Ital J Pediatr [JOURNAL]
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200 papers
Incidence, mortality, and survival trends of retinoblastoma in children: a systematic review and meta-analysis of population-based studies.
Yan Y, Li G, Wang W … +1 more , Ni N
Ital J Pediatr · 2026 Jun · PMID 42374466 · Full text
BACKGROUND: Retinoblastoma (RB) is the most common childhood intraocular malignancy, with substantial global disparities in outcomes. This study aimed to provide pooled estimates of incidence, survival, mortality, and me...
BACKGROUND: Retinoblastoma (RB) is the most common childhood intraocular malignancy, with substantial global disparities in outcomes. This study aimed to provide pooled estimates of incidence, survival, mortality, and metastasis based on population-based data. METHODS: A systematic review and meta-analysis was conducted in PubMed, Scopus, Web of Science, Embase, and the Cochrane Library through August 2025. Eligible studies were population- or registry-based and reported at least one epidemiological outcome. Random-effects models were applied, with assessments of heterogeneity, publication bias, and subgroup analyses. RESULTS: Twenty-five studies (52 study arms) were included. The global pooled incidence of RB was 0.12 per 1,000,000 (95% CI: 0.09-0.14), with high heterogeneity (I = 95%). Incidence was highest in the Americas and Europe and lowest in Africa. One-, three-, and five-year survival rates were 94% (95% CI: 90-98), 81% (95% CI: 74-89), and 91% (95% CI: 87-94), respectively. Pooled mortality was 13% (95% CI: 9-16), and mortality increased with older age at diagnosis. The pooled metastasis rate was 6% (95% CI: 2-9). CONCLUSIONS: RB incidence and survival show striking geographic and socioeconomic disparities. Delayed diagnosis and limited access to care drive persistently poor outcomes in many low-resource regions, underscoring the need for improved registries, earlier detection, and equitable treatment worldwide.
Epidemiological trends of multidrug-resistant organisms in a tertiary-care pediatric hospital, 2017-2023.
D'Amore C, Bernaschi P, Ciliento G … +8 more , Beccia F, Villani L, Zama B, Cappelli E, Ravà L, Perno CF, Raponi M, Ciofi Degli Atti M
Ital J Pediatr · 2026 Jun · PMID 42363205 · Full text
BACKGROUND: Antimicrobial resistance (AMR) is a growing global threat, particularly for children under 5 years. This study is aimed to investigate temporal trends and describe the epidemiological characteristics of MDR b...
BACKGROUND: Antimicrobial resistance (AMR) is a growing global threat, particularly for children under 5 years. This study is aimed to investigate temporal trends and describe the epidemiological characteristics of MDR bacteria isolated in hospitalized children from 2017 to 2023 in an academic children's hospital in Italy. METHODS: We included all bacterial isolates obtained from blood or cerebrospinal fluid (CSF) cultures collected from pediatric patients evaluated in both inpatient settings and the Emergency Department between 1 January 2017 and 31 December 2023. The study included the main ESKAPE pathogens (including Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa) and other relevant MDROs such as Escherichia coli. Data were extracted from the hospital microbiology data warehouse, and resistance proportions were calculated as MDR isolates over total isolates for each pathogen. Associations between year, patient characteristics, ward type, and MDRO infections were evaluated using univariable and multivariable logistic regression; trends over time were evaluated using the Cochrane-Armitage test for categorical variables. RESULTS: Out of 51,886 blood or CSF cultures, 1,528 (2.9%) were positive for microorganisms of interest, and 211 (13.8%) were MDROs. The highest resistance proportions were observed in Carbapenems-Resistant Pseudomonas Aeruginosa/Pseudomonas Aeruginosa (CRPA/PA, 52.8%), followed by Methicilln-Resistant Staphylococcus Aureus/Staphylococcus Aureus (MRSA/SA, 36.7%), Carbapenem-Resistant Klebsiella Pneumoniae/Klebsiella Pneumoniae (CRKP/KP, 12.6%), and Vancomycin-Resistant Enterococcus (VRE)/Enterococcus (VRE/E, 11.5%). Significant reductions were recorded for MRSA/SA (43.5% in 2017 to 25.7% in 2023; p = 0.001) and CRPA/PA (85.0% to 47.1%; p < 0.001), while CRKP/KP and VRE/E showed no significant temporal trends. Neonatology and PICU showed higher odds for MRSA isolation (p < 0.001) compared to medical wards. Onco-hematology displayed an adjusted OR of 3.0 (95% CI: 1.2-7.7) for VRE. Year was independently associated with CRPA, with adjusted ORs of 0.03 and 0.14 in 2020 and 2021 (p < 0.01) compared to 2017. CONCLUSIONS: Understanding local AMR patterns remains essential for guiding empirical therapy across heterogeneous hospital settings.
Practice and challenges of newborn hearing screening: analysis of a five-year database in Italy.
Coraci D, Fantoni M, Tonon E … +3 more , Marchi R, Ronfani L, Orzan E
Ital J Pediatr · 2026 Jun · PMID 42351255 · Full text
Early identification and treatment of hearing impairments are essential for children's development. International guidelines recommend a stepwise approach to conduct hearing screening in newborns. However, while the majo...
Early identification and treatment of hearing impairments are essential for children's development. International guidelines recommend a stepwise approach to conduct hearing screening in newborns. However, while the majority of countries worldwide implemented universal newborn hearing screening, inconsistencies remain in procedures and data management. In particular, Level 3 of the screening pathway-comprising diagnostic confirmation and therapeutic management-has received limited attention in the literature, despite its central role in determining program effectiveness and patient outcomes. This study investigates the clinical and organizational aspects of Level 3 within the neonatal hearing screening program of the Friuli-Venezia Giulia Region in Italy, analyzing data from 106 children enrolled between 2019 and 2023. The analysis considers the regional protocol, the roles of birthing centers, pediatricians, hospitals, and the Regional Center for Pediatric Hearing Loss Care, and subdivides Level 3 into four Phases (A-D) reflecting both organizational and diagnostic functions. By examining patient flow, false positives, loss to follow-up/documentation, and management practices, the study highlights how organizational factors-particularly the coordination between local and specialized facilities-produce "cascade" outcomes directly affecting diagnostic timelines and treatment initiation. Findings provide critical insights into weaknesses of the current system and propose directions for improving program efficiency, accuracy, and overall quality of care.
