 more , Ayalew CA, Kassa AA, Temesgen A, Bayeh GM, Yenew C, Yemata GA, Shimels T, Anteneh RM, Yirdaw G, Mekonen H, Mekonnen BA, Alemayehu MA, Tsega SS, Yigzaw ZA, Ejigu AG, Addis WD, Malkamu B, Teym A, Sharew KE, Alene T, Adane D, Ahmed AF
Ital J Pediatr · 2026 Mar · PMID 41872934 · Full text
BACKGROUND: Neonatal seizures are sudden, abnormal brain activities that occur during the neonatal period, are the most common neurological emergencies in newborns, and are associated with high morbidity and mortality ra...
BACKGROUND: Neonatal seizures are sudden, abnormal brain activities that occur during the neonatal period, are the most common neurological emergencies in newborns, and are associated with high morbidity and mortality rates. Approximately 2–20% of neonates admitted to neonatal intensive care units (NICUs) worldwide experience neonatal seizures. Although established guidelines for managing neonatal seizures are available, no risk prediction models exist to help the clinical decision-making process; thus, the practices remain inconsistent across local facilities and resources. This study aims to develop and validate a neonatal risk prediction model for seizures among neonates admitted to NICUs at comprehensive specialized hospitals in Northwest Ethiopia. METHODS: A retrospective follow-up study was conducted among 907 neonates admitted to the NICU in comprehensive specialized hospitals in Northwest Ethiopia. A systematic random sampling technique was employed to select the neonates’ records. Predictors for multivariable binary logistic regression analysis were selected via penalized LASSO for the variable selection method. A risk prediction nomogram was constructed from the simplified model. The discriminatory, prediction and calibration power of the risk prediction model was evaluated. Using the Youden index-identified cutoff point criterion, the level of risk of neonates for seizures was determined. Finally, decision curve analysis was performed to assess its clinical utility. For analysis purposes, Stata 17 and R.4.4.0 were used. RESULTS: The incidence of neonatal seizures among neonates admitted to the NICU was 21.39% (95% CI: 18.83, 24.18%). The neonatal risk prediction nomogram was constructed using preterm birth, subgaleal hemorrhage, perinatal asphyxia, maternal history of seizure, hypoglycemia, and phototherapy as independent predictors. The internally validated discriminatory power of the model was 77.735% (95% CI: 73.912%, 81.634%), with a calibration plot test value of 0.056. The optimism coefficient of the simplified model was 0.0197. Decision curve analysis revealed a greater net benefit of the model in clinical practice than the “treat all” or “treat none” strategies did. CONCLUSIONS: The incidence of neonatal seizures among neonates admitted to the NICU was relatively high. The predictive power of the constructed nomogram was good. Despite some limitations, the model offers superior net clinical benefit compared with the “treat all” or “treat none” strategies; however, further external validation is recommended for its wider application.
Analysis of cerebral hemodynamics in neonates receiving extracorporeal membrane oxygenation support.
Liu JF, Zeng YT, Liu YN … +4 more , Gao ZY, Cai H, Zheng YR, Chen Q
Ital J Pediatr · 2026 Mar · PMID 41872873 · Full text
BACKGROUND: Cerebral hemodynamic disturbances are common in neonates receiving extracorporeal membrane oxygenation (ECMO), yet systematic data describing changes in cerebral hemodynamics during ECMO support remain limite...
BACKGROUND: Cerebral hemodynamic disturbances are common in neonates receiving extracorporeal membrane oxygenation (ECMO), yet systematic data describing changes in cerebral hemodynamics during ECMO support remain limited. This study was conducted to evaluate the changes in cerebral hemodynamics in neonates undergoing ECMO support. METHODS: This single-center retrospective study included 32 neonates who received ECMO from July 2021 to December 2023 as the ECMO group. Relevant clinical data were collected, including cranial ultrasound examinations before and during ECMO support. Cranial ultrasound data from normal neonates matched for age and sex with the ECMO group were collected as a normal group. RESULTS: A total of 32 neonates received ECMO support, among whom 12 (37.5%) developed cerebrovascular complications. After ECMO initiation, the peak systolic velocity (PSV) of the anterior cerebral artery (ACA) increased from 27.8 ± 5.2 cm/s to 43.9 ± 7.5 cm/s, the mean velocity (MV) increased from 15.8 ± 3.6 cm/s to 27.6 ± 3.2 cm/s, and the end-diastolic velocity (EDV) increased from 9.9 ± 3.1 cm/s to 19.6 ± 2.9 cm/s, with all changes reaching statistical significance (P < 0.05). These parameters remained relatively stable during ECMO support but were still lower than the corresponding values observed in the normal control group. CONCLUSIONS: Cranial ultrasound can serve as an effective tool for assessing cerebral hemodynamics in neonates during ECMO support. Although ECMO significantly improves cerebral perfusion in these patients, their cerebral blood flow velocities during support remain lower than the normal ranges typically observed in healthy neonates.
