Ital J Pediatr [JOURNAL]
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200 papers
Past diseases history: an important predictor of persistent learning disability in US children.
Mao S, Wu L
Ital J Pediatr · 2026 Mar · PMID 41794747 · Full text
OBJECTIVE: We aimed to analyse the role of past diseases history (PDH), including developmental delay (DD), autism, intellectual disability (ID), attention deficit disorder (ADD) / attention-deficit/hyperactivity disorde...
OBJECTIVE: We aimed to analyse the role of past diseases history (PDH), including developmental delay (DD), autism, intellectual disability (ID), attention deficit disorder (ADD) / attention-deficit/hyperactivity disorder (ADHD) and asthma in persistent learning disability (PLD) risk in children. METHODS: 1952 children were recruited from the US National Health Interview Survey (NHIS) from 2019 to 2023 according to a predefined criteria. Logistic regression analysis was performed to detect the association between PDH and PLD risk. Threshold effect analysis was used to detect the threshold age point. Interaction and Joint effects analyses between age/sex and PDH with PLD risk was conducted. Receiver operating curve (ROC) analysis was used to investigate the single and incremental predictive value of PDH on PLD risk. Population attributable fraction (PAF) of PDH in PLD risk was computed. Sensitivity analyses were performed by sub-age/sex group analyses, repeated analyses after propensity score matching (PSM), and E-values to assess the potential impact of unmeasured confounders. RESULTS: History of DD, autism, ID, ADD/ADHD, and asthma were all significantly associated with increased PLD risk. ID history resulted in 13.25 more times of PLD risk. Increase of PDH numbers led to an elevating trend of PLD risk. Age over 8 years showed 6% decreasing trend of PLD risk (odds ratio (OR):0.94, 95% confidence interval (CI): 0.89–0.99), while age over 12 years showed a lower PLD risk (OR < 1). 3 past diseases and 2–11 years old group had 10.78 more times PLD risk (OR: 11.78, 95% CI: 3.50, 39.68) compared with that in 2–11 years old children without PDH. 2 past diseases and female group had 2.24 more times PLD risk (OR: 3.24, 95% CI: 1.61, 6.50) compared with that in female without PDH. 2–11 years old and female showed a stronger joint effect with past diseases numbers for predicting PLD. PDH numbers had a good discriminatory power for predicting PLD risk. Combined five past diseases history accounted for over 10% of PAF for PLD risk. ID and ADD/ADHD, and autism and asthma history were the top contributors to PLD risk in female and male, respectively. Sensitivity analyses yielded similar results. CONCLUSIONS: PDH showed good prediction, discriminatory power and certain contribution to PLD risk, while lower than 12 years old, female, and increased PDH numbers may be indicators of PLD susceptibility. Early warning of PDH may be needed in specific populations with learning disability (LD).
Negative pressure wound therapy (NPWT) in the open abdomen in a preterm newborn with necrotizing enterocolitis: case report.
Paradiso FV, Silvaroli S, Nanni L
Ital J Pediatr · 2026 Mar · PMID 41787431 · Full text
BACKGROUND: Necrotizing enterocolitis (NEC) totalis is a devastating intestinal disease that affects ~ 5% of preterm neonates; its appropriate surgical management is still controversial. Although the temporary open abdom...
BACKGROUND: Necrotizing enterocolitis (NEC) totalis is a devastating intestinal disease that affects ~ 5% of preterm neonates; its appropriate surgical management is still controversial. Although the temporary open abdomen associated with negative pressure wound therapy (NPWT) has become an increasingly used therapeutic option, its use is still relatively limited in premature babies with NEC. CASE REPORT: On the 6th day of life a male preterm neonate born at 32 + 3 weeks of gestational age (1570 g) developed bowel perforation. He underwent a bed-side laparotomy and a NEC totalis was found with three intestinal perforations (one jejunal and two contiguous ileal perforations). In order to re-esplore the baby, an open abdomen NPWT was applied (Suprasorb CNP P3-Lohmann-Rauscher), with an intrabdominal drainage film, setting the pressure at -20 mmHg. After 72 h a second surgery was performed. The entire bowel showed a good trophism; no new perforations were found. The two ileal perforations were closed with running sutures and a jejunostomy was performed. The postoperative course was uneventful and the oral feeding started on the fifth postoperative day. Two months later a barium enema through the mucous fistula showed a normal intestinal progression of the contrast medium, and the jejunostomy was closed. CONCLUSION: The temporary open abdomen associated with NPWT is a valuable resource in critical premature neonates; it allows the creation of a “artificial third space” which is crucial in lowering bowel edema and intrabdominal pressure. Moreover, the use of an intrabdominal film may represent a new perspective whose effectiveness needs further studies.
Risk factors for mortality in children with pertussis and hyperleukocytosis undergoing exchange transfusion: a single-center retrospective cohort study.
Wu X, Yang R, Xu H … +2 more , Zhao R, Gan C
Ital J Pediatr · 2026 Mar · PMID 41782062 · Full text
BACKGROUND: Pertussis-related hyperleukocytosis is a major driver of pediatric mortality. While exchange transfusion (ET) improves survival, predictors of death in ET-treated children remain poorly defined. We sought to...