Clinical characteristics in antibody-positive pediatric patients with immune-mediated necrotizing myopathy.
Xu Y, Zhang Z, Chu Y … +7 more , He F, Mao L, Yang L, Yin F, Peng J, Yang L, Zhang C
Ital J Pediatr · 2026 Jun · PMID 42343475 · Full text
OBJECTIVE: To investigate the clinical characteristics and therapeutic strategies of childhood immune-mediated necrotizing myopathy (IMNM) and to provide evidence for clinical diagnosis and management. METHODS: This sing...
OBJECTIVE: To investigate the clinical characteristics and therapeutic strategies of childhood immune-mediated necrotizing myopathy (IMNM) and to provide evidence for clinical diagnosis and management. METHODS: This single-center retrospective study analyzed the clinical data of 10 children diagnosed with antibody-positive IMNM at the Children's Medical Center, Xiangya Hospital, Central South University, from January 2016 to May 2025. The onset features, clinical manifestations, laboratory findings, muscle magnetic resonance imaging (MRI) characteristics, treatment modalities, and prognosis were summarized. RESULTS: Among the 10 patients, 4 were male and 6 were female, with a median age at onset of 5.5 years (range: 3-16 years). The main clinical manifestations included symmetric proximal muscle weakness (100%) and cutaneous manifestations (50%, including Gottron's sign and periorbital rash). Creatine kinase (CK) levels were markedly elevated, with a median of 3988.5 U/L (range: 2080-13524 U/L). Muscle MRI revealed edema or fatty infiltration in the thigh muscles. Anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies were detected in 4 patients (40%), and anti-signal recognition particle (SRP) antibodies in 6 patients (60%). Electromyography (EMG) showed myopathic changes in all tested cases (8/10 patients). Muscle histopathology was available for one patient, demonstrating myofiber necrosis, regeneration, and inflammatory cell infiltration. All patients received glucocorticoid therapy, combined with oral methotrexate. Additionally, 5 patients were treated with rituximab, and 9 patients received intravenous immunoglobulin (IVIG). During follow-up, 2 patients achieved complete remission, 1 patient showed partial remission, 3 patients exhibited no significant remission, and 4 patients experienced relapse. CONCLUSION: Childhood IMNM is characterized by proximal muscle weakness, typical rash, and significantly elevated CK levels, frequently accompanied by anti-SRP or anti-HMGCR antibodies. Early immunosuppressive therapy, including glucocorticoids combined with immunosuppressants or IVIG, may be associated with clinical improvement in this small retrospective series.
A comparison of pediatric sepsis definitions based on systemic inflammatory response syndrome and Phoenix criteria: a single-center PICU retrospective study.
Zhou L, Li S, Ding Q … +4 more , Tang T, Cheng J, Yang H, Tan L
Ital J Pediatr · 2026 Jun · PMID 42321878 · Full text
BACKGROUND: The 2024 international pediatric sepsis consensus definition has undergone a paradigm shift from a systemic inflammatory response syndrome (SIRS)-based framework to the organ dysfunction-centered Phoenix Seps...
BACKGROUND: The 2024 international pediatric sepsis consensus definition has undergone a paradigm shift from a systemic inflammatory response syndrome (SIRS)-based framework to the organ dysfunction-centered Phoenix Sepsis Criteria (PSC). We aimed to evaluate the diagnostic concordance, predictive performance for 28-day pediatric intensive care unit (PICU) mortality, and phenotypic overlap between these two pediatric sepsis definitions. METHODS: This single-center retrospective cohort study included 1034 children aged > 1 month to < 18 years with confirmed or suspected infection who were directly admitted to the PICU of Children's Hospital of Chongqing Medical University between January 1, 2020, and November 21, 2023. All patients were independently evaluated for sepsis using both the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) SIRS criteria and the 2024 PSC. Diagnostic agreement was assessed using the Kappa coefficient. Binary logistic regression was employed to establish association models between factors and phenotypes, as well as between factors and PICU 28-day mortality. Predictive performance was compared using the C-statistic. RESULTS: Among 1034 patients, 613 (59.3%) met the Sepsis-SIRS criteria with a 28-day PICU mortality of 15.2% (93/613), 744 (72.0%) met the Sepsis-Phoenix criteria with a mortality of 16.3% (121/744), 489 (47.3%) met both criteria with a mortality of 18.6% (91/489), and 166 (16.1%) met neither criterion with a mortality of 2.4% (4/166). Agreement between the two criteria was poor (kappa = 0.202, 95% CI: 0.143-0.261). After adjusting for clinically relevant confounders, the PSC remained a strong independent predictor of 28-day mortality (adjusted OR = 5.123, 95% CI: 2.128-12.333, p < 0.001), whereas the SIRS criteria showed no independent predictive value (adjusted OR = 0.937, 95% CI: 0.523-1.678, p = 0.827). The PSC demonstrated significantly superior discriminatory ability compared with the SIRS criteria (C-statistic = 0.809 vs. 0.589, p < 0.001). Notably, 20.2% of SIRS-positive patients were not classified as sepsis by the Phoenix Criteria, and this subgroup had an extremely low mortality of 1.6%, reflecting higher specificity of the PSC. CONCLUSIONS: The SIRS and PSC identify partially overlapping populations with distinct risk stratification, showing poor diagnostic concordance. The PSC has superior independent predictive performance for PICU 28-day mortality and may be considered for prognostic assessment of infected children in the PICU setting. Importantly, historical study results based on the SIRS criteria should be extrapolated cautiously to PSC-defined populations.
A comparison between early onset sepsis (EOS) risk calculator and modified new protocol in a newborn ≥ 35 weeks: a simulation study.