Validation of the Italian version of the Short Mood and Feelings Questionnaire (SMFQ) in a sample of adolescents.
Almerico L, Pezzella A, Bravaccio C … +4 more , Iuliano R, Catone G, Pisano S, Senese VP
Ital J Pediatr · 2026 Mar · PMID 41865016 · Full text
BACKGROUND: Depression is a prevalent and often persistent mental disorder, with onset frequently occurring during adolescence and associated with serious long-term consequences. Consequently, the availability of valid,...
BACKGROUND: Depression is a prevalent and often persistent mental disorder, with onset frequently occurring during adolescence and associated with serious long-term consequences. Consequently, the availability of valid, age-appropriate, and easily administered screening instruments is essential. The Short Mood and Feelings Questionnaire (SMFQ) is a widely used tool, available in multiple languages, for the screening of depressive symptoms in young people. Although an Italian version of the SMFQ has already been used in previous studies, it has not yet undergone formal validation. The present study aimed to evaluate the psychometric properties of the Italian SMFQ, assess measurement invariance (MI) across sex and age, and provide preliminary normative data. METHODS: A sample of 580 adolescents (317 males, 263 females), aged 14-20 years, completed the Italian SMFQ along with additional instruments to assess validity: the Personality Assessment Questionnaire and the Strengths and Difficulties Questionnaire for convergent validity, and the Weinstein's Noise Sensitivity Scale for divergent validity. Analyses focused on dimensionality, measurement invariance, reliability, and validity. RESULTS: As regards dimensionality, both one- and two-factor models showed adequate fit, with the two-factor model showing better fit. MI analyses supported full invariance across age for the 13-item version and partial invariance across sex. The 12-item version (excluding item 6) achieved full invariance across both sex and age. The scale showed good internal consistency and good convergent and divergent validity. Finally, given the significant effects of sex and age, normative data were computed as a function of both factors. CONCLUSIONS: The Italian SMFQ demonstrated excellent psychometric properties for assessing depressive symptoms in adolescents. However, its use for clinical diagnostic purposes requires further validation through clinical studies.
Retrospective study: clinical analysis of Kawasaki disease complicated with macrophage activation syndrome.
Bie W, Guan Y, Du Q … +2 more , Li L, Yu P
Ital J Pediatr · 2026 Mar · PMID 41864993 · Full text
BACKGROUND: Kawasaki disease complicated with macrophage activation syndrome (KD-MAS) has the characteristics of low incidence, high rate of sequelae, and high mortality. We aims to explore early warning indicators that...
BACKGROUND: Kawasaki disease complicated with macrophage activation syndrome (KD-MAS) has the characteristics of low incidence, high rate of sequelae, and high mortality. We aims to explore early warning indicators that can be used for the diagnosis of KD-MAS, providing a reference basis for early clinical intervention. METHODS: The clinical data of 15 children with KD-MAS and 140 children with Kawasaki disease (KD) admitted to Jinan Children’s Hospital from January 2020 to March 2025 were retrospectively collected, and statistical analysis was conducted on the above data of the KD-MAS group and the KD group. RESULTS: There were no statistically significant differences between the two groups in terms of gender ratio, the proportion of incomplete Kawasaki disease, the incidence of coronary artery lesion, peripheral blood white blood cell(WBC) count, neutrophil ratio(N%), C-reactive protein(CRP), serum total bilirubin(STB) and serum potassium༈K+༉ level (P > 0.05). The age of onset in the KD-MAS group was significantly younger than that in the KD group, and the hospitalization time was longer (P < 0.05). Among the 9 KD-MAS children who completed bone marrow smear examination, 6 showed hemolysis phenomenon.The incidence of hepatosplenomegaly, organ damage, and insensitivity to intravenous immunoglobulin (IVIG) was higher in the KD-MAS group than in the KD group (P < 0.05).The levels of serum ferritin(SF), alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactate dehydrogenase(LDH) and triglyceride(TG) in the KD-MAS group were higher than those in the KD group, while the levels of hemoglobin(HB), platelet(PLT) count, serum albumin(ALB), erythrocyte sedimentation rate(ESR), fibrinogen(FIB) and serum natrium(Na+) level were lower than those in the KD group (P < 0.05).The ROC curve analysis showed that the AUC values for indicators such as hepatomegaly, no response to IVIG treatment, SF, AST, FIB, PLT count, ALT, LDH, TG, and HB were all relatively high. CONCLUSION: When children with KD show significant elevation of SF, hepatomegaly or no response to IVIG treatment, the possibility of concurrent MAS should be vigilant. Moreover, the simultaneous increase of AST, ALT, LDH and TG, along with the decrease of HB, PLT and FIB, has certain clinical significance in suggesting the occurrence of MAS.
Exploratory study of plasma GFAP and GAD65-Ab levels in children with ADHD.
