Ital J Pediatr [JOURNAL]
Sun
200 papers
Flow-synchronized nasal intermittent positive pressure ventilation for prevention of extubation failure in neonates: a review of literature and a case series of neonates with congenital diaphragmatic hernia successfully managed with this strategy.
Ronci S, Caoci S, Gizzi C … +8 more , Calzolari F, Capolupo I, De Rose DU, Maddaloni C, Martini L, Savignoni F, Moretti C, Dotta A
Ital J Pediatr · 2025 Dec · PMID 41331880 · Full text
BACKGROUND: Advances in neonatal medicine have improved survival rates in neonatal intensive care units, especially for high-complexity cases like congenital diaphragmatic hernia (CDH). Despite these advances, managing r...
BACKGROUND: Advances in neonatal medicine have improved survival rates in neonatal intensive care units, especially for high-complexity cases like congenital diaphragmatic hernia (CDH). Despite these advances, managing respiratory failure in CDH infants remains challenging due to lung hypoplasia, respiratory insufficiency, and pulmonary hypertension. Lung-protective ventilation strategies are crucial to minimize ventilator-induced lung injury, but weaning them from invasive mechanical ventilation remains complex, and extubation failure rates are high. CASE PRESENTATION: This retrospective case series describes the use of Flow-Synchronized Nasal Intermittent Positive Pressure Ventilation (sNIPPV) in four neonates with surgically corrected left CDH admitted to the "Bambino Gesù" Children's Hospital in Rome (Italy) from 2022 onwards. Flow-sNIPPV was administered using the Giulia ventilator, which features a flow sensor for synchronization. We observed improved outcomes in terms of extubation success, in comparison to non-synchronized Nasal Intermittent Positive Pressure Ventilation (NIPPV). Synchronization reduced work of breathing (WOB), improved lung ventilation, and enhanced gas exchange without increasing ventilation-related complications. Additionally, this study reviews the current literature on the use of sNIPPV in neonates, highlighting the need for more research on its role in weaning post-extubation in CDH infants. CONCLUSIONS: Flow-sNIPPV shows promise in preventing extubation failure in neonates with CDH by improving ventilation and reducing WOB. Synchronization enhances lung ventilation, stabilizes the chest wall, and may reduce thoraco-abdominal asynchrony in CDH infants. While the findings are promising, larger multicenter studies are required to confirm the efficacy and safety of sNIPPV as a routine weaning strategy in CDH neonates after repair surgery.
Comparison of safety and immunogenicity between Healive®, Havrix® and live attenuated Hepatitis A vaccines in pediatric population: a systematic review with meta-analysis.
Abo Zeid M, Elrosasy A, Farho MA … +8 more , Rifai M, Aboelkhier MM, Elkhrashy MN, Zabady AH, Zaki MSA, Hamed EM, Dawood SA, Abuzaid Y
Ital J Pediatr · 2025 Dec · PMID 41331784 · Full text
BACKGROUND: Healive is an inactivated vaccine for hepatitis A virus developed in China and was found to be well-tolerated and highly immunogenic in adults and children. It is our aim this study to compare the safety and...
BACKGROUND: Healive is an inactivated vaccine for hepatitis A virus developed in China and was found to be well-tolerated and highly immunogenic in adults and children. It is our aim this study to compare the safety and immunogenicity of Healive® with Havrix® and live attenuated vaccines in pediatric populations. METHODS: A systematic search of PubMed, Scopus, Web of Science, and Embase databases was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) comparing Healive with other vaccines were included. RESULTS: Seven RCTs involving 3664 patients were included. Healive showed comparable efficacy to Havrix regarding seroconversion rates and GMT at one month (SMD = 0.24, 95% CI [-0.11 to 0.59]), but achieved better results at six (SMD = 0.85, 95% CI [0.57 to 1.07]) and seven months (SMD = 0.55, 95% CI [0.41 to 0.70]). When compared to live attenuated vaccines, Healive demonstrated superior GMT at one month (SMD = 0.31, 95% CI [0.07 to 0.56]) and two years (SMD = 0.36, 95% CI [0.06 to 0.67]). CONCLUSION: Healive appears to be effective and safe for preventing hepatitis A, providing at least five years of protection. This review underscores the importance of ongoing research to optimize hepatitis A vaccination strategies, including standardized assays for antigen content, clarification of protective antibody levels, and large-scale trials in regions of intermediate endemicity.
Family costs for pediatric hospitalized respiratory syncytial virus lower respiratory tract infections: an Italian multicenter study.
Bozzola E, D'Auria E, Vittucci AC … +9 more , Trapani S, Peroni D, Esposito S, Badolato R, Giannattasio A, Piccotti E, Baraldi E, Marcellusi A, Respiriamo Study Group*
Ital J Pediatr · 2025 Dec · PMID 41331440 · Full text
BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory tract disease, particularly in young children. It represents a significant cause of morbidity and mortality worldwide, as well...
BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory tract disease, particularly in young children. It represents a significant cause of morbidity and mortality worldwide, as well as a substantial cost driver in cases requiring hospitalization. The aim of the study was to generate data on the direct and indirect costs borne by families of children hospitalized with RSV-associated acute lower respiratory tract infection (ALRTI). MATERIAL AND METHODS: Inpatient children aged 24 months of age or below affected by ALRTI were enrolled at nine Italian pediatric hospitals. The study was conducted between November and March of 2022–2024, covering two consecutive RSV seasons in Italy. Direct and indirect costs incurred by families were collected through questionnaires completed by the parents at admission (T0) and again after 7 days (T1). RESULTS: A total of 296 patients were enrolled during the study period and divided into two groups according to nasal swab results: 225 RSV-positive (76%) and 71 RSV-negative (24%). Family finances were reported to be affected by direct costs in 79% of the RSV+ group and 63.1% of the RSV-group. Direct costs were similar at T0 (€ 52.5 ± 94.6 in RSV+ group and € 53.5 ± 171.4 in RSV- group), but higher at T1 in the RSV+ group (€ 53.8 ± 126.6 vs € 32.3 ± 64.4). Regarding indirect costs, a greater proportion of parents in the RSV-positive group reported taking additional paid leave from work at T1 (41.8% vs 25.3%; p-value = 0.0426) as well as more unpaid leave (13.7% vs 7%). DISCUSSION: This study highlights the substantial economic burden of RSV-related hospitalizations from the household perspective, encompassing both direct out-of-pocket expenses and indirect costs due to work absenteeism across two consecutive epidemic seasons. By documenting the real-life financial impact of RSV on families, our findings provide an important parent-centered perspective, support a more comprehensive evaluation of the RSV burden and underscore the need for broad preventive measures against the disease.
I have the right to carry a backpack: access to the school of children and adolescents in paediatric palliative care in the Veneto Region (Italy).
Santini A, Rosa M, Marinetto A … +6 more , Grigolon E, Giacomelli L, Vecchi L, Agosto C, Tommasi V, Benini F
Ital J Pediatr · 2025 Dec · PMID 41331430 · Full text
BACKGROUND: This universal right of access to school applies to all children and adolescents, including paediatric palliative care (PPC) patients. PPC patients display several different levels of disability and cognitive...
BACKGROUND: This universal right of access to school applies to all children and adolescents, including paediatric palliative care (PPC) patients. PPC patients display several different levels of disability and cognitive impairment that pose challenges to school inclusion. Therefore, strategies to offer an efficient and tailored school experience that relies on the support of school assistants and support teachers are essential. METHODS: In this retrospective study, data of patients of school age (3–19 years) followed at the Paediatrics Hospice of Padua were collected cross-sectionally from clinical charts, routine visits, and calls to patients and caregivers. RESULTS: Our results showed that school attendance by students with severe disabilities is remarkably low, especially for those children displaying complex care needs, resulting in a high care burden on families. Notwithstanding, family choices significantly influence school attendance, which may be a consequence of the inadequacy of the services offered by the education system, linked to organisational and structural factors CONCLUSIONS: It is vital to identify the key issues and strengths of the current educational system to develop effective strategies that help families and promote school involvement. Investing in teacher and staff support, along with ongoing training for school personnel, is crucial.
Clinical and molecular characterization of 14 Egyptian children with fructose-1,6-bisphosphatase deficiency.
Magdy RM, Sadek AA, Hemdan SB … +4 more , Mahmoud AS, Abdel Fattah NH, Abdelkreem E, Abdelatif RG
Ital J Pediatr · 2025 Dec · PMID 41327277 · Full text
BACKGROUND: Fructose-1,6-bisphosphatase (FBP1) deficiency is a rare inherited disease characterized by recurrent episodes of lactic acidosis and ketotic hypoglycemia. To date, no cases have been reported in the Egyptian...
BACKGROUND: Fructose-1,6-bisphosphatase (FBP1) deficiency is a rare inherited disease characterized by recurrent episodes of lactic acidosis and ketotic hypoglycemia. To date, no cases have been reported in the Egyptian population. This study aimed to elucidate the phenotypic and molecular spectrum of FBP1 deficiency in Egypt. METHODS: This observational study included children with FBP1 deficiency diagnosed and managed at an Egyptian medical center between 2022 and 2024. Clinical and laboratory data of acute metabolic episodes were thoroughly reviewed. All patients underwent blood acylcarnitine assay, urinary organic acids analysis, and whole-exome sequencing. Patients' outcomes were classified into favorable, neurodevelopmental impairment, and death. RESULTS: This cohort included 14 Egyptian children (from 11 families) with FBP1 deficiency. The median age at disease onset was 13 months, ranging from the first week of life to 36 months. All patients exhibited acute lactic acidosis, and most (13/14) had hypoglycemia. Four FBP1 variants were identified: c.88G > T (p.Glu30Ter), c.652_661delinsTCACGAGGGCT (p.Arg218SerfsTer9), c.960delinsGG (p.Ser321ValfsTer13), and c.902_904del (Glu301del). The c.960delinsGG variant was detected in nine cases, suggesting a founder effect. The c.652_661delinsTCACGAGGGCT is a novel variant. One case had a coexisting partial biotinidase deficiency. Regarding outcome, two patients died during the neonatal period, while the remainder achieved normal neurodevelopment. CONCLUSION: This is the first study of FBP1 deficiency in Egypt, which expands the demographic, clinical, and genetic spectrum of this rare disease.
Nomogram-based prediction model for extubation failure in preterm infants with invasive mechanical ventilation.
Tan C, Sui Y, Wang L
Ital J Pediatr · 2025 Dec · PMID 41327240 · Full text
BACKGROUND: Achieving early and successful extubation was a critical aspect in the respiratory management of preterm infants. This study aims to identify variables for assessment and establish a predictive model to estim...
