Ital J Pediatr [JOURNAL]
Sun
200 papers
Social networks, messaging apps, addictive use, and academic performance in adolescents: findings from the EHDLA study.
Aquino-Blanco A, Quiroz-Cárdenas F, Montenegro-Espinosa JA … +9 more , Martín-Calvo N, Yañéz-Sepúlveda R, Gutiérrez-Espinoza H, Olivares-Arancibia J, Rahmati M, Stubbs B, Smith L, López-Gil JF, Jiménez-López E
Ital J Pediatr · 2025 Dec · PMID 41462306 · Full text
BACKGROUND: Academic performance in adolescence is a key predictor of future educational, occupational, and health outcomes. While social networks (SNs) and messaging apps are increasingly integrated into adolescents’ da...
BACKGROUND: Academic performance in adolescence is a key predictor of future educational, occupational, and health outcomes. While social networks (SNs) and messaging apps are increasingly integrated into adolescents’ daily lives, their impact on academic achievement remains debated. This study aimed to evaluate associations between the use of SNs, messaging apps, addictive behaviors, and academic performance in Spanish adolescents. METHODS: A cross-sectional analysis was conducted using data from the Eating Healthy and Daily Life Activities (EHDLA) study, which included 583 adolescents aged 12–17 years from three secondary schools in Valle de Ricote, Spain, during the 2021–2022 academic year. SNs and messaging app use were assessed via a self-report scale. Addictive behaviors were measured using the Short Social Networks Addiction Scale-6 Symptoms (SNAddS-6 S). Academic performance was evaluated using grade point average (GPA) and subject-specific grades obtained from school records. Associations were analyzed using generalized linear models adjusted for important covariates. RESULTS: The median age of participants was 14 years (interquartile range: 13 to 15), with 57% female. TikTok and WhatsApp were the most frequently used platforms. No statistically significant association was found between the overall use of SNs and GPA. However, higher levels of addictive behaviors related to SNs use were significantly associated with lower academic performance (B = − 0.15, 95% CI: − 0.26 to − 0.03, p = 0.014). CONCLUSIONS: There was no significant association between overall SNs use and GPA. However, a significant negative association was observed for addictive behaviors related to SNs use. These findings highlight the need for educational interventions that address problematic or addictive patterns of SN use, fostering self-regulation and healthy digital habits while preserving the benefits of online connectivity.
Septic complications of head and neck infections as emerging conditions in the post-COVID-19 era: an epidemiological study in a pediatric care center in Sicily.
La Cognata D, Finocchiaro MC, Trobia GL … +2 more , Azzolina AA, Di Stefano VA
Ital J Pediatr · 2025 Dec · PMID 41457294 · Full text
BACKGROUND: Head and neck area abscesses are severe bacterial infections that commonly arise as complications of viral upper respiratory tract infections in pediatric patients. These infections can affect various anatomi...
BACKGROUND: Head and neck area abscesses are severe bacterial infections that commonly arise as complications of viral upper respiratory tract infections in pediatric patients. These infections can affect various anatomical structures, including the tonsils, retropharyngeal spaces, paranasal sinuses, middle ear, and salivary glands. The most frequent clinical presentations include otomastoiditis, retropharyngeal abscesses, and periorbital cellulitis. Although traditionally considered rare in developed countries, in recent years, particularly in the post-COVID-19 (COronaVIrus Disease 19) pandemic period, we have observed a notable increase in these complications at our center. METHODS: We conducted a retrospective, single-center epidemiological study on our cases of septic complications involving the head and neck region, comparing two three-year periods (from January to December): 2017-2019 and 2022-2024. Cases were classified into four categories: otomastoiditis, periorbital cellulitis, retropharyngeal abscesses, and other abscesses (including lateral cervical and cerebral abscesses). For each year the incidence rate of these complications was calculated in relation to the total number of hospital admissions. Statistical comparison was performed using the Chi-square test. RESULTS: The comparison between the two three-year periods (2017-2019 vs. 2022-2024) revealed a dramatic increase in head and neck suppurative infections: 8 cases in 2017-2019 compared to 56 cases in 2022-2024. The incidence rose from 0.32% to 2.42%, a statistically significant difference (p < 0.01). The incidence rate peaked in 2024, reaching 3.3%. The most frequent complication was periorbital cellulitis, followed by otomastoiditis. Notably, in 2022, a case of cerebral abscess occurred, requiring transfer to intensive care. CONCLUSIONS: Our study highlights an unexpected increase in head and neck suppurative-inflammatory complications. While recent publications have documented a rise in pediatric respiratory infections in the post-COVID-19 era, specific studies addressing the surge in these conditions remain scarce. This trend may be linked to the so-called COVID-19 immunity gap and/or to emerging patterns of antimicrobial resistance. However, given the retrospective observational design of our study, establishing a causal link is not possible. Pending further scientific evidence, enhanced surveillance remains essential to promptly identify these conditions, given their rapid progression and high morbidity.
Pediatric procedural sedation and analgesia in the emergency setting in community hospitals in Italy: current status and challenges.
