Italian Journal of Pediatrics最新文献

Background: During the pandemic, the pneumology team at Bambino Gesù Children's Hospital highlighted that telemedicine was a valuable tool for remotely managing the medical needs of children with medical complexity (CMC). Following the telemedicine experience during the emergency phase, a telemedicine service was established, and new tools were tested to optimize televisits and the overall eHealth approach for patients. In this context, the TytoHome™ device was tested for performing objective examinations remotely. This pilot study, conducted at our hospital, explored the management of CMC patients on long-term mechanical ventilation via the telemedicine platform and the TytoHome™ device.

Methods: This study involved the treatment of 10 pediatric patients over one year using this approach. The patients were already receiving care at our hospital and were undergoing long-term mechanical ventilation (LTV) at home-4 on invasive mechanical ventilation (IMV) and 6 on non-invasive ventilation (NIV). A database was developed to collect patient data, including personal details, vital parameters, objective examinations, audio quality, and patient satisfaction. A descriptive analysis was subsequently performed using the data collected during the earlier stages of the study.

Results: The utility of the TytoCare device for medically complex children was evaluated. The families were "satisfied" with the remote follow-up visits, and healthcare personnel rated the audio quality of the visits as "good."

Conclusions: In conclusion, the remote management of these patients using the Tyto device offered several advantages. In our experience, Tyto proved to be a useful tool for the remote medical management of complex patients.

Background: Generalized Pustular Psoriasis (GPP) is an autoinflammatory, multisystemic disease, characterized by widespread eruption of neutrophilic pustules on erythematous base, accompanied by systemic symptoms such as fever, leukocytosis, arthralgia, and general malaise. Globally, the disease is rare, particularly in children. If not adequately diagnosed and treated, systemic inflammation and multiorgan involvement can be life-threatening. The pathogenesis of GPP mainly involves the innate immune system, with inflammatory processes and neutrophil activation driven primarily by IL-36, but also by IL-1, TNF-alpha, IL-17 A. In particular, IL-17 A acts as a potent inducer of neutrophil recruitment. We report the case of a 7-years-old girl with GPP successfully treated with Ixekizumab, an IL-17 A antagonist.

Case presentation: A 7-years-old girl with an history of plaque psoriasis came to our attention for the sudden appearance of erythematous patches surmounted by pustules on the trunk and lower limbs, following repeated episodes of purulent tonsillitis. We started therapy with cyclosporine at a dosage of 3,5 mg/kg/day, with no clinical benefit and progression of manifestations to a sub-erythrodermic state after 2 weeks. Blood tests showed neutrophilic leukocytosis, and the patient experienced hyperpyrexia and malaise. Since ixekizumab was recently approved for pediatric use in patients with moderate to severe plaque psoriasis, we started therapy with 80 mg Ixekizumab, combined with prednisone at a dosage of 12.5 mg/day, gradually tapered until discontinuation after 15 days. A second dose of Ixekizumab 40 mg was administered at week-4, according to the indication of ixekizumab in pediatric plaque psoriasis. At week-8 the patient achieved complete remission of skin manifestations and normalization of blood count. After achieving a stable remission, at week 36 we decided to increase the administration interval to 6 weeks. The patient is still on therapy with ixekizumab 40 mg every 6 weeks, maintaining complete remission during a 52-week follow-up, without safety concerns.

Conclusions: This report supports the use of ixekizumab as a safe and effective option, both in the short and long-term, in the treatment of GPP, even at pediatric age. Larger studies are needed to confirm this positive, real-life experience.

Background: Intracardiac thrombus (ICT) is the rarest yet most severe complication of severe Mycoplasma pneumoniae pneumonia (SMPP) in children. This study aims to elucidate the clinical characteristics of patients with SMPP-related ICT.

Methods: We retrospectively enrolled 68 children with SMPP (18 cases of ICT, 50 cases of non-ICT) who were admitted from January 2014 to January 2024. We compared their demographic data, clinical symptoms, laboratory tests, imaging findings, treatment strategies, and prognoses. Additionally, we summarized data from 33 confirmed SMPP-related ICT cases reported in 12 references.

Results: In our cohort, the ICT group exhibited higher incidences of tachypnea, chest pain, inflammation, and elevated D-dimer levels. They also presented more severe radiological findings and had longer hospital stays compared to the non-ICT group. The chordae tendineae-attached was the most common type (61.1%). Pathological examinations revealed ICT sizes ranging from 480 to 31,500 mm³. A favorable prognosis was observed in 94.4% of ICT patients. Clinical features did not significantly differ between various ICT types. In the overall cohort (51 cases), the right ventricle was the predominant location (68.6%). Notably, 66.7% of patients had concurrent extracardiac thrombosis, with pulmonary thrombosis being the most common subtype (41.2%).