Li RL, Shan YD, Lu P … +9 more , Liu TT, Yu ZF, Lv GG, Liu NN, Zhang W, Zhang JY, Gao WJ, Zhang LM, Miao HT
Ital J Pediatr · 2026 Mar · PMID 41864973 · Full text
BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children of school age. In mice with ADHD, glial fibrillary acidic protein (GFAP) levels were significantly higher...
BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children of school age. In mice with ADHD, glial fibrillary acidic protein (GFAP) levels were significantly higher, whereas glutamic acid decarboxylase 65 (GAD65) levels were lower. The goal of this study is to look at the potential function of GFAP and GAD65 antibodies (GAD65-Ab) in mice and children with ADHD by assessing GFAP and GAD65-Ab levels in the blood. METHODS: An ADHD model was established in pregnant mice with 15 mg/kg of S-ketamine administration using intraperitoneal injection for 5 days from G14 to G18. Children were enrolled if they met in ADHD Rating Scale (ARS) in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for ADHD based on clinical interviews. Venous blood was obtained from children and mice under aseptic conditions and the serum was centrifuged and preserved. Clear supernatants from mice and children were processed simultaneously in duplicate, side by side, for ELISA assay with the calibrators supplied in the GFAP and GAD65-Ab kit. RESULTS: In mice with ADHD-like behaviors, there was a strong positive connection between serum GFAP levels and open-arm times in the elevated plus maze, which corresponded with the association between serum GFAP levels and hyperactivity-impulsivity ratings (r [Spearman] = 0.496, P = 0.004). The optimal cut-off value of serum GFAP levels as an indicator for auxiliary diagnosis of ADHD was projected to be 28.8 ng/ml based on the receiver operating characteristic (ROC) curve, yielding a sensitivity of 28.6% and a specificity of 100%; the area under the curve was 0.7221 (95% CI, 0.5553–0.8889; P = 0.0214). Additionally, we discovered that in mice exhibiting ADHD-like behaviors, a reduction in context-related freezing time was connected to an increase in blood GAD65-Ab levels. With an ideal cut-off value of 9.2 ng/ml (sensitivity, 77.3%; specificity, 88.4%; Area Under the Curve (AUC), 0.7044; 95%CI, 0.5336–0.8752; P = 0.0342), there was a striking link between inattention scores and serum GAD65-Ab levels (P = 0.0336; r [Pearson] = 0.486, P = 0.048). CONCLUSION: The data support the theory that elevated blood levels of GFAP and GAD65-Ab may be involved in the pathophysiology of ADHD in children and that these levels may be correlated with the severity of ADHD in children. TRIAL REGISTRATION: Name of the registry: The study of the accuracy and specificity of glial fibrillary acid protein (GFAP) combined with glutamate decarboxylase autoantibody GAD-Ab in the diagnosis of Attention Hyperactivity Deficit Hyperactivity Disorder (ADHD). Trial registration number: ChiCTR2300068366. Date of registration: 02/16/2023. URL of trial registry record: https://www.chictr.org.cn/index.html .
Availability of diagnostic tools and stewardship protocols for managing infectious diseases in Italian paediatric emergency departments: a nationwide survey.
Denina M, Mazzetti G, Castagno E … +3 more , Zampogna S, Bondone C, SIMEUP Research Group
Ital J Pediatr · 2026 Mar · PMID 41864967 · Full text
BACKGROUND: Infectious diseases are a leading cause of Paediatric Emergency Department (PED) visits worldwide, characterised by significant clinical variability in both presentation and severity. Literature highlights th...
BACKGROUND: Infectious diseases are a leading cause of Paediatric Emergency Department (PED) visits worldwide, characterised by significant clinical variability in both presentation and severity. Literature highlights that infection biomarkers and rapid etiological tests, when integrated into standardised clinical protocols, are essential for timely diagnosis and appropriate treatment, reducing misdiagnosis and antibiotic misuse. However, these tools are not consistently available in Italian PEDs. The objective of this survey is to assess the availability of diagnostic tools and current diagnostic practices in Italian PEDs, focusing on infection biomarkers, Point-of-Care (PoC) technologies, and the presence of disease-specific antimicrobial stewardship protocols. METHODS: A cross-sectional survey, in collaboration with the Italian Society of Paediatric Emergency Medicine (SIMEUP), was conducted among clinicians working in PEDs across Italy. An online questionnaire was submitted at one referent for each centre, collecting data about each hospital activity, availability of diagnostic biomarkers, the use of PoC technologies, microbiological test reporting times, and availability of disease-specific protocols. RESULTS: Data were collected from 55 PEDs representing almost all Italian regions, with a predominance of first- and second-level centres. Venous blood sampling was the primary method for investigating febrile children (80%), while only 20% of centres used capillary sampling as the initial diagnostic method. Limited access to PoC technologies for capillary samples (blood count and C-reactive protein available in 27.3%) contributed to this preference. Except for the SARS-CoV-2 nasopharyngeal swab (85% of PEDs), other PoC microbiological tests were less frequently available, making rapid etiological diagnosis more difficult. Laboratory-based microbiological tests were widely available (blood cultures, 93%; culture testing on specific samples, 84%; nasal swabs for influenza, 84%), but they often had reporting times exceeding 48 hours, which delays clinical decisions. Only 3.6% of centres had formal antibiotic prescription and de-escalation protocols, possibly leading to variability in clinical practice and overuse of antibiotics. CONCLUSIONS: This study highlights the fragmentation of diagnostic resources and practices in Italian PEDs, particularly in first-level centres. There is a clear need to expand access to PoC technologies, reduce test reporting times, and implement standardised protocols to improve diagnostic accuracy and enhance antibiotic stewardship.