Langeli M, Predieri F, Di Toma M … +8 more , Campanozzi A, Rugolotto S, Torcetta F, Mazza A, Zangardi T, Bazo M, Pizzini C, Bressan S
Ital J Pediatr · 2025 Dec · PMID 41444991 · Full text
BACKGROUND: We investigated the use of mild procedural sedation/analgesia in children at community hospitals to describe current practices and identify challenges to its effective implementation. METHODS: Cross-sectional...
BACKGROUND: We investigated the use of mild procedural sedation/analgesia in children at community hospitals to describe current practices and identify challenges to its effective implementation. METHODS: Cross-sectional survey among all medical and nursing staff of the Paediatric, Emergency, Anesthesiology and Surgical Units of four secondary care hospitals in Italy, in the years 2021-2022. RESULTS: The response rate was 80% (range across centers 57%-100%); 346 complete questionnaires were analyzed (52.6% physicians; 47.4% nurses). Overall, procedural pain in children was considered a relevant topic by 90.8% of staff. Procedural sedation/analgesia was considered helpful for procedural success (97.4%) and for improving children's experience of pain/anxiety (98.6%). However, 47.7% were not satisfied with the management of procedural pain/anxiety at their workplace and 56.9% reported a lack of adequate knowledge. In fact, only 22.8% demonstrated adequate knowledge on fasting times and 39.6% on correct patient monitoring during procedural sedation. From a pharmacological perspective, midazolam was the most accessible (80.9%) and used (58.7%) medication, while intranasal fentanyl and nitrous oxide were less available (15.3% and 2.9% respectively) and used (7.2% and 2.6% respectively). Procedural sedation was generally practiced by anesthesiologists (65.9%). Overall, 91.9% of respondents performed/participated in < 4 pediatric sedations per month. For 64.3% lack of training represented the greatest barrier to pediatric sedation/analgesia implementation. CONCLUSIONS: Despite staff awareness about the importance of pediatric procedural sedation/analgesia, lack of specific knowledge and training, as well as limited availability of sedative/analgesic medications represent current challenges to procedural sedation implementation in community hospitals without a pediatric emergency room.
Beyond the screen: a social cognitive theory perspective on gender, online gaming, and social well-being in Jordan.
Khatatbeh H, Khatatbeh Y, Pakai A … +1 more , Khatatbeh M
Ital J Pediatr · 2025 Dec · PMID 41444667 · Full text
BACKGROUND: The global expansion of online gaming raises worries about its impact on adolescent well-being, particularly regarding Internet Gaming Disorder (IGD) and its association with social health and bullying. This...
BACKGROUND: The global expansion of online gaming raises worries about its impact on adolescent well-being, particularly regarding Internet Gaming Disorder (IGD) and its association with social health and bullying. This study addresses a research gap in the Middle East by exploring gender-specific trends in gaming habits, social perceptions, and the prevalence of IGD among adolescents in Jordan. Utilizing the Social Cognitive Theory (SCT), the study aimed to identify predictors of IGD and exposure to social bullying. METHODS: 403 adolescents (aged 10-17) were selected from the northern Jordan in this cross-sectional, survey-based study. Participants responded to the Arabic version of the IGD-20 scale, in addition to items about their gaming habits, social perceptions, and exposure to social bullying. Furthermore, was used to measure IGD. Linear regression models were employed to identify factors predicting IGD scores and exposure to social bullying. RESULTS: 52.9% of the participants were at risk for or had IGD. Significant gender differences were found, with males spending more time gaming (p = 0.012) and preferring competitive games, while females favored "Fashion/dress" games. Key predictors of higher IGD scores were daily gaming hours, a perception of gaming as harmful, and poor social relationships. A higher IGD score also predicted increased exposure to social bullying. Crucially, gender did not significantly predict IGD or social bullying in the final models. CONCLUSION: Our findings, guided by SCT, suggest that gaming habits are often gender-specific, however, the core risk factors for IGD are not. Developing IGD is more closely tied to excessive gaming, poor social relationships, and exposure to bullying. So, effective measures should promote healthy gaming habits and foster strong social support systems for all adolescents, rather than exclusively targeting a specific gender. No Patient or Public Contribution. CLINICAL TRIAL NUMBER: Not applicable.
3-M syndrome: evolution of the phenotype over time.
Bacchi I, Vandelli S, Coccia E … +20 more , Giannini L, Zuntini R, Teneggi R, Caraffi SG, Baroni MC, Contrò G, Peruzzi A, Ambrosetti I, Pollazzon M, Sartori C, Lausch E, Matysiak U, Gambini L, Gargano G, Orlando V, Novelli A, Iughetti L, Unger S, Superti-Furga A, Garavelli L
Ital J Pediatr · 2025 Dec · PMID 41437277 · Full text
BACKGROUND: 3-M syndrome is an autosomal recessive disease characterized by short stature, facial dysmorphism and skeletal anomalies. To date, biallelic pathogenic CUL7 variants are responsible for the majority of cases,...