Conclusions: The clinical characteristics of SMPP-related ICT are non-specific, often coexisting with severe pulmonary lesions and significantly elevated inflammatory markers. All ICT types were chordae tendineae or wall-attached, rather than mobile. These findings suggest that an inflammation storm induced by SMPP may play a significant role in the pathogenesis of in situ thrombosis within the heart and major blood vessels.

Background: Kawasaki disease (KD) primarily affects young children and can lead to coronary artery lesions. Intravenous immunoglobulin (IVIG) treatment is essential; however, it may fail in 10-20% of cases, increasing the risk of complications. Complete blood count (CBC) tests can help assess disease severity and predict risks. This study investigated the impact of IVIG on peripheral blood cells, including neutrophil count, platelet-lymphocyte ratio, hemoglobin level, mean platelet volume (MPV), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), in children with KD complicated by coronary artery lesions (CALs).

Methods: This retrospective analysis included children diagnosed with typical KD. The neutrophil count, hemoglobin level, platelet-lymphocyte ratio, MPV, ESR, and CRP were compared between those with (CAL⁺) and without (CAL^-) CALs during the acute phase, as well as at 7 days, 1 month, and 2 months after normalizing body temperature with IVIG.

Results: A total of 76 children with KD were analyzed, including 30 with CAL⁺. CAL⁺ and CAL^- patients exhibited elevated neutrophil counts during the acute phase, with no significant differences (P > 0.05) between groups. After IVIG treatment, CAL^- patients demonstrated a more pronounced reduction in neutrophil count (P < 0.05) than CAL⁺ patients. Hemoglobin levels differed significantly during the acute phase (P < 0.05) but were comparable post-treatment (P > 0.05) between CAL⁺ and CAL^- patients. The platelet-lymphocyte ratio varied significantly between groups during the acute phase and 1-month post-treatment (P < 0.05). Mean ESR and CRP levels were significantly elevated at all time points in the CAL⁺ group compared with the CAL^- group. No significant differences in MPV were observed between groups.

Conclusions: After IVIG treatment, CAL^- patients demonstrated a more important reduction in neutrophil count than CAL⁺ patients after IVIG. Pediatric patients with KD and CAL⁺ showed lower hemoglobin and platelet-lymphocyte ratio and higher ESR and CRP compared with CAL^-, suggesting that they may serve as indicators for CAL in pediatric patients with KD.

Drug hypersensitivity reactions (DHRs) in pediatric patients present significant clinical challenges due to their potential for severe, life-threatening reactions such as anaphylaxis. Although less common than in adults, DHRs in children are more difficult to diagnose and manage due to limited pediatric-specific research. This study focuses on the role of premedication as a preventive strategy for DHRs, exploring its potential benefits and limitations. While approaches like H1-antihistamines combined with gradual drug dose escalation show promise for reducing mild histamine-mediated reactions, evidence regarding premedication's effectiveness, particularly for non-IgE-mediated mechanisms, remains inconclusive. Rapid drug desensitization (RDD) protocols demonstrate high success rates in certain cases; however, there are no strong recommendations for or against premedication, and controlled studies documenting its real efficacy are lacking. Further research is crucial to establish clear guidelines and improve the safety and outcomes of pediatric drug allergy management.

Background: Early administration of reading, writing and math standardised tests allows us to assess the risk of developing a learning disorder and to plan a specific intervention. The ease of access to technological tools and past pandemic restrictions have led to the abandonment of face-to-face assessment in favour of teleassessment methods. Although these kinds of assessments sometimes seem comparable in the literature, their equivalence is not clearly defined. The first aim of our research was to test the comparability of the two modalities using a complete battery of neuropsychological tests. Second, we addressed whether the administration order could influence performance.

Methods: Using a within-subject sample design, we compared face-to-face and teleassessment performance in reading, writing and math tasks in 64 children attending first and second year of primary school.

Results: Teleassessment scores were lower than face-to-face; math tests weighted on difference. Differences were mitigated by previous experience with face-to-face modality.

Conclusions: Although there was considerable overlap between the two administration methods, teleassessment could lead to overestimation of the risk for learning disorders.

Background: The use of antiseizure medication in patients with epilepsy is one of the significant risk factors associated with abnormal vitamin D status. We aimed to identify risk factors related to hypovitaminosis D in pediatric patients treated with antiseizure medications.

Method: A cross-sectional retrospective cohort study was conducted on 127 pediatric epilepsy patients who received antiseizure drugs from December 2021 to December 2022. Demographic data, seizure types, diet, physical activity, duration, and types of antiseizure medications were analyzed.

Results: Among the 127 patients in this study, 53% were male, and the mean age was 9,1 ± 4,6 years (range: 2-17). The mean serum 25(OH)D level at baseline in winter/autumn was 24,2 ± 14,2 ng/mL; 47.0% of the patients were 25(OH) D deficient, 23% were 25(OH)D insufficient, and 30% had a vitamin D level within the normal range. The vitamin 25(OH) D level was 27,6 ± 12,2 in the epilepsy group with non-enzyme-induced antiseizure drugs, 21,76 ± 19,7 in the group with enzyme-induced antiseizure drugs, and 13,96 ± 7,9 in the group with combined antiseizure drugs (p < 0.001).

