Ital J Pediatr [JOURNAL]
Sun
200 papers
Changes in pediatric primary care contacts: has the RSV-immunization modified the age-related access?
Boracchini R, Barbieri E, Canova B … +3 more , Baraldi E, Giaquinto C, Cantarutti A
Ital J Pediatr · 2026 Feb · PMID 41629983 · Full text
BACKGROUND: Primary care is essential during children’s development, especially in the first years of life. Contacts with the Family Pediatricians (FP) always presented with seasonality, peaking in infants and toddlers....
BACKGROUND: Primary care is essential during children’s development, especially in the first years of life. Contacts with the Family Pediatricians (FP) always presented with seasonality, peaking in infants and toddlers. In Italy, nirsevimab was widely introduced in November 2024, potentially influencing the pattern of pediatric care utilization. This study aimed to evaluate temporal changes in FP contacts and the burden of bronchiolitis following nirsevimab introduction. METHODS: A retrospective observational study has been conducted within Pedianet, an Italian primary-care network of FPs. Children residing in the Veneto region under five years of age and active between September 2022 and 2025 were included. All FP contacts were considered, identifying bronchiolitis-related visits and immunization ones. Age-specific incidence rates (IR) expressed in 100 person-months with 95% confidence intervals (CI) were calculated. RESULTS: A total of 25,399 children (median follow-up: 20.99 months) were included. Overall, 71.68 (95%CI:71.46–71.91) contacts per 100 person-months were recorded, showing clear seasonality with decreasing incidence while increasing age. After excluding immunization contacts, the difference in IRs between children in their first and second year of life was smaller in 2024/2025 than in 2023/2024, particularly in November (1-year:88.96 [95%CI:85.78–92.14] and 2-year:84.68 [95%CI:81.40–87.95] compared with 119.3 [95%CI:115.47–123.12] and 94.19 [95%CI:90.72–97.66]). Bronchiolitis burden among infants < 1 year declined from 6.58 (95%CI:5.70–7.47) to 1.24 (95%CI:0.87–1.62) contacts per 100 person-months in January 2024 and 2025, respectively, with a delayed seasonal peak in February 2025 (IR = 2.00, 95%CI:1.50–2.50). CONCLUSIONS: Following nirsevimab introduction, the burden of bronchiolitis markedly decreased, and differences in early-life contact rates narrowed. These findings support the need for adaptive pediatric care planning and continuous surveillance of respiratory disease trends accounting for preventive strategies implemented at the community level.
State of art of oral corticosteroids in children with acute asthma and wheezing.
Mazzuca C, Valluzzi RL, Ficari A … +5 more , Lo Scalzo L, Urbani S, Cafarotti A, Fiocchi A, Fierro V
Ital J Pediatr · 2026 Jan · PMID 41612390 · Full text
BACKGROUND: Oral corticosteroids (OCS) are widely used in the management of pediatric asthma exacerbations and recurrent wheezing. Despite their established efficacy, concerns about safety, optimal dosing, and appropriat...
BACKGROUND: Oral corticosteroids (OCS) are widely used in the management of pediatric asthma exacerbations and recurrent wheezing. Despite their established efficacy, concerns about safety, optimal dosing, and appropriate clinical contexts persist. METHODS: This narrative review synthesizes evidence from studies published between 2000 and 2025, focusing on the efficacy, safety, and clinical applications of OCS in children. Pharmacological data were also included from earlier literature. RESULTS: Evidence indicates that OCS remain essential for managing moderate-to-severe asthma exacerbations in school-age children. In preschool wheezing, their benefit is inconsistent and appears limited to selected subgroups, such as children with virus-associated wheezing or established asthma. Short courses and lower doses provide comparable efficacy with improved tolerability. Among the available molecules, dexamethasone has emerged as a promising alternative due to better palatability and adherence, while deflazacort shows comparable efficacy but requires further validation. CONCLUSIONS: The role of OCS in pediatric respiratory disease should be individualized, balancing efficacy and safety. Future studies should refine patient selection and evaluate alternative corticosteroid molecules to optimize therapeutic strategies.
Cord blood cardiac markers and tissue doppler echocardiography findings in infants of diabetic mothers.
Taşkın SN, Doğan V, Acungil ZK … +8 more , Cinni RG, Bilge S, Gök ŞÜ, Aydoğan L, Benli İ, Kara AE, İnce DA, Yılmaz R
Ital J Pediatr · 2026 Jan · PMID 41578354 · Full text
BACKGROUND: Maternal diabetes mellitus (DM) significantly affects fetal cardiac and placental structure and function. This study aimed to assess structural and functional cardiac changes in infants of diabetic mothers (I...
BACKGROUND: Maternal diabetes mellitus (DM) significantly affects fetal cardiac and placental structure and function. This study aimed to assess structural and functional cardiac changes in infants of diabetic mothers (IDMs) using echocardiographic data and cord blood cardiac biomarkers. METHODS: M-mode and pulsed-wave tissue Doppler imaging (PW-TDI) echocardiography along with cord blood cardiac markers were evaluated in 40 IDMs and 40 healthy term newborns. Cardiac biomarkers included troponin T (Trop-T), N-terminal pro-brain natriuretic peptide (NT-proBNP), and ischemia-modified albumin (IMA). RESULTS: Among the diabetic mothers, 87.5% had gestational diabetes mellitus (GDM) and 12.5% had type 1 diabetes mellitus (T1DM). Interventricular septum (IVS) thickness was significantly greater in the IDM group. Of the IDMs, 32.5% had asymmetric septal hypertrophy. Mid-septal tissue Doppler Imaging (TDI) parameters showed significantly altered velocities and time intervals. NT-proBNP and IMA levels were significantly elevated in the IDMs group, while Trop-T was not statistically different. No correlation was found between TDI parameters and biomarker levels. CONCLUSION: Cardiac dysfunction and elevated cord blood biomarkers in IDMs reflect subclinical stress. These findings support the utility of TDI and biochemical markers for early cardiac assessment in IDMs. Larger studies are needed to validate the use of these markers for routine screening and to better understand their pathophysiological significance.
