Ital J Pediatr [JOURNAL]
Sun
200 papers
Clinical characteristics and trend changes of Kawasaki disease in children because of the Omicron pandemic.
Wang X, Yi Y, Gu M … +6 more , Ou X, Wang X, Liu H, Yang X, Zhang M, Shen X
Ital J Pediatr · 2025 Nov · PMID 41250024 · Full text
BACKGROUND: This study aims to inform the enhancement of prevention and control strategies for Kawasaki disease (KD) by conducting a retrospective analysis of its clinical features in the context of the Omicron pandemic....
BACKGROUND: This study aims to inform the enhancement of prevention and control strategies for Kawasaki disease (KD) by conducting a retrospective analysis of its clinical features in the context of the Omicron pandemic. METHODS: KD cases from the three years preceding the Omicron pandemic were categorized as the control group, while cases occurring during the Omicron pandemic were designated as the observation group. Comparative analyses were performed between these groups, focusing on demographic characteristics such as the proportion of hospitalizations for KD, age, gender, and place of residence, as well as clinical data encompassing symptoms, laboratory findings, imaging results, diagnosis and treatment, and prognosis. RESULTS: A total of 407 children participated in the study, with 180 allocated to the observation group and 227 to the control group. During the Omicron outbreak, the proportion of KD among hospitalized children gradually declined, with a more pronounced decrease observed in rural areas compared to urban areas. No significant differences were noted in age, sex, or season between the two groups. Compared to the control group, the observation group demonstrated a lower incidence of conjunctival congestion, extremity changes, mucosal alterations, and joint and urinary system damage (P < 0.05). Furthermore, our study identified significantly elevated levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), increased rates of valve regurgitation and pericardial effusion, and prolonged recovery time for inflammatory markers in the observation group (P < 0.05). Additionally, no statistically significant differences were observed in coronary lesions during the one-year follow-up period. CONCLUSION: Because of the Omicron pandemic, the proportion of children hospitalized for KD decreased. Meanwhile, the incidence of clinical symptoms was low, and the inflammatory reaction was heavy. Moreover, there was a trend towards increased IKD and IVIGR and no difference in coronary lesions at 1 year of follow-up. This might indicate that we should pay attention to early diagnosis of IKD and treatment of IVIGR to prevent and treat KD. TRIAL REGISTRATION: Retrospectively registered.
High prevalence and pathogen-specific variations of co-infections in pediatric adenovirus pneumonia: a retrospective epidemiological analysis from Northern China.
Lang Y, Gong C, Li D
Ital J Pediatr · 2025 Nov · PMID 41239512 · Full text
BACKGROUND: To investigate the characteristics of co-infection pathogen profiles in children with adenovirus pneumonia and provide guidance for clinical diagnosis and rational treatment. METHODS: A retrospective analysis...
BACKGROUND: To investigate the characteristics of co-infection pathogen profiles in children with adenovirus pneumonia and provide guidance for clinical diagnosis and rational treatment. METHODS: A retrospective analysis was conducted on the etiological results of co-infections in children hospitalized with adenovirus pneumonia in the Respiratory Department of Hebei Children's Hospital from January 1, 2024, to December 31, 2024. Differences in co-infections across genders, age groups, and seasons were analyzed. RESULTS: Among 5,373 children hospitalized with community-acquired pneumonia, 330 cases (6.1%) were diagnosed with adenovirus pneumonia, of which 310 (93.9%) exhibited co-infections. Bacterial co-infections predominated (70.0%, 231/330), with Streptococcus pneumoniae (45.2%), Haemophilus influenzae (40.9%), and Moraxella catarrhalis (2.7%) being among the most frequently detected, followed by Staphylococcus aureus (2.4%), Bordetella pertussis (2.1%), Pseudomonas aeruginosa, Enterobacter cloacae, and Streptococcus pyogenes. Viral co-infections were identified in 45.5% (150/330), primarily rhinovirus (26.4%), influenza A/B (7.3%), parainfluenza virus (5.8%), respiratory syncytial virus (RSV, 4.8%), metapneumovirus (4.5%), coronavirus (1.5%), and bocavirus (0.3%). Additionally, Mycoplasma pneumoniae co-infections accounted for 44.5% (147/330). Gender-specific analysis revealed significantly higher RSV co-infection rates in girls than boys (P < 0.05), with no notable gender disparities for other pathogens. Age-related differences showed higher bacterial co-infection rates in infants/toddlers compared to preschool/school-age groups (P < 0.05), where Streptococcus pneumoniae peaked in infants/toddlers, parainfluenza virus was most frequent in infants/toddlers, and Mycoplasma pneumoniae predominated in school-age children. Seasonally, co-infection rates remained consistent year-round, though RSV and influenza A/B peaked in winter, parainfluenza virus in summer, metapneumovirus was least detected in summer, and Mycoplasma pneumoniae exhibited the highest positivity in autumn and the lowest in spring. CONCLUSION: Adenovirus pneumonia in children in this region exhibits a high rate of co-infections, predominantly bacterial (especially Streptococcus pneumoniae and Haemophilus influenzae), followed by viral (rhinovirus, influenza, parainfluenza, RSV) and Mycoplasma pneumoniae. Co-infection profiles vary by gender, age, and season. Timely identification of co-pathogens is critical for guiding rational antimicrobial use and improving prognosis.
How a major discovery can become a public health failure when used subotptimally: lessons from early nirsevimab implementation.
Buonsenso D, Perramon-Malavez A, Morello R … +3 more , Gentili C, Bellorofonte M, Soriano-Arandes A
Ital J Pediatr · 2025 Nov · PMID 41239479 · Full text
BACKGROUND: In this Debate, based on our clinical data from the "pre-nirsevimab" and "first year of nirsevimab implementation" bronchiolitis seasons, we challenge the validity of policy decisions that led to partial immu...