Armiraglio S, Perniciaro S, Bossi A … +1 more , Agosti MA
Ital J Pediatr · 2026 Jun · PMID 42304492 · Full text
BACKGROUND: Early onset sepsis (EOS) is a potentially fatal condition in neonates and its correct management is still a challenge for neonatologists. Early antibiotic administration in the neonatal period may carry risks...
BACKGROUND: Early onset sepsis (EOS) is a potentially fatal condition in neonates and its correct management is still a challenge for neonatologists. Early antibiotic administration in the neonatal period may carry risks and reducing unnecessary antibiotic therapy remains a key objective. It is well known that EOS risk calculator has reduced investigations and antibiotics for suspected EOS, but many limitations have been identified (e.g. strong value to respiratory symptoms, lack of standardized neonatal monitoring). To develop a new protocol, called Neosafe, for the management of newborn ≥ 35 weeks at risk of EOS based on the EOS risk calculator and serial physical examination with the aim of reducing blood investigations and unnecessary antibiotic therapy. METHODS: In this single-center observational retrospective study 2000 Neonates ≥ 35 weeks were enrolled. A new protocol called Neosafe has been developed, which deviates from the original for two major changes: (1) different serial physical examination (SPE) recommendation for each risk situations (2) clinical scenario revisited with multiple signs. Comparison between Neosafe protocol and EOS risk calculator simulated data were performed using McNemar's test (statistical significance p < 0,05) and the Cohen's kappa coefficient was used to assess the degree of agreement among them. RESULTS: 48/2000 infants (2,4%) would have performed blood investigations versus 82/2000 (4,1%) whether Neosafe protocol would have been applied (p < 0,0001). 43/2000 infants (2,2%) with Neosafe protocol would have received antibiotics versus 80/2000 (4,0%) with EOS risk calculator (p < 0,0001). All infants who would not receive antibiotics for Neosafe protocol were infants with equivocal signs and isolated mild to moderate respiratory distress, but predisposed to advanced medical monitoring. Proven sepsis during the study period were 4, 2 of them were lost by both (no symptoms at birth, blood tests performed for non-infectious reasons). 1829 infants (91,5%) would receive routinal nursing SPE monitoring, 128 advanced medical SPE monitoring and 43 advanced medical SPE+vital for neonatal intensive care unit (NICU). CONCLUSIONS: In our study Neosafe protocol could have reduced blood investigations and antibiotic therapy. Neosafe protocol could be a promising tool that integrates the use of digital technologies and direct attention to the patients. More trials are needed for further improvements.
Impact of regional heterogeneity of RSV infection prophylaxis on bronchiolitis in Italy.
Badolato R, Ceconi V, Bellu' R … +26 more , Baraldi E, Azzari C, Cutrera R, Midulla F, Bernardini R, Cipolla D, Concolino D, Consolaro A, Cortis E, Cualbu A, D'Andrea M, Dinnella G, Fain S, Felici E, Gaggiano S, Giordano P, Guarino A, Iughetti L, Lapacciana E, Pietrobelli A, Pennoni G, Ruffini E, Gizzi C, Agosti M, Agostiniani R, ITARSV-Task-force
Ital J Pediatr · 2026 Jun · PMID 42288825 · Full text
Respiratory syncytial virus (RSV) remains a leading cause of bronchiolitis and hospitalization in infants across Italy, particularly during predictable seasonal outbreaks. With the 2023-2025 RSV seasons marking the first...
Respiratory syncytial virus (RSV) remains a leading cause of bronchiolitis and hospitalization in infants across Italy, particularly during predictable seasonal outbreaks. With the 2023-2025 RSV seasons marking the first large-scale rollout of the monoclonal antibody nirsevimab, this study aimed to evaluate the implementation strategies, regional variability, and early clinical impact of RSV prophylaxis at the national level. We conducted a nationwide, multicenter, observational study across 19 Italian regions. Data were collected through the Italian Society of Pediatrics and the Italian Society of Neonatology, focusing on regional differences in rollout timing, organizational models, logistical challenges, and RSV-related hospitalizations and pediatric intensive care unit (PICU) admissions. The results highlighted significant regional heterogeneity. Northern and central regions such as Veneto, Lombardy, and Tuscany initiated prophylaxis earlier and experienced fewer logistical barriers, resulting in marked reductions in RSV hospitalizations - up to 83.7% in Friuli-Venezia Giulia. Conversely, southern and smaller central regions, including Molise, Marche, and Umbria, faced delayed starts, supply shortages, and bureaucratic challenges, leading to more modest decreases. PICU admissions mirrored these trends. Overall, the national introduction of nirsevimab correlated with a significant reduction in RSV-related morbidity, especially in regions with early, well-organized rollouts. Comparative international studies from France, Spain, and Luxembourg reinforce the Italian findings: timely and universal prophylaxis leads to substantial public health benefits. The study concludes that early campaign activation, consistent drug availability, and efficient organization are critical for maximizing the protective effect of RSV immunization.
Predictive value of the hemoglobin-albumin-lymphocyte-platelet score for intravenous immunoglobulin resistance in children with Kawasaki disease.
Li K, Li F, Zeng N … +3 more , Sang H, Zhao Y, Chen M
Ital J Pediatr · 2026 Jun · PMID 42286758 · Full text
BACKGROUND: Intravenous immunoglobulin (IVIG) resistance is a major clinical challenge in children with Kawasaki disease (KD) and is associated with an increased risk of coronary artery lesions. Early identification of p...