Multidisciplinary Delphi Consensus on management of children with moderate-severe atopic dermatitis.
Marseglia GL, Tosca MA, Miraglia Del Giudice M … +13 more , Belloni Fortina A, Bonamonte D, Neri I, Peroni DG, D'Avino A, Comberiati P, Filippeschi C, Manti S, Galli E, Mori F, Caffarelli C, Licari A, Ciprandi G
Ital J Pediatr · 2026 Mar · PMID 41862987 · Full text
Atopic dermatitis is a compelling challenge in daily practice. Type 2 inflammation is the most common endotype in children and adolescents with AD. As a result, anti-inflammatory drugs, mainly corticosteroids (CS) and im...
Atopic dermatitis is a compelling challenge in daily practice. Type 2 inflammation is the most common endotype in children and adolescents with AD. As a result, anti-inflammatory drugs, mainly corticosteroids (CS) and immunomodulatory agents, represent the first-line treatment to dampen type 2 inflammation. However, biologics, particularly dupilumab, dramatically changed the natural history of AD patients. A steering committee composed by expert pediatricians and dermatologists promoted a multidisciplinary Delphi Consensus to improve the knowledge about this topic. Experts in this field participated in the Consensus of three groups of statements concerning definition, diagnosis, and management. There was agreement for all proposed statements. The outcomes of the present multidisciplinary Delphi Consensus propose shared, evidence-based recommendations that may be fruitful in clinical practice.
The quality and reliability of Kawasaki disease-related short videos on TikTok and Bilibili: a cross-platform content analysis using GQS, mDISCERN, and JAMA benchmarks.
Wang Q, Jiang W, Wang J
Ital J Pediatr · 2026 Mar · PMID 41862981 · Full text
BACKGROUND: Kawasaki disease (KD) represents the leading cause of acquired heart disease in children, with timely diagnosis and treatment being crucial to prevent severe coronary complications. The widespread use of shor...
BACKGROUND: Kawasaki disease (KD) represents the leading cause of acquired heart disease in children, with timely diagnosis and treatment being crucial to prevent severe coronary complications. The widespread use of short-video platforms such as TikTok and Bilibili has made them increasingly important sources of health information for the public. However, the quality and reliability of KD-related content on these platforms remain largely unassessed. This study aimed to evaluate the educational quality and informational reliability of short videos about KD on TikTok and Bilibili, two of the most popular social media platforms in China. METHODS: We conducted a cross-sectional analysis of the top 100 videos retrieved for KD on each platform. A total of 186 videos were assessed using the Global Quality Scale (GQS), modified DISCERN (mDISCERN), and JAMA benchmark criteria. Uploaders were categorized as professionals or non-professionals. Video characteristics, engagement metrics, and content coverage were analyzed. RESULTS: Overall quality was suboptimal (median scores: GQS = 2, mDISCERN = 2, JAMA = 2). Videos from professionals scored significantly higher than those from non-professionals (p < 0.001). TikTok videos were shorter but had higher engagement and GQS scores than Bilibili videos (p < 0.001). Content coverage was skewed: clinical manifestations were discussed in > 80% of videos, while prognosis and prevention were covered in < 25%. Engagement metrics showed negligible correlation with quality scores. CONCLUSIONS: KD-related short videos on popular Chinese platforms exhibit notable quality deficiencies and content gaps. Incomplete or low-quality online information may delay caregiver recognition and timely medical evaluation, potentially increasing the risk of coronary complications in children with KD. Although professional involvement is associated with better quality, overall reliability remains limited. These findings highlight the need for improved content governance and tailored strategies for accurate health communication on social media.
The impact of sleep disorders of children with severe medical complexity on their caregivers' sleep: a perspective from two pediatric palliative care centers.
Pigani F, Burlo F, Peri F … +4 more , Bolognani M, Uez F, Barbi E, De Zen L
Ital J Pediatr · 2026 Mar · PMID 41862978 · Full text
PURPOSE: This study aimed to investigate sleep patterns in children with severe medical complexity (CMC) eligible for pediatric palliative care (PPC) and to evaluate the specific impact of these patterns on their caregiv...