BACKGROUND: 3-M syndrome is an autosomal recessive disease characterized by short stature, facial dysmorphism and skeletal anomalies. To date, biallelic pathogenic CUL7 variants are responsible for the majority of cases, but biallelic deleterious changes in OBSL1 and CCDC8 can also establish the diagnosis. CASES PRESENTATION: We report two unrelated newborns showing clinical signs compatible with 3-M syndrome and we describe the evolution of the phenotype of the first patient over time. Molecular analysis identified two compound heterozygous CUL7 variants in the first individual and a homozygous CUL7 variant in the second one. CONCLUSIONS: We reviewed the literature highlighting the clinical differences between patients with variants in CUL7, OBSL1 and CCDC8. Our paper highlights how the clinical diagnosis of 3-M is easier in the first months of life, while in older children the phenotype becomes increasingly nuanced. It also underlines the clinical relevance of Next Generation Sequencing and functional studies, which may be necessary to confirm the pathogenicity of some variants, becoming an essential part of the multidisciplinary management of patients.
Impact of point-of-care ultrasound (POCUS) in pediatric emergency departments: a meta-analysis of randomized controlled trials.
Alsabri M, Hasan MT, Rath S … +5 more , Elsnhory AB, Elnady MI, Gadelmawla AF, Batarseh SF, Alaswad M
Ital J Pediatr · 2025 Dec · PMID 41437104 · Full text
Point-of-care ultrasound (POCUS) is a bedside diagnostic tool clinicians use to provide immediate insights and guide therapeutic interventions. It has become increasingly significant in pediatric emergency departments (E...
Point-of-care ultrasound (POCUS) is a bedside diagnostic tool clinicians use to provide immediate insights and guide therapeutic interventions. It has become increasingly significant in pediatric emergency departments (EDs) for diagnosing conditions, managing critical scenarios, and guiding procedures due to its portability, ease of use, and lack of radiation. This study aims to systematically review and analyze the efficacy of POCUS compared to conventional diagnostic methods in pediatric emergency settings. A literature search was conducted across PubMed, SCOPUS, Web of Science, Embase, and Cochrane Library up to February 2025. The inclusion criteria were pediatric patients aged 1 month to 18 years in EDs, with studies comparing POCUS to conventional methods. Primary outcomes included first-attempt procedural success and overall success rates. Secondary outcomes included time to procedure completion, mean number of attempts, hospitalization rates, and discharge rates. Data analysis was conducted in R employing a random-effects model, with dichotomous data analyzed as risk ratio (RR) and 95% confidence interval (CI), and continuous data as unbiased standardized mean difference (SMD). Statistical significance was defined at p < 0.05. Eighteen randomized controlled trials involving 2264 patients met the inclusion criteria. POCUS significantly improved first-attempt success (RR = 1.25; 95% CI: 1.09-1.43). The overall procedural success showed a significant benefit with POCUS (RR = 1.12; 95% CI: 1.03-1.22). However, no significant differences were noted in the time to procedure completion, number of attempts for a successful procedure, and rates of hospitalization and discharge to home. POCUS significantly improves first-attempt and overall procedural success rates in pediatric emergency settings, although it does not significantly reduce procedure times or the number of attempts. These findings underscore the importance of integrating POCUS into pediatric emergency care to enhance diagnostic accuracy and procedural success, though further research is needed to optimize its implementation across different age groups and procedures.
Can lung ultrasound replace chest computed tomography in pediatric patients with complicated community-acquired pneumonia?
Fawzy EF, Hamed AM, Kamel SM … +3 more , Mohamed NR, Deraz IH, Mohamed AS
Ital J Pediatr · 2025 Dec · PMID 41437087 · Full text
BACKGROUND: Complicated community-acquired pneumonia (CCAP) in children can result in severe morbidities. While computed tomography (CT) is the gold standard for diagnosis, its radiation exposure has led to the increased...
BACKGROUND: Complicated community-acquired pneumonia (CCAP) in children can result in severe morbidities. While computed tomography (CT) is the gold standard for diagnosis, its radiation exposure has led to the increased use of lung ultrasound (LUS) as a safer radiation-free alternative. This study aimed to evaluate the diagnostic accuracy of LUS in detecting complications in pediatric patients with CCAP and determine its value in their follow up as well as its value in determining patients liable for surgical intervention as pleural decortication comparing its efficacy with chest CT. METHODS: This is a prospective observational cohort study that was conducted on 56 pediatric patients with CCAP at our tertiary-level referral pediatric hospital. Patients underwent clinical evaluation, laboratory investigations, chest X-ray, CT, and LUS. The sensitivity, specificity, and accuracy of LUS were compared with CT for detecting consolidations, pleural thickening, effusions, lung abscesses, and hydropneumothorax. RESULTS: Compared to CT chest, LUS showed high sensitivity (92.6% for the right lung and 94.1% for the left lung) and specificity (88% and 100%, respectively) in detecting pleural effusions and consolidations, with substantial agreement with CT (p < 0.001). However, it had lower sensitivity in detecting lung abscesses (33.3% for the right lung, 0% for the left lung) and hydropneumothorax. Pleural thickness measured by LUS was a predictor for surgical intervention (cut-off > 2.2 mm). Follow-up LUS indicated significant improvement in lung lesions after one month. CONCLUSION: LUS is a reliable tool for detecting pleural effusions and consolidations in pediatric CCAP, reducing the need for CT in many cases. However, its limitations in identifying abscesses and hydropneumothorax highlight the need for combined diagnostic approaches.
Cell wall-inhibiting antibiotics resistance in Streptococcus pneumoniae causing invasive diseases: a global systematic review and meta-analysis in pediatric populations.