BACKGROUND: In this Debate, based on our clinical data from the "pre-nirsevimab" and "first year of nirsevimab implementation" bronchiolitis seasons, we challenge the validity of policy decisions that led to partial immunization coverage of eligible newborns and infants during the 2024-25 season in Italy. MAIN BODY: Starting with a pre-nirsevimab prospective cohort of 780 newborns, we documented that 84 (9.2%) were diagnosed with acute bronchiolitis (45 of them (5.8% of the cohort) were RSV positive. 44 patients (5.6%) were hospitalized due to bronchiolitis, of which 7 (0.9%) patients were admitted to the Pediatric Intensive Care Unit. Among hospitalized, 31 infants (70%) had RSV infection. Secondly, we evaluated the impact on bronchiolitis admissions during the first year of nirsevimab use in our region, showing a negligible effect on the most severe cases, probably due to the fact that a low coverage will risk to miss the relatively small number of infants (about 10%) that will develop RSV bronchiolitis in the first year of life. These findings inspired our clinical insights and reflections arguing that without a long-term, cost-conscious approach to implementation, even major scientific breakthroughs like nirsevimab risk becoming public health failures. CONCLUSIONS: Our clinical insights and reflections aim to inspire deeper engagement among policymakers, health agencies, and clinicians to better adapt and integrate RSV preventive strategies-maximizing benefit not only for susceptible infants, but for society at large. In a world of finite healthcare resources, optimizing both the reach and the value of such essential interventions is imperative, given the multitude and diversity of health needs our society is facing.
Efficacy of a mixture of simethicone and tyndallized bacillus coagulans in infant colic: a pilot study on behalf of Italian Society of Pediatrics (SIP).
Saviano M, Russo M, Buono P … +8 more , La Pietra M, Sorrentino E, Chianese A, Ementato S, Illiano G, Napolitano G, Dolce P, Staiano A
Ital J Pediatr · 2025 Nov · PMID 41225617 · Full text
BACKGROUND: Infant colic is a common functional gastrointestinal disorder characterized by excessive crying with no effective treatment available. We aimed to evaluate the efficacy of a mixture of Tyndallized Bacillus Co...
BACKGROUND: Infant colic is a common functional gastrointestinal disorder characterized by excessive crying with no effective treatment available. We aimed to evaluate the efficacy of a mixture of Tyndallized Bacillus Coagulans and Simethicone in reducing the crying time in colicky infants and improving quality of sleep and infants' and parents' quality of life. METHODS: A pilot study was conducted on a group of 41 infants with diagnosis of Infant Colic according to Rome IV criteria. We administered to all the enrolled infants a mixture of Tyndallized bacillus coagulans and Simethicone for 28 days. The primary outcome was the mean infant crying duration at 28th day. The secondary outcome was the improvement in the quality of sleep and infants' and parents' quality of life. RESULTS: Forty-one infants were enrolled, two didn't complete the study. In 89% of patients, we observed at least a 50% reduction in crying time at 28 days post-intervention. This success rate was significantly higher (p < 0.001) compared to a physiological reduction in newborn/infant crying, estimated at 39%. We observed that the mean daily crying time at the end of the treatment was significantly lower (p < 0.001). Regarding the sleep duration we found a significantly longer diurnal and nocturnal sleep at 28th day (p < 0.001 and p < 0.001, respectively). In addition, a significant improvement of mothers' and fathers' quality of life and severity perception of IC was detected at 28th day (p < 0.001 and p < 0.001, respectively). No relevant adverse events were observed. CONCLUSIONS: Tyndallized bacillus coagulans and Simethicone seems to be promising in the management of infants with colic. Nevertheless, further studies are needed to confirm this preliminary data. TRIAL REGISTRATION: ClinicalTrial.gov, NCT06458881. Registered 11 June 2024-Retrospectively registered.
Comparison of ERS/ATS guidelines across versions: differences in the application of bronchodilator responsiveness criteria in pediatric asthma by age subgroups (2005 vs 2021).
Zhao J, Liu S, Liu F … +4 more , Lin Y, Qin J, Wang X, Luo J
Ital J Pediatr · 2025 Nov · PMID 41219993 · Full text
BACKGROUND: The 2021 updated guidelines revised the bronchodilator responsiveness (BDR) positivity criteria to an increase in FEV₁ or FVC of > 10% of the predicted value. This new standard aims to reduce the impact of ba...
BACKGROUND: The 2021 updated guidelines revised the bronchodilator responsiveness (BDR) positivity criteria to an increase in FEV₁ or FVC of > 10% of the predicted value. This new standard aims to reduce the impact of baseline lung function variability in determining BDR. However, it should be noted that supporting evidence for children and young adults is limited and thus cannot provide fully substantiated recommendations. The study systematically compare the test results of the BDR diagnostic criteria in the 2005 and 2021 versions of the ERS/ATS guidelines in a clinical setting in children of different age groups with asthma and to explore the reasons for the differences. METHODS: This was a single-center, retrospective, cross-sectional study. The applications of the 2005 and 2021 versions of BDR standards in different age groups(4-5 years, 6-11 years, 12-18 years) with asthma was compared, the lung-function characteristics of children with inconsistent results were analyzed, and the trend of the proportion of BDR + changing with the degree of airflow obstruction was analyzed. RESULTS: A total of 1,525 children with asthma were included in this study. There is a significant difference in the number of inconsistent group between the two methods (P < 0.01). In each age group, the number of people in the 2005 + 2021- group was higher than that in the 2005-2021 + group. The kappa consistency test revealed the kappa values of all age groups to be > 0.80 (P < 0.01) and consistent. The inconsistent group had lower lung-function values than the consistent group. The 2005BDR-2021BDR + group of lung-function values were higher than 2005BDR + 2021BDR- group. The analysis revealed that only Z-FEV1 (OR = 0.773, 95% CI: 0.650 to 0.919, p = 0.004) was an independent factor of Inconsistent results.The trends of 2005BDR + and 2021BDR + were consistent with the degree of airflow obstruction, indicating a weak positive correlation. CONCLUSIONS: The kappa test showed that the results of 2005BDR and 2021BDR were consistent, but there were differences between the inconsistent groups. Z-FEV1 is an independent factor affecting the inconsistent results, so baseline data is the main reason for the inconsistent results of the two methods. The 2021BDR standard may reduce the influence of baseline lung function when determining the results. The positive rate obtained based on the two evaluation criteria maintained the same trend with the degree of airflow obstruction. All showed a weak positive correlation.