Conclusion: The number of antiseizure drugs, treatment with enzyme-induced antiseizure drugs, duration of epilepsy, abnormalities in magnetic resonance imaging, and etiology play important roles in determining the vitamin D level.

Background: The timely initiation of trophic feeding (TF) is crucial for premature newborns, but challenging due to immaturity, respiratory instability, abdominal distension, resource scarcity, and healthcare worker expertise. Moreover, there is a dearth of information on predictors of full trophic feeding time. Therefore, this retrospective cohort study aimed to investigate the time it takes and its predictors to initiate minimal enteral feeding in preterm neonates in Southern Oromia, Ethiopia.

Method: A facility-based retrospective follow up study was conducted among 434 randomly selected preterm neonates admitted to NICU of Bule Hora University Teaching Hospital and Yabello General Hospital from January 1, 2021 to December 30, 2022. Data were extracted by a pretested structured checklist, entered into Epidata 3.1 and then transferred to Stata version 17 for analysis. Kaplan Meier survival curve and log rank test were used to estimate survival time and a statistical comparison respectively. Bivariable and multivariable cox proportional hazard model was fitted to identify predictors of time to initiate TF and their outputs are presented using Adjusted Hazard Ratio (AHR) with 95% Confidence Intervals (CIs).

Result: The overall incidence density of TF initiation was reported as 43.6 per 100 neonate-days. Moreover, the median (IQR) time to initiate TF was found to be 2 (1-4) days. Neonates delivered vaginally had a higher likelihood of early TF initiation (AHR: 1.64, CI: 1.26, 2.13), while those born between 32 and 34 weeks (AHR: 0.61, CI: 0.46, 0.81), VLBW neonates (AHR: 0.45, CI: 0.34, 0.60), neonates without KMC (AHR: 0.59, CI: 0.46, 0.79), and those in level II hospitals were less likely to start TF promptly (AHR: 0.78, CI: 0.62, 0.99). Furthermore, neonates with sepsis (AHR: 1.76, CI: 1.36, 2.28) and hypothermia (AHR: 1.51, CI: 1.19, 1.93) had delayed TF initiation.

Conclusion: We observed a significant low rate of early TF initiation and higher death rate of preterm newborn in our study as compared to the global. Preterm neonates with lower GA, no KMC, and a VLBW are more likely to have a delayed initiation. Our results highlight that staff training on identifying neonates suitable for TF, and ensuring adequate resources for KMC in all NICU levels should be considered.

Background: Intracranial abscess (IA) is a rare disorder in childhood. Clinical manifestations of brain abscess include headache, fever, and focal neurological deficits. This study aimed to examine the demographic, clinical, laboratory, and imaging findings in children with IA.

Methods: Children admitted to the pediatric infection service with a diagnosis of IA between 2011 and 2022 were included in the study. Abscesses were divided into two groups: infratentorial and supratentorial. Demographic characteristics of the patients, complaints, MRI findings, and follow-up data were recorded and compared between the two groups.

Results: The study included a total of 23 patients, 9 (39.1%) of whom were male, with a mean age at diagnosis of 79.3 ± 65.4 months. The most common complaints were headache (39.1%), fever (91.3%), focal neurological deficits (60.9%), seizures, loss of consciousness (26.1%), and meningitis findings (60.9%). The most frequent etiology was post-operative procedures (30.4%), followed by a history of meningomyelocele (13%), and congenital heart disease (8.7%). On MRI, 68.7% of the supratentorial abscesses were multiple and commonly localized in the frontal and parietal regions. Treatment included ceftriaxone (82.6%), vancomycin (65.2%), meropenem (43.5%), metronidazole (34.8%), and linezolid (17.4%). The median hospitalization duration for patients was 32 days (range: 14-150). Of the patients, 34.8% were hospitalized and followed in the intensive care unit, and neurosurgery performed surgical interventions in 60.9% of cases, with evacuation in 21.7% of cases. In cultures, the causative agent was identified on average within 4 ± 1.3 days. Recurrence of abscess occurred in three (13%) cases, and 13% of cases had residual sequelae.

Conclusions: Intracranial abscess is a rare infectious disease that can result in long-term neurological deficits requiring extended follow-up and treatment. A correct and effective approach also positively impacts the prognosis of patients.

Background: Autoimmune rheumatic diseases (ARDs) in children can negatively impact renal function, potentially leading to acute kidney injury (AKI). This study compares the prevalence of AKI and other adverse in-hospital outcomes among hospitalized children with ARDs.

Methods: A retrospective analysis was conducted using the United States Nationwide Inpatient Sample (NIS) database from 2005 to 2020. The study included children aged 1-17 years with ARDs, categorized into inflammatory arthritis, ANCA-associated vasculitis, systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