Digital media exposure and pediatric health: the recommendations from the Italian Society of Pediatrics Digital Dependency Commission.
Bozzola E, Irrera M, Barni S … +14 more , Caruso C, Leccese B, Franzese E, Fioretti L, Bernardelli L, Scarpato E, Cupertino V, Mazzone T, Russo R, Benevento A, Strappato B, Cervellini M, Ferrara P, Agostiniani R
Ital J Pediatr · 2026 Jan · PMID 41578309 · Full text
BACKGROUND: Digital media exposure has become an integral component of childhood and adolescence, profoundly reshaping developmental environments worldwide. The Italian Pediatric Society (SIP) Digital Dependency Commissi...
BACKGROUND: Digital media exposure has become an integral component of childhood and adolescence, profoundly reshaping developmental environments worldwide. The Italian Pediatric Society (SIP) Digital Dependency Commission aim to provide indications for families and paediatricians to minimize the potential consequences related to media device and social media use in minors. MATERIALS AND METHODS: A systematic review of the international literature was performed in Pubmed searching for Mesh key terms from 1st January 2018 to 1st April 2025. Outcomes of interest encompassed physical health, obesity, neurocognitive development, sleep, visual health, mental well-being, behavioural addiction, and cyberviolence. RESULTS: The analysis demonstrates that excessive and unregulated digital media exposure is associated with sedentary behaviour, unhealthy dietary patterns, obesity, and cardiometabolic risk. High screen use is linked to language delays, impaired attention, reduced executive functioning, and structural brain changes. Evidence reveals sleep disruption, with delayed sleep onset, reduced duration, and circadian rhythm disturbances. Visual health is compromised through increased symptoms of digital eye strain and accelerating myopia progression. Mental health outcomes include anxiety, depressive symptoms, emotional dysregulation, loneliness, and social comparison stress. Problematic digital, gaming disorder, cyberbullying and online violence often coexist with psychological distress and emotional and behavioural difficulties. DISCUSSION: The findings highlight digital media exposure as a multifaceted and powerful determinant of pediatric health. On the base of these findings, the SIP Digital Dependency Commission provide the following recommendations: Delay introduction of personal smartphones until at least 13 years of age; use simplified models until 18. Avoid unsupervised Internet access before age 13; enable parental controls thereafter. Postpone social media access ideally until 18, but not earlier than 14 years. Prohibit device use during meals, before bedtime, and within bedrooms. Encourage outdoor activities, sports, reading, and creative play as primary developmental experiences. Promote school-based digital literacy education, including privacy protection, cyber-ethics, and critical evaluation of sources. Pediatricians should routinely evaluate screen habits during visits, screen for risk factors, and counsel families using anticipatory guidance. CONCLUSION: Coordinated action by clinicians, educators, parents, and policymakers is essential to promote a balanced and healthy digital ecosystem for children and adolescents.
Pathogen trends and paradigm shifts of respiratory infections in children: a 5-year retrospective study from Perugia.
Elena F, Sofia N, Paola P … +7 more , Laura P, Angela B, Barbara C, Antonella M, Giuseppe DC, Alberto V, Francesco V
Ital J Pediatr · 2026 Jan · PMID 41545885 · Full text
BACKGROUND: Respiratory infections are one of the most common causes of morbidity and mortality among children. After the COVID-19 pandemic, the epidemiology of respiratory tract infections has changed and has been bette...
BACKGROUND: Respiratory infections are one of the most common causes of morbidity and mortality among children. After the COVID-19 pandemic, the epidemiology of respiratory tract infections has changed and has been better traced by more frequent and less expensive molecular and antigenic tests. The main aim of this retrospective study was to evaluate the epidemiology of respiratory infections among children hospitalized in Perugia during the epidemic seasons of 2018-2019 and 2023-2024, comparing clinical severity, hospitalization length, diagnostic and therapeutic interventions. METHODS: We retrospectively analysed hospital records of all patients admitted to our clinic from October 2018 to March 2019 and from October 2023 to March 2024. RESULTS: In the post-COVID-19 era, hospitalizations for respiratory infections increased proportionally to other hospitalization causes, remaining the most common ones. Length of hospital stay was shorter, with no difference based on age, C-Reactive Protein levels or symptoms at admission. A change of respiratory infection epidemiology after the COVID-19 pandemic has been witnessed also in our setting: Respiratory Syncytial Virus and Influenza played a central role, displaying earlier peaks and severe clinical pictures. Increased use of molecular testing allowed for prompt etiological diagnoses, likely contributing to shorter inpatient stays and fewer antibiotic prescriptions, thus reducing economic burden for each patient and promoting improved antibiotic stewardship. CONCLUSION: In our setting, respiratory infections still accounted for the majority of pediatric hospitalizations during the autumn/winter seasons. A comprehensive testing strategy for etiological diagnosis of respiratory infections in hospitalized patients seemed to be cost-effective by reducing hospital stay and antibiotic prescriptions. This study may inform healthcare policy by emphasizing the importance of etiological diagnosis and the economic burden of inappropriate treatments.