Clinical characteristics of acute lower respiratory tract infection caused by Omicron, respiratory syncytial virus, and influenza virus a in children in Chengdu: a retrospective study.
Chen M, Zhang L, Dong H … +1 more , Hu S
Ital J Pediatr · 2025 Oct · PMID 41174794 · Full text
BACKGROUND: This study investigated the differences in clinical features of acute lower respiratory tract infection in children caused by suspected Omicron, respiratory syncytial virus (RSV), and influenza virus A (Flu A...
BACKGROUND: This study investigated the differences in clinical features of acute lower respiratory tract infection in children caused by suspected Omicron, respiratory syncytial virus (RSV), and influenza virus A (Flu A). METHODS: A retrospective analysis was conducted on the clinical data of 241 hospitalized children with lower respiratory tract infections due to suspected Omicron, RSV, or Flu A at Chengdu Women and Children's Central Hospital from December 9, 2022 to August 1, 2023. Differences in age, sex, clinical characteristics, laboratory results, imaging findings, and fractional exhaled nitric oxide (FENO) results between the three viral infections were analyzed. RESULTS: Patients infected with suspected Omicron were predominantly infants and toddlers; in contrast, those infected with Flu A were mostly preschool children. Fever was most common in Flu A-infected patients, followed by RSV-infected and Omicron-infected patients. Inspiratory crackles in the lungs were most frequently observed in suspected Omicron-infected patients, whereas wheezing was more common in RSV-infected patients. No wheezing was observed in the lungs of any suspected Omicron-infected patients. Patients with both suspected Omicron and RSV infections had longer hospital stays. Notably, Flu A infection significantly decreased white blood cell count and increased neutrophil percentage (Neu%) compared with the other two infections. Furthermore, patients with suspected Omicron infection exhibited a pronounced reduction in Neu%; however, the decrease in lymphocyte percentage (Lym%) was considerable in all groups, with the Flu A-infected group showing the greatest decline. C-reactive protein levels were markedly higher in the RSV- and Flu A-infected groups. Liver function was significantly affected in suspected Omicron-infected patients, who were also more likely to have Mycoplasma pneumoniae or bacterial infections. Pulmonary consolidation was more common in suspected Omicron-infected patients, and they had the highest positive rate of FENO. CONCLUSIONS: The clinical manifestations of suspected Omicron infection in patients with acute lower respiratory tract infections are similar to those of Flu A and RSV infections. However, these infections exhibit more severe liver function damage, lung consolidation, and airway inflammation. Paying attention to respiratory tract infections caused by the suspected Omicron virus in children is imperative to ensure timely and appropriate diagnosis and treatment. Promoting child vaccination remains crucial for safeguarding susceptible populations and protecting children's health.
Clinical characteristics and risk factors for pathological fractures in children with Staphylococcus aureus osteoarticular infections: a retrospective cohort study.
Cui Y, Zhang Y, Wang L … +2 more , Wang F, Shen Y
Ital J Pediatr · 2025 Oct · PMID 41174689 · Full text
OBJECTIVE: To identify the clinical characteristics of and risk factors for pathological fractures secondary to osteoarticular infections (OAI) in children. METHODS: We conducted a retrospective analysis of 159 children...
OBJECTIVE: To identify the clinical characteristics of and risk factors for pathological fractures secondary to osteoarticular infections (OAI) in children. METHODS: We conducted a retrospective analysis of 159 children with acute OAI treated at our institution between July 2012 and June 2024. Patients were divided into a pathological fracture group (n = 24) and a no-fracture group (n = 135). Data analyzed included age, sex, time to admission, Pediatric Intensive Care Unit (PICU) admission and length of stay, non-orthopedic admission, disseminated infection, delayed surgery, precipitating factors, initial symptoms, pre-hospital peak temperature, inflammatory markers, extent of infection, affected bone diameter, bacteremia, pathogen (MSSA or MRSA) and susceptibility, antibiotic use, number of infected sites, surgical method, number of pre-fracture and total surgeries, postoperative fever duration, recurrent fever, length of stay, and number of hospitalizations. RESULTS: The median time to pathological fracture was 55 days, which was significantly positively correlated with age (r = 0.719, P < 0.001). Children aged ≤ 49.5 months constituted the largest proportion of the fracture group (70.8%), followed by children aged 7-15 years (29.2%). The femur was the most commonly affected bone (29.2%), followed by the fibula (25.0%) and tibia (20.8%). Univariate analysis revealed that the pathological fracture group had a higher proportion of children aged ≤ 49.5 months, higher rates of bacteremia, disseminated infection, and PICU admission, more frequent surgical delays, a greater number of pre-fracture and total surgical procedures, more hospitalizations, longer postoperative fever duration, a larger extent of infection, and a smaller affected bone diameter (all P < 0.05). C-reactive protein (CRP) and procalcitonin (PCT) levels were also significantly elevated in the fracture group (P < 0.05). Conversely, no significant differences were found in sex, age as a continuous variable, PICU stay duration, non-orthopedic admission, precipitating factors, pre-hospital symptom duration, initial symptoms, pre-hospital peak temperature, concurrent septic arthritis, number of osteomyelitis sites (≥ 2 or ≥ 3), number of total infected sites (≥ 3), surgical method, recurrent fever, white blood cell (WBC) count, neutrophil percentage (NE%), neutrophil count (NE), erythrocyte sedimentation rate (ESR), or the time for these markers to normalize. Antimicrobial susceptibility and usage patterns were also similar between groups (all P > 0.05). Binary logistic regression analysis identified disseminated infection (OR 22.6), age ≤ 49.5 months (OR 13.8), elevated PCT, a larger extent of infection, and a smaller affected bone diameter as independent risk factors for pathological fracture (all P < 0.05). CONCLUSION: Younger age is a critical determinant for earlier and more rapid development of pathological fractures in pediatric OAI. Age ≤ 49.5 months, disseminated infection, elevated PCT, a larger extent of infection, and a smaller diameter of the affected bone are independent predictors of this severe complication. Prophylactic immobilization with a cast or brace should be strongly considered for patients with these risk factors to prevent fracture and subsequent displacement.
Severe upper airway dysfunction in GNAO1-related disorders.