BACKGROUND: Intravenous immunoglobulin (IVIG) resistance is a major clinical challenge in children with Kawasaki disease (KD) and is associated with an increased risk of coronary artery lesions. Early identification of patients at high risk of IVIG resistance remains clinically important. METHODS: Medical data were collected from KD patients at Anhui Provincial Hospital between January 2018 and December 2023. Multivariable logistic regression was performed to identify independent risk factors for IVIG resistance in KD. The study further performed subgroup analyses and restricted cubic spline (RCS) to visualize the dose-response association between hemoglobin-albumin-lymphocyte-platelet score (HALP) and IVIG resistance. The predictive performance of HALP was evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA), and internal validation was performed using bootstrap resampling. RESULTS: A total of 598 patients were included, of whom 58 (9.7%) were identified as IVIG-resistant. Patients with IVIG-resistant KD had significantly lower HALP scores, and low HALP was identified as an independent risk factor for IVIG resistance. The association was consistent across subgroups defined by age, sex, and incomplete KD (IKD). The area under the curve (AUC) for HALP in predicting IVIG resistance was 0.854, outperforming NLR (AUC = 0.751), PLR (AUC = 0.793), and SII (AUC = 0.759). In addition, DCA showed that HALP provided greater net benefit when the threshold probability ranged from 0.02 to 0.63. Moreover, subgroup ROC indicated that HALP had higher predictive value in patients aged ≤ 6 months (AUC = 0.934) and ≥ 48 months (AUC = 0.947). CONCLUSIONS: HALP is independently associated with IVIG resistance in children with KD and demonstrated good performance for early risk stratification, particularly in patients aged ≤ 6 months and ≥ 48 months. As a simple and readily available biomarker, HALP may serve as a useful complementary tool in routine pediatric clinical practice.
Perceptions of challenges in clinical pediatric research: a survey of Italian pediatricians.
Tozzi AE, Croci I, Pignata C … +3 more , Agostiniani R, Moschese V, Italian Society of Pediatric Research (SIRP) Council
Ital J Pediatr · 2026 Jun · PMID 42286725 · Full text
BACKGROUND: Clinical research is essential for advancing pediatric care, yet pediatricians often face unique structural, organizational, and methodological barriers that may hinder their participation in scientific activ...
BACKGROUND: Clinical research is essential for advancing pediatric care, yet pediatricians often face unique structural, organizational, and methodological barriers that may hinder their participation in scientific activities. Understanding these obstacles is crucial to designing effective strategies that strengthen pediatric research capacity in Italy, a country with a leading role in European pediatric output. This study aimed to investigate Italian pediatricians' perceptions of barriers, facilitators, and needs related to conducting research, applying evidence in clinical practice, and publishing scientific work. METHODS: We conducted a cross-sectional online survey of Italian pediatricians using an 18-item questionnaire administered between April and May 2025. Data were analyzed descriptively, and multilevel logistic regression assessed associations between perceived barriers and respondents' characteristics. RESULTS: A total of 717 pediatricians involved in clinical and/or research activities were included. Among those engaged in research (n = 385), the most frequently reported personal barriers were difficulties balancing clinical and research duties (79.3%) and limited access to funding (67.9%). Operational issues such as delayed Ethics Committee approvals (80.8%) and challenges in multicenter data sharing (55.9%) were also prominent. Many respondents expressed dissatisfaction with current research evaluation systems: 78.2% believed that metrics should reflect long-term patient impact, and 73.1% reported that existing criteria penalize pediatric researchers in low-resource settings. Regarding scientific publishing, major obstacles included limited time (75%), complexity of data analysis (58.7%), and publication costs (55%). Interest in support initiatives was high, particularly for monthly evidence summaries (88.5%) and training in artificial intelligence tools (74.3%). Multivariate analysis revealed significant differences by age, gender, and professional role, especially concerning perceived research training adequacy and data analysis difficulties. CONCLUSIONS: Italian pediatricians face substantial structural, organizational, and methodological barriers to conducting research. Despite this, they show strong motivation to engage in scientific activities and express clear needs for training, infrastructural support, and improved evaluation systems. Strengthening funding opportunities, enhancing institutional support, and streamlining ethical and administrative procedures are essential to advancing pediatric research capacity and improving future child health outcomes.
Congenital heart disease prolongs the time to full enteral feeding in neonates with abdominal operation: a dual-center, propensity score-matched retrospective cohort study.
Liu Y, Guo J, Tan Y … +5 more , Wang Y, Xiang X, Du J, Kang W, Hei M
Ital J Pediatr · 2026 Jun · PMID 42277913 · Full text
BACKGROUND: Congenital heart disease (CHD) may cause intestinal hypoperfusion and feeding intolerance. The aim of this study was to assess whether CHD prolongs the time to achieve full enteral feeding in neonates underwe...
BACKGROUND: Congenital heart disease (CHD) may cause intestinal hypoperfusion and feeding intolerance. The aim of this study was to assess whether CHD prolongs the time to achieve full enteral feeding in neonates underwent abdominal surgery. METHODS: This was a dual-center retrospective study. Neonates who underwent abdominal surgery were subdivided into two groups: those with CHD and those without. The primary outcome was the time to achieve full enteral feeding after abdominal surgery. Propensity score matching (ratio of 1:2) was performed to balance covariates. Cox regression analysis was used to evaluate the association. Subgroup analysis further stratified CHD patients based on hemodynamic significance as determined by echocardiographic criteria. RESULTS: A total of 341 newborns were enrolled: 136 with CHD and 205 without. For infants with vs. without CHD, the median gestational age was 35.6 (32.4, 37.8) weeks vs. 36.6 (32.1, 39.0) weeks, birth weight was 2270.0 (1547.5, 3007.5) vs. 2630.0 (1700.0, 3300.0) g, corrected gestational age on surgery day was 37.2 (34.2, 39.4) weeks vs. 39.0 (35.1, 41.4) weeks, respectively (all P < 0.05). There was no significant difference between 2 groups in preoperative feeding nor in operation duration (both P > 0.05). After propensity score matching, 64 neonates with CHD and 128 without CHD were compared. The postoperative time to achieve full feeding was 21.6 days (95% CI: 15.1 ~ 28.1) for CHD and 17.4 (95% CI: 14.2 ~ 20.7) days for non-CHD (P = 0.014). Multivariable analysis found that CHD was an independent risk factor (HR = 2.046, 95% CI: 1.189 ~ 3.519, P = 0.010). Subgroup analysis revealed that only hemodynamically significant CHD (HR = 2.712, 95% CI: 1.414 ~ 5.198, P = 0.003) contributed to this association, while non-significant CHD did not (HR = 1.112, 95% CI: 0.523 ~ 2.370, P = 0.781). CONCLUSIONS: The presence of CHD significantly prolongs the time to achieve full enteral feeding postoperatively and increases the risk of feeding intolerance in neonates undergoing abdominal surgery, an effect primarily driven by hemodynamically significant CHD. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry on November 8, 2025 (Registry website: http://www.chictr.org.cn) (Registration No. ChiCTR2500112685).