BACKGROUND: Achieving early and successful extubation was a critical aspect in the respiratory management of preterm infants. This study aims to identify variables for assessment and establish a predictive model to estimate preterm infants who may experience extubation failure following invasive mechanical ventilation. METHODS: A retrospective analysis was conducted on 265 very low birth weight infants (VLBWIs) with neonatal respiratory distress syndrome (NRDS) who received invasive mechanical ventilation and intratracheal surfactant administration in the neonatal intensive care unit (NICU) of a tertiary hospital. Infants were divided into an extubation failure group and an extubation success group based on whether reintubation was required within 72 h after extubation. Independent risk factors for extubation failure were identified, and a nomogram prediction model was constructed. Additionally, 71 VLBWIs from another tertiary hospital, meeting the same inclusion criteria, were used as an external validation dataset to assess the model’s performance. RESULTS: Gestational age, birth weight, patent ductus arteriosus (PDA) diameter, hematocrit (Hct) before extubation, and sepsis were identified as independent risk factors for extubation failure. The nomogram model based on these factors achieved a concordance index of 0.888 for internal validation (training set) and 0.862 for external validation (independent dataset), indicating robust consistency between predicted and observed probabilities. The sensitivity and specificity of the model were 89.8% and 77.8%, respectively, with an area under the receiver operating characteristic curve (AUC) of 0.888 (95% CI: 0.845–0.931). Calibration curves demonstrated a high degree of agreement between predicted and actual probabilities. CONCLUSION: Gestational age, birth weight, PDA diameter, hematocrit, and sepsis are key factors influencing initial extubation failure in preterm infants. The nomogram model based on these factors demonstrates excellent predictive accuracy and provides valuable guidance for clinical decision-making regarding extubation.
Predictive value of the combined evaluation of the neutrophil-to-lymphocyte ratio and lactate dehydrogenase level for coronary artery lesions in patients with acute Kawasaki disease.
Li L, Wan Y, Li GA … +1 more , Tao SS
Ital J Pediatr · 2025 Nov · PMID 41318589 · Full text
OBJECTIVE: The objective of this research was to explore the predictive value of the combination of the neutrophil-to-lymphocyte ratio (NLR) and lactate dehydrogenase level for coronary artery lesions (CAL) in patients w...
OBJECTIVE: The objective of this research was to explore the predictive value of the combination of the neutrophil-to-lymphocyte ratio (NLR) and lactate dehydrogenase level for coronary artery lesions (CAL) in patients with acute Kawasaki disease (aKD). METHODS: We retrospectively reviewed a total of 215 patients diagnosed with aKD. Patients were divided into two groups according to their CAL: aKD patients without CAL (n = 134) and those with CAL (n = 81). We compared the differences in age at diagnosis, sex, and laboratory and echocardiography data between the two groups. Multivariate logistic regression analysis was performed to evaluate the risk factors for predicting CALs in patients with aKD. Receiver operating characteristic (ROC) curve analysis was performed to detect the sensitivity and specificity of the NLR, LDH, and the combination of the two values in patients with CAL with aKD. RESULTS: PLT, ALB, LDH, CK, and CK-MB in aKD patients without CAL were significantly greater than those in patients with CAL, whereas hs-CRP and TBIL were significantly lower than those in patients with CAL (P < 0.05). Echocardiography data showed that LCAd, RCAd, LVDd, IVSd, and LVPWd were significantly greater in aKD patients with CAL than in those without CAL (P < 0.05). After adjusting for age at diagnosis, sex, LDH, CK, IVSd, LVPWd, LVDd, and LVEF, NLH remained an independent risk indicator related to CAL (OR: 1.210, 95% CI: 1.0221.432, P = 0.027). ROC analysis revealed that LDH demonstrated excellent sensitivity (90.28%), whereas the NLR showed excellent specificity (91.79%). The combined evaluation exhibited good sensitivity (52.78%), specificity (80.30%), and AUC (0.727, 95% CI: 0.660 to 0.787); these findings indicate that the combined assessment is superior to the single-index assessment using the NLR (P Combination vs. NLR = 0.007). CONCLUSION: The present research concluded that NLH is an independent risk indicator related to CAL in aKD patients. When the NLR is > 4.06 and/or LDH is < 370.4 U/L, aKD patients are more likely to develop CAL. The combination of NLR and LDH level has good predictive value for CAL in aKD patients. CLINICAL TRIAL NUMBER: Not applicable.
Invasive Group A Streptococcus infections in children during the post-pandemic period: results from a multicenter study in Italy.
Chiappini E, Renni M, De Luca M … +21 more , Bosis S, Garazzino S, Dotta L, Badolato R, Zallocco F, Zama D, Frassanitto A, Liguoro I, Buonsenso D, Colomba C, Romani L, Lorenzetti G, Ceroni F, Denina M, Monti N, Lisi C, Galli L, Nicolini G, Castelli Gattinara G, Lo Vecchio A, Italian Society of Pediatric Infectious Diseases (SITIP)
Ital J Pediatr · 2025 Nov · PMID 41316382 · Full text
BACKGROUND: Group A Streptococcus causes pediatric infections from mild to severe forms. Since late 2022, invasive cases have increased in Europe, possibly due to reduced post-COVID-19 immunity, more respiratory virus ci...