Bernardi K, Ortigoza-Escobar JD, Dominguez-Carral J … +4 more , Espinoza-Quinteros I, Mendo LD, Koy A, Thiel M
Ital J Pediatr · 2025 Oct · PMID 41153036 · Full text
BACKGROUND: GNAO1-related disorders (GNAO1-RD) encompass a wide phenotypic spectrum, including muscular hypotonia, movement disorders (MD), epilepsy, developmental delay, and intellectual disability. MD often presents wi...
BACKGROUND: GNAO1-related disorders (GNAO1-RD) encompass a wide phenotypic spectrum, including muscular hypotonia, movement disorders (MD), epilepsy, developmental delay, and intellectual disability. MD often presents with dystonia and choreoathetosis, and dyskinetic crises can lead to life-threatening conditions. Despite increasing reports, limited information exists on the impact of upper airway dysfunction in GNAO1-RD patients. This study examines the implications of muscular hypotonia on upper airway function and subsequent clinical outcomes. METHODS: This study includes four patients, three from the GNAO1 registry in Germany, with data collected from medical records including neurological examinations, EEG recordings, genetics, imaging studies, and video documentation of dyskinetic movements and respiratory symptoms. Treatment interventions and clinical outcomes were documented. RESULTS: The study involved four patients (three males and one female) aged between 15 months and 12 years, all of whom were within the severe spectrum of GNAO1-RD. All patients exhibited severe hypotonia and hyperkinetic MD, leading to recurrent dyskinetic crises. Respiratory complications included an inspiratory stridor and airway obstructions. All patients died at young age (2.4, 2.8, 7.8 and 12 years) due to respiratory complications. Despite interventions such as DBS and tracheostomy, clinical outcomes remained poor. CONCLUSIONS: Upper airway dysfunction significantly contributes to the high morbidity and mortality in GNAO1-RD patients. Current therapeutic options are limited; while DBS can be life-saving during acute crises, it does not address swallowing or airway dysfunction effectively. Multimodal approaches and larger, multicenter trials are needed to improve outcomes for these patients.
Adverse reactions to acetaminophen and ibuprofen in pediatric patients: a narrative review.
Vassallo F, Martinelli M, Varcamonti L … +1 more , Buono P
Ital J Pediatr · 2025 Oct · PMID 41152986 · Full text
Acetaminophen and ibuprofen are among the most commonly used over-the-counter (OTC) medications for managing fever and pain in children. Although their safety profiles are well established, there has been a progressive i...
Acetaminophen and ibuprofen are among the most commonly used over-the-counter (OTC) medications for managing fever and pain in children. Although their safety profiles are well established, there has been a progressive increase in reports of suspected adverse drug reactions (ADRs) in pediatric populations in recent years. This trend may be partly attributable to improved reporting systems, but also to increased consumption. For example, the proportion of pediatric ibuprofen packages purchased without a prescription rose from 28% in 2008 to 70% in 2015. From 2020 to 2024, pediatric ibuprofen use grew by over 60%, and accordingly, the number of reported ADRs also increased. This rise may be due to specific pharmacovigilance programs targeting pediatric populations and the fact that, since 2009, ibuprofen in Italy no longer requires a prescription, making it more accessible and widely perceived as safe.To provide a narrative review of suspected ADRs related to Acetaminophen and ibuprofen use in children.A literature search was conducted using PubMed and Embase databases, employing the following terms: (Children OR Pediatrics) AND (Acetaminophen OR Ibuprofen OR NSAID OR Nonsteroidal Anti-Inflammatory Drugs) AND (Adverse Events OR ADRs).A total of 337 records were identified, of which 15 studies were eligible for inclusion. According to Italian consumption data from the last five years, acetaminophen use declined from 68.8% in 2019 to 63.5% in 2024, while ibuprofen use increased from 31.2% to 36.7% (2). Additionally, the number of pediatric ibuprofen packages purchased increased by 61% between 2019 and 2024. Data from the European spontaneous reporting database (EudraVigilance) also showed a significant rise in reported ADRs in children receiving either drug. However, for comparable levels of use, ibuprofen appears to be associated with a higher rate of potentially serious adverse events.Our analysis shows a marked increase in reported ADRs related to antipyretic use in children, likely linked to the rising use of ibuprofen in recent years. These findings emphasize the need for better parental education and healthcare provider guidance on the safe and appropriate use of antipyretics in pediatric patients.
The effect of a Web-Based BF education program for adolescent pregnant women in the third trimester on BF practices.
Can V, Bulduk M
Ital J Pediatr · 2025 Oct · PMID 41146226 · Full text
BACKGROUND: It is crucial to prepare adolescent mothers-who represent a vulnerable group where the importance of breastfeeding is increasingly emphasized-for the BF experience. A method on the rise or increasingly popula...
BACKGROUND: It is crucial to prepare adolescent mothers-who represent a vulnerable group where the importance of breastfeeding is increasingly emphasized-for the BF experience. A method on the rise or increasingly popular for promoting breastfeeding is through web-based education interventions. The aim of this study was to evaluate the effect of a web-based breastfeeding education program, developed by the researchers, on breastfeeding outcomes among adolescent pregnant women in the postpartum period. METHODS: This randomized controlled study involved a sample of 100 pregnant adolescents, aged 15-19 years, who were in their third trimester of pregnancy. The study commenced after obtaining ethical approval and permissions from the hospital where the research was conducted. A web-based breastfeeding education program was administered to the experimental group. Data were collected using a Socio-Demographic Data Form, the breastfeeding Self-Efficacy Scale Short Form (Antenatal Version), the breastfeeding Self-Efficacy Scale Short Form (Postnatal Version), and the LATCH breastfeeding Diagnosis and Assessment Scale. Data collection occurred during the third trimester (pretest) and the 1st and 8th postnatal weeks (posttest). Out of the initial 100 mothers, 90 completed the study. RESULTS: The results indicated that adolescent mothers in the experimental group scored higher than those in the control group in the 1st and 8th postnatal weeks. Additionally, rates of exclusive breastfeeding and the intention to breastfeed for up to two years were higher in the experimental group compared to the control group. CONCLUSIONS: It was concluded that the web-based breastfeeding education program effectively improved breastfeeding self-efficacy, breastfeeding success, exclusive breastfeeding rates, and intentions to breastfeed for up to two years.