Crossed cerebellar diaschisis in a COVID-19 patient with hemiconvulsion-hemiplegia syndrome: a case report and literature review.
Zhang Y, Dong Z, Zheng F … +1 more , Zhu H
Ital J Pediatr · 2026 Jan · PMID 41530799 · Full text
BACKGROUND: Crossed cerebellar diaschisis (CCD) is rare in patients with hemiconvulsion-hemiplegia syndrome (HHS). This report presents a novel and instructive case of CCD combined with HHS in a 7-month-old infant with c...
BACKGROUND: Crossed cerebellar diaschisis (CCD) is rare in patients with hemiconvulsion-hemiplegia syndrome (HHS). This report presents a novel and instructive case of CCD combined with HHS in a 7-month-old infant with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C). MAIN BODY: A previously healthy 7-month-old male infant presented with high-grade fever, frequent left-sided seizures, and subsequent left-sided paralysis. Diagnosed with COVID-19 and MIS-C, he exhibited critical hyperinflammation and multi-organ dysfunction. Brain magnetic resonance imaging (MRI) was pivotal, revealing unilateral cytotoxic edema in the right cerebral hemisphere and restricted diffusion in the contralateral cerebellum, confirming the diagnoses of HHS and CCD. Despite management with anticonvulsants and immunomodulation, his condition deteriorated rapidly, leading to death within 45 h. The pathophysiology is proposed to center on the MIS-C-triggered cytokine storm, which likely creates a substrate for excitotoxic injury and diaschisis. CONCLUSION: This case represents, to our knowledge, the first documented fatal instance of CCD associated with HHS in a pediatric patient with acute COVID-19 and MIS-C. It underscores the potential for severe neurological complications in this population and broadens the recognized spectrum of neurovascular injuries linked to COVID-19. The early detection of CCD in such settings may serve as a critical radiological marker for a high-risk disease course.
Clinical impact of targeted next-generation sequencing in paediatric pneumonia management: a real-world study evaluating diagnostic concordance and antimicrobial stewardship across multiple specimen types.
Lin F, Sang G, Wang Z … +2 more , Kong M, Chen Q
Ital J Pediatr · 2026 Jan · PMID 41527107 · Full text
OBJECTIVE: This study aims to evaluate the clinical utility of targeted next-generation sequencing (tNGS) in a real-world paediatric pneumonia cohort. METHODS: A retrospective cohort study was conducted of 586 children h...
OBJECTIVE: This study aims to evaluate the clinical utility of targeted next-generation sequencing (tNGS) in a real-world paediatric pneumonia cohort. METHODS: A retrospective cohort study was conducted of 586 children hospitalised with pneumonia who underwent tNGS testing alongside conventional microbiological methods. The study evaluated diagnostic concordance between tNGS and composite reference standards, assessed the impact on antimicrobial therapy changes within 48 h and identified predictors of tNGS-guided therapy modifications. Statistical analyses included McNemar’s test for paired comparisons, Cohen’s kappa for concordance and multivariable logistic regression for predictors of therapy change. RESULTS: Among the 586 patients (median age 5.0 years, 48.5% girls), tNGS showed a significantly higher positivity rate of 96.9% compared with 45.2% for polymerase chain reaction (PCR; 13 respiratory pathogens panel), 38.1% for culture, 15.4% for antigen testing (influenza A/B, respiratory syncytial virus, adenovirus, Mycoplasma pneumoniae) and 25.3% for serology (all P < 0.001). The diagnostic concordance between tNGS and composite reference standards showed high positive percent agreement (97.4%, 95% confidence interval [CI] 95.7%–98.5%) but low negative percent agreement (6.0%, 95% CI 2.0%–13.5%), with poor overall concordance (κ = 0.05, 95% CI 0.01–0.09). Targeted NGS results led to antimicrobial therapy changes in 30.2% of patients (95% CI 26.5%–33.9%), with 61 escalations, 72 de-escalations and 44 class switches. Age was the only significant predictor of therapy change (adjusted odds ratio 1.14, 95% CI 1.08–1.20, P < 0.001). Specimen-type analysis revealed the highest culture positivity in bronchoalveolar lavage (56.7%) and the highest PCR positivity in sputum (69.2%). CONCLUSIONS: Targeted NGS showed higher pathogen detection rates than conventional methods and influenced antimicrobial management in nearly one-third of paediatric pneumonia cases. The predominance of de-escalation suggests potential for antimicrobial stewardship. However, the low negative percent agreement indicates that tNGS may detect clinically insignificant organisms.
Ictal vomiting as the first manifestation of Tuberous Sclerosis Complex: report of two pediatric cases.
Cuzzola E, Massara S, Sforza G … +5 more , Voci A, Proietti Checchi M, Mazzone L, Valeriani M, Moavero R
Ital J Pediatr · 2026 Jan · PMID 41519906 · Full text
BACKGROUND: Tuberous sclerosis complex (TSC) is a multisystem genetic disorder caused by pathogenic variants in TSC1 or TSC2, affecting approximately 1 in 6,000 live births. Diagnosis can be established genetically or cl...