BACKGROUND: Group A Streptococcus causes pediatric infections from mild to severe forms. Since late 2022, invasive cases have increased in Europe, possibly due to reduced post-COVID-19 immunity, more respiratory virus circulation, and emergence of virulent strains. METHODS: A retrospective, multicenter observational study was conducted in twelve Italian pediatric Hospitals, including patients under 18 years hospitalized with invasive or severe Group A Streptococcus infection. Data were anonymized and analyzed to identify factors associated with Pediatric Intensive Care Unit (PICU) admission and discharge with sequelae or death. RESULTS: Seventy-five children with invasive or severe Group A Streptococcus infection were included; the majority (69.3%) were aged 2-10 years. Invasive Group A Streptococcus (iGAS) infection accounted for 58.7% (n = 44) and severe GAS (sGAS) infection for 41.3% (n = 31) of cases. Pediatric Intensive Care Unit admission was required in 45.3% (n = 34) of the entire patient cohort, in this subgroup viral coinfection (OR 5.684, p = 0.003), sepsis/septic shock (OR 4.406, p = 0.003), iGAS diagnosis (OR 4.153, p = 0.005), and procalcitonin (PCT) > 0.5 ng/mL (OR 7.105, p = 0.019) were independently associated with admission; the use of corticosteroids (OR 4.641, p = 0.003) and intravenous immunoglobulin (IVIG) (OR 16.667, p = 0.003) was also significantly more frequent. All patients received empirical β-lactam antibiotics; anti-toxin therapy was administered in 47 patients (62.7%): clindamycin (49.3%), linezolid (16.0%), and rifampicin (1.3%). Mechanical ventilation was required in 24.0% (n = 18), and 49.3% (n = 37) underwent surgery. Post-infectious sequelae occurred in 20.0% (n = 15) and four children died, mostly due to streptococcal toxic shock syndrome. CONCLUSION: Pediatric invasive group A streptococcal infection continues to pose a significant clinical challenge, with notable rates of morbidity and mortality, underscoring the need for early recognition and close monitoring of high-risk patients. A widespread use of adjunctive therapies was documented. Continued surveillance and robust clinical research are essential to optimize management strategies and improve patient outcomes.
Value of the neutrophil percentage-to-albumin ratio in predicting intravenous Immunoglobulin resistance in Kawasaki disease: a retrospective cohort study.
Du Q, Zhang X, Sun H … +5 more , Bi Z, Li X, Wei X, Li L, Zhou W
Ital J Pediatr · 2025 Nov · PMID 41310824 · Full text
BACKGROUND: Intravenous immunoglobulin (IVIG) resistance in Kawasaki disease (KD) is associated with coronary artery lesions (CALs). Available studies suggest that inflammation and nutritional status play a key role in I...
BACKGROUND: Intravenous immunoglobulin (IVIG) resistance in Kawasaki disease (KD) is associated with coronary artery lesions (CALs). Available studies suggest that inflammation and nutritional status play a key role in IVIG resistance. Given this, the neutrophil percentage to albumin ratio (NPAR), a new combined indicator of inflammation and nutritional status, may be an important predictor of IVIG resistance. METHODS: This was a retrospective cohort study involving 591 children diagnosed with KD. Participants were categorized based on their NPAR levels, and their clinical data were analyzed to assess the relationship between NPAR and IVIG resistance. Multivariable logistic regression model was conducted to evaluate the association between inflammatory biomarkers and IVIG resistance. A restricted cubic spline (RCS) model was employed to investigate the dose-response relationship between NPAR, other inflammatory biomarkers, and the risk of IVIG resistance. Furthermore, subgroup analyses were performed to assess the effects of age, sex, and other relevant factors on the association between NPAR and IVIG resistance. The receiver operating characteristic curve (ROC) was utilized to estimate the predictive power of NPAR and other inflammatory biomarkers. RESULTS: Among 591 participants with KD, 72 (12.2%) were IVIG resistance, and these patients showed a higher incidence of CALs (26.4% vs. 11.6%). Higher NPAR levels were significantly associated with an increased proportion of IVIG resistance. Specifically, the proportion of IVIG resistance was 2.5% in the lowest NPAR tertile, compared to 25.4% in the highest tertile (p < 0.001). The multivariable logistic regression model confirmed that NPAR was significantly associated with IVIG resistance. Each unit increase in NPAR was linked to 14.53 times increase in the odds of IVIG resistance (OR: 15.53, 95% CI: 7.83–30.84, p < 0.001). After adjusting for confounders such as age, gender, and laboratory parameters, the association remained strong (OR: 21.80, 95% CI: 8.84–53.74, p < 0.001). Additionally, the study demonstrated a dose-response relationship between NPAR levels and IVIG resistance, with higher NPAR values corresponding to greater risk. Subgroup analyses confirmed the stability of these findings. Furthermore, the area under the curve (AUC) for NPAR predicting IVIG resistance was 0.794, outperforming other inflammatory biomarkers. CONCLUSION: This study demonstrated that NPAR, as a comprehensive indicator of inflammation and nutritional status, was significantly associated with IVIG resistance and can serve as a reliable predictor. Although the clinical application value of NPAR requires further validation, it shows promise as a novel biomarker for early identification of high-risk individuals and improving clinical management strategies. CLINICAL TRAIL NUMBER: Not applicable.
Pediatrics advances in 2024: choices in allergy, cardiology, critical care, endocrinology, gastroenterology, immunology, infectious diseases, neonatology, nephrology, neurology, nutrition, palliative care respiratory tract illnesses, and social media.
Caffarelli C, Bozzola E, Piro E … +5 more , Tchana B, Buono EV, Cunico D, Bernasconi S, Corsello G
Ital J Pediatr · 2025 Nov · PMID 41310799 · Full text
Over the past year, there have been several developments in various fields of pediatric medicine. This review features essential publications that have been published in the Italian Journal of Pediatrics in 2024. Papers...
Over the past year, there have been several developments in various fields of pediatric medicine. This review features essential publications that have been published in the Italian Journal of Pediatrics in 2024. Papers have been selected in the areas of allergy, cardiology, critical care, endocrinology, gastroenterology, immunology, infectious diseases, neonatology, nephrology, neurology, nutrition, palliative care, respiratory tract illnesses, and social media. The findings have been examined to identify opportunities for improving the management of the diseases.