Breaking barriers in pediatric stroke care: a comprehensive systematic review and meta-analysis of emergency department management practices.
Helal MB, Kamal I, Alsabri M … +8 more , Zaazouee MS, Khalifa MA, Elawad SOM, Aziz MM, Ashmawy RE, Abo-Elnour DE, Aderinto N, Rinnan JMA
Ital J Pediatr · 2025 Oct · PMID 41146173 · Full text
Pediatric stroke is a life-threatening emergency condition characterized by a wide range of presentations, which frequently delays the diagnosis and intervention. This study aimed to evaluate the clinical presentation, d...
Pediatric stroke is a life-threatening emergency condition characterized by a wide range of presentations, which frequently delays the diagnosis and intervention. This study aimed to evaluate the clinical presentation, diagnostic approaches, and outcomes of pediatric patients presenting with suspected stroke in emergency settings. A systematic search was conducted in PubMed, Embase, Cochrane Library, Scopus, and Web of Science for studies published up to May 2024. Nineteen peer-reviewed studies investigating pediatric stroke in emergency settings were included. A qualitative synthesis was performed, and meta-analysis was conducted when appropriate. The risk of bias was assessed using the NIH Quality Assessment Tool for Observational Cohort and Case Series Studies. Out of 2,958 identified records, 19 studies (13 cohort studies and 6 case series) met the inclusion criteria, with 8 eligible for meta-analysis. The pooled mortality rate was 19.2% (95% CI: 8.1%-30.4%), while intubation and ICU admission were required in 21.6% (95% CI: 10.9%-32.3%) and 37.6% (95% CI: 18%-57.2%) of cases, respectively. The average hospital stay was 11.12 days (95% CI: 8.58-13.65). CT was more frequently used (80.71%) than MRI (35.86%) for neuroimaging. The mean time from symptom onset to diagnosis was 9.95 h. Variability in prehospital management and diagnostic accuracy was noted across studies. Migraines (19.39%) and seizures (12.75%) were the most common non-stroke diagnoses reported. Pediatric stroke remains underrecognized and frequently misdiagnosed in emergency settings. Delays in diagnosis, reliance on CT over MRI, and inconsistent triage practices contribute to suboptimal outcomes. Standardized, pediatric-specific stroke protocols emphasizing early recognition, appropriate imaging, and timely intervention are urgently needed to improve patient care and outcomes.
The role of thoracic ultrasound in a rare combination of lung abscess and congenital pulmonary airway malformation (CPAM): case report and brief review.
Amendolea A, Gaeta G, Avino G
Ital J Pediatr · 2025 Oct · PMID 41131622 · Full text
BACKGROUND: Congenital Pulmonary Airway Malformation (CPAM) is a rare lung anomaly in pediatric patients, often diagnosed prenatally or postnatally. Although typically asymptomatic, CPAM can present with severe complicat...
BACKGROUND: Congenital Pulmonary Airway Malformation (CPAM) is a rare lung anomaly in pediatric patients, often diagnosed prenatally or postnatally. Although typically asymptomatic, CPAM can present with severe complications such as recurrent infections or lung abscesses. Thoracic ultrasound (LUS) is emerging as a valuable diagnostic tool, offering a non-invasive and radiation-free alternative to traditional imaging. CASE PRESENTATION: We present the case of a 2-year-old girl with persistent fever, cervical lymphadenopathy, and elevated inflammatory markers, initially raising suspicion for incomplete Kawasaki disease (KD). Despite the administration of intravenous immunoglobulin (IVIG), the fever persisted, prompting further investigations. Lung ultrasound revealed a 5.5 cm lesion with hyperechoic spots and vascularization, suggestive of a lung abscess associated with CPAM. Diagnosis was confirmed by chest CT, and the patient was successfully treated with targeted antibiotic therapy. CONCLUSIONS: This case highlights the importance of considering CPAM as a differential diagnosis in pediatric patients with persistent fever of unknown origin. It also underscores the potential of lung ultrasound as a non-invasive diagnostic tool, complementing traditional imaging methods, in the management of complex pediatric conditions.
Macrolide-resistant Mycoplasma pneumoniae pneumonia in Chinese children: a retrospective study of clinical features and prognosis.
Zheng Y, Li G, Dai H … +1 more , Zhu Y
Ital J Pediatr · 2025 Oct · PMID 41126285 · Full text
BACKGROUND: This study systematically investigated the clinical features, imaging findings, and treatment outcomes associated with macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMPP) in children, aiming to suppor...
BACKGROUND: This study systematically investigated the clinical features, imaging findings, and treatment outcomes associated with macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMPP) in children, aiming to support early clinical intervention and prevent disease progression. METHODS: Clinical data from 346 children with Mycoplasma pneumoniae pneumonia (MPP) who underwent bronchoscopic treatment between May 2023 and April 2024 were retrospectively analyzed. Patients were stratified into a macrolide-resistant group (MRG) (n = 281) and a macrolide-sensitive group (MSG) (n = 65). Comparative analyses included demographics, clinical symptoms, laboratory findings, treatment protocols, bronchoscopic findings, pathogen load, and prognoses. RESULTS: Among the 346 cases of MPP, 81.2% (281/346) were classified as MRMPP. Resistant strains predominated in autumn and winter (P < 0.05), with no significant differences in sex, age, or body mass index between groups (P > 0.05). The MRG showed significantly longer durations of fever, cough, abnormal lung sounds, macrolide and glucocorticoid use, and hospital stay and incurred higher hospitalization costs (all P < 0.05). Rates of oxygen therapy, ≥ 2 bronchoscopic interventions, second-line antibiotic use, and extrapulmonary complications were also higher in the MRG, while co-infections were more common in the MSG (P < 0.05). The MRG exhibited elevated neutrophil percentages and C-reactive protein, lactate dehydrogenase, and D-dimer levels (all P < 0.05). Pulmonary consolidation and bronchoscopic mucus plugs were more frequent in the MRG, while thin white secretions were typical of the MSG (P < 0.05). No significant difference in adverse prognosis was observed between groups (6.8% vs. 3.0%, P = 0.74). Multivariate logistic regression and receiver operating characteristic curve analyses identified mucus plug formation (odds ratio = 35.619, P = 0.001) and fever duration of > 6.5 days (area under the curve = 0.794, P < 0.001) as independent risk factors for adverse prognosis. CONCLUSION: MRMPP is associated with a prolonged disease course, more complex clinical features, and greater therapeutic challenges. However, macrolide resistance gene mutations alone do not predict adverse outcomes. Special attention should be given to patients with mucus plug formation and fever lasting > 6.5 days because they are at greater risk of unfavorable prognosis and may benefit from early intervention.