BACKGROUND: Tuberous sclerosis complex (TSC) is a multisystem genetic disorder caused by pathogenic variants in TSC1 or TSC2, affecting approximately 1 in 6,000 live births. Diagnosis can be established genetically or clinically based on characteristic neurocutaneous, renal, and cardiac findings. Epilepsy occurs in up to 90% of individuals, with a wide spectrum of seizure types, including epileptic spasms and focal seizures, often evolving into Lennox–Gastaut syndrome. METHODS: We describe two pediatric cases with genetically confirmed TSC who presented with prolonged, stereotyped episodes of retching and vomiting as the initial clinical manifestation. Brain MRI and long-term video-EEG monitoring were performed to investigate the neurological origin of these symptoms. RESULTS: In one patient, video-EEG recordings demonstrated an ictal pattern temporally correlated with the vomiting episodes, confirming their epileptic nature. In the other, although no episodes were captured during monitoring, the interictal EEG revealed both synchronous and asynchronous epileptiform discharges in the bilateral frontal regions, supporting a possible epileptic basis. To our knowledge, these represent the first reported cases of ictal vomiting as the initial seizure manifestation in TSC. CONCLUSIONS: These cases emphasize the need to consider recurrent, stereotyped gastrointestinal symptoms as potential ictal phenomena, particularly in individuals with TSC who are at high risk for epilepsy. Early and prolonged electroencephalographic monitoring may be crucial for timely recognition and appropriate management.
Towards a shared diagnostic approach for pediatric short stature: a Delphi consensus of the Italian Society of Pediatrics and the Italian Society for Pediatric Endocrinology and Diabetology.
Mameli C, Cianfarani S, De Sanctis L … +13 more , Maghnie M, Wasniewska M, Chiarelli F, Faienza MF, Street ME, De Luca G, Sacchetti C, Orso M, Polistena B, Agostiniani R, Cherubini V, Staiano A, Salerno M
Ital J Pediatr · 2026 Jan · PMID 41519847 · Full text
BACKGROUND: Short stature is a common reason for referral in pediatric practice, but significant variability exists in diagnostic approaches and referral criteria. Therefore, the aim of this consensus was to improve the...
BACKGROUND: Short stature is a common reason for referral in pediatric practice, but significant variability exists in diagnostic approaches and referral criteria. Therefore, the aim of this consensus was to improve the management of children with short stature through the knowledge and expertise of various Italian centers through a Delphi-consensus process. METHODS: A multidisciplinary scientific board of 11 experts and 1 patient advocate were involved in a consensus process and used the Delphi method. The scientific board identified 4 key domains regarding short stature: clinical evaluation, biochemical assessment, imaging and genetic investigation. Two literature searches were conducted. The first search aimed to identify international guidelines and consensus on the diagnosis of short stature in children. The second search sought to retrieve clinical studies focusing on the four domains. The results of the literature searches were evaluated by the scientific board and a total of 14 statements were drafted and submitted to a panel of 39 pediatricians and pediatric endocrinologists using a two-round Delphi method conducted between February and March 2025. Consensus was defined as ≥ 80% agreement or disagreement (scores 7–9 or scores 1–3 on a 9-point Likert scale). RESULTS: In the first Delphi round, 34 out of 39 experts responded (response rate 87%), and consensus was reached on 11 out of 14 statements. The remaining 3 statements were revised by the scientific board and re-submitted. In the second round, 34 of 34 eligible experts responded (100%), and consensus was achieved for one additional statement. Overall, a strong agreement was reached for 12 out of 14 statements. CONCLUSION: This consensus provides valuable insights and recommendations to guide pediatricians in approaching a child with short stature. By addressing clinical, biochemical, imaging and genetic domains this consensus provides a model of growth monitoring that may result in early detection and appropriate management of children with short stature.
Nutritional management of neonates who undergo major surgery for gastrointestinal disorders: a joint position paper of the Italian Society of Neonatology (SIN), the Italian Society of Pediatric Surgery (SICP), and the Italian Society of Pediatric Nutrition (SINUPE).
De Rose DU, Aceti A, Liotto N … +19 more , Morlacchi L, Maggiora E, Costa S, Conforti A, Giannì ML, Baldassarre ME, Verlato G, Betta P, Decembrino N, Consales A, Ottaviano C, Scuderi MG, Putignani L, Fava G, Orfeo L, Agosti M, Salvatori G, Capolupo I, Collaborators of the Working Group on Nutrition of Surgical Newborn
Ital J Pediatr · 2026 Jan · PMID 41519795 · Full text
Neonates undergoing major gastrointestinal surgery for congenital or acquired disorders require complex nutritional management to support their growth and recovery. Prolonged fasting can be detrimental, necessitating tim...
Neonates undergoing major gastrointestinal surgery for congenital or acquired disorders require complex nutritional management to support their growth and recovery. Prolonged fasting can be detrimental, necessitating timely and appropriate nutritional support. This joint position paper by the Italian Society of Neonatology, the Italian Society of Pediatric Surgery, and the Italian Society of Pediatric Nutrition aims to provide evidence-based suggestions for the nutritional care of these vulnerable infants, addressing the lack of robust randomized controlled trials in this field through expert opinion. A panel of experts in neonatology, paediatric surgery, and paediatric nutrition across Italy reviewed the literature by searching the PubMed database (1990- September 2024) using specific keywords. English-language papers were analysed without restrictions on study design or outcomes. Identified references were cross-checked, and additional relevant literature was included based on expert knowledge. The panel formulated suggestions based on the available evidence and clinical expertise. The position paper provides specific suggestions for various aspects of nutritional management, including the timing and modalities of enteral nutrition (EN), the choice of milk (prioritizing human milk), vitamin and trace element supplementation, and condition-specific guidance for gastrointestinal disorders such as oesophageal atresia, congenital diaphragmatic hernia, chylothorax, intestinal atresia, abdominal wall defects, Hirschsprung disease, necrotizing enterocolitis, and intestinal failure. Early EN (within 48 hours post-surgery) is generally advised and then tailored according to feeding tolerance. The paper also emphasizes the importance of monitoring micronutrient deficiencies and promoting oral feeding skills. This joint position paper offers a comprehensive and multidisciplinary approach to the nutritional management of neonates undergoing major gastrointestinal surgery. Recognizing the limitations of current evidence, these suggestions aim to standardise and optimise nutritional care, based on available data and expert consensus, ultimately improving outcomes for this high-risk population. The paper highlights the need for individualised nutritional strategies, careful monitoring, and further research in this challenging area of neonatal care.