Bilateral acute mastoiditis during Epstein-Barr virus infection in a child with alagille syndrome: a case report and scoping review.
Guida M, Farruggia P, Pellegrino C … +11 more , Mescolo F, Saia GF, Marino C, Rutilio TG, Menager S, Torrente B, Imparato S, Volpe F, Fernandez CD, Sciortino M, Corsello G
Ital J Pediatr · 2026 Jun · PMID 42260672 · Full text
BACKGROUND: Bilateral acute mastoiditis is an uncommon complication of acute otitis media and is often associated with systemic infections or underlying predisposing conditions. Viral infections, particularly Epstein-Bar...
BACKGROUND: Bilateral acute mastoiditis is an uncommon complication of acute otitis media and is often associated with systemic infections or underlying predisposing conditions. Viral infections, particularly Epstein-Barr virus (EBV), may facilitate secondary bacterial complications in susceptible pediatric patients. Alagille syndrome, a multisystem genetic disorder, may further increase vulnerability to severe infections due to immune and anatomical factors. METHODS: We report a case of bilateral acute mastoiditis occurring in a child with Alagille syndrome during acute EBV infection: clinical, laboratory, microbiological, and radiological findings were collected and analysed. Furthermore, a scoping review was conducted to contextualize diagnostic and therapeutic strategies in pediatric mastoiditis. RESULTS: A 12-year-old boy with known Alagille syndrome presented with persistent fever during confirmed EBV infection. During hospitalization, he developed clinical signs of bilateral mastoiditis. Contrast-enhanced computed tomography confirmed bilateral mastoid involvement. Blood cultures yielded Streptococcus pneumoniae. The patient was treated with intravenous broad-spectrum antibiotics (ceftriaxone and vancomycin) and underwent bilateral myringotomy with drainage. Clinical conditions improved rapidly, allowing step-down to oral antibiotic therapy and complete recovery without complications. CONCLUSIONS: This case underscores the rare association between bilateral mastoiditis, EBV infection, and Alagille syndrome and highlights the potential interplay between viral-induced immune dysregulation and genetic susceptibility in promoting severe bacterial complications. Early recognition, appropriate antimicrobial therapy, and timely surgical intervention are essential to ensure favourable outcomes. Children with underlying genetic conditions may require closer monitoring during systemic viral infections to prevent severe complications.
Electrolyte balance and muscle damage after adolescent binge alcohol use: a retrospective study.
Hunjan I, Pistritto E, Corsello A … +7 more , Bianchetti MG, Alberti I, Vassilopoulou E, Agostoni C, Salvini F, Lavagno C, Milani GP
Ital J Pediatr · 2026 Jun · PMID 42260596 · Full text
BACKGROUND: Binge alcohol drinking is a recognized cause of peripheral muscle damage, leading to increased creatine kinase levels. However, the potential role of electrolyte and osmolality changes in muscle damage remain...
BACKGROUND: Binge alcohol drinking is a recognized cause of peripheral muscle damage, leading to increased creatine kinase levels. However, the potential role of electrolyte and osmolality changes in muscle damage remains unclear. This study investigates the prevalence of muscle damage in adolescents after binge drinking and its association with ethanol, potassium, sodium, calcium, and osmolality levels. METHODS: A retrospective review of medical records from the Pediatric Emergency Department, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, was conducted. The study included 150 adolescents (13.2 to 18.0 years of age, female to male ratio 1.03) diagnosed with binge drinking between 2013 and 2023. Exclusion criteria encompassed muscle trauma, crush syndrome, pre-existing conditions, or medications affecting muscle metabolism and electrolyte balance. Muscle damage was defined as creatine kinase levels exceeding 1.5 times the upper limit of normal. RESULTS: Muscle damage was identified in 61 (41%) cases, predominantly in males (female to male ratio 0.24; p < 0.0001). Ethanol levels (1.87 [1.57-2.30] versus 2.01 [1.61-2.36] g/L; median and interquartile range), potassium (3.6 [3.3-3.9] versus 3.7 [3.5-3.9] mmol/L), sodium (140 [139-142] versus 140 [138-142] mmol/L), total calcium (2.31 [2.27-2.37] versus 2.29 [2.25-2.31]; mmol/L), albumin-adjusted calcium (2.27 [2.22-2.32] versus 2.29 [2.18-2.31]; mmol/L), effective osmolality (286 [283-290] versus 287 [284-290] mosm/kg), and total osmolality (333 [326-342] versus 337 [326-342] mosm/kg) were similar in individuals without and with muscle damage. CONCLUSIONS: In adolescents, muscle damage is common after binge alcohol drinking, particularly in males. The pathogenesis appears to be independent of ethanol concentration, electrolyte imbalances, and osmolality changes.
Risk factors analysis of poor prognosis in ICU-admitted children with severe influenza pneumonia: a retrospective case-control study.
Shan Z, Jia W, Li W … +2 more , Li P, Song C
Ital J Pediatr · 2026 Jun · PMID 42260580 · Full text
BACKGROUND: This study investigated independent prognostic risk factors for adverse outcomes in children admitted to the ICU with severe influenza pneumonia to guide early risk stratification and timely clinical interven...