Difference in anterior fontanelle closure between non-syndromic craniosynostosis and normal controls: a retrospective cross-sectional study.
Fu J, Zhan Q, Liu J … +2 more , Zhao R, Jiang W
Ital J Pediatr · 2025 Oct · PMID 41126260 · Full text
BACKGROUND: This study aimed to investigate the differences in anterior fontanelle closure time and size between children with non-syndromic craniosynostosis and controls on CT imaging. METHODS: A retrospective cross-sec...
BACKGROUND: This study aimed to investigate the differences in anterior fontanelle closure time and size between children with non-syndromic craniosynostosis and controls on CT imaging. METHODS: A retrospective cross-sectional study was conducted involving 182 children with non-syndromic craniosynostosis and 2,777 age-matched controls (≤ 36 months). The status, size, and timing of anterior fontanelle closure were compared between the two groups. Receiver Operating Characteristic (ROC) curve analysis was utilized to assess the diagnostic value of anterior fontanelle measurements. Additionally, correlation analysis was performed to determine the relationship between age and fontanelle size. RESULTS: Patients with craniosynostosis exhibited higher closure rates under 24 months, particularly at 7-9 months (22.7% vs. 3.2%, P < 0.0001) and 10-12 months (50.0% vs. 6.9%, P < 0.0001), but lower closure rates at 25-36 months (80.0% vs. 94.0%, P < 0.01). ROC curve analysis identified an optimal cut-off age for fontanelle closure of 9.5 months in craniosynostosis patients (AUC = 0.85) and 17.5 months in controls (AUC = 0.93). Spearman correlation analysis revealed weaker relationships between age and fontanelle size in craniosynostosis patients compared to controls. CONCLUSIONS: Anterior fontanelle measurements, particularly closure timing and size, have potential as assistant markers for the early identification of craniosynostosis. However, definitive diagnosis requires clinical evaluation and imaging confirmation. These findings underscore the importance of early recognition and intervention in craniosynostosis to prevent complications.
Thermal water inhalation for allergic rhinitis and recurrent respiratory infections: a narrative review of the evidence.
Varricchio A, Brindisi G, Brunese FP … +13 more , Daglia M, Dinardo G, Drago L, Gori A, Indolfi C, Naso M, Tondina E, Trincianti C, Varricchio A, Zicari AM, Miraglia Del Giudice M, Ciprandi G, Nutraceutical and Medical Device Task Force of the Italian Society of Pediatric Allergy, Immunology (SIAIP)
Ital J Pediatr · 2025 Oct · PMID 41126223 · Full text
Allergic rhinitis (AR) and recurrent respiratory infections (RRIs) are common conditions that significantly impact quality of life and healthcare systems. Thermal water inhalation therapies have emerged as a potential no...
Allergic rhinitis (AR) and recurrent respiratory infections (RRIs) are common conditions that significantly impact quality of life and healthcare systems. Thermal water inhalation therapies have emerged as a potential non-pharmacological option due to their immunomodulatory and anti-inflammatory properties. This narrative review aimed to evaluate the efficacy and safety of thermal water inhalations in managing patients with AR and RRIs. The inclusion criteria were pertinent articles written in English and published in journals listed in PubMed. Six studies conducted in Italy, involving 548 participants (most of whom were children and adolescents), met the inclusion criteria. Significant improvements were observed in nasal mucociliary transport time, with reductions ranging from 2 to 8 min across treatment groups. Total Symptom Scores decreased significantly (one study reported a > 50% reduction). The frequency and duration of upper respiratory tract infections were reduced considerably in the treatment groups compared to the controls. However, results for nasal cytology were inconsistent, and heterogeneity in study designs limited comparability. The reviewed studies highlighted the potential of thermal water therapies to enhance mucociliary clearance, alleviate symptoms, and reduce reliance on other pharmacological treatments. On the other hand, these studies have a regional limitation and this review was not systematic. In conclusion, this narrative review may suggest that thermal water inhalations could be a promising option for managing patients with AR and RRIs, providing an alternative therapy with significant clinical benefits. Nevertheless, further high-quality, standardized, and international studies are necessary to confirm these findings and facilitate meta-analyses. These treatments could play a valuable role in reducing the burden of respiratory and allergic conditions.
Beckwith-Wiedemann spectrum (BWSp): an update on diagnosis, management, and follow-up from the scientific committee of the Italian BWSp association.
Russo S, Milani D, Meossi C … +19 more , Marcucci L, Pajno R, Butti N, Cocchi G, Tannorella P, Bertoletti M, Carli D, Meazzini MC, Tortora C, Ferrari M, Zampino G, Massuras S, Ferrero GB, Quarello P, Rossetti G, Montirosso R, De Pellegrin M, Riccio A, Mussa A
Ital J Pediatr · 2025 Oct · PMID 41126215 · Full text
Beckwith-Wiedemann spectrum (BWSp) is a congenital imprinting disorder characterized by overgrowth, cancer predisposition, and diverse clinical manifestations, resulting from epigenetic and genetic alterations at chromos...