PURPOSE: This study aimed to investigate sleep patterns in children with severe medical complexity (CMC) eligible for pediatric palliative care (PPC) and to evaluate the specific impact of these patterns on their caregivers’ sleep quality and quantity. METHODS: A multicenter descriptive and exploratory study was conducted across two PPC services in Italy, enrolling 15 children with high-complexity needs and 26 caregivers. Participants completed a dedicated questionnaire and a seven-day sleep diary to record data on sleep duration, nocturnal awakenings, medication use, and the caregivers’ estimated sleep loss. The relationship between the child’s sleep variables and the caregiver’s lost sleep hours was analyzed using Spearman rank-order correlation. RESULTS: Children reported a median nocturnal sleep duration of eight hours, yet 86.6% experienced nocturnal awakenings. Conversely, caregivers reported a median sleep duration of six hours, estimating a median loss of two hours of rest per night. Statistical analysis revealed no significant correlation between the child’s total sleep duration and the caregiver’s sleep loss. However, a strong, statistically significant correlation was found between the number of the child’s nocturnal awakenings and the caregiver’s hours of sleep lost. CONCLUSION: Caregivers of CMC experience significant sleep deprivation, which is primarily driven by sleep fragmentation due to the child’s need for nocturnal assistance rather than the child’s total sleep duration. Even when children achieve a normal quantity of sleep, the frequent interruptions required for care severely compromise the parents’ ability to rest, highlighting the need for targeted support interventions.
Changes in childhood vaccine hesitancy during the COVID-19 pandemic: a retrospective study based on data from Turkey.
Özmen Sever S, Aksu SB, Zeren Öztürk G
Ital J Pediatr · 2026 Mar · PMID 41857752 · Full text
BACKGROUND: Vaccine refusal is a growing public health concern, threatening herd immunity and the control of vaccine-preventable diseases. The COVID-19 pandemic has influenced healthcare delivery and vaccine refusal beha...
BACKGROUND: Vaccine refusal is a growing public health concern, threatening herd immunity and the control of vaccine-preventable diseases. The COVID-19 pandemic has influenced healthcare delivery and vaccine refusal behavior as a proxy for vaccine hesitancy. This study aimed to assess changes in childhood vaccine refusal behavior during the pandemic in Turkey. METHODS: We conducted a retrospective observational study including 2,786 children born between 2017 and 2022 who reached 24 months of age and had complete vaccination records from primary healthcare. Children were categorized as pre-pandemic or post-pandemic based on birthdate. Data on vaccine refusal type, timing, and frequency were collected. Statistical analyses included chi-square tests, with p < 0.05 considered significant. RESULTS: Overall, 3.7% (n = 102) of children had at least one vaccine refusal. Refusal rates were 3.9% before and 3.4% after the pandemic onset, with no significant difference (p = 0.474). However, the median age of first refusal shifted from 12 months pre-pandemic to 1 month post-pandemic. Vaccines given after one year (e.g., MMR, varicella, Hepatitis A) were more frequently refused pre-pandemic, whereas those scheduled in infancy were more often refused post-pandemic. Live vaccines and later doses in multi-dose schedules had the highest refusal rates. Early-onset refusals were strongly associated with multiple vaccine refusals (p < 0.01). CONCLUSION: While overall refusal rates remained stable, the timing of hesitancy shifted to earlier infancy during the pandemic. These findings emphasize the need for targeted parental education and early communication strategies to sustain vaccine coverage and prevent resurgence of vaccine-preventable diseases.
Bowel preparation for colonoscopy in children: a survey of the Italian society of pediatric gastroenterology, hepatology and nutrition.
Difrancisca E, Corsello A, Genduso M … +6 more , Antoniello LM, Cananzi M, Renzo S, De Angelis P, Cavataio F, Romano C
Ital J Pediatr · 2026 Mar · PMID 41857657 · Full text
BACKGROUND: Adequate bowel preparation is critical for the success of pediatric colonoscopy. International guidelines recommend standardized low-volume regimens, although several studies also support individualized, pati...