Diagnostic accuracy of MMBV in predicting bacterial infection in febrile children: a systematic review and meta-analysis.
Brigadoi G, Visentin D, Casotto V … +4 more , Oteri C, Denina M, Donà D, Bressan S
Ital J Pediatr · 2026 Jan · PMID 41514352 · Full text
BACKGROUND: Distinguishing viral from bacterial infections in febrile children remains challenging despite available biomarkers. MMBV is a promising host-protein biosignature that computationally integrates TNF-related a...
BACKGROUND: Distinguishing viral from bacterial infections in febrile children remains challenging despite available biomarkers. MMBV is a promising host-protein biosignature that computationally integrates TNF-related apoptosis-induced ligand, interferon-γ-induced protein-10, and C-reactive protein. MMBV uses predefined score thresholds for viral/non-bacterial (0–35), equivocal (36–65) and bacterial (66–100) etiologies. We conducted a systematic review and meta-analysis to evaluate MMBV diagnostic accuracy in febrile children. METHODS: Embase, MEDLINE, the Cochrane Library, Scopus, and CINAHL were searched until July 1, 2024. Studies evaluating MMBV diagnostic accuracy in febrile children, comparing the results of the MMBV score with a predefined reference standard established by an expert panel, were included. Two investigators independently screened, extracted data and evaluated the quality of eligible/included studies using the QUADAS-2 tool. Aggregate estimates of sensitivities and specificities were calculated with 95% confidence intervals (CI), overall and by type of infections. RESULTS: Of 486 studies identified, 14 met inclusion criteria, and nine were included in the meta-analysis. The pooled sensitivity and specificity estimates were 0.87 (95%CI 0.79–0.92, I2 55.6%) and 0.93 (95%CI 0.92–0.94, I2 0.0%), respectively. Pooled sensitivity and specificity for studies on febrile children, regardless of source, were 0.86 (95%CI 0.82–0.89, I2 0.0%) and 0.93 (95%CI 0.92–0.94, I2 0.0%). For studies on respiratory infections and fever without source, they were 0.89 (95%CI 0.79–0.95, I2 75.4%) and 0.93 (95%CI 0.91–0.94, I2 15.0%) CONCLUSIONS: MMBV showed high diagnostic accuracy, and results remained consistently elevated across sub-analyses. Additional studies are needed to evaluate its effectiveness in reducing unnecessary antibiotic prescriptions in febrile children. STUDY PROTOCOL REGISTRATION NUMBER: The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the number CRD42024506430. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=506430.
Risk prediction of encephalitis in hand, foot and mouth disease: a nomogram model based on platelet indices for resource-limited settings.
Cheng FF, Wang K, Cao ML … +5 more , Hui ZF, Shi WX, Yan WH, Tian JM, Zhan SH
Ital J Pediatr · 2026 Jan · PMID 41507966 · Full text
OBJECTIVE: This study aimed to assess differences in peripheral blood platelet indices including platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and the platelet-to-lymphocyte ratio (...
OBJECTIVE: This study aimed to assess differences in peripheral blood platelet indices including platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and the platelet-to-lymphocyte ratio (PLR) between children with hand, foot and mouth disease (HFMD) complicated by encephalitis and those with uncomplicated HFMD. A further objective was to develop a robust predictive model for HFMD complicated by encephalitis, specifically designed for resource-limited clinical settings. METHODS: This retrospective study enrolled children with HFMD who were hospitalized at the Children’s Hospital of Soochow University between January 2015 and December 2020. The participants were categorized into two groups: an encephalitis group (HFMD complicated by encephalitis) and a control group (those with uncomplicated HFMD). The baseline data, clinical features and platelet indices of the children in the two groups were then compared. Binary logistic regression analysis was used to identify the risk factors for HFMD complicated by encephalitis, and a nomogram prediction model for HFMD complicated by encephalitis was developed based on these risk factors. RESULTS: The risk factors in children with HFMD complicated by encephalitis included fever for more than 3 days, listlessness, headache, limb myoclonus, positive neck resistance and/or pathological signs, and certain PLT, PDW, and PLR values. These risk factors were used to construct a simple and practical nomogram prediction model for HFMD complicated by encephalitis, which demonstrated strong predictive performance with an area under the curve (AUC) of 0.902, along with satisfactory calibration and stability upon validation. CONCLUSION: The nomogram prediction model of platelet indices (PLT, PDW and PLR) combined with clinical risk factors demonstrated a robust predictive capacity for HFMD complicated by encephalitis. CLINICAL TRIAL NUMBER: Not applicable.
Extended NICUs or specialized pediatric networks? The need to reinforce centralized, multidisciplinary care - a comment on Decembrino et al.