Beckwith-Wiedemann spectrum (BWSp) is a congenital imprinting disorder characterized by overgrowth, cancer predisposition, and diverse clinical manifestations, resulting from epigenetic and genetic alterations at chromosome 11p15.5. BWSp represents the most common imprinting disorder, with a prevalence exceeding 1:10,000. The disorder is primarily associated with loss or gain of methylation at imprinting control regions IC2 and IC1, paternal uniparental disomy of 11p15, or pathogenic variants in CDKN1C. Advances in molecular diagnostics have refined genotype-phenotype correlations, improving both clinical management and tumor screening protocols. This review, produced by the Scientific Committee of the Italian BWSp Association (AIBWS), builds upon the 2018 international consensus, incorporating updated scientific evidence up to 2024. The committee critically assessed post-2017 literature using PRISMA and Delphi methodologies to revise ten key topics, including diagnosis and criteria, prenatal testing, molecular testing strategies, tumor surveillance, macroglossia surgery, growth monitoring, limb-length discrepancy, cognitive and psychosocial outcomes, and MLID (multi-locus imprinting disturbances). A major focus is optimizing diagnosis in cases with negative methylation tests on DNA from blood, where somatic mosaicism often necessitates alternative tissue testing. The review emphasizes prenatal diagnosis challenges, recommends including ART-related pregnancies in diagnostic criteria, and proposes a prenatal scoring system. Updated tumor surveillance strategies are presented, including universal α-fetoprotein screening for hepatoblastoma up to 3 years and genotype-based protocols for Wilms tumor. CDKN1C-related neuroblastoma surveillance is also addressed. MLID, often co-occurring with IC2-LoM, is discussed regarding clinical relevance, testing strategies, and implications for recurrence risk, particularly involving maternal-effect gene variants. Orthopedic and surgical management of limb-length discrepancy (LLD) and macroglossia is reviewed, alongside growth chart development and their role in personalized interventions. New findings on cognitive, behavioral, and psychosocial aspects highlight the need for routine screening and supportive care. The transition to adult care remains underexplored, though recommendations include attention to residual pediatric complications, fertility, and potential long-term risks. This review reinforces the importance of a multidisciplinary and personalized approach to BWSp across the lifespan, calling for further research to refine diagnostics, long-term outcomes, and transition models.
Clinical features of MPP with or without viruses among hospitalized children in 2023, Wenzhou, Zhejiang, China.
Chen L, Li H, Zhong P … +6 more , Zheng W, Zhang H, Li S, Shi H, Chen Y, Liu Q
Ital J Pediatr · 2025 Oct · PMID 41121272 · Full text
BACKGROUND: M. pneumoniae (MP) is a common cause of childhood pneumonia, but there is limited understanding of whether virus co-infections affect clinical severity of M. pneumoniae pneumonia (MPP). METHODS: We conducted...
BACKGROUND: M. pneumoniae (MP) is a common cause of childhood pneumonia, but there is limited understanding of whether virus co-infections affect clinical severity of M. pneumoniae pneumonia (MPP). METHODS: We conducted a retrospective cohort study of MPP at the Second Affiliated Hospital of Wenzhou Medical University in 2023 to compare clinical characteristics and outcomes between MP with and without viral co-infection in children, including length of stay, febrile/ cough /wheeze duration, treatment, severity of MPP, and serum biomarkers. We also collected MP targeted next generation sequencing (tNGS) data from the bronchoalveolar lavage fluid (BALF) samples and analyzed MP whole-genome sequencing (WGS) data from a public database to investigate MP genome, typing, and drug resistance. RESULT: The annually seasonal analysis showed that a higher prevalence of MP occurred from summer to winter. Viral pathogens in our study were highly detected in either autumn or winter. Virus co-infection cases showed a peak in November. HRV was the most frequent detected virus in our study. There was no significant different of gender in all the MPP patients. Compared with single MP infection, children with virus co-infection were younger. They had a shorter febrile duration, longer cough duration, and less proportion of severe MPP cases. Laboratory biomarkers (e.g. CRP, WBC, D-D, PCT) were also significant different between MP mono and viral co-infection groups. 74.07% the samples from BALF performed an A2063G mutation with macrolide-resistant MP (MRMP). By the analysis of phylogenetic tree and the Multi-Locus Sequence Typing (MLST), we suggested that the predominant strains of MP in our study remains ST3 and MRMP strains were independently selected from various genetic backgrounds of MP due to macrolide usage. CONCLUSION: These findings illustrated that viral co-infection aggravated MP associated bronchi and bronchioles damage, but did not increased severity of MPP, suggesting a potential attenuation of disease severity. TRIAL REGISTRATION: Medical Research Registration and Filing Information System. 2024-K-274-02.Registered 26 August 2024. https://www.medicalresearch.org.cn/clinicalResearch .
Specific plasma lipid species in children are causally associated with kawasaki disease: a mendelian randomization analysis.
Zhen C, Zhang S, Guo F
Ital J Pediatr · 2025 Oct · PMID 41121199 · Full text
BACKGROUND: Kawasaki Disease (KD) is an acute pediatric vasculitis and the leading cause of acquired heart disease in children, yet its etiology involving lipid metabolism remains unclear. This study aimed to investigate...
BACKGROUND: Kawasaki Disease (KD) is an acute pediatric vasculitis and the leading cause of acquired heart disease in children, yet its etiology involving lipid metabolism remains unclear. This study aimed to investigate the potential causal associations between plasma lipid species, measured in a pediatric cohort, and the risk of KD using a two-sample Mendelian randomization (MR) approach. METHODS: We utilized summary statistics from a genome-wide association study (GWAS) of 227 plasma lipid species in 1,149 children and adolescents (median age 11.2 years). Summary statistics for KD were obtained from a meta-analysis of two GWAS datasets comprising 479 cases and 490,361 controls of European ancestry. We employed inverse-variance weighted (IVW) MR as the primary analysis, complemented by nine robust univariable MR methods (UVMR), five multivariable MR (MVMR) methods (MVMR-IVW, -Egger, -PRESSO, -Lasso, -Median), and MR-Bayesian Model Averaging (MR-BMA) to assess causality and account for pleiotropy and lipid correlations. RESULTS: The primary IVW analysis suggested nine lipid species associated with KD risk. Robust UVMR analyses provided corroborating evidence, notably showing consistent negative associations for Lysophosphatidylcholine (0:0/20:0) and Triglyceride (52:5) across multiple methods. Subsequent MVMR consistently identified positive causal associations between Phosphatidylcholine (40:8), Phosphatidylinositol (36:4), and Sphingomyelin (d36:3) and increased risk of KD. Furthermore, MR-BMA identified Triglyceride (56:5) as the lipid species with the strongest evidence for a protective effect (highest marginal inclusion probability = 0.275). CONCLUSION: Leveraging genetic data specific to a pediatric population, this MR study provides novel evidence supporting potential causal roles for specific plasma lipid species in the pathogenesis of Kawasaki disease. These findings offer new insights into the molecular mechanisms underlying Kawasaki disease and highlight potential pathways for future investigation and therapeutic targeting.