BACKGROUND: Pertussis-related hyperleukocytosis is a major driver of pediatric mortality. While exchange transfusion (ET) improves survival, predictors of death in ET-treated children remain poorly defined. We sought to identify independent predictors of death to refine treatment strategies. METHODS: A single-center retrospective cohort study analysis of 44 children with pertussis-related hyperleukocytosis treated with ET was conducted. Patients were stratified into survival (n = 27) and mortality (n = 17) groups. Univariate comparisons of clinical, laboratory, and ET-related parameters were performed. Multivariate logistic regression identified independent mortality risk factors. RESULTS: The mortality group exhibited a younger median age at onset (55 vs. 103 days, p = 0.006), higher peak white blood cell (WBC) count (82.19 ± 21.95 vs. 68.10 ± 18.78 × 10⁹/L, p = 0.023), and greater incidence of pre-ET cardiovascular failure (94.1% vs. 22.2%, p < 0.001). In multivariable analysis using Firth's penalized logistic regression, pre-ET cardiovascular failure (OR 53.69, 95% CI 3.63-795.10), higher peak WBC count (OR 1.09 per 1 × 10⁹/L increase, 95% CI 1.02-1.17), and younger age at onset (OR 0.97 per day increase, 95% CI 0.95-0.99) showed significant associations with mortality. CONCLUSION: Younger age at onset, marked leukocytosis, and pre-ET cardiovascular failure were associated with increased mortality in children with pertussis complicated by hyperleukocytosis. These factors may help identify patients at higher risk and highlight the importance of early recognition, close monitoring, and timely supportive management. Further prospective studies with larger sample sizes are warranted to validate these findings and to inform optimized management strategies in this vulnerable population.
Amplitude-integrated electroencephalography for early diagnosis and severity assessment of neonatal intracranial hemorrhage: a multicenter retrospective study.
Liang Y, Xiang R, Zhong Y … +3 more , Zhou J, Lu W, Pan S
Ital J Pediatr · 2026 Mar · PMID 41772641 · Full text
BACKGROUND: Neonatal intracranial hemorrhage (ICH) poses substantial neurodevelopmental risks; however, existing neuroimaging modalities (ultrasound, CT, MRI) are limited by accessibility and safety concerns. This study...
BACKGROUND: Neonatal intracranial hemorrhage (ICH) poses substantial neurodevelopmental risks; however, existing neuroimaging modalities (ultrasound, CT, MRI) are limited by accessibility and safety concerns. This study aimed to evaluate the predictive value of amplitude-integrated electroencephalography (aEEG) parameters for the early diagnosis and severity assessment of neonatal ICH. METHODS: In this multicenter retrospective study, 383 neonates (253 with ICH, 130 without ICH) admitted between 2018 and 2023 were analyzed. aEEG parameters, including cerebral function monitoring (CFM) scores, amplitude limits, and sleep-wake cycling, were compared between ICH and non-ICH groups. ICH severity was classified according to the Papile criteria. Multivariable logistic regression identified independent predictors, and receiver operating characteristic (ROC) curves were used to assess diagnostic performance. RESULTS: CFM scores and lower margin of amplitude (LMA) were significantly reduced in neonates with ICH compared to controls, in both preterm and term subgroups (all P < 0.001). Multivariable logistic regression identified CFM score (OR = 0.38, 95% CI: 0.21–0.68, P = 0.001) and lower limit of amplitude (OR = 0.01, 95% CI: 0.00–0.10, P < 0.001) as protective factors against ICH, while higher LMA was associated with increased risk (OR = 11.56, 95% CI: 3.09–43.20, P < 0.001). The diagnostic model demonstrated good discriminative ability, with an area under the ROC curve (AUC) of 0.849 (95% CI: 0.819–0.879). Furthermore, lower CFM scores and LMA values correlated significantly with increasing ICH severity in term neonates (P < 0.05). CONCLUSION: aEEG parameters, particularly CFM scores and LMA, serve as reliable indicators for the early diagnosis and severity assessment of neonatal ICH. As a non-invasive bedside tool, aEEG may complement traditional neuroimaging, facilitating earlier intervention and potentially improving neurodevelopmental outcomes.
Dual rare genetic variants: case report of a child with SBIDDS syndrome and citrullinemia type 1.
Boeri S, Siri L, Martinez Popple M … +4 more , Capra V, Romano F, Fedi C, Nobili L
Ital J Pediatr · 2026 Feb · PMID 41761260 · Full text
BACKGROUND: The arginine methyltransferase 7 (PRMT7) gene plays a role in signal transduction and protein interactions and negatively regulates neuronal differentiation. Pathogenic variants of PRMT7 cause SBIDDS syndrome...
BACKGROUND: The arginine methyltransferase 7 (PRMT7) gene plays a role in signal transduction and protein interactions and negatively regulates neuronal differentiation. Pathogenic variants of PRMT7 cause SBIDDS syndrome (Short stature, brachydactyly, intellectual developmental disability, and seizures). PRMT7 has been shown to interact with the argininosuccinate synthetase (ASS1) gene; biallelic pathogenic variants of ASS1 are associated with citrullinemia type 1. We report a patient with biallelic variants for SBIDDS syndrome and citrullinemia type 1. CASE PRESENTATION: The child exhibits severe intellectual disability, microcephaly, dysmorphisms, and seizures, consistent with the characteristics of these conditions. Exome sequencing identified variants c.1575 +1 G > A and c.232 dupT;p.Leu78Phefs*24 (NM_019023) in compound heterozygosity in the PRMT7 gene and variants c.1168G > A;p.Gly390Arg and c.-5-10C > G in exon 3 of the ASS1 gene (previously also identified in neonatal metabolic screening). The patient also has Wolf-Parkinson-White syndrome (WPW), behavioral issues, and brain morphological abnormalities, features that are poorly described in prior studies. CONCLUSIONS: It is not yet clear whether the clinical severity observed in this patient could also be partially due to interactions between these variants, as such interactions are not well-documented in the literature. Further research is necessary to elucidate the interplay between these two genes.
A retrospective, single-center analysis of clinical features and mortality risk factors in pediatric pertussis patients with severe pneumonia and encephalopathy complications in Southwest China.