Machine learning model for predicting severe infection in children with idiopathic nephrotic syndrome: multicenter retrospective study.
Yu S, Tang W, Zhang D … +12 more , Shen F, Wang A, Chen H, Chen H, Zhang F, Xiao L, Li Y, Chen Z, Wang L, Wang M, Yang H, Li Q
Ital J Pediatr · 2025 Nov · PMID 41291834 · Full text
BACKGROUND: Infection is a common complication of idiopathic nephrotic syndrome (INS), and early identification of severe infection can improve patient outcome. METHODS: This multicenter retrospective study developed and...
BACKGROUND: Infection is a common complication of idiopathic nephrotic syndrome (INS), and early identification of severe infection can improve patient outcome. METHODS: This multicenter retrospective study developed and validated machine learning (ML) models that predict severe infection in children with INS. The derivation cohort (n = 2357) consisted of INS patients at one institution, and was separated into a training set and testing set. The external validation set (n = 372) consisted of INS patients from three other hospitals. Data were collected for 41 variables, and ten of them were then selected by univariate analysis and Least Absolute Shrinkage and Selection Operator (LASSO) regression. Ten ML models were compared, and the best one was identified using receiver operating characteristic (ROC) analysis and other methods. RESULTS: The incidence rate of severe infection was 6.8% in the derivation cohort. The Light Gradient Boosting Machine (LightGBM) model had the best predictive performance (accuracy: 0.843, precision: 0.843, recall: 0.842, F1: 0.843, sensitivity: 0.842, specificity: 0.844, AUROC:0.912, AUPRC:0.915). The ten predictors were C-reactive protein, hemoglobin, white blood cells, activated partial thromboplastin time, creatinine, high-density lipoprotein, corrected serum calcium, complement 3, and number of immunosuppressants, and incidence of SRNS. This model had an AUROC of 0.979 and AUPRC of 0.842 in the external validation cohort. CONCLUSION: A LightGBM model for predicting severe infection in patients with INS had excellent performance. Future applications of this model may provide an effective, convenient, and cost-effective approach for early identification of severe infection in children with INS.
Recommendations for antibacterial prophylaxis in children receiving chemotherapy: a joint initiative of SITIP and infectious disease group of AIEOP.
Zama D, Leardini D, Baccelli F … +14 more , Muratore E, Castagnola E, Del Bene M, De Luca M, Funiciello E, Galaverna F, Masetti R, Muggeo P, Mura RM, Perruccio K, Ricci E, Spadea M, Lo Vecchio A, Cesaro S
Ital J Pediatr · 2025 Nov · PMID 41291819 · Full text
BACKGROUND: Current guidelines for managing infections in pediatric patients with cancer do not recommend routine antibiotic prophylaxis (AP). However, several aspects of AP, including the role of diagnosis, the impact o...
BACKGROUND: Current guidelines for managing infections in pediatric patients with cancer do not recommend routine antibiotic prophylaxis (AP). However, several aspects of AP, including the role of diagnosis, the impact of neutropenia duration, screening for resistant bacterial colonization, and antibiotic stewardship, remain a matter of debate. METHODS: To address these issues, a panel of experts from the Italian Association of Pediatric Hematology and Oncology (AIEOP) and the Italian Society of Pediatric Infectious Diseases (SITIP) conducted a Delphi consensus. A comprehensive literature review and a national survey of pediatric oncology centers identified clinically relevant topics that are not fully covered by current guidelines. Based on this, the expert panel developed and voted on 14 statements covering eight key areas: the role of diagnosis, duration of neutropenia, screening for colonization with antibiotic resistant bacteria, use of validated risk scores, implementation of antimicrobial stewardship programs, periodic monitoring of local epidemiology, choice of antibiotic for prophylaxis, and the risk of resistance following prophylaxis. RESULTS: The panel reached a consensus against prophylaxis in patients receiving monoclonal antibody therapy and advised against using the duration of neutropenia alone as a criterion to initiate prophylaxis, recommending it only for severe neutropenia (< 500/mm³). They also emphasized the importance of screening for multidrug resistant bacteria and implementing antimicrobial stewardship supported by specialist consultation. CONCLUSIONS: These recommendations provide guidance for clinicians on the selective use of AP, supporting informed decision making while ensuring appropriate treatment and reducing the emergence of multidrug resistant bacterial infections.
Use of digital media device in pediatric adolescents affected by anorexia nervosa.
Marchili MR, Spina G, Cirillo F … +10 more , Roversi M, Irrera M, Burla V, Mascolo C, Pretelli I, Castiglioni MC, Zanna V, Raucci U, Bozzola E, Villani A
Ital J Pediatr · 2025 Nov · PMID 41291786 · Full text
BACKGROUND: In the last years the use of digital media devices (MD) among adolescents has increased exponentially, becoming a central component of daily life for many young. The aim of the present study is to explore the...