BACKGROUND: This study investigated independent prognostic risk factors for adverse outcomes in children admitted to the ICU with severe influenza pneumonia to guide early risk stratification and timely clinical intervention. METHODS: This retrospective study included 139 eligible pediatric ICU patients with severe influenza pneumonia. Univariate and multivariate logistic regression was applied to analyze the independent risk factors for poor prognosis with severe influenza pneumonia, and the Receiver operating characteristic (ROC) curve was used to evaluate the effectiveness of risk factors. RESULTS: Among the 139 children, 45 had a poor prognosis and 94 had a good prognosis. Multiple clinical and laboratory parameters differed significantly between the two groups (all P[Formula: see text]0.05). The three independent risk factors associated with poor prognosis were identified: fever peek [Formula: see text]41[Formula: see text](Odds ration [OR] [Formula: see text] 13.584, P[Formula: see text] 0.036), requirement for invasive mechanical ventilation (IMV) (OR [Formula: see text] 47.526, P[Formula: see text] 0.006), and elevated interleukin-6 (IL-6) levels (OR [Formula: see text] 1.049, P[Formula: see text] 0.002).The optimal cut-off value of IL-6 for predicting poor prognosis was 492.05 pg/mL (Area under the Curve [AUC] [Formula: see text] 0.755; sensitivity 46.7[Formula: see text], specificity 94.7[Formula: see text]; 95[Formula: see text] Confidence Interval [CI]: 0.666-0.844). The AUCs for fever peak [Formula: see text] 41[Formula: see text] and IMV were 0.623 and 0.737, respectively, whereas the combined AUC for all three indicators reached 0.848 [Formula: see text]95[Formula: see text] CI: 0.784-0.912). CONCLUSION: Fever peak [Formula: see text]41[Formula: see text], requirement for IMV, and IL-6 levels exceeding 492.05 pg/mL are robust independent early predictors of poor prognosis in children admitted to the ICU with severe influenza pneumonia. Combined assessment of these markers demonstrates strong predictive performance and supports targeted early intervention in high-risk patients.
Management of acute otitis media with otorrhea in Italian pediatric practice: a national survey.
Marchisio P, Miraglia Del Giudice M, d'Avino A … +3 more , Zampogna S, Ciprandi G, Marseglia G
Ital J Pediatr · 2026 Jun · PMID 42252384 · Full text
BACKGROUND: Acute otitis media (AOM) is a common pediatric infection, and spontaneous tympanic membrane perforation and otorrhea represent a clinically significant subset that requires specific management. Understanding...
BACKGROUND: Acute otitis media (AOM) is a common pediatric infection, and spontaneous tympanic membrane perforation and otorrhea represent a clinically significant subset that requires specific management. Understanding current practices among pediatricians is crucial for identifying areas of concordance with guidelines, management strategies, and potential educational needs. METHODS: A national survey was conducted among Italian pediatricians, including both family pediatricians and hospital-based specialists, to assess their attitudes and practices regarding the definition, epidemiology, diagnosis, and treatment of AOM with otorrhea. A dedicated questionnaire included 20 items concerning different aspects of AOM management, including the potentiality of topical treatment for otorrhea. Data were also stratified for age, type of work, and geographic area. RESULTS: Five hundred pediatricians participated in the survey. The survey revealed that 57.6% of respondents preferred "acute otitis media with otorrhea" as the disease definition. AOM with otorrhea is most frequently observed in winter (45%) and autumn/spring (25% each). Approximately two-thirds of pediatricians (66%) manage 5-20 cases monthly during peak incidence. Otorrhea is reported in <10% of AOM cases by 58.6% of practitioners. A substantial majority (80.2%) initiate antibiotic treatment at the first observation in the presence of otorrhea, primarily systemic (78.2%), with amoxicillin-clavulanate (60.2%) being the preferred drug for 8-10 days (72.4%). Recurrences within 3 months are reported by 72.8% of respondents, with <10% of patients reporting them. There is raised interest in treatment alternatives (85.8%) and a preference for topical administration for specific patient categories (60.6%). CONCLUSIONS: This national survey suggests that Italian pediatricians commonly favor early antibiotic treatment for acute otitis media with otorrhea, while areas of uncertainty remain regarding watchful waiting, treatment duration, and the role of topical therapy. These findings highlight the need for clearer, practice-oriented guidance and further research.
S. aureus infections in hospitalized children with hematological, hepatological or kidney diseases over a 16-year period at a tertiary care hospital in Sweden: a retrospective observational study.
Farmand S, Kurz H, Isaksson J … +3 more , Chromek M, Henriques-Normark B, Sundin M
Ital J Pediatr · 2026 Jun · PMID 42237343 · Full text
BACKGROUND: Staphylococcus aureus (S. aureus) continues to be a significant pathogen responsible for a wide spectrum of infections with potentially fatal outcomes. The existing literature on S. aureus infection in childr...
BACKGROUND: Staphylococcus aureus (S. aureus) continues to be a significant pathogen responsible for a wide spectrum of infections with potentially fatal outcomes. The existing literature on S. aureus infection in children is still limited and highly heterogeneous, making it difficult to establish standardized indicators for complicated infections-especially in children with underlying medical conditions. Within this study we describe the clinical course and outcome of S. aureus infections in hospitalized pediatric patients with significant underlying disease or risk factors and assess whether clinical and/or laboratory features may be associated with the infectious course. METHODS: Patients receiving inpatient care for S. aureus infection at the Karolinska University Hospital Huddinge, Sweden were identified by ICD-coding. Infection frequency, clinical course, underlying disease and medication were reviewed. Events were grouped according to severity (mild versus complicated) and subgroup analysis was performed. RESULTS: Between 01/2004 and 12/2019, 38 patients with proven inpatient S. aureus infection were identified. These patients displayed a high number of recurrence accounting for a total number of 68 S. aureus infection episodes. All patients had significant underlying co-morbidities and risk factors. In 58 episodes (85.3%) an indwelling device was present. No S. aureus related mortality occurred and sequelae were extremely rare. Patients with complicated infection were more likely to display fever and elevated CRP at presentation, while leukocyte and neutrophil numbers did not significantly differ. Outpatient care prior to infection, local infection signs and a good or excellent status at presentation were associated with mild infection in our cohort. CONCLUSIONS: Recurrent infections were frequent among affected patients. Prompt antibiotic treatment upon suspicion of infection as well as the removal of indwelling devices may have contributed to the overall favorable outcomes in our cohort. Further studies are required to address the usefulness of identified variables to guide clinical decision making.
Accurate prediction of mortality in children with sepsis: development and validation of an explainable model based on real-world data.