Li Y, Wu Q, Tan L … +2 more , Liu C, Chi X
Ital J Pediatr · 2026 Feb · PMID 41749225 · Full text
BACKGROUND AND OBJECTIVE: Pertussis remains a serious threat to infants and young children, especially when complicated by pneumonia or encephalopathy. This study aimed to describe the clinical features, complications, t...
BACKGROUND AND OBJECTIVE: Pertussis remains a serious threat to infants and young children, especially when complicated by pneumonia or encephalopathy. This study aimed to describe the clinical features, complications, treatments, and mortality risk factors in children with pediatric pertussis patients with severe pneumonia and/or encephalopathy complications over ten years in Southwest China. METHODS: A retrospective study was conducted on hospitalized children with pediatric pertussis patients with severe pneumonia and/or encephalopathy complications at the Children’s Hospital of Chongqing Medical University from 2015 to 2024. Clinical data were analyzed across groups with different complications. Mortality risk factors were identified using univariate and multivariate analyses. RESULTS: A total of 1,088 cases were included. Patients were grouped into severe pneumonia without encephalopathy(Group A); encephalopathy without severe pneumonia (Group B); both severe pneumonia and encephalopathy (Group C). Those with both severe pneumonia and encephalopathy (Group C). had more apnea, pulmonary hypertension, extreme leukocytosis, thrombocytosis, and Acinetobacter baumannii infection. They required more intensive treatments (P < 0.05), had longer hospital stays, and the highest mortality. Seizures were more frequent in the encephalopathy group (Group B), while elevated lactate and immunoglobulin use were less common (P < 0.05). Univariate analysis identified several factors significantly associated with mortality, including female sex, pulmonary hypertension, elevated lactic acid levels, lymphocytosis, leukocytosis, Complications of severe pneumonia, combined severe pneumonia with encephalopathy. Multivariate analysis identified pulmonary hypertension, and White blood cell count(≥30 × 10⁹/L) as independent death risk factors. CONCLUSION: Pediatric pertussis patients with severe pneumonia and/or encephalopathy complications in children is often complicated by pneumonia and/or encephalopathy, making treatment more difficult. Rising antibiotic resistance and strain differences in Bordetella pertussis may reduce treatment effectiveness. The increase in severe cases after the pandemic may be due to lower population immunity. Promoting maternal pertussis vaccination in China is urgently needed as a preventive measure.
Impact of cerebral oxygenation-guided resuscitation during immediate postnatal transition on brain injury and brain growth detected by MRI in very preterm neonates: a secondary outcome analysis of the multicenter randomized phase 3 clinical COSGOD III trial.
Hammerl M, Schreiner C, Griesmaier E … +11 more , Kiechl-Kohlendorfer U, Pfurtscheller D, Avian A, Tschauner S, Goeral K, Buchmayer J, Lista G, Stucchi I, Bua J, Neubauer V, Pichler G
Ital J Pediatr · 2026 Feb · PMID 41736052 · Full text
BACKGROUND: The prospective, randomized-controlled multicenter COSGOD III trial was designed to investigate whether interventions guided by cerebral oxygen saturation (crSO2) measured with near-infrared spectroscopy (NIR...
BACKGROUND: The prospective, randomized-controlled multicenter COSGOD III trial was designed to investigate whether interventions guided by cerebral oxygen saturation (crSO2) measured with near-infrared spectroscopy (NIRS group) during the immediate postnatal transition increase survival without cerebral injury of very preterm infants compared with standard care alone (control group). The aim of this secondary outcome study was to compare brain injury and brain growth between the two groups, as assessed by magnetic resonance imaging (MRI) at near-term age. METHODS: Patients from five centers participating in the COSGOD III trial, which performed near-term MRI, were evaluated for the presence of brain injury (intraventricular hemorrhage, cerebellar hemorrhage, white matter injury) and brain growth (transcerebellar/biparietal diameter, interhemispheric distance). RESULTS: This study included 172 infants (86 per group) with a median gestational age of 28.4 weeks and a median birth weight of 1045 grams. The incidence of brain injury did not differ between the groups. Infants in the NIRS group exhibited a significantly larger median biparietal diameter (median [IQR] 78.6 [76.3–82.1] mm) compared to the control group (76.7 [74.7–80.0] mm). A trend toward a lower rate of abnormal biparietal diameter was observed in the NIRS group. CONCLUSIONS: Monitoring of crSO2 with dedicated treatment guidelines during the immediate postnatal transition had no effect on the incidence of brain injury assessed by MRI. The significantly larger biparietal diameter in the NIRS group may be indicative of enhanced brain development. The relationship between this structural advance in the NIRS group and long-term functional outcomes requires further investigation.
The use of detergents, moisturizers and the experience with therapeutic education among Italian pediatric patients with atopic dermatitis.
Giovannini M, Pertile R, Pucci A … +17 more , Simonetti G, Geat D, Novembre E, Pace M, Ricci G, Barni S, Mori F, Tomei L, Filippeschi C, Oranges T, Pedaci F, Tronconi G, Peroni D, Galli E, Neri I, Giannetti A, Baldo E
Ital J Pediatr · 2026 Feb · PMID 41731580 · Full text
BACKGROUND: Daily skin care using appropriate detergents and moisturizers is essential in the management of pediatric atopic dermatitis (AD). Despite guideline recommendations, real-life adherence and caregiver practices...