Alhusseini LB, Chaki SSG, Noshak MA … +2 more , Azizian K, Kouhsari E
Ital J Pediatr · 2025 Dec · PMID 41430708 · Full text
Streptococcus pneumoniae causes diseases such as meningitis and bacteremia, which lead to high morbidity and mortality rates among children under 5 years old. The invasive form of the disease, known as invasive pneumococ...
Streptococcus pneumoniae causes diseases such as meningitis and bacteremia, which lead to high morbidity and mortality rates among children under 5 years old. The invasive form of the disease, known as invasive pneumococcal disease, is a significant global health threat to children. Additionally, antimicrobial resistance in this bacterium has greatly hindered worldwide efforts to prevent and treat infections. In this meta-analysis, we reviewed published studies to provide a comprehensive overview of the global status of resistance to anti-cell wall antibiotics among S. pneumoniae strains causing invasive diseases. We searched PubMed, Scopus, and Embase for relevant studies published up to July 25, 2022. All statistical analyses were conducted using the R statistical software package. Our meta-analysis included 54 studies from 23 countries, spanning the period from 1994 to 2022. The average prevalence rates of antibiotic resistance were as follows: 30.1% for penicillin-non-susceptible pneumococci, 1.2% for amoxicillin, 2.5% for amoxicillin-clavulanic acid, 6.1% for ceftriaxone, and 0.6% for vancomycin. No significant differences were observed in resistance rates for vancomycin, amoxicillin-clavulanic acid, or amoxicillin. Additionally, no notable variations were found across age groups, over time, or based on different antibiotic susceptibility testing methods. The high prevalence of penicillin-non-susceptible pneumococci represents a significant challenge for global healthcare systems. Furthermore, our findings highlight considerable geographical variation in antibiotic resistance levels to cell wall-targeting antibiotics among S. pneumoniae isolates globally.
"Infectious mononucleosis" flag, high-fluorescence lymphocyte percentage, and platelet-to-lymphocyte ratio as diagnostic and prognostic biomarkers for infectious mononucleosis in Chinese children.
Wei Y, Zhang K, Wang P … +1 more , Yuan E
Ital J Pediatr · 2025 Dec · PMID 41430622 · Full text
BACKGROUND: Infectious mononucleosis (IM) may lead to severe complications and present diagnostic challenges in certain clinical settings. This study aimed to preliminarily evaluate the clinical utility of novel CBC-deri...
BACKGROUND: Infectious mononucleosis (IM) may lead to severe complications and present diagnostic challenges in certain clinical settings. This study aimed to preliminarily evaluate the clinical utility of novel CBC-derived graphical and numerical indicators as potential tools for rapid, accurate early diagnosis and monitoring of IM in children. METHODS: A total of 204 pediatric patients with IM, exhibiting a favorable prognosis, 109 pediatric patients diagnosed with other infectious diseases, and 86 healthy controls were enrolled from the Third Affiliated Hospital of Zhengzhou University. Multiple complete blood count (CBC)-derived indicators-including the machine learning-based "IM" flag, high-fluorescence lymphocyte percentage (HFLC%), and platelet-to-lymphocyte ratio (PLR)-were analyzed at initial diagnosis and on days 7, 14, and 21. RESULTS: The "IM" flag, HFLC%, and PLR were independent predictors of IM (all P < 0.01). The "IM" flag and PLR demonstrated high diagnostic efficacy across all pediatric age groups, while HFLC% showed significant diagnostic utility specifically in children over 72 months (all P < 0.001). Optimal diagnostic cutoff values were 1.95 for HFLC% and 46.35 for PLR. During follow-up, the "IM" flag gradually turned negative within 7 days (P < 0.017), HFLC% decreased significantly (all P < 0.01), whereas PLR levels showed a progressively increasing trend over 14 days (all P < 0.001). CONCLUSIONS: The "IM" flag, HFLC%, and PLR demonstrate significant diagnostic and prognostic value in pediatric IM, supporting their potential for clinical application.
Low invasive surfactant administration by videolaringoscopy: a feasibility study.
Petrillo F, Gizzi C, Valenzano L … +5 more , Manzari R, Marciante S, Buongiorno D, Bevilacqua V, Dani C
Ital J Pediatr · 2025 Dec · PMID 41430308 · Full text
BACKGROUND: Less invasive surfactant administration (LISA) is a gentle emerging technique for surfactant administration through a thin catheter in infants receiving noninvasive ventilation. It seems to offer some advanta...
BACKGROUND: Less invasive surfactant administration (LISA) is a gentle emerging technique for surfactant administration through a thin catheter in infants receiving noninvasive ventilation. It seems to offer some advantages to very preterm infants. The purpose of the FRee of Invasiveness & Neonatal Delicate LISA (FRI&NDLI) study was to evaluate the feasibility and safety of using videolaryngoscopy for positioning the thin catheter tip beyond the vocal cords. METHODS: We studied preterm infants with 24-32 weeks of gestation, born between September 2020 and January 2024. Data of infants with mild/moderate respiratory distress syndrome (RDS) who received surfactant through the FRI&NDLI procedure were recorded. Frequency of successes and incidence of related adverse effects of the procedure were also recorded. RESULTS: Twenty-three infants with 28.9 ± 2.8 weeks of gestational age and a birth weight of 1255 ± 458 g who received 25 procedures were studied. No episodes of apnoea, bradycardia, or desaturation were recorded during the glottis visualization in videolaryngoscopy. Two episodes of bradycardia, 8 episodes of desaturation, and 1 episode of surfactant reflux were observed during surfactant administration. CONCLUSION: We found that the FRI&NDLI procedure was safe and associated with less adverse effects than previously reported for LISA procedure using direct laringoscopy. Our findings support the possibility of planning further studies to compare the effectiveness of FRI&NDLI and LISA procedure for surfactant administration in preterm infants.