Brisca G, Ingelmo PM, Camporesi A … +11 more , Di Nardo M, Dato A, Ricci Z, Bussolin L, Conti G, Tesoro S, Minardi C, Marinosci GZ, Wolfler A, Moscatelli A, Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI)
Ital J Pediatr · 2026 Jan · PMID 41501911 · Full text
The recent article by Decembrino et al. highlights the burden of RSV-related bronchiolitis admissions to Italian Neonatal Intensive Care Units (NICUs) during the 2021 season and proposes extending NICU roles to compensat...
The recent article by Decembrino et al. highlights the burden of RSV-related bronchiolitis admissions to Italian Neonatal Intensive Care Units (NICUs) during the 2021 season and proposes extending NICU roles to compensate for the national shortage of Pediatric Intensive Care Unit (PICU) beds. While acknowledging the urgent problem, we argue that such a strategy risks fragmenting pediatric critical care. Evidence consistently demonstrates that critically ill children achieve better outcomes in high-volume, specialized centers equipped with multidisciplinary expertise, resources, and continuous training. Italy currently counts only 273 PICU beds, corresponding to one per 35,856 children, far below European standards and with significant regional disparities-most notably in Southern Italy and Sardinia. International data indicate that higher patient volumes are associated with improved survival, supporting the consolidation of PICUs within sustainable hub-and-spoke networks. Regional initiatives, such as the Ligurian model integrating a central hub with 24/7 pediatric transport, demonstrate the feasibility of this approach. Future planning should focus on strengthening national referral systems, enhancing transport capabilities, and consolidating pediatric intensive care. With RSV prevention strategies evolving, Italy must build a resilient and flexible system, ensuring that all critically ill children have timely access to specialized, high-quality care.
Recent advancements in pediatric purulent meningitis: diagnosis and treatment.
Yang L, Jin W, Liu Y … +5 more , Hu W, Chen Y, Wang G, Li W, Gao Q
Ital J Pediatr · 2026 Jan · PMID 41501818 · Full text
Purulent meningitis is a common disease of the central nervous system affecting children. It arises from various pathogens transmitted through diverse routes and can lead to significant sequelae, even death. The pathogen...
Purulent meningitis is a common disease of the central nervous system affecting children. It arises from various pathogens transmitted through diverse routes and can lead to significant sequelae, even death. The pathogenesis involves varying degrees of meningeal damage by pathogens, breaching the blood-brain barrier (BBB) and triggering immune responses and other physiological processes. Early diagnosis of purulent meningitis relies on recognizing clinical symptoms and conducting comprehensive examinations in patients. This includes young children presenting with systemic symptoms of infectious toxemia, neurological abnormalities, C-reactive protein (CRP), and procalcitonin (PCT) levels. Additionally, examination of cerebrospinal fluid (CSF) for abnormalities, identification of bacterial pathogens at the genetic level, brain computed tomography (CT) and magnetic resonance imaging (MRI) findings are crucial. Culturing bacteria from CSF remains the gold standard for diagnosing purulent meningitis. Current treatment approaches primarily involve antibacterial drugs, supportive therapy, and immunotherapy. Promising advancements are being made in exploring further treatment options and strategies. It is noteworthy that poor prognosis in pediatric patients can be inferred from clinical manifestations, laboratory findings, and imaging results. This review expounds on the recent progress in understanding the pathogenesis, early recognition, treatment strategies, and risk factors associated with poor outcomes in purulent meningitis affecting children (See Graphical Abstract).
Construction of a forest plot prediction model based on Lasso regression for Epstein-Barr virus associated hemophagocytic lymphohistiocytosis in children.
Su Y, Xu M, Cao M … +3 more , Li Y, Hu S, Zhou W
Ital J Pediatr · 2026 Jan · PMID 41492100 · Full text
BACKGROUND: To identify risk factors for the progression of Epstein-Barr virus(EBV) infection to Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) and guide clinical intervention by analyzing the...
BACKGROUND: To identify risk factors for the progression of Epstein-Barr virus(EBV) infection to Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) and guide clinical intervention by analyzing the clinical data and laboratory examination between infectious mononucleosis and EBV-HLH infection using a forest plot prediction model. METHODS: Clinical data and laboratory tests of children with “Epstein-Barr virus infection and hemophagocytic lymphohistiocytosis” who were hospitalized in Children’s Hospital of Soochow University from January 2019 to December 2024 were collected. A total of 1358 children of infectious mononucleosis associated with EBV (IM group) and 86 children of hemophagocytic lymphohistiocytosis associated with EBV (EBV-HLH group) were included. The differences between the groups were retrospectively analyzed and regression analysis was performed. The proximity matching method was selected for 1:4 matching between the EBV-HLH group and the IM group. The forest plot prediction model was established based on Lasso regression to analyze the clinical differences between the IM group and the EBV-HLH group. RESULTS: Lasso regression model screening identified hemoglobin (HB), ferritin (FER), fibrinogen (FIB) and CD3 + CD4 + as hexhibiting good predictive value for EBV-HLH, with areas under the receiver operating characteristic (ROC) curve of 0.904, 0.973, 0.866 and 0.783, and specificities of 0.799, 0.965, 0.802 and 0.892, respectively. The prediction model constructed using HB, FER, FIB, and CD3 + CD4 + showed excellent predictive accuracy. With an optimal cut-off value of F = 56.95, the model achieved a sensitivity of 95.30% and a specificity of 99.70%. CONCLUSIONS: The early diagnosis of EBV-HLH lacks specific indicators. In this study, a predictive model for EBV-HLH was established using LASSO regression, incorporating four key parameters (HB, FER, FIB, and CD3 + CD4 + T-cell subsets). This model may serve as a screening tool for the early diagnosis of EBV-HLH and provide a diagnostic basis for clinical practice. CLINICAL TRIAL NUMBER: Not applicable.