BACKGROUND: Daily skin care using appropriate detergents and moisturizers is essential in the management of pediatric atopic dermatitis (AD). Despite guideline recommendations, real-life adherence and caregiver practices vary widely. Therapeutic education is considered a key tool to improve awareness and optimize disease management. The aim of this study is to evaluate the use of detergents, moisturizers, and the experience with therapeutic education among a large cohort of Italian children with AD. METHODS: An observational multicenter study was conducted on 529 pediatric patients aged ≤ 18 year with a physician-confirmed diagnosis of AD, who were evaluated between June 2020 and December 2021 across seven specialized centers in Italy. Clinical and demographic data was collected through physician interviews. Patients’ skin care routines, including cleansing practices and moisturizer use, were analyzed alongside reported therapeutic education experiences. Categorical variables were analyzed using the chi-squared test or Fisher’s exact test; continuous variables were compared using Student’s t-test or the Wilcoxon-Mann-Whitney test, depending on distribution. Normality was assessed with the Kolmogorov-Smirnov test. Statistical significance was set at p-value ≤ 0.05. RESULTS: Overall, 73.9% of patients used lukewarm water for bathing and 74.4% dried their skin by tamponing. Specific detergents were used by 56.0% of participants, most commonly during both flare-ups and remission. A moderate correlation was found between detergent use (ml/week) and body surface area (BSA) (r = 0.300, p-value < 0.0001). Specific moisturizers were used by 65.4% of patients; 73.0% applied them in both acute and remission phases, mainly after bathing. No significant correlation was found between moisturizer volume and BSA (r = 0.087, p-value = 0.085). Therapeutic education was received by 69.0% of families, mainly through physician counseling. Educational exposure was significantly associated with better adherence to recommended practices, including higher usage of specific detergents and moisturizers, more appropriate bathing techniques, and broader product application. Families who received physician-led education also reported significantly greater confidence (p-value < 0.0001) and satisfaction (p-value = 0.007) in managing AD care. CONCLUSIONS: This study highlights significant variability in general washing and moisturizing practices among Italian pediatric AD patients and underlines the potential key role of therapeutic education in improving adherence to skin care, along with greater caregiver confidence and satisfaction. These findings support the implementation of structured, multidisciplinary educational programs to enhance disease management and patient outcomes.
Clinical and biochemical evaluation of children with short stature in the primary care setting: a systematic review.
Mameli C, Agostiniani R, Banderali G … +11 more , Bozzola E, Di Stefano VA, Greco L, Pecoraro C, Rugolotto S, Sollai S, Verduci E, Guadagni L, Giudice CL, Caforio G, Staiano A
Ital J Pediatr · 2026 Feb · PMID 41723458 · Full text
Short stature is a frequent reason for pediatric referral, yet clear diagnostic criteria remain elusive. Variability in clinical definitions, reference growth charts, and laboratory screening tests complicates the evalua...
Short stature is a frequent reason for pediatric referral, yet clear diagnostic criteria remain elusive. Variability in clinical definitions, reference growth charts, and laboratory screening tests complicates the evaluation of affected children. This systematic review aimed to analyze the diagnostic approaches used in clinical and biochemical assessments of short stature in children in the primary care setting. This systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251002215). Two independent literature searches were performed to address two domains: clinical and biochemical assessment. Studies were selected based on predefined inclusion and exclusion criteria, and risk of bias was assessed using the JBI critical appraisal tools. All procedures were conducted by independent reviewers, and discrepancies were resolved by consensus or through a third reviewer. A total of 424 studies were included, 35 in the clinical and 7 in the biochemical domain. Definitions of short stature considered in the studies varied considerably: 28 studies used a threshold of < 2 standard deviation score, while 19 applied percentile-based cut-offs (mostly the 3rd percentile); 8 studies considered both definitions, 3 studies do not report any definition. Growth velocity and target height were rarely used, despite their diagnostic value. Local growth charts were employed when available; otherwise, WHO and CDC references were most used. Laboratory assessments also varied greatly, with complete blood count and urine/stool analyses commonly performed, while thyroid function and celiac disease screening were inconsistently applied. There is substantial heterogeneity in the clinical and biochemical evaluation of children with short stature across studies. This reflects the absence of universally accepted diagnostic criteria and standardized screening protocols. These findings emphasize the need for internationally accepted, evidence-based guidelines to improve diagnostic accuracy and clinical management of children with short stature.
Optimizing pediatric vesicoureteral reflux management: a single-center experience with contrast-enhanced ultrasound in reducing radiation exposure and antibiotic use.
Tamasi S, Masucci A, De Chiara FA … +5 more , Chiera A, Tardi M, Martemucci L, Zeccolini M, D'Arcangelo R
Ital J Pediatr · 2026 Feb · PMID 41715207 · Full text
BACKGROUND: Vesicoureteral reflux is the most common pediatric urological anomaly and a leading cause of urinary tract infections in children. Traditional follow-up typically relies on voiding cystourethrography, which e...
BACKGROUND: Vesicoureteral reflux is the most common pediatric urological anomaly and a leading cause of urinary tract infections in children. Traditional follow-up typically relies on voiding cystourethrography, which exposes young patients to ionizing radiation. The introduction of contrast-enhanced ultrasound provides a radiation-free alternative with comparable diagnostic accuracy. This study aims to demonstrate that the use of contrast-enhanced ultrasound can shorten follow-up intervals, thereby reducing the duration of antibiotic prophylaxis. METHODS: A prospective observational study was conducted between 2019 and 2024, involving 1050 children with urinary tract infections, hydronephrosis, or a known history of vesicoureteral reflux. The cohort included both male and female children, aged between 1 and 15 years. Diagnosis was confirmed using conventional ultrasound and contrast-enhanced ultrasound. Patients with grade III to V vesicoureteral reflux underwent contrast-enhanced voiding urosonography at 12 months, replacing the standard voiding cystourethrography typically performed at 24 months. Clinical data were collected on reflux severity, gender distribution, and changes in antibiotic use. RESULTS: Early reassessment using contrast-enhanced voiding urosonography resulted in a significant reduction in the duration of antibiotic prophylaxis. A substantial number of patients showed resolution or downgrading of vesicoureteral reflux at 12 months, allowing for earlier discontinuation of treatment. The diagnostic accuracy of the ultrasound-based approach was consistent across age groups and genders. CONCLUSIONS: In our single-center experience, the incorporation of contrast-enhanced voiding urosonography into follow-up protocols for pediatric vesicoureteral reflux has been demonstrated to be a safe and effective alternative to traditional imaging. By allowing earlier reassessment without radiation exposure, contrast-enhanced voiding urosonography facilitates the safe discontinuation of prophylactic antibiotics, thereby enhancing patient safety and contributing to the reduction of antibiotic resistance. TRIAL REGISTRATION: Not applicable. This is an observational study and does not meet the criteria for mandatory trial registration.