Multilevel analysis of prevalence and associated factors of minimum dietary diversity among children 6-23 months in Somaliland: evidence from Somaliland demographic and health survey (2020).
Osman OM, Abdi HA, Nuh AM … +3 more , Ali HA, Muse AH, Osman AM
Ital J Pediatr · 2025 Dec · PMID 41408306 · Full text
BACKGROUND: Inadequate feeding practices during infancy and early childhood have profound and often irreversible consequences for child nutrition, with devastating impacts particularly prevalent in low- and middle-income...
BACKGROUND: Inadequate feeding practices during infancy and early childhood have profound and often irreversible consequences for child nutrition, with devastating impacts particularly prevalent in low- and middle-income countries. These suboptimal practices contribute significantly to elevated mortality rates and heightened global disease burden. Alarmingly, more than 3.4 million children under the age of five lose their lives each year due to inappropriate feeding practices, underscoring the urgent need for targeted interventions to address this critical public health challenge. In Somaliland, little is known about how the dietary diversity of children aged 6-23 months aligns with the recommendations and factors that shape it, whether individual, community-based, or both. METHODS: This study used data from the Somaliland Demographic and Health Survey 2020 (SLDHS 2020). SLDHS2020 represents the nationwide household survey gathering demographic and health information across all six primary regions of Somaliland. The survey participants were women aged between 15 and 49 years. RESULTS: The prevalence of infants and young children who met the recommended minimum dietary diversity was only 9.3%. Mothers aged 35 years and older were 2.75 times more likely to have MDD in their children compared to those aged 15-24 years (AOR = 2.75, 95% CI: 1.00-7.12). Similarly, mothers with formal education had 2.45 times higher odds of ensuring MDD for their children than those without formal education (AOR = 2.45, 95% CI: 1.26-4.77). Mothers without media exposure were 85% less likely to provide diverse diets to their children than those with media exposure (AOR = 0.15, 95% CI: 0.045-0.502). Older children (12-23 months) had nearly five times higher odds of meeting MDD than younger children (6-8 months) (AOR = 4.95, 95% CI: 1.59-15.3). CONCLUSION: The study found that only 9.3% of children aged 6-23 months in Somaliland met the Minimum Dietary Diversity (MDD) criteria. Significant variations were observed in relation to the mother's educational attainment, with those possessing formal education exhibiting 2.45 times higher odds of their children achieving MDD (AOR = 2.45, 95%CI:1.26-4.77). Additionally, maternal age was a factor, as mothers aged 35 and above had 2.75 times higher odds (AOR = 2.75, 95%CI:1.00-7.12). Household wealth also played a critical role, with children from wealthier families having 6.78 times higher odds (AOR = 6.78, 95%CI:1.82-25.1). Geographic disparities were evident, as children residing in Togdheer had 95% lower odds (AOR = 0.05, 95%CI:0.00-0.299) than those in Awdal, and those in rural or nomadic settings experienced diminished access (AOR = 0.28-0.48). Given that 80.8% of mothers lack formal education and 97.7% have no media exposure, it is imperative to prioritise maternal literacy programs, region-specific agricultural support, and expanded media outreach to address these disparities.
Doxycycline vs levofloxacin for macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children: a real-world study from China.
Yang R, Xu H, Zhang Z … +5 more , Zhao R, Liu Q, Liu M, Zheng G, Wu X
Ital J Pediatr · 2025 Dec · PMID 41402982 · Full text
BACKGROUND: Macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) is a growing concern in paediatrics, yet comparative data on second-line antibiotics remain limited. This study aimed to evaluate the efficacy an...