BACKGROUND: In the last years the use of digital media devices (MD) among adolescents has increased exponentially, becoming a central component of daily life for many young. The aim of the present study is to explore the use of MD in adolescents affected by anorexia nervosa (AN), compared to healthy ones. Furthermore, we compared MD use between inpatient and outpatient adolescents with AN. METHODS: This single-center prospective study enrolled patients aged 9-18 years affected by AN and admitted at IRCCS Bambino Gesù Children's Hospital, Rome, Italy, between January 2024 and August 2024. Participants completed a questionnaire to explore their relationship with MD in terms of time of use, addiction, activities, parents' role, MD consequences and children perception. Results from AN patients were then compared to those of the general population cohort described in our previous paper. RESULTS: During the study period, 113 patients were enrolled. AN patients spent less time per day on screens compared to controls. In detail, the majority of AN adolescents (40.6%) spent between two and three hours per day on MD, while most of the control group (54%) spends more than three hours per day on screen (p < 0.001). Furthermore, both AN (69.9%) and control (56%) group primarily uses MD before going to bed. Finally, most of AN individual (43.6%) primarily uses devices for browsing social networks, showing a statistically significant difference compared to controls (24.0%, p = 0.044). Notably, children aged 9-14 years also largely use MD to access social networks (40.8%). AN outpatients statistically use MD for a prolonged time compared to AN inpatients. CONCLUSION: AN patients spend less time per day on screens compared to the general population. This habit may find a possible explanation in a polarization of thinking about food. An alarming fact is the strong relationship of adolescents with MD even among the youngest - aged 9-14 years - and the difficulty in renouncing it for a limited period. In conclusion, we believe it is necessary to intensify controls in order to safeguard the mental health of children.
Development and validation of an online nomogram for screening metabolic-associated fatty liver disease in obese children.
Hu J, Wang M, Wang X … +12 more , Guo M, Lu Y, Zhang Z, Li M, Sun G, Ma X, Zhang Y, Zhang W, Li D, Chen Y, Luo S, Wei H
Ital J Pediatr · 2025 Nov · PMID 41287084 · Full text
BACKGROUND: Metabolic-associated fatty liver disease (MAFLD) has emerged as a critical pediatric health concern, particularly among children with obesity. However, its diagnosis poses substantial challenges, especially i...
BACKGROUND: Metabolic-associated fatty liver disease (MAFLD) has emerged as a critical pediatric health concern, particularly among children with obesity. However, its diagnosis poses substantial challenges, especially in the use of non-invasive methods. Our goal was to construct an online nomogram for screening MAFLD in obese children. METHODS: We designed a retrospective cross-sectional study involving 2,512 obese children. Detailed anthropometric data and laboratory parameters were collected. The study dataset was randomly allocated into training (n = 1758) and validation (n = 754) sets at a 7:3 ratio. To identify MAFLD risk factors, we conducted logistic regression analyses, from which a web-based predictive nomogram was constructed. Using receiver operating characteristic (ROC) curves and area under the curve (AUC), the nomogram's performance was assessed and contrasted with the triglyceride glucose (TyG) index, Zhejiang University (ZJU) index, and Korean NAFLD (K-NAFLD) score. The goodness-of-fit of the nomogram was evaluated using calibration plots, and the nomogram's clinical value was assessed using decision curve analysis (DCA). RESULTS: A total of 1,344 participants (53.50%) were diagnosed with MAFLD by ultrasound. Age, gender, BMI Z-score, waist circumference (WC), homeostatic model assessment of insulin resistance (HOMA-IR), and alanine aminotransferase (ALT) were identified as independent factors influencing MAFLD in obese children. These six variables were selected for the construction of the nomogram. ROC analysis revealed that the nomogram had superior diagnostic performance for MAFLD detection compared to the other three models, with AUC values of 0.874 (95% confidence interval [CI]: 0.858-0.890) in the training set and 0.870 (95% CI: 0.845-0.895) in the validation set. Calibration plots indicated a good fit of the nomogram in both datasets. Furthermore, DCA demonstrated its strong clinical applicability. CONCLUSIONS: This study developed an online nomogram that demonstrates robust diagnostic accuracy and clinical utility for assessing obese children's MAFLD risk.
The association between copeptin and hypertension in children and adolescents: a systematic review.
Mojtahedi SY, Pourpashang P
Ital J Pediatr · 2025 Nov · PMID 41286965 · Full text
Copeptin, a stable surrogate marker of arginine vasopressin, has been implicated in blood pressure regulation, but its role in pediatric hypertension remains unclear. This systematic review evaluates the association betw...
Copeptin, a stable surrogate marker of arginine vasopressin, has been implicated in blood pressure regulation, but its role in pediatric hypertension remains unclear. This systematic review evaluates the association between copeptin levels and hypertension in children and adolescents. A comprehensive search was conducted in PubMed, Scopus, Web of Science, Embase, and Cochrane Library up to February 21, 2025. Additional sources, including Google Scholar and reference lists of relevant articles, were screened to ensure literature saturation. Observational studies (cohort, case-control, and cross-sectional) assessing copeptin levels in relation to blood pressure in pediatric populations (< 18 years) were included. Copeptin levels were assessed using validated biochemical methods, including enzyme-linked immunosorbent assay. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Due to heterogeneity in study designs and outcome measurements, a narrative synthesis was performed. Twelve studies met the inclusion criteria, with sample sizes ranging from 25 to 351 participants. Some studies reported a significant association between higher copeptin levels and hypertension, particularly in children with obesity or metabolic disorders. However, other studies found no significant correlation. Differences in study design, sample characteristics, copeptin measurement methods, and confounding factors contributed to the heterogeneity of findings. The evidence on the association between copeptin and hypertension in children is inconclusive. While some studies support its potential role as a biomarker, inconsistencies highlight the need for standardized methodologies and longitudinal studies. Future research should explore copeptin's clinical utility in pediatric hypertension risk stratification.Systematic review registration number PROSPERO: CRD420251003190.
Birth weight distribution of neonates in Lombardy: development of CedAP charts and comparison with national and international charts.
Tunesi S, Spada E, Celata C … +1 more , Russo AG
Ital J Pediatr · 2025 Nov · PMID 41272815 · Full text
BACKGROUND: Birth weight (BW) is an indicator for the assessment of neonatal health. No recent studies have specifically evaluated the distribution of BW in infants born in Lombardy and no updated regional neonatal chart...