Yang XJ, Gu W, Miao HJ … +6 more , Shi D, Qian YL, Wu MY, Chen XH, Sun YQ, Ge XH
Ital J Pediatr · 2026 Jun · PMID 42237326 · Full text
BACKGROUND: Sepsis remains the leading cause of in-hospital deaths among children, and there is currently a lack of precise early prediction models. This study aimed to develop an interpretable machine learning (IML) mod...
BACKGROUND: Sepsis remains the leading cause of in-hospital deaths among children, and there is currently a lack of precise early prediction models. This study aimed to develop an interpretable machine learning (IML) model to predict in-hospital mortality in pediatric patients diagnosed with sepsis according to the 2024 Phoenix Sepsis Diagnostic Criteria. METHODS: This single-center retrospective cohort study analyzed 464,459 children who were hospitalized in the Children's Hospital Affiliated to Nanjing Medical University from January 2018 to December 2023 were screened. Based on the Phoenix Sepsis Score, 2,477 cases of childhood sepsis were finally diagnosed. The features were filtered using three methods the minimum absolute contraction and selection operator (LASSO) regression, the Boruta algorithm, and random forest importance ranking, ultimately identifying 12 features. Eight machine learning algorithms were trained on 70% of the data and evaluated on a 30% test set. The optimal model was screened based on the accuracy of the test set and the area under the receiver operating characteristic curve (AUC). The interpretability of the model is enhanced by leveraging SHapley Additive exPlanations (SHAP) summary graphs, individual SHAP force maps, and partial dependency plots (PDPs). RESULTS: A total of 2,477 patients with sepsis met the participation criteria, with a median age of 26 months (IQR, 5-78 months). Among the 2,477 participants, 1,448 (58.5%) were boys. The CatBoost model demonstrated the best performance among the 8 constructed models, achieving an AUC of 0.889 and an accuracy of 92.9% in the test set. Notably, at the default decision threshold, the model demonstrated high specificity but relatively low sensitivity. However, by optimizing the decision threshold using the Youden Index, the model's sensitivity was substantially improved to 83.05%, effectively mitigating the potential risk of missed diagnoses for high-risk patients in clinical practice. Feature importance analysis indicated that invasive mechanical ventilation, Glasgow Coma Scale score, platelet count, uric acid, and SpO/FiO ratio were the top five features that had the greatest impact on the CatBoost model. SHAP analysis provided both global feature importance and individualised risk explanations, and the model has been deployed as a freely accessible web calculator. CONCLUSIONS: The IML model developed in this study provides a highly interpretable and accurate tool for the early prediction of in-hospital mortality in pediatric sepsis patients. The SHAP approach improves model interpretability and helps clinicians understand the factors driving those predictions. However, as a single-center retrospective study, the generalizability of our findings to other clinical settings may be limited. Future multi-center prospective studies are necessary to further validate the model and address its current limitations in sensitivity to minimize the risk of missing high-risk cases.
Measles challenges: global resurgence and factors affecting eradication.
Mohamedosman EHA, Ullah MF, Alnour TMS … +3 more , Elssaig EH, Yousif A, Holie MI
Ital J Pediatr · 2026 Jun · PMID 42237192 · Full text
Measles is one of the most highly contagious and inflictive human viral infections, and approximately 90% of exposed individuals become infected following the exposure. The infection is communicable from one day before t...
Measles is one of the most highly contagious and inflictive human viral infections, and approximately 90% of exposed individuals become infected following the exposure. The infection is communicable from one day before the prodromal symptom onset until four days after rash onset. Up to 40% of people who attract measles will have other health problems arising during the course of infection. There is no specific treatment for measles. Recent reports highlight that measles infection erases the already existing immune memory of various pathogens. The latest measles outbreaks in sub-Saharan Africa and Europe show the ease with which measles virus can re-enter communities. However, measles outbreaks in recent years have been reported in all regions of the world, including countries that had previously declared the disease eliminated such as United Kingdom and the United States. The present review article provides an outlook of the current epidemiology and challenges to support the global efforts in controlling the disease through discussion on the recent resurgence and enumerating the factors hindering the eradication of measles. This constellation of factors contributing to measles resurgence and outbreak propagation is multifactorial. Key drivers include suboptimal vaccine coverage, stemming from either outright vaccine refusal or barriers to healthcare access leading to incomplete vaccination schedules. This results in a diminution of herd immunity, compromising community-wide protection. Furthermore, primary or secondary vaccine failure, while rare, contributes to a residual pool of susceptible individuals. Diagnostic challenges, including the misdiagnosis of measles as other exanthematous illnesses, can delay outbreak containment and facilitate silent transmission. An epidemiological consequence of prolonged low transmission is an upward shift in the age-specific susceptibility profile, exposing older children and adults who lack natural immunity. Finally, sociopolitical instability, conflict, and resultant internal displacement create conditions conducive to outbreaks by disrupting healthcare infrastructure, hampering vaccination campaigns, and fostering high-density living conditions among vulnerable populations. This review addresses a major gap in measles eradication by integrating scattered evidence on measles resurgence into an integrated comprehensive framework, encompassing health system, epidemiological, immunological, and sociopolitical factors.
Ultrasound elastography in pediatric care: bridging innovation and noninvasive diagnostics.
Piersanti M, Ferrari F, Piccirillo M … +9 more , Agostiniani R, Zerunian M, Caruso D, Civitelli F, Graziani M, Parisi P, Cortis E, Di Nardo G, Mennini M
Ital J Pediatr · 2026 Jun · PMID 42231359 · Full text
This review explores the application and limitations of ultrasound elastography (USE) in the pediatric population, addressing its diagnostic value across different organs and suggesting future directions for research and...