Survival in infants with trisomy 18, palliative care and ethical reflections: a single center considerations.
Caggiano S, Persia S, D'Amore F … +9 more , Macchiaiolo M, Fornari M, Clemente V, Paglietti MG, Schiavino A, Butera G, Filippelli S, Zucaro L, Cutrera R
Ital J Pediatr · 2026 Jan · PMID 41485045 · Full text
BACKGROUND: Trisomy 18 was once considered a fatal diagnosis due to the presence of cardiac and extracardiac lesions. However, with the increasing use of therapeutic management, 3% to 25% of infants with trisomy 18 may s...
BACKGROUND: Trisomy 18 was once considered a fatal diagnosis due to the presence of cardiac and extracardiac lesions. However, with the increasing use of therapeutic management, 3% to 25% of infants with trisomy 18 may survive beyond their first year, depending on the interventions provided. Currently, there are no clear and widely accepted criteria to guide medical decisions for children with trisomy 18. This means that patients could often be at risk of either over-treatment or therapeutic abandonment. We aimed to explore the effectiveness of intensive and non-intensive treatments in enhancing the clinical burden of disease and survival of children with trisomy 18 syndrome METHODS: a retrospective monocentric study in Bambino Gesù Children’s Hospital, IRCCS Rome, Italy. We enrolled all patients discharged from our hospital with genetic diagnosis of trisomy 18 between 2018 and 2023. Clinical data from birth were collected and categorized into two groups: those who received intensive treatment and those who underwent a palliative approach. Intensive treatment was defined as corrective heart surgery, use of invasive respiratory support, or at least one hospitalization in an intensive care unit. Survival probabilities at different age intervals were calculated, and the clinical burden of disease was assessed, taking into account device dependence, number of emergency department visits per year, and the daily intake of medications at home RESULTS: 32 patients were enrolled. Children with a low device dependence had significantly higher survival(p= 0,01). Neither palliative nor corrective heart surgery affected survival for patients with major cardiac defects. Conversely in children with minor heart defects surgery significantly increased survival probability(p= 0.01), particularly the corrective approach(p= 0.01). High number of emergency department visits(p=0.03) and high number of drugs taken daily(p=0.02) significantly reduced survival. No significant differences emerged between the two groups in terms of burden of disease. CONCLUSIONS: proportional to the initial clinical conditions all treatment options, which may include both comfort care and heart surgery, should be re-evaluated to determine the approach that prioritizes the best interest of each child with trisomy 18.
Caregiving ability of parents of TBI children at discharge: status quo and derived care strategies.
Wan Q, Qi M, Cao T
Ital J Pediatr · 2026 Jan · PMID 41484884 · Full text
BACKGROUND: The rehabilitation and nursing care of children with traumatic brain injury (TBI) necessitate long-term caregiving, and the caregiving ability of parents exerts a critical influence on the prognosis of these...
BACKGROUND: The rehabilitation and nursing care of children with traumatic brain injury (TBI) necessitate long-term caregiving, and the caregiving ability of parents exerts a critical influence on the prognosis of these children. This study was designed to analyze the current status of caregiving ability among parents of children with TBI at discharge and identify its influencing factors.. METHODS: Parents of children with TBI who were admitted to our hospital from June 1, 2024, to June 30, 2025, were recruited as participants. Relevant information about the children and their parents was collected, and the parents’ caregiving ability at the time of discharge was evaluated.. RESULTS: A total of 245 parents of children with TBI were enrolled in the study. The mean score of discharge caregiving ability among these parents was 62.14 ± 8.07. Correlation analysis showed that the child’s age (r=-0.564), TBI classification (r=-0.610), the parent’s relationship to the child (differentiated between mothers and fathers) (r = 0.596), educational level (r = 0.614), and personal monthly income (r = 0.625) were significantly correlated with the parents’ caregiving ability. Multiple linear regression analysis revealed that the child’s age, TBI classification, the parent’s relationship to the child, educational level, and personal monthly income are influencing factors of caregiving ability (adjusted R² = 0.560, p < 0.05).. CONCLUSIONS: The caregiving ability of parents of children with TBI is insufficient when their children are discharged, highlighting the need for improvement. Clinically, targeted nursing interventions should be implemented based on the identified influencing factors to optimize the prognosis of children with TBI.
Clinical features and analysis of the misdiagnosis of anomalous origin of the left coronary artery from the pulmonary artery in children.
Chen S, Zhou Z, Xiang P … +6 more , Zheng M, Zhang K, Zhou X, Wang N, Li M, Cheng Z
Ital J Pediatr · 2026 Jan · PMID 41484639 · Full text
BACKGROUND: Anomalous left coronary artery from the pulmonary artery(ALCAPA) is a rare congenital cardiovascular malformation. The main manifestations are non-specific and prone to misdiagnose. Without active treatment,...