BACKGROUND: Birth weight (BW) is an indicator for the assessment of neonatal health. No recent studies have specifically evaluated the distribution of BW in infants born in Lombardy and no updated regional neonatal charts are available. The aim of this study is to trace region-specific BW charts (CedAP charts) for neonates born in Lombardy and to compare them with the INeS charts, specific for Italian neonates, and with the Intergrowth21st (IG21) international neonatal charts. METHODS: Data of 361,105 singleton live births were extracted from the certificate of assistance in childbirth (CedAP) registry. The Extended Mechanistic Growth Function method was used to trace CedAP charts. The comparison with the INeS and the IG21 charts was performed by centiles shape, computing z-scores means and standard deviation, and by the proportion of small-for-gestational-age (SGA), appropriate-for-gestational-age (AGA), and large-for-gestational-age (LGA) detected with each chart. RESULTS: The CedAP charts are similar to the INeS charts, particularly at lower centiles, while at higher centiles the CedAP charts tend to show slightly higher values. Comparisons with the IG21 charts show more differences. According to INeS charts, the mean BW z-score is close to expected, with minor deviations observed across gestational ages (GA). According to IG21 z-scores, the mean values were negative for preterm classes and positive for term neonates. The SDs are comparable in all the three charts. The proportion of neonates classified as SGA is overestimated in IG21 charts at GA < 33 weeks and underestimated at term. In contrast, the INeS and CedAP classifications are more consistent, with CedAP showing a slight underestimation of SGA at term. The IG21 charts tend to classify fewer preterm neonates as LGA. CONCLUSION: While IG21 represent a useful tool for studies of populations comparison, CedAP and INeS charts may be more appropriate for assessing neonates in Lombardy and throughout all Italy. These findings suggest that the INeS charts remain relevant for clinical practice, CedAP charts providing complementary, region-specific charts. Further studies are needed to assess the clinical predictive performance of different neonatal charts in identifying neonates at risk for adverse outcomes.
Clinical characteristics and predictor analysis of pediatric Mycoplasma pneumoniae pneumonia with small segment molded sputum plugs: a retrospective study.
Hong B, Li C, He S … +2 more , Fu J, Chen D
Ital J Pediatr · 2025 Oct · PMID 41272809 · Full text
BACKGROUND: This study aimed to analyze the clinical characteristics and identify predictive factors associated with small segment molded sputum plugs in pediatric patients with Mycoplasma pneumoniae pneumonia (MPP). MET...
BACKGROUND: This study aimed to analyze the clinical characteristics and identify predictive factors associated with small segment molded sputum plugs in pediatric patients with Mycoplasma pneumoniae pneumonia (MPP). METHODS: A retrospective analysis was performed on the clinical data of pediatric patients diagnosed with MPP who underwent bronchoscopy at our hospital between December 2021 and April 2024. Multivariate logistic regression was employed to determine independent predictors of small segment molded sputum plug formation. RESULTS: Among 116 pediatric patients with MPP who met the study criteria, 48 (41.38%) were found to have small segment molded sputum plugs, while 68 (58.62%) did not. Patients with a history of recurrent respiratory infections, diminished breath sounds, and radiological evidence of atelectasis were significantly more likely to develop molded sputum plugs (P < 0.05). Furthermore, the group with small segment molded sputum plugs exhibited a longer duration of fever (P = 0.025) and elevated levels of procalcitonin (PCT; P = 0.024), alanine aminotransferase (ALT; P = 0.048) and prothrombin time (PT; P = 0.021). Multivariate logistic regression analysis identified a history of recurrent respiratory infections and diminished breath sounds as independent predictors for the development of small segment molded sputum plugs. CONCLUSIONS: A history of recurrent respiratory infections and diminished breath sounds emerged as independent predictors of small segment molded sputum plugs in pediatric MPP. These findings highlight the importance of considering these clinical features during the evaluation of MPP patients to inform diagnostic and therapeutic decision-making. Future studies are warranted to investigate the potential benefits of early detection and intervention on clinical outcomes in pediatric MPP.
Diagnosis, management, and prevention of bronchiolitis in primary care: a survey of Italian family paediatricians.
Picca M, Pezzini C, Baggi E … +4 more , Manzoni P, Mezzopane A, La Vecchia A, Milani GP
Ital J Pediatr · 2025 Nov · PMID 41257972 · Full text
BACKGROUND: Primary care paediatricians play a key role in the diagnosis, management, and prevention of bronchiolitis, but data on their clinical practices remain limited. METHODS: An online survey was conducted via emai...