Women satisfaction with breastfeeding care in maternity hospitals: a survey from Italy.
Davanzo R, Lanfranchi E, Perugi S … +5 more , Giordano G, Giannì ML, Baldassarre ME, Agosti M, Breastfeeding Section, Italian Society of Neonatology
Ital J Pediatr · 2026 Feb · PMID 41699729 · Full text
OBJECTIVES: This study examines the satisfaction of women with the breastfeeding support they received in a sample of Italian maternity hospitals as part of postnatal care. METHODS: Between November 15th and December 15t...
OBJECTIVES: This study examines the satisfaction of women with the breastfeeding support they received in a sample of Italian maternity hospitals as part of postnatal care. METHODS: Between November 15th and December 15th, 2023, a 20-items questionnaire was administered to 20 mothers who were consecutively discharged from each of the 26 Maternity Hospitals, that participate in a national project on the promotion of breastfeeding. RESULTS: A total of 520 questionnaires were collected. Overall, the evaluation provided by women regarding the postnatal care was positive. The health team was perceived as welcoming, communicating clear information, practically and emotionally supporting, helpful in teaching how to take care of their baby and respectful of the mother-baby relationship. Moreover, the team was considered attentive to preventing and treating pain experienced by new mothers. In 20.2% of cases, women reported that the information provided about support resources after hospital discharge was lacking. CONCLUSIONS: The current study indicates that most women view postpartum care and breastfeeding support positively. However, positive results in studies assessing women's satisfaction must be interpreted with caution, as the relationship between expectations and satisfaction is not always clear. Additionally, we need to carefully consider what women report on insufficient information provided at hospital discharge, which may impact subsequent support.
Effects of feeding behavior training on sensory processing and developmental areas in children with cerebral visual impairment: a randomized controlled study.
Cemali Ö, Tiryaki AY, Cemali M … +1 more , Torpil B
Ital J Pediatr · 2026 Feb · PMID 41691324 · Full text
BACKGROUND: To investigate the effects of feeding behavior training on feeding behavior, sensory processing, and developmental outcomes in children with cerebral palsy (CP) and cerebral visual impairment (CVI). METHODS:...
BACKGROUND: To investigate the effects of feeding behavior training on feeding behavior, sensory processing, and developmental outcomes in children with cerebral palsy (CP) and cerebral visual impairment (CVI). METHODS: This study included 40 children aged 48–60 months diagnosed with CP and CVI who had feeding behavior problems. Participants were randomly assigned to either an intervention group (n = 20) or a control group (n = 20). Both groups received sensory integration training twice weekly in 40-minute sessions over a 12-week period. Additionally, the intervention group received feeding behavior training with the same frequency and duration. Feeding behavior was assessed using the Behavioral Pediatric Feeding Assessment Scale (BPFAS); sensory processing was evaluated with the Dunn Sensory Profile (SP); and developmental domains were assessed using the Ankara Developmental Screening Inventory (ADSI). RESULTS: Children in the intervention group showed statistically significant improvements in BPFAS scores (p < 0.001; Cohen’s d = -1.725) and in the subdomains of the SP, including seeking, sensitivity, avoiding, sensation seeking, emotional reactivity, and oral sensitivity (p < 0.05; Cohen’s d ranging from − 0.904 to − 1.29), compared to the control group. No statistically significant differences were observed between the groups in ADSI scores (p > 0.05). CONCLUSION: The addition of feeding behavior training to sensory integration therapy significantly improved feeding behaviors and specific sensory processing domains in children with CP and CVI. These findings underscore the importance of combining behavioral and sensory-based approaches when addressing complex feeding challenges in this population. CLINICAL TRIAL NUMBER: This study was registered on the clinicaltirals.gov site with the registration number ‘NCT06827743’ (Registration date: 12.02.2025).
Trends in emergency department utilization by patients with chronic conditions aged 15 and over in a tertiary-care Italian pediatric emergency department (2010-2022).
Casotto V, Cocco R, Pipitone C … +4 more , Tirelli F, Scanferla S, Colombatti R, Bressan S
Ital J Pediatr · 2026 Feb · PMID 41664214 · Full text
BACKGROUND: Adolescents and young adults (AYAs) with chronic conditions are increasingly surviving into adulthood, yet little is known on their use of pediatric emergency departments (PEDs). In Italy, most PEDs apply an...