BACKGROUND: Macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) is a growing concern in paediatrics, yet comparative data on second-line antibiotics remain limited. This study aimed to evaluate the efficacy and safety of doxycycline and levofloxacin in treating MUMPP in children. METHODS: This single-centre, real-world observational cohort study was conducted in a tertiary paediatric hospital in China. We included children hospitalised with M. pneumoniae pneumonia between July and December 2023. Patients were classified as having macrolide-sensitive M. pneumoniae pneumonia (MSMPP) or MUMPP according to their clinical response to initial azithromycin therapy. MUMPP patients were further allocated to the doxycycline, levofloxacin, or azithromycin group, based on the second-line antibiotic prescribed. Clinical characteristics, treatment outcomes, and adverse events were compared across groups. The primary outcome measures were the duration of pulmonary signs and the duration of fever after the change of antibiotic. The secondary outcome measure was the incidence of adverse events. RESULTS: MUMPP accounted for 66.6% (365/548) of cases. Compared with MSMPP, children with MUMPP had higher rates of tachypnoea (17.5% vs 1.6%, p < 0.001) and high-grade fever (82.2% vs 60.7%, p < 0.001).The median fever duration after second-line antibiotic treatment was 0 days (IQR 0–1) in both the doxycycline (n = 190) and levofloxacin (n = 130) groups, with no significant difference between them (p = 0.088), but both were significantly shorter than in the azithromycin group (n = 45; median 3 days, IQR 2–3; both p < 0.001). IPTW-adjusted and age-stratified (3–6 years) analyses, in which baseline characteristics were fully balanced, yielded consistent results, and showed no significant difference between the doxycycline and levofloxacin groups in defervescence rates across the four time intervals (within 24 h, 24–48 h, 48–72 h, and > 72 h), and no differences in pulmonary sign resolution among any of the three groups. No cases of tooth discolouration or musculoskeletal complications were observed, and no gastrointestinal events of GSRS grade ≥5 or other CTCAE grade ≥3 adverse events occurred in any treatment group during the treatment period. CONCLUSIONS: This study demonstrated that both doxycycline and levofloxacin are effective and safe treatments for paediatric MUMPP. Their judicious use may also help optimise antibiotic prescribing practices and mitigate antimicrobial resistance.
The impact of nutritional and socioeconomic status on academic performance of primary urban school children in northern Ethiopia: a cross-sectional study.
Gedamu TE
Ital J Pediatr · 2025 Dec · PMID 41402912 · Full text
BACKGROUND: Urban school children are challenged from varying degrees of poverty, access to resources and health services ultimately impacting their academic performance. Educational success is complex highlighting that...
BACKGROUND: Urban school children are challenged from varying degrees of poverty, access to resources and health services ultimately impacting their academic performance. Educational success is complex highlighting that several factors may contribute to its outcome. Among these, undernutrition and socioeconomic status significantly impact academic performance. The interplay between these determinants and educational outcomes is particularly significant in developing countries such as northern Ethiopia. Children from lower socioeconomic backgrounds often experience nutritional deficiencies that can adversely impact cognitive development leading for poor educational achievement. Thus, this research can fill existing gaps regarding the interaction between undernutrition and socioeconomic factors that enable to understand how they interact to affect children’s educational outcomes. In addition, the study will provide practical implications for policymakers and educators in Ethiopia as it enables them for developing more effective educational policies that address unique challenges faced by urban school children in northern Ethiopia. Therefore, our study aimed to assess predictors of academic performance among primary school students to address the multifaceted issues and develop effective interventions. METHOD: This institution-based cross-sectional study was conducted in three of seven primary public schools. Simple random sampling technique were employed to select the schools and proportional allocation was done to each school to draw a total of 399 study participants. An interviewer administered questionnaire were used to gather socioeconomic data from the children’s legal guardians. Academic performance was evaluated using the average scores from all subjects over two semesters obtained from school rosters. Nutritional status was assessed via anthropometric measurements with Height-for-Age (HAZ), Weight-for- Age (WAZ) and Body Mass Index-for-Age (BAZ) calculated according to the WHO 2007 standard reference guidelines. WHO Anthro version 3.2.2 was used for the analysis and interpretation of nutritional status. Data were entered, cleaned and validated using Epi Data version 3.1 and subsequently analyzed using SPSS version 24. A bivariate and multivariate logistic regression were done to determine candidate variables and significantly associated factors respectively. Variables with p-value of ≤ 0.05 with 95% confidence interval in the multivariate model were considered as factors associated with the outcome variable. RESULT: The mean academic performance of study participants was 71.65 (SD = 12.63). The prevalence of stunting, wasting, underweight and overweight was 23.8%, 34.0%, 24.0% and 4.3% respectively. In the adjusted analysis, age of child (AOR = 2.26, 95% CL: 1.39–3.67), head of household (AOR = 2.79, 95% CL: 1.55–5.04), absenteeism (AOR = 1.73, 95%CL: 1.07–2.79), preschool attendance (AOR = 1.47, 95% CL: 0.93–2.31) and monthly income (AOR = 1.67, 95% CL: 1.02–2.74) were significantly associated with educational achievement. CONCLUSION: Undernutrition particularly stunting remains a significant public health issue that might negatively affect academic performance. While undernutrition has showed association in the bivariate logistic regression, it does not adversely affect the children’s academic performance. Conversely, age of child, head of household, monthly income, school attendance and preschool enrollment significantly impacted educational outcomes suggesting that interventions should focus on these factors in collaboration with stakeholders, teachers, parents and the community. Yet this finding highlights the potential aims for intervention at primary public schools, further research is needed to comprehensively understand which factors reduced urban primary public school children’s academic performance.
SARS-CoV-2 infection during pregnancy and necrotizing enterocolitis: case report and review of the literature.
Serra G, Pensabene M, Bacile D … +8 more , Pace MRD, Ferraro D, Giuffrè M, Piro E, Salerno S, Schierz IAM, Sergio M, Corsello G
Ital J Pediatr · 2025 Dec · PMID 41398690 · Full text
BACKGROUND: Necrotizing enterocolitis (NEC) is a severe intestinal disease primarily affecting premature newborns, with high morbidity and mortality. Although typically linked to prematurity and low birth weight, recent...