BACKGROUND: Adequate bowel preparation is critical for the success of pediatric colonoscopy. International guidelines recommend standardized low-volume regimens, although several studies also support individualized, patient-tailored approaches. Despite this, real-world pediatric practices remain highly heterogeneous. This national survey aimed to investigate current bowel preparation practices for pediatric colonoscopy in Italy and compare them with international recommendations. METHODS: A nationwide electronic survey was conducted among centers affiliated with the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). The questionnaire explored bowel preparation protocols, adherence to international guidelines, and the occurrence of adverse events. RESULTS: A total of 39 centers participated in the survey. Sodium picosulfate and polyethylene glycol with electrolytes were the most commonly used preparation agents, although high-volume solutions are often poorly tolerated. Only 43.6% of centers adhered to international guidelines recommending low-volume regimens, whereas 12 centers (30.8%) adopted multiple preparation strategies tailored to clinical indications and patient-specific characteristics. Preparation setting (home vs. hospital), agent selection, and use of enemas or laxatives varied significantly. Adverse events were uncommon, and most centers considered bowel preparation stressful for children. The Boston Bowel Preparation Scale was the most commonly used tool for assessing bowel cleanliness. Nearly all clinicians expressed a strong need for national pediatric guidelines. CONCLUSIONS: This survey, conducted by SIGENP, reveals substantial variability in bowel preparation practices for pediatric colonoscopy across Italian centers, reflecting a trend also observed in other countries. Our results underscore the urgency of developing and implementing pediatric bowel preparation guidelines to ensure safety, improve tolerability, and reduce heterogeneity of practice. Further research is needed to assess whether such variability may offer benefits through individualized approaches tailored to the specific needs of each child.
Functional study of peripheral blood CD8 + T cells in Epstein-Barr virus-associated infectious mononucleosis.
Cao M, Xu M, Su Y … +5 more , Xu J, Ji Z, Chen Q, Li Y, Zhou W
Ital J Pediatr · 2026 Mar · PMID 41840612 · Full text
BACKGROUND: This study aimed to explore the function and clinical significance of peripheral blood CD8 + T cells in EBV-associated infectious mononucleosis (IM). METHODS: From June 2022 to May 2024, blood samples of 48 I...
BACKGROUND: This study aimed to explore the function and clinical significance of peripheral blood CD8 + T cells in EBV-associated infectious mononucleosis (IM). METHODS: From June 2022 to May 2024, blood samples of 48 IM children and 24 healthy controls were collected. ELISA detected IFN-γ, IL-10, TGF-β1 levels, and RT-PCR measured perforin and granzyme B mRNA levels. RESULTS: results showed higher white blood cell, lymphocyte counts, etc. in the case group. Also, more CD3+, CD3 + CD8+ and NK cells, lower CD4+/CD8 + ratio were found in cases. IFN-γ, IL-10, perforin, granzyme B were higher, while TGF-β1 was lower in cases. Some negative and positive correlations were found among cytokines and cell counts. CONCLUSION: CD8 + T cells and their related cytokines IFN-γ, IL-10, TGF-β1, perforin and granzyme B are involved in the immune process of infectious mononucleosis related to EBV. CLINICAL TRIAL NUMBER: Not applicable.
Cross-cultural adaptation of the Italian version of the "Child and Youth Mental Health Instrument for Developmental Disabilities" (I-ChYMH-DD).
Sforza E, Leoni C, De Rosa E … +12 more , Bellani J, Viscogliosi G, Di Paola A, Zampino M, Fischetto R, Pane M, Rigante D, Servidei S, Primiano G, Onesimo R, Carfì A, Giuseppe Z
Ital J Pediatr · 2026 Mar · PMID 41832570 · Full text
BACKGROUND: The Child and Youth Mental Health and Developmental Disability ChYMH-DD is a psychometrically rigorous tool for care planning for children with developmental disabilities. It allows paediatricians and other h...
BACKGROUND: The Child and Youth Mental Health and Developmental Disability ChYMH-DD is a psychometrically rigorous tool for care planning for children with developmental disabilities. It allows paediatricians and other healthcare professionals to perform a comprehensive assessment of children functional status and family burden. AIM: The aim of this study was to translate, culturally adapt, and preliminarily assess the Italian version of the ChYMH-DD for use in clinical settings involving pediatric patients with developmental disabilities. METHODS: The original version of the ChYMH-DD was translated and cross-culturally adapted through five stages: (1) initial translation, (2) synthesis of the translations, (3) back translation, (4) expert committee, and (5) test of the pre-final version. RESULTS: In the present study we successfully translated and adapted the ChYMH-DD into the Italian language. Translation of the questionnaire was performed without significant difficulties. During the third stage, no gross inconsistencies and conceptual errors as compared to the original version were highlighted. CONCLUSION: The Italian version of ChYMH-DD increase access to a valid and homogeneous assessment for children of Italian-speaking families and can support clinical decision-making. The Italian ChYMH-DD has potential to improve patients’ quality of life and quality of the care received for children with developmental disabilities.
Clinical characteristics in hospitalized children with infectious mononucleosis in Shanghai China: a single-center retrospective study.
Zhao X, Wu Q, Lv J … +3 more , Xia Z, Wu M, Wu Q
Ital J Pediatr · 2026 Mar · PMID 41821049 · Full text
OBJECTIVE: To investigate clinical features and peripheral blood inflammatory markers in children with Epstein-Barr virus (EBV)-induced infectious mononucleosis (IM), analyze their correlation with disease severity, enab...