BACKGROUND: Adolescents and young adults (AYAs) with chronic conditions are increasingly surviving into adulthood, yet little is known on their use of pediatric emergency departments (PEDs). In Italy, most PEDs apply an upper age limit of 15 years, creating challenges in managing patients transitioning from pediatric to adult care. This study describes PED utilization by AYAs with chronic conditions in a tertiary care center. METHODS: We conducted a retrospective study at the PED of Padua University Hospital from January 2010 to December 2022. Eligible visits included patients aged ≥ 15 years with chronic conditions. Demographic, clinical, and management data were extracted and analyzed. Trends were assessed using Joinpoint regression. RESULTS: Overall, 2249 (0.7% of total PED visits) involved AYAs with chronic conditions. Visits increased by 241.6% from 2010 to 2011 to 2021-2022, with a significant annual growth of 18.2% after 2015. Most patients were aged 15-18 years (86.8%) and presented with acute symptoms (≥ 94%). Triage data showed 65.1% urgent and 4.4% emergent classifications. Resource use was substantial: 63.7% required laboratory tests, 25.7% imaging, 53.6% specialist consultation, and 37.6% hospital admission. Hemato-oncological diseases were the leading cause of visits, while neuropsychiatric presentations rose from 6% in 2010-2011 to 22% in 2021-2022. CONCLUSIONS: Despite institutional age limits, AYAs with chronic conditions increasingly rely on PEDs, often for complex and urgent care. Rising neuropsychiatric visits and persistent non-urgent use highlight gaps in outpatient and transitional care. Structured transition programmes and enhanced collaboration between pediatric and adult services could strengthen continuity and appropriateness of care, with recent pilot initiatives representing a promising step forward.
A comprehensive systematic review and meta-analysis of the safety of procedural sedation in pediatric emergency rooms.
Alsabri M, Rath S, Elbataa A … +7 more , Shehab MA, Chhetri J, Amer MS, Abdelwahab OA, Sleem R, Siddiq A, Kurian E
Ital J Pediatr · 2026 Feb · PMID 41664211 · Full text
PURPOSE: In pediatric emergency departments (PEDs), procedural sedation is frequently used to reduce pain and anxiety to support therapeutic and diagnostic procedures. The purpose of this meta-analysis was to evaluate th...
PURPOSE: In pediatric emergency departments (PEDs), procedural sedation is frequently used to reduce pain and anxiety to support therapeutic and diagnostic procedures. The purpose of this meta-analysis was to evaluate the safety profiles of common sedatives in the setting of PEDs. METHODS: An extensive search of four databases was conducted to identify studies reporting adverse effects associated with procedural sedation in pediatric emergency settings. Studies that reported on sedation-related outcomes and involved patients younger than 18 were considered eligible. A proportionate meta-analysis was conducted employing random-effects model. RESULTS: Sixty-six trials with a total of 20,043 pediatric patients were included. Propofol had the highest incidence of apnea (39%) and ketamine had the lowest (14%). The combined incidence of apnea was 19% (95% CI: 15–23%). 36% of patients (95% CI: 31–41%) had hypoxia; the highest rates were seen with etomidate (83%) and dexmedetomidine (56%), while the lowest rates were seen with nitrous oxide (9%), and chloral hydrate (11%). 40% of instances had agitation, which was most common with regimens based on midazolam. Among the secondary adverse events were nausea (44%) and vomiting (55%). Higher rates of apnea and hypoxia were noted in children above the age of 3. CONCLUSION: While nitrous oxide and chloral hydrate showed better safety profiles, propofol was linked to the highest risk of respiratory complications. These results highlight the significance of further research to improve sedation protocols and support the necessity of agent-specific, patient-centered sedation techniques in pediatric emergency care.
Keeping up the beat of Kleefstra syndrome.
Marchetti GB, Gaudioso F, Meossi C … +7 more , Mura M, Agostoni C, Gervasini C, Massa V, Pezzoli L, Iascone M, Milani D
Ital J Pediatr · 2026 Feb · PMID 41654978 · Full text
Long QT syndrome (LQTS) is a rare and potentially life-threatening arrhythmia characterized by delayed repolarization on electrocardiogram (EKG) evaluation. Although LQTS is primarily associated with defects in ion chann...
Long QT syndrome (LQTS) is a rare and potentially life-threatening arrhythmia characterized by delayed repolarization on electrocardiogram (EKG) evaluation. Although LQTS is primarily associated with defects in ion channels, in approximately 20% of cases the genetic cause remains unknown. Kleefstra syndrome (KS), a rare neurodevelopmental disorder caused by alterations in the EHMT1 gene, has been associated with various cardiac abnormalities, including structural defects and arrhythmias. Here we report the second case of LQT in a patient with KS, strengthening the association between these two conditions. Although rare in KS, LQT may represent a potentially life-threatening condition that requires careful monitoring. Further, we present a detailed clinical case and a literature review on cardiac rhythm abnormalities in KS, highlighting the importance of EKG monitoring in these patients. Further studies are needed to clarify the link between EHMT1 and cardiac arrhythmias and to establish the potential role of EHMT1 in the epigenetic modulation of cardiac pacemakers. These insights may have important implications in management of patients with KS and other Mendelian disorders of epigenetic machinery (MDEMs).
How do Italian adolescents see themselves? Body weight congruence and its determinants in the 2021/2022 HBSC study.
Ciardullo S, Pierannunzio D, Bacigalupo I … +5 more , Andreozzi S, Dalmasso P, Lazzeri G, Vieno A, Nardone P
Ital J Pediatr · 2026 Feb · PMID 41654912 · Full text
BACKGROUND: Body weight self-perception refers to the level of agreement between an individual’s perceived and actual weight status. Body weight congruence (BWC) indicates the correct perception of one’s body weight comp...