BACKGROUND: Anomalous left coronary artery from the pulmonary artery(ALCAPA) is a rare congenital cardiovascular malformation. The main manifestations are non-specific and prone to misdiagnose. Without active treatment, the prognosis is poor. The study summarized the clinical characteristics of ALCAPA in children, analyzed the causes of misdiagnosis, and aimed to improve the rate of accurate initial diagnosis. METHODS: We retrospectively analyzed 19 children diagnosed with ALCAPA at the Children’s Hospital of Chongqing Medical University between December 2012 and July 2022. Diagnosed was established by color Doppler echocardiography, digital subtraction angiography(DSA), or confirmed intraoperatively. Patients were categorized into infant(≤ 1 year) and child(> 1 year) groups. Clinical characteristics, and causes of misdiagnosis were summarized and analyzed. RESULTS: Fourteen of the 19 patients(73.68%) were misdiagnosed at their initial echocardiographic examination. The correct diagnosis was subsequently confirmed through repeat echocardiography or DSA. Clinical features differed between infant and child groups. CONCLUSION: Electrocardiogram can provide valuable diagnostic clues for ALCAPA. Echocardiography remains a primary diagnostic tool, but it is also the most frequent source of misdiagnosis. Comprehensively evaluation combining clinical manifestations with multiple auxiliary examinations is essential to reduce misdiagnosis errors and improve the accuracy of first-time diagnosis.
Efficacy and safety of a single dose of nirsevimab against respiratory syncytial virus infection in infants: a meta-analysis and time-to-event analysis.
Sayed MS, Elgendy MA, Gamil N … +7 more , Abdullah HH, Alhwary A, Ibrahim RA, Samir SH, Jibril NS, Abdulazeem H, Alsabri M
Ital J Pediatr · 2025 Dec · PMID 41469925 · Full text
Respiratory syncytial virus (RSV) is one of the causes of lower respiratory tract infections (LRTIs) and related hospitalizations in neonates and infants. Clinical trials have shown that a single dose of nirsevimab can p...
Respiratory syncytial virus (RSV) is one of the causes of lower respiratory tract infections (LRTIs) and related hospitalizations in neonates and infants. Clinical trials have shown that a single dose of nirsevimab can prevent this infection and its related complications. We systematically searched PubMed, Embase, Web of Science (WOS), Scopus, and Cochrane Central on 25 November 2024 and updated on 18 April 2025, without automated filters or language restrictions. Studies reported the outcomes after nirsevimab in infants were retrieved. A random effects model was applied for analysis. A total of 425,362 infants were pooled from 26 studies (6 randomized controlled trials and 20 observational cohorts studies). The immunization with nirsevimab reduced the incidence of RSV-LRTIs by 63% (risk ratio [RR]: 0.37; 95% CI [0.29; 0.47], p-value < 0.001, I = 91.77%), hospitalization by 73% (RR: 0.27; 95% CI [0.20; 0.37], p-value < 0.001, I = 97.46%). Nirsevimab also reduced the incidence of all-cause LRTIs and hospitalization, bronchiolitis, ICU admission, emergency unit visits, and all-cause mortality. The high heterogeneity was raised from pooling the real-world data across different clinical settings such as different geographical locations. There was no statistical significance regarding safety outcomes; serious, GIT adverse events, adverse events of special interest, and adverse events > grade 3 between the two groups. The time to event analysis showed that nirsevimab significantly reduced the RSV-LRTIs (Hazard Ratio (HR): 0.25; 95% CI [0.16; 0.37]) and hospitalization (HR: 0.14; 95% CI [0.08; 0.25]). The immunization with a single dose of nirsevimab significantly reduced the RSV-LRTIs and hospitalization in infants who were at risk for RSV infection without any identified safety concerns. The long-term safety concerns are still unclear across the current studies.
The assessment of continuity of care and care coordination for Children and Youth with Special Health Care Needs (CYSHCN): a cross-sectional descriptive study in Northeastern Italy.
Zanello E, Maggiore A, Dobrina R … +10 more , Barbiero C, Causin E, Cragnolin E, Novello L, Plet S, Ronfani L, Toscani P, Urriza M, Valencak F, Giangreco M
Ital J Pediatr · 2025 Dec · PMID 41462316 · Full text
BACKGROUND: Children and Youth with Special Health Care Needs (CYSHCN) represent a growing, though numerically limited, category of the paediatric population requiring care from multiple professionals across different se...
BACKGROUND: Children and Youth with Special Health Care Needs (CYSHCN) represent a growing, though numerically limited, category of the paediatric population requiring care from multiple professionals across different settings. As such, they are at increased risk of experiencing fragmented care, lower quality of services, and unmet health needs. Continuity of care and care coordination are essential to ensure adequate assistance. This study aimed to assess the continuity and coordination of care for CYSHCN in a region of north-east Italy. METHODS: Over 21 months (2018-2020), CYSHCN meeting the inclusion criteria were enrolled at a public tertiary university hospital as part of a cross-sectional study. Data about care activities performed over 12 months by Family Paediatricians (FPs), General Practitioners (GPs), and Community Healthcare Professionals (CHPs) were collected using a structured tool. After 9-12 months, parents' perceptions of continuity of care were assessed using a 20-item questionnaire on a 5-point Likert scale. In 2020, families and professionals were also asked about perceived changes in care due to the COVID-19 pandemic. RESULTS: Most of the 51 children enrolled had oncological conditions (60.8%). FPs/GPs and CHPs reported 116 and 155 care activities respectively, with statistically significant differences in the type, setting, and intensity of care. Parents reported high levels of perceived continuity of care, though slightly lower ratings were observed for family paediatrician and care coordinator. Among 109 respondents (32 FPs/GPs, 20 CHPs, 32 parents), perceived changes in care during the pandemic were reported more frequently by professionals (58.4%) than by families (43.8%). However, most parents (85.7%) considered the care they received to be adequate. CONCLUSIONS: Continuity and coordination of care for CYSHCN were generally well maintained in the region, even during the pandemic. Nonetheless, gaps remain in the role of primary care providers and informational continuity. Strengthening care integration-especially through better communication systems and the use of ICT-may enhance coordination, particularly for children with complex needs and those in rural settings.
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