OBJECTIVE: To investigate clinical features and peripheral blood inflammatory markers in children with Epstein-Barr virus (EBV)-induced infectious mononucleosis (IM), analyze their correlation with disease severity, enable early identification of severe cases, and provide a theoretical basis for early clinical intervention. METHODS: A retrospective analysis was performed on 156 hospitalized children with EBV-related IM (January 2019-December 2024). EBV nucleic acid was detected via real-time PCR. Patients were grouped by blood EBV-DNA load (positive/negative). Demographics, clinical manifestations, laboratory findings, and liver/spleen/lymph node imaging were collected and analyzed. RESULTS: Among 156 pediatric IM patients (mean age 7 years), IM occurred predominantly in spring (28.20%) and autumn (28.21%), with children aged ≥ 7 years identified as the high-risk group. EBV-DNA positivity was higher in summer and winter. EBV-DNA positivity correlated with disease severity, as evidenced by longer hospitalization (9 vs. 7 days, P = 0.038), elevated inflammatory markers (LDH, ALT, AST), coagulation abnormalities (D-dimer; P < 0.05), and altered immune profiles (elevated CD3+CD8+ T cells and reduced NK cells; P < 0.05). Receiver operating characteristic (ROC) analysis identified CD3+ T cells (AUC = 0.664) and D-dimer (AUC = 0.692) as primary predictors biomarkers for IM, with CD8+ T cells, LDH, and ALT as supportive biomarkers. Biomarker combination boosted predictive accuracy (AUC = 0.713, 72.1% sensitivity, 62% specificity), demonstrating key synergistic diagnostic value in EBV pathogenesis. CONCLUSION: EBV infection is prevalent among school-aged children in Shanghai, causing significant cellular and humoral immune dysfunction. Longitudinal monitoring of immunological parameters is crucial. EBV-DNA load is a valuable prognostic biomarker for severe IM; elevated inflammatory markers and immune dysregulation in EBV-DNA-positive children are critical for severity assessment.
Impact of Nirsevimab on bronchiolities in pediatric primary care in Lazio Region: an observational study.
Petrone D, Sani I, De Vittori V … +4 more , Brenna S, Rotili PL, Fonte MT, Scientific Committee of the Italian Pediatrician Federation (FIMP), Rome, Italy
Ital J Pediatr · 2026 Mar · PMID 41820965 · Full text
BACKGROUND: Bronchiolitis is the leading cause of lower respiratory tract infections in infants, with respiratory syncytial virus (RSV) as the primary pathogen. Nirsevimab, a long-acting monoclonal antibody, was introduc...
BACKGROUND: Bronchiolitis is the leading cause of lower respiratory tract infections in infants, with respiratory syncytial virus (RSV) as the primary pathogen. Nirsevimab, a long-acting monoclonal antibody, was introduced in Europe in late 2022 for RSV prophylaxis in all infants. In Italy, the 2024–2025 immunization campaign faced regional disparities in implementation. This study aimed to evaluate the impact of Nirsevimab in reducing bronchiolitis diagnoses and hospitalizations in infants during their first RSV season in the Lazio Region. METHODS: We conducted a retrospective cohort study using data from 29 primary care pediatricians in Lazio. Infants born between August 17, 2024, and March 31, 2025, were included. Bronchiolitis diagnoses were clinically defined, and immunization status was obtained from the regional vaccination registry. We excluded premature infants (< 33 weeks) and those diagnosed before the immunization campaign began on December 9, 2024. To adjust for confounding, we applied inverse probability weighting (IPW) based on a propensity score including demographic and clinical covariates. A negative binomial mixed-effects model was used to estimate incidence rate ratios (IRRs) for bronchiolitis and hospitalizations. RESULTS: Among 818 eligible infants, 613 (74.9%) were immunized. A total of 58 bronchiolitis cases were recorded (7.1%), with 6.5% in the immunized group and 8.8% in the non-immunized group. Crude analysis showed a 25.7% risk reduction, while IPW-adjusted analysis indicated a 50.4% reduction (95% CI: 44.4%–55.7%). Hospitalizations occurred in 2.0% of infants, with adjusted analysis showing a 49.1% reduction in hospitalization risk among immunized infants. The immunization campaign’s late start likely limited its full impact, as 40 early-season cases were excluded. CONCLUSIONS: Nirsevimab immunization significantly reduced the risk of bronchiolitis and related hospitalizations in a real-world primary care setting. This result aligns with previous studies, though it may be underestimated due to the delayed campaign start and inclusion of all-cause bronchiolitis. These findings support early and widespread implementation of Nirsevimab to optimize protection and reduce RSV burden in infants.
Neuropsychological profile and clinical benefits of multimodal interventions in a child with ADHD, Generalized Anxiety Disorder, and Social (Pragmatic) Communication Disorder within the context of intellectual giftedness: a case report.