This review explores the application and limitations of ultrasound elastography (USE) in the pediatric population, addressing its diagnostic value across different organs and suggesting future directions for research and clinical practice. A literature review was conducted using PubMed to identify studies published between 2010 and 2025 that examined USE applications in children. The search focused on studies assessing the liver, kidney, bowel, pancreas, muscle, connective tissue, and lung. The review highlights the established clinical application of USE in the assessment of liver fibrosis. It also provides an overview of new potential applications in kidney diseases, inflammatory bowel disease, cystic fibrosis, and muscle disorders. Two-dimensional shear wave elastography (2D-SWE) demonstrates excellent diagnostic accuracy in liver disease. However, in kidney applications, variability in results and the lack of standardized protocols limit clinical utility. SWE has shown promise in in the early detection of pancreatic insufficiency and muscle stiffness in cerebral palsy. Emerging applications include monitoring lung fibrosis and assessing fetal lung development. Despite its advantages-being noninvasive, repeatable, and well tolerated-USE remains limited by operator dependency, lack of standardization, and poor reproducibility in specific organs remain a major challenge. USE demonstrates significant potential for noninvasive diagnostics in pediatric care, especially in reducing invasive procedures and improving patient follow-up. However, further studies are needed to establish standardized protocols, reliable cut-off values, and broader applications across different organ systems. Integration of USE with other imaging modalities and utilizing advancements in artificial intelligence may enhance its diagnostic yield.
Early and high Influenza A circulation alongside reduced Respiratory Syncytial Virus prevalence during autumn 2025 in paediatric patients attending emergency department.
Di Maio VC, Scutari R, Ranno S … +18 more , Coltella L, Cortazzo V, Colagrossi L, Vittucci AC, Antilici L, Linardos G, Salvatori A, Gentile L, Onori M, Lucignano B, Vrenna G, Pisani M, Cristaldi S, Raponi M, Russo C, Bernaschi P, Villani A, Perno CF
Ital J Pediatr · 2026 Jun · PMID 42226285 · Full text
The recent implementation of preventive strategies against Respiratory Syncytial Virus (RSV) in infants has raised questions about potential changes in RSV seasonality and the circulation of other respiratory viruses. Th...
The recent implementation of preventive strategies against Respiratory Syncytial Virus (RSV) in infants has raised questions about potential changes in RSV seasonality and the circulation of other respiratory viruses. This study aimed to compare respiratory virus activity among paediatric patients presenting to the Bambino Gesù Children's Hospital (Rome, Italy), with respiratory symptoms and available BioFire Respiratory Panel 2.1 plus results during September-December 2024 (N = 670) and 2025 (N = 905). RSV detection decreased significantly in December 2025 compared with the same period in 2024 (6.3% vs 29.4%, risk ratio [RR]: 0.21, 95% confidence interval [CI] 0.16-0.28; p < 0.001). By contrast, influenza A viruses had an earlier onset in 2025 and emerged as the dominant pathogen compared with 2024 (21.0%, in 2025 vs 4.5%, in 2024; RR: 4.69, 95% CI 3.23-6.80; p < 0.001). Unlike September-December 2024, parainfluenza viruses (PIVs) 3 and 4 circulated in 2025 (0.4% vs 3.5% for PIV 3; 0.0% vs 3.6% for PIV-4; p < 0.001 for both), mainly observed in infants (median age 0.7 years; interquartile range: 0.2-1.2; mean±standard deviation: 0.9 ± 0.8). Circulation of adenovirus (11.5%, vs 6.1%; p < 0.001) and human coronavirus HKU1 (3.6%, vs 0.1%; p < 0.001) also increased in 2025 compared with 2024. The observed epidemiological shifts suggest potential effects associated with the introduction of RSV prophylaxis in Italy and highlight the importance of continued paediatric surveillance in monitoring evolving viral patterns and guiding public health decisions.
Glutaric acidemia type 1 in a non-newborn-screened cohort: clinical, biochemical, and molecular features and neurologic outcomes.
Selamioğlu A, İdrisoğlu M, Kılıç Ş … +7 more , Güneş D, Karaca M, Balcı MC, Çakar NE, Atalar F, Gedikbaşı A, Gökçay G
Ital J Pediatr · 2026 May · PMID 42210298 · Full text
BACKGROUND: Glutaric acidemia type 1 (GA1) is a rare but treatable autosomal recessive neurometabolic disorder caused by biallelic pathogenic variants in the GCDH gene. In the absence of newborn screening (NBS), diagnosi...
BACKGROUND: Glutaric acidemia type 1 (GA1) is a rare but treatable autosomal recessive neurometabolic disorder caused by biallelic pathogenic variants in the GCDH gene. In the absence of newborn screening (NBS), diagnosis often occurs after irreversible neurological injury. METHODS: This retrospective, descriptive, cross-sectional study included 50 patients with biochemically and/or genetically confirmed GA1 from two tertiary centers in Turkey, where GA1 is not part of the national NBS program. Demographic, clinical, biochemical, neuroimaging, and molecular genetic data were collected from medical records. Motor and communication functions were evaluated using the Gross Motor Function Classification System (GMFCS) and the Communication Function Classification System (CFCS). RESULTS: The cohort comprised 29 males (58%) and 21 females (42%) from 42 unrelated families, with parental consanguinity present in 78%. Median age at diagnosis was 10 months (range: 3 months-17 years). Most patients presented with the acute-onset type (66%), followed by the insidious-onset type (34%). Encephalopathic crises occurred in 66% of patients, with gastroenteritis and respiratory infections being the most common precipitating factors. Severe motor (GMFCS level 5: 61.5%) and communication (CFCS level 5: 30.8%) impairments were frequent. Neuroimaging revealed basal ganglia involvement in 86.1% and frontotemporal atrophy in 72.2% of patients. Biochemically, 70% were high excretors, and secondary carnitine deficiency was common (84.6%). Genetic analysis (n = 29) identified 15 pathogenic/likely pathogenic GCDH variants, with c.743 C > T (p.Pro248Leu) being the most frequent variant (34.4%), suggesting a founder effect. Twelve patients (24%) died during follow-up (median age: 6.2 years). CONCLUSIONS: In this large Turkish GA1 cohort diagnosed outside NBS, delayed diagnosis was associated with severe and irreversible neurological sequelae, high mortality, and multisystem complications. Our findings strongly support the urgent inclusion of GA1 in national NBS programs, especially in high-consanguinity populations, alongside structured lifelong management strategies to improve long-term outcomes.
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