BACKGROUND: Primary care paediatricians play a key role in the diagnosis, management, and prevention of bronchiolitis, but data on their clinical practices remain limited. METHODS: An online survey was conducted via email by the Lombardy section of the Italian Primary Care Paediatrics Society (SICuPP) between January 1 and April 30, 2025. Primary care paediatricians were invited to participate via email. Associations were assessed using the chi-square or Fisher’s exact test. Multivariable logistic regression identified factors associated with the prescription of antibiotics, corticosteroids, and bronchodilators—three drug categories commonly used in bronchiolitis despite not being recommended by current guidelines. RESULTS: The response rate was 28.8%, yielding 306 valid responses. Most respondents (62.1%) had over 20 years of clinical experience. Diagnostic criteria varied: 42.8% used 12 months as the upper age limit, 42.2% used 24 months, and 5.6% applied no age limit. Diagnostic approaches differed, with 45.1% relying on wheezing/grunting and 36.9% on wet sounds. Pulse oximetry was always used by 39.5%, and 67.9% never used rapid viral tests. Bronchodilators and steroids were recommended by 37.6% and 32.3%, respectively. Antibiotics were prescribed in 30.1% of cases with poor general condition and 18.6% with fever. Nirsevimab prophylaxis was well accepted (96.4%), with high caregiver compliance (97.7%). Paediatricians diagnosing bronchiolitis up to 36 months were less likely to report never prescribing antibiotics (OR 0.13, 95% CI 0.02–0.51), whereas those relying on widespread sounds were more likely than those using grunting or wheezing (OR 2.42, 95% CI 1.23–4.83). Bronchodilator use was lower with diagnosis based on widespread sounds (OR 0.38, 95% CI 0.18–0.77). Steroid use was higher without an age limit (OR 3.09, 95% CI 1.09–9.25) and lower with widespread sounds (OR 0.31, 95% CI 0.13–0.66). CONCLUSIONS: This first Italian survey on bronchiolitis management in primary care reveals substantial variability in diagnostic and treatment practices. Diagnostic inconsistency is associated with non-guideline-recommended prescribing. Standardized diagnostic criteria are needed. Nirsevimab prophylaxis was widely accepted, supporting its continued use to reduce the burden of bronchiolitis.
Transient Headache and Neurological Deficits with cerebrospinal fluid Lymphocytosis (HaNDL) syndrome in children: case report and narrative review.
Abrate G, Rossi R, Grasso G … +5 more , Lauria B, Vassia C, Castagno E, Bondone C, Versace A
Ital J Pediatr · 2025 Nov · PMID 41257749 · Full text
BACKGROUND: The transient Headache and Neurological Deficit with cerebrospinal fluid Lymphocytosis (HaNDL) Syndrome is a rare form of primary headache, with few cases reported in children. CASE PRESENTATION AND REVIEW: W...
BACKGROUND: The transient Headache and Neurological Deficit with cerebrospinal fluid Lymphocytosis (HaNDL) Syndrome is a rare form of primary headache, with few cases reported in children. CASE PRESENTATION AND REVIEW: We report the case of a 15-year-old female with HaNDL syndrome showing paresthesia to the right side of her face and upper limbs, asthenia, dysarthria and aphasia, followed by left periorbital pulsating headache with moderate nausea, lasting about four hours. Forty-four cases of pediatric HaNDL syndrome are reported in literature (ours included), but only 25 fulfilled all diagnostic criteria according to ICHD-3. Overall, 59.1% were females. Sensory symptoms affected 71.4% of patients, followed by impaired speech (69.0%) and motor symptoms (52.4%). At CSF analysis, the mean value of white blood cells was 201.1/µl; proteinorrhachia was reported in 31 patients (70.5%). When asked, neuroimaging was negative. Symptomatic treatment was reported only in 14 patients (31.8%). CONCLUSIONS: HaNDL is a rare self-limiting syndrome affecting both adults and children. The etiology is unknown, but autoimmune mechanisms have been proposed. HaNDL is a diagnosis of exclusion: differential diagnoses include stroke, tumors, epilepsia, neuro-infective disorders, autoimmune encephalitis, vasculitis, hemiplegic migraine and migraine with aura. Usually, HaNDL episodes last less than 3 months; therapy is symptomatic. The diagnostic work out includes CSF analysis, neuroimaging and EEG. The treatment is symptomatic, and the course is self-limiting, usually resolving within 3 months.
Prevalence, risk perception, and motivations behind E-cigarettes and heated tobacco use: a cross-sectional study in Italian adolescents.
Virgili F, Del Parco F, La Regina DP … +6 more , Mancino E, Petrarca L, Conti MG, Bonci E, Nenna R, Midulla F
Ital J Pediatr · 2025 Nov · PMID 41250072 · Full text
BACKGROUND: E-cigarettes and Heated Tobacco Products (HTPs), which emerged as "safer" alternatives to traditional cigarettes, remain easily accessible and widely misperceived as harmless, especially among adolescents. Ou...
BACKGROUND: E-cigarettes and Heated Tobacco Products (HTPs), which emerged as "safer" alternatives to traditional cigarettes, remain easily accessible and widely misperceived as harmless, especially among adolescents. Our study aimed to assess the prevalence of e-cigarette and HTP use among Italian adolescents, and investigate underlying motivations, risk perceptions, and social influences. METHODS: We conducted a cross-sectional survey among 200 adolescents aged 11-18 years. Participants completed a 50-item anonymous questionnaire exploring sociodemographic characteristics, smoking behaviors, reasons for use, risk awareness, and social influence. RESULTS: Among participants, 23% reported using e-cigarettes and 16% HTPs. Disposable, flavored and nicotine-containing products were highly prevalent. Among vapers, use was significantly more frequent in those aged > 14 years, and in individuals reporting social influence, stress, or sadness/apathy. Similar patterns were observed among HTP users. Risk perception was low: 85% of participants believed e-smoking was less harmful than conventional smoking, and only 5% recognized e-cigarettes as significantly harmful. Only 20% of all participants had been asked about smoking during medical visits, with significantly lower rates among those < 14 years. A comprehensive analysis of usage patterns, psychosocial correlates, and risk perception is provided in the full manuscript. CONCLUSION: The underestimation of health risks associated with electronic smoking devices pose a serious Public Health challenge. Findings highlight the urgent need for targeted interventions combining stricter access control, enhanced risk communication, and integration of tobacco prevention into school and clinical settings. Greater attention should be paid to the psychological dimension of adolescent smoking and the evolving landscape of nicotine delivery systems.
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