Battisti A, Varuzza C, Brunozzi G … +4 more , Lazzaro G, De Rossi P, Vicari S, Menghini D
Ital J Pediatr · 2026 Mar · PMID 41814369 · Full text
BACKGROUND: In recent years, particular interest has been directed toward the topic of intellectual giftedness. An IQ above 130, typically assessed with standardized cognitive scales, is a widely recognized criterion for...
BACKGROUND: In recent years, particular interest has been directed toward the topic of intellectual giftedness. An IQ above 130, typically assessed with standardized cognitive scales, is a widely recognized criterion for giftedness. Gifted children often face emotional and socio-relational difficulties, particularly anxiety, due to perfectionism and high-performance pressures. Co-occurring neurodevelopmental disorders like Attention-Deficit/Hyperactivity Disorder (ADHD) and Social (Pragmatic) Communication Disorder complicate their adaptation in various life contexts. This is the case of twice-exceptional children, who are those presenting intellectual giftedness alongside one or more disorders. ADHD, characterized by inattention, hyperactivity, and impulsivity, poses significant academic and social challenges, making accurate diagnosis and appropriate treatment in gifted individuals crucial. Similarly, Social (Pragmatic) Communication Disorder induces significant relational difficulties with peers, with potential deeply negative consequences for children’s psychological well-being. A thorough neuropsychological and emotional-behavioural assessment, along with personalized and holistic therapeutic approaches, are essential for optimal adaptation in all life contexts for twice-exceptional children. CASE PRESENTATION: The present study aimed to thoroughly characterize the neuropsychological and psychopathological profile of a gifted child to gain a deeper understanding of his overall well-being and to identify the need for a personalized intervention plan. Specifically, this case report describes a 7-year-and-8-month-old boy assessed due to attention difficulties, anxiety, socio-relational challenges, and behavioural concerns. The child underwent extensive neuropsychological and psychopathological evaluations. The study details his medical history, diagnostic formulation, pharmacological and behavioural interventions, and a six-month follow-up to monitor clinical progresses. Applied interventions demonstrated efficacy in addressing ADHD symptoms and various emotional-behavioural aspects. The positive progression of ADHD symptoms across various life contexts demonstrated the effectiveness of the proposed treatments and highlighted the appropriateness of the educational and environmental adjustments implemented within the school setting. In contrast, socio-relational difficulties have shown limited response to treatments and will require more targeted approaches. CONCLUSIONS: The study underscores the importance of early and targeted interventions for twice-exceptional children to mitigate adverse outcomes. Emphasizing multidisciplinary interventions that engage diverse stakeholders across various contexts, our findings highlight the necessity of tailored approaches to ensure appropriate development and psychological well-being for gifted children with associated clinical conditions.
Oxidative stress-related genes in Kawasaki disease: a multi-omics Mendelian randomization study.
Sun J, Dong N, Qi D … +2 more , Wang M, Zhao Q
Ital J Pediatr · 2026 Mar · PMID 41803955 · Full text
BACKGROUND: Kawasaki disease (KD) is a vasculitis of unknown etiology. Oxidative stress is hypothesized to play a key role in KD pathogenesis. However, the specific genes and mechanisms underlying this association remain...
BACKGROUND: Kawasaki disease (KD) is a vasculitis of unknown etiology. Oxidative stress is hypothesized to play a key role in KD pathogenesis. However, the specific genes and mechanisms underlying this association remain unclear. METHODS: In this study, we employed a two-step strategy combining SMR screening and differential expression gene (DEG) validation to identify oxidative stress-related genes associated with KD. First, we used the Mendelian randomization approach (SMR) to assess causal associations between genes and KD, integrating data from genome-wide association studies (GWAS), blood methylation quantitative trait loci (mQTLs), expression QTLs (eQTLs), and proteomic QTLs (pQTLs) obtained from public databases. Subsequently, we validated the candidate genes through DEG analysis in two independent KD patient cohorts (GSE68004 and GSE100154). RESULTS: Integrated analysis identified SLC9A1 and RPS6KA1 as candidate risk loci. Genetically predicted upregulation of SLC9A1 expression (OR = 7.25, P = 0.02) and RPS6KA1 protein abundance (OR = 2.82, P = 0.01) was causally associated with increased KD risk. These findings were validated in clinical cohorts, where both genes were consistently upregulated in KD patients across GSE68004 and GSE100154 (all P < 0.05), aligning with SMR predictions. Additionally, APRT emerged as a multi-omics candidate, demonstrating consistent causal evidence across mQTL, eQTL, and pQTL layers, supported by downregulation in the GSE68004 cohort. CONCLUSIONS: This study highlights prioritized SLC9A1 and RPS6KA1 as potential causal drivers of KD, and highlighted APRT as a potential multi-layer regulatory target. These findings provide genetic evidence linking oxidative stress pathways to KD pathogenesis, offering novel targets for therapeutic intervention. CLINICAL TRIAL NUMBER: Not applicable.
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