BACKGROUND: Body weight self-perception refers to the level of agreement between an individual’s perceived and actual weight status. Body weight congruence (BWC) indicates the correct perception of one’s body weight compared with its actual value. Understanding the agreement between body mass index (BMI) and weight self-perception among adolescents might provide important information regarding health behaviours and psychosocial characteristics in this population. The aim of this study is to investigate the self-perception of body weight among Italian adolescents aged 11, 13, 15, and 17 years, and analyse its congruence with their BMI. Furthermore, it explores the association between BWC and selected socio-demographic and contextual factors. METHODS: Data from the Italian Health Behaviour in School-Aged Children (HBSC) survey were used. HBSC is the first Italian population-based survey on adolescent behaviours, representative at national and regional levels and involving students (aged 11, 13, 15 and 17-year-olds have also been included) recruited from school classes throughout all Italian regions. The school class was the primary sampling unit, drawn by a stratified systematic cluster sampling from the list of all public and private schools. RESULTS: In 2022 the Italian HBSC involving 89,321 adolescents. 63.8% of the population correctly perceived their body weight in relation to their BMI category. Overestimation of body weight was more frequent among girls than boys (26.3% vs. 9.3%); in contrast, boys were more likely to underestimate their weight (26.0% vs. 10.7%). Overestimation climbed from 11 to 17 years, whereas underestimation decreased with age. The risk of weight overestimation and underestimation was associated with adolescents’ health perception; a greater risk was observed among adolescents who considered their health as poor. CONCLUSIONS: Overall, our findings corroborate existing literature: body weight misperception decreases with increasing age, girls tend to overestimate their weight, and boys tend to underestimate it. Sex differences represent an important aspect to consider when designing sex-specific interventions in public health.
Dexmedetomidine for LISA procedure: a prospective observational single center experience.
Galeazzo B, Tormena F, Papappicco CAM … +4 more , Gomirato S, Vendramin S, Gregori D, Lago P
Ital J Pediatr · 2026 Feb · PMID 41639887 · Full text
BACKGROUND: Respiratory Distress Syndrome (RDS) is the most common respiratory problem of preterm newborns. The preferred way to manage RDS is with Less Invasive Surfactant Administration (LISA), which involves direct la...
BACKGROUND: Respiratory Distress Syndrome (RDS) is the most common respiratory problem of preterm newborns. The preferred way to manage RDS is with Less Invasive Surfactant Administration (LISA), which involves direct laryngoscopy in spontaneously breathing infants. Despite its widespread diffusion, the optimal sedation protocol for LISA remains unclear. Dexmedetomidine, an α2-adrenergic agonist, offers sedative and analgesic properties with minimal respiratory depression. This pilot study aims to evaluate dexmedetomidine for LISA procedure focusing on the frequency of adequate sedation (defined as N-PASS score −2 to −5) and analgesia (NIPS score < 4) and adverse events related to dexmedetomidine. METHODS: This is a prospective observational study conducted in our tertiary Italian NICU from May 2021 to July 2024. We enrolled preterm neonates aged between 26+0 to 36+6 weeks, diagnosed with RDS who required LISA. We also analyzed the study population into two groups based on a cut-off of 32 weeks to understand possible differences in adverse events and sedation and analgesia scores, even if this was not our prior aim. Dexmedetomidine (1 µg/kg) was administered intravenously before LISA. Primary outcomes included pain control assessed by Neonatal Infant Pain Scale (NIPS) score, sedation adequacy assessed by Neonatal Pain, Agitation, and Sedation Scale (N-PASS), and success rate of the procedure (such as laryngoscopy conditions assessed by Goldberg score and number of attempts). We also assessed the safety of the procedure evaluating adverse events, such as intubation rates, apneas/desaturations, bradycardia, and hypotension. RESULTS: Forty-seven preterm newborns received dexmedetomidine. The median (IQR) gestational age (weeks/days), birth weight (grams) and age (hours) at LISA were respectively 29+6 (28+5, 33+1) weeks, 1421 (1069–2074) g, 3 (2.5–6) hours. Pain scores indicated adequate pain control during the procedure (NIPS < 4 in 76% during laryngoscopy). Light sedation (N-PASS −2 to −5) was observed in 23% of patients before the procedure, lasting up to 60 minutes. Excessive sedation (N-PASS −6 to −10) occurred in 7% of babies (3 patients). Laryngoscopy conditions were adequate in 90% of neonates (Goldberg score < 6). Apnea/desaturation with/without bradycardia occurred in 13% of newborns. Six patients were intubated (13%) within 72 hours after the procedure. Hypotension was noted in 6.4% of patients. CONCLUSION: Premedication with dexmedetomidine resulted in a good success rate for pain control; however, an adequate level of sedation was not consistently achieved. While the frequency of adverse events was acceptable, a more rapid-onset sedative may be preferable for this procedure. Further randomized controlled trials are needed to establish an optimal sedation strategy for LISA in preterm newborns. TRIAL REGISTRATION: Register: ClinicalTrials.gov, number ID NCT04820101, enregistered 03–29-2021, https://clinicaltrials.gov/study/NCT04820101?cond = RDS&term =dexmedetomidine&rank = 1#study-record-dates .
Real-world effectiveness of nirsevimab against respiratory syncytial virus in pediatric practice: the Piemonitorab study.
Funiciello E, Spadavecchia A, Cagnazzo C … +6 more , Ferrara L, Griglio B, Sottile A, Berchialla P, Fagioli F, Piemonitorab Study Group
Ital J Pediatr · 2026 Feb · PMID 41639727 · Full text
BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections (LRTIs) in pediatric populations, resulting in a substantial burden of disease. Immunization with the monoclonal anti...
BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections (LRTIs) in pediatric populations, resulting in a substantial burden of disease. Immunization with the monoclonal antibody nirsevimab has shown efficacy in preventing RSV infection and reducing disease severity. This study aimed to evaluate the real-world effectiveness of a universal nirsevimab prophylaxis program against RSV-related LRTIs in children in the Piedmont region, Italy. METHODS: A prospective, multicenter, observational study was conducted in the Piedmont Region (Italy). The primary endpoints were to assess nirsevimab immunization coverage among eligible infants and the number of RSV-related emergency department (ED) visits and hospitalizations during the 2024–2025 RSV season (October 1, 2024 to March 31, 2025). Secondary endpoints included the occurrence of adverse events following nirsevimab administration and the frequency of severe RSV-related outcomes, including intensive care unit (ICU) admission, need for respiratory support, and antibiotic therapy. The outcomes observed during the 2024–2025 season were compared with those from the 2022–2023 and 2023–2024 seasons. RESULTS: During the study period, nirsevimab was administered to 71.5% of the eligible infants. According to individual-level analyses restricted to the at-risk population, nirsevimab-immunized children had a significantly lower risk of RSV-related ED visits (RR 0.14, 95% CI 0.11–0.18), hospitalization (RR 0.15, 95% CI 0.11–0.20), respiratory support (RR 0.14, 95% CI 0.09–0.19), and antibiotic therapy (RR 0.08, 95% CI 0.02–0.28) than nonimmunized children did. The estimated nirsevimab effectiveness exceeded 80% for RSV-related ED visits, hospitalization, and respiratory support. Compared with the two previous RSV seasons, the 2024–2025 season presented a notable decrease in RSV-related healthcare utilization. CONCLUSION: Universal nirsevimab prophylaxis is associated with a substantial reduction in medically attended RSV-related LRTIs among infants experiencing their first RSV season, including fewer ED visits and a lower frequency of severe disease requiring hospitalizations, respiratory support, and antibiotic use.
An expert opinion on the management of pediatric patients with wheezing and mild asthma: translating 2025 GINA strategy report into clinical practice in Italy.
Santamaria F, Baraldi E, Cavalieri L … +4 more , Cutrera R, La Grutta S, Piacentini G, Siscaro G
Ital J Pediatr · 2026 Feb · PMID 41639716 · Full text
BACKGROUND: Preschool wheezing and mild asthma are among the most frequent chronic respiratory conditions in children. These conditions can significantly affect quality of life, be associated with wheeze exacerbations, a...
BACKGROUND: Preschool wheezing and mild asthma are among the most frequent chronic respiratory conditions in children. These conditions can significantly affect quality of life, be associated with wheeze exacerbations, and predispose to persistent airway disease. Early recognition and tailored management are crucial to prevent long-term morbidity. OBJECTIVE: This Expert Opinion paper aims to translate the 2025 Global Initiative for Asthma (GINA) Strategy Report into the Italian clinical context, providing guidance for early recognition, risk stratification, and personalized management of pediatric patients with wheezing and mild asthma. CONTENT: The paper discusses the heterogeneity of preschool wheezing phenotypes and the emerging concept of “pre-asthma”, highlighting the prognostic role of biomarkers such as blood eosinophils, fractional exhaled nitric oxide (FeNO), and early aeroallergen sensitization in predicting disease persistence. It also addresses the impact of early-life wheezing on lung function trajectories, challenges in defining mild asthma, and the rationale for stepwise treatment strategies according to age. Particular emphasis is placed on practical aspects of care, such as the use of low dose of inhaled corticosteroids (ICS), suboptimal adherence to therapy, inhaler misuse, the benefits of dose counters to avoid pseudo-adherence, and the importance of caregiver education and shared decision-making in inhaler selection. Applying GINA 2025 principles through individualized, biomarker-informed, and education-based strategies can improve outcomes in children with early or mild asthma, bridging the gap between evidence-based recommendations and usual pediatric care in Italy.
Risk factors for pulmonary hemorrhage of very low birth weight infants: a meta-analysis.
Wang J, Chen J, Shi J … +1 more , Dai Y
Ital J Pediatr · 2026 Feb · PMID 41634721 · Full text
BACKGROUND: Pulmonary hemorrhage (PH) is influenced by various perinatal factors. This study aims to identify the risk factors associated with pulmonary hemorrhage in very low birth weight infants and provide a reference...
BACKGROUND: Pulmonary hemorrhage (PH) is influenced by various perinatal factors. This study aims to identify the risk factors associated with pulmonary hemorrhage in very low birth weight infants and provide a reference for the prevention of this condition in this vulnerable population. METHODS: A comprehensive literature search was conducted across several databases, including PubMed, Web of Science, Embase, Cochrane Library, Scopus, CNKI, CBM, Wanfang Database and VIP Database, covering publications up to May 20, 2024. The meta-analysis was performed using RevMan 5.4 and Stata 16.0 software to analyze the risk factors for pulmonary hemorrhage in very low birth weight infants. RESULTS: A total of 14 studies were analyzed, comprising 13 case-control studies and 1 cohort study. The combined sample included 17,122 neonates, with 1,363 neonates in the case group and 15,759 neonates in the control group. The meta-analysis identified several risk factors for pulmonary hemorrhage in very low birth weight infants, including patent ductus arteriosus (OR = 2.95, 95% CI: 2.06–4.24), low 5-minute Apgar score (OR = 1.36, 95% CI: 1.01–1.84), use of surfactant (OR = 2.29, 95% CI: 1.40–3.75), respiratory distress syndrome (OR = 6.71, 95% CI: 3.67–12.28), and early-onset sepsis (OR = 6.02, 95% CI: 2.82–12.82). Protective factors identified included complete course of antenatal corticosteroids (OR = 0.36, 95% CI:0.17–0.79). CONCLUSIONS: Several risk factors, including patent ductus arteriosus, low 5-minute Apgar scores, use of surfactant, respiratory distress syndrome, and early-onset sepsis, are associated with an increased risk of pulmonary hemorrhage in very low birth weight infants. In contrast, complete course of antenatal corticosteroids has a protective effect in reducing the risk of this severe complication.
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