BACKGROUND: Necrotizing enterocolitis (NEC) is a severe intestinal disease primarily affecting premature newborns, with high morbidity and mortality. Although typically linked to prematurity and low birth weight, recent reports have suggested a potential association between NEC and maternal SARS-CoV-2 infection during pregnancy. This study aims to explore this relationship through a systematic literature review and the presentation of a novel clinical case. CASE PRESENTATION: A female neonate born at 37 + 2 weeks of gestation to a mother with third-trimester SARS-CoV-2 infection presented with feeding intolerance, abdominal distension, and bloody stool at 8 days of life. Diagnostic evaluation confirmed necrotizing enterocolitis, necessitating multiple surgeries for bowel resection, stoma creation, and repair of perforations. Despite intensive multidisciplinary care, the patient developed severe complications, including short bowel syndrome and intestinal failure, leading to death at 18 months. SARS-CoV-2 IgG positivity in the neonate suggested transplacental antibody transfer after maternal infection, while most of the other possible risk factors were excluded. CONCLUSIONS: The presented case highlights the potential role of maternal SARS-CoV-2 infection in necrotizing enterocolitis pathogenesis. Literature review identified 10 studies documenting similar associations. Cases ranged in severity, with outcomes influenced by gestational age, infection timing, and neonatal risk factors. The proposed mechanisms include virus-induced inflammation, placental dysfunction, and altered neonatal gut microbiota. Our findings emphasize the importance of considering maternal SARS-CoV-2 infection as a contributing factor in NEC, especially in term neonates without known predisposing conditions. Further research is crucial to elucidate the possible link between COVID-19 and NEC, and guide management of affected neonates. Preventive strategies, including vaccination and optimized prenatal care, are essential to mitigate risks.
Predictive value of blood composite ratios for Kawasaki disease and coronary artery lesions in febrile children.
Li S, Guan S, Liu L … +5 more , Chen S, Yan Z, Zeng Y, Ouyang F, Zhong J
Ital J Pediatr · 2025 Dec · PMID 41398595 · Full text
BACKGROUND: Kawasaki disease (KD) is a systemic vasculitis in children, with coronary artery lesions (CALs) presenting as severe complications. Early diagnosis is of paramount importance; however, current biomarkers lack...
BACKGROUND: Kawasaki disease (KD) is a systemic vasculitis in children, with coronary artery lesions (CALs) presenting as severe complications. Early diagnosis is of paramount importance; however, current biomarkers lack both simplicity and reliability. This study assessed the predictive value of blood composite ratios (BCRs) for KD and CAL. METHODS: In this retrospective study, we analyzed data from 153 pediatric patients with febrile illness from 2016 to 2023. BCRs, including the neutrophil-to-lymphocyte ratio (NLR), the eosinophil-to-lymphocyte ratio (ELR), the eosinophil-to-monocyte ratio (EMR), and the eosinophil-to-basophil ratio (EBR), were calculated from admission laboratory data. The relationships between BCRs and the incidence of KD and CAL were evaluated using statistical and regression analyses. RESULTS: Patients with KD presented markedly elevated NLRs, ELRs, EMRs, and EBRs in comparison with those in the febrile control group. The NLR and ELR were found to be significantly associated with the incidence of KD and CAL, with optimal cutoff values of 0.632 and 0.01, respectively. The combined use of BCR indices resulted in increased predictive efficacy for the incidence of KD. CONCLUSIONS: BCRs, particularly the NLR and ELR, are valuable for the early identification of high-risk KD patients and CAL damage. These ratios have the potential to enhance clinical management and optimize patient care, although validation in prospective studies is needed.
Correction: Primary care pediatricians' involvement in influenza vaccination campaign in Italy.
Indaco R, Leoni F, Panza C … +1 more , Rossi PG
Ital J Pediatr · 2025 Dec · PMID 41390816 · Full text
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Beyond the label: ethical and clinical implications of off-label drug use in pediatric emergency care.
Colombo M, Plebani A, Agosti M
Ital J Pediatr · 2025 Dec · PMID 41390441 · Full text
Off-label prescribing, the use of medications outside of approved indications, is a common practice in pediatric emergency medicine. This practice is driven by factors such as limited pediatric-specific clinical trial da...
Off-label prescribing, the use of medications outside of approved indications, is a common practice in pediatric emergency medicine. This practice is driven by factors such as limited pediatric-specific clinical trial data, regulatory hurdles, and the urgent need to treat critically ill children. While off-label prescribing can be lifesaving, it raises significant ethical and legal concerns. This article explores the prevalence, challenges, and potential consequences of off-label drug use in pediatric emergency departments. A case study illustrates the complexities of off-label prescribing in a real-world clinical scenario. The discussion highlights the importance of balancing clinical needs with regulatory requirements and ethical considerations. Future research should focus on optimizing informed consent procedures, enhancing postmarketing surveillance, and developing evidence-based guidelines to ensure the safe and effective use of off-label medications in pediatric emergency care.
Genetic and clinical phenotype of Dent disease in Chinese children and the etiological analysis of early - onset chronic kidney disease.
Zhou L, Yu Z, Yang Y … +5 more , Han Y, Qiu L, Zhang Y, Yang F, Zhou J
Ital J Pediatr · 2025 Dec · PMID 41361832 · Full text
BACKGROUND: A prominent feature of Dent disease (DD) is the progressive decline in renal function, with 30% - 80% of male patients advancing to end-stage renal disease between the ages of 30 and 50 years. However, limite...