Ceftriaxone-induced cholelithiasis in pediatrics: pooled frequency, symptoms, and associated factors - systematic review and meta-analysis.
Yaseen T, Alam K, Zawiah M … +2 more , Suleiman AK, Khan AH
Ital J Pediatr · 2025 Oct · PMID 41074174 · Full text
Ceftriaxone is commonly used in pediatric infections, but its association with cholelithiasis poses potential health concerns. To determine the pooled frequency of ceftriaxone-induced cholelithiasis in pediatric patients...
Ceftriaxone is commonly used in pediatric infections, but its association with cholelithiasis poses potential health concerns. To determine the pooled frequency of ceftriaxone-induced cholelithiasis in pediatric patients and identify factors commonly associated with its occurrence. Web of Science, PubMed, Google Scholar, and Scopus were systematically searched until March 2024.Studies reporting ceftriaxone-induced cholelithiasis in pediatric patients (0-18 years) were included. Randomized controlled trials (RCTs) and prospective and retrospective cohort studies published in English were eligible. PRISMA guidelines were followed. The Newcastle‒Ottawa Scale and CASP tools were used to assess risk of bias. A random-effects meta-analysis estimated the pooled frequency. Sensitivity analysis was conducted to explore heterogeneity. The primary outcome was the pooled frequency of ceftriaxone-induced cholelithiasis. Secondary outcomes included identification of factors commonly associated with its occurrence and their impact on symptom burden. Eleven studies (1 RCT, 10 cohort studies) met the inclusion criteria. The pooled frequency of cholelithiasis was 15% (95% CI: 9-23%), with significant heterogeneity (I² = 81.76%). Commonly associated factors included high ceftriaxone doses (> 2 g/day), prolonged use (> 5 days), short bolus injections, and dehydration. Most cases resolved upon discontinuation, but symptomatic patients experienced nausea, vomiting, and abdominal pain. Ceftriaxone-induced cholelithiasis is relatively common in pediatric patients, particularly those with associated risk factors. Clinicians should monitor for biliary complications and consider alternative treatments when feasible. PROSPERO REGISTRATION: CRD42024503807.
Pediatric stewardship in Italy: a necessity, not an option - a National Multi-Society Expert Consensus on Antimicrobial and Diagnostic Stewardship (SIP, SITIP, SIMRI, SIAIP, SIMEUP, SIPPS, SICUPP, SIMIT, SIMPE, SIPINF, SIT, SIAATIP, SARNEPI, AIEOP, SIM, SITI, SIF, SIFACT, SITA, SIN).
Dona D, Barbieri E, Brigadoi G … +50 more , Barchitta M, Berardi A, Bosis S, Buchini S, Buonsenso D, Cagliero A, Campana BR, Capello F, Carrozzo R, Castagnola E, Cazzato S, Cesaro S, Chiappini E, Colomba C, Comar M, De Alessandri A, De Luca M, Esposito B, Filograna MR, Franceschi A, Galli L, Garazzino S, Gemmi F, Gres E, Lancella L, Liberati C, Lo Vecchio A, Lo Giudice M, Marseglia G, Martelli G, Mengato D, Mercadante S, Meschiari M, Miraglia Del Giudice M, Montagnani C, Muggeo P, Nicolini G, Nobili S, Pea F, Pedrotti D, Reggiani L, Sambri V, Sanguinetti M, Santiloni A, Silvani MC, Vatiero L, Zama D, Zampogna S, Zanai R, Esposito S
Ital J Pediatr · 2025 Oct · PMID 41068927 · Full text
Antimicrobial Stewardship Programs (ASPs) and Diagnostic Stewardship Programs (DSPs) are essential for optimizing infectious disease management and addressing antimicrobial resistance (AMR). However, the implementation o...
Antimicrobial Stewardship Programs (ASPs) and Diagnostic Stewardship Programs (DSPs) are essential for optimizing infectious disease management and addressing antimicrobial resistance (AMR). However, the implementation of pediatric ASPs presents distinct challenges that set them apart from adult-focused initiatives. Additionally, many existing ASP guidelines are primarily tailored to the U.S. healthcare system, requiring significant adaptation to fit the diverse healthcare infrastructures, resources, and prescribing practices across different countries. These factors highlight the need for context-specific strategies to ensure the effective implementation of pediatric ASPs worldwide. To develop a national, intersociety consensus on pediatric ASPs in Italy, an ASP steering committee was established, bringing together a multidisciplinary group of experts. A systematic scoping review was conducted to identify relevant literature on ASPs and DSPs published between 2007 and August 2024, retrieving 260 articles. Based on this evidence, 33 recommendations were formulated, covering general ASP and DSP principles (10 recommendations), ASP interventions (14), DSP interventions (3), and monitoring strategies (6). Consensus on the importance and feasibility of each recommendation was reached using the Delphi method, with two rounds of anonymous questionnaires. The steering group defined a priori criteria for recommendation acceptance, requiring at least 80% agreement on the importance of each item. This consensus highlights the critical role of a multidisciplinary approach in ASP implementation, supported by institutional leadership. Given the variability in healthcare systems, ASP interventions must be tailored to specific settings, considering factors such as hospital resources, patient complexity, and the parent-child dynamic. Standardized metrics for assessing the impact of ASPs are essential for benchmarking and ensuring sustainability, although data collection remains a significant challenge. While there was strong agreement on the importance of the recommendations, feasibility assessments identified key areas requiring further refinement, particularly in settings with limited pediatric-specific expertise and diagnostic tools. This national consensus provides a structured framework for the implementation of pediatric ASPs in Italy, equipping clinicians with essential tools to optimize antibiotic use in both inpatient and outpatient settings. It represents a foundational step toward improving pediatric ASP, fostering national and international collaboration, and guiding future research to address implementation barriers.
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