BACKGROUND: A prominent feature of Dent disease (DD) is the progressive decline in renal function, with 30% - 80% of male patients advancing to end-stage renal disease between the ages of 30 and 50 years. However, limited research exists on the chronic kidney disease (CKD) progression in pediatric patients with DD. This study aimed to retrospectively analyze the clinical features, genetic variant spectrum, and prognosis of pediatric patients with DD and explore the factors associated with early renal failure during childhood in these patients. METHODS: We analyzed the genetic backgrounds, clinical phenotypes, and laboratory data of 23 unrelated patients with DD. RESULTS: All patients were males with low-molecular-weight proteinuria. CLCN5 variants were detected in 19 patients (Dent disease type 1, DD1), and OCRL variants were identified in 4 patients (Dent disease type 2, DD2). Sixteen mutations have not been reported previously. During follow-up, progression to CKD was documented in 7 patients: 6 with DD1 and 1 with DD2. CKD stages were distributed as follows: 4 patients at stage II, 2 at stage III, and 1 at stage V. Nephrolithiasis (100% vs 30.76%, P = 0.011), nephrocalcinosis (85.33% vs 15.38%, P = 0.010), and acute kideny injury (100% vs 0%, P < 0.001) were significantly more common in those CKD patients with DD1. CONCLUSION: This study expands the genetic spectrum of Dent disease and highlights that some pediatric patients may progress to CKD during childhood. CKD progression may be associated with early occurrences of nephrolithiasis, nephrocalcinosis, and acute kidney injury.
Vitamin K-dependent and other rare coagulation factor deficiencies: a single-center experience.
Terzi Ö, Hatipoğlu SS
Ital J Pediatr · 2025 Dec · PMID 41361303 · Full text
BACKGROUND: Rare coagulation factor deficiency (RFD) is characterized by a deficiency of factor (F) I, FII, FV, FVII, FX, FXI, FXII, FXIII, or a combined deficiency of FV + FVIII or vitamin K-dependent factors and accoun...
BACKGROUND: Rare coagulation factor deficiency (RFD) is characterized by a deficiency of factor (F) I, FII, FV, FVII, FX, FXI, FXII, FXIII, or a combined deficiency of FV + FVIII or vitamin K-dependent factors and accounts for approximately 5% of all bleeding disorders. The prevalence of RFD in the general population can range from 1 in 1,000,000 for FX to 1 in 2–3 million for FXIII. Combined deficiencies of vitamin K-related factors have been reported in 30 families worldwide. These patients can present with a wide range of clinical symptoms, from mucocutaneous bleeding to life-threatening symptoms such as central nervous system and gastrointestinal bleeding. Treatment of these disorders is primarily based on the replacement of the deficient factor. METHODS: In this retrospective study, data from 92 children with RFDs were analyzed to describe the distribution, clinical features, treatment patterns, and outcomes of RFDs. RESULTS: The most common factor deficiencies were F VII and F XII deficiency and while combined vitamin-K dependent coagulation factor was found in 3 patients. Of the 92 patients included in the study, 72 exhibited bruising and/or bleeding. The most common type of bleeding was oral and nasal mucosal bleeding. Factor activity was ≤ 5% in 22 patients, 6–20% in 12 patients, and 20–50% in the remaining 60 patients. Among patients with factor levels < 5%, there were both patients without bleeding and patients with recurrent cerebral hemorrhage. Similarly, when factor levels reached 50%, some patients experienced bleeding while others remained asymptomatic. Acute and severe bleeding was controlled with treatment in nine patients. Twenty-seven patients with recurrent bleeding symptoms received prophylaxis. RFDs are more common in regions with high rates of consanguineous marriage, which was 29% in our study. CONCLUSIONS: No significant results were obtained regarding an increased risk of bleeding as factor plasmatic levels decreased in patients with RFD. Because of its autosomal recessive inheritance, improving access to genetic counseling and testing is important. Delays in diagnosis and treatment and lack of appropriate prevention are important risk factors that increase life-threatening bleeding.
Advances in multi-omics and therapeutic studies of Henoch-Schönlein purpura.
Xu M, Wei Z, Wang L … +4 more , Liang W, Gao F, Sang S, Zhang R
Ital J Pediatr · 2025 Dec · PMID 41350890 · Full text
Henoch-Schönlein purpura (HSP) is a vasculopathic disease due to lesions in blood vessels, and patients with HSP presenting with renal injury are at risk of further progression to end-stage renal disease, resulting in a...
Henoch-Schönlein purpura (HSP) is a vasculopathic disease due to lesions in blood vessels, and patients with HSP presenting with renal injury are at risk of further progression to end-stage renal disease, resulting in a severe disease burden, the pathogenesis of which is currently unclear. By integrating multi-omics data, biomarkers and signaling pathways that are specifically expressed in HSP can be screened, thus finding new perspectives for resolving the pathogenesis of HSP. The aim of this review is to explore the developmental pathways of HSP and to reveal key biomarkers and therapeutic targets. Finally, we discuss the therapeutic approaches to HSP, with the hope that these insights will drive the future development of personalized medicine and improve patient prognosis and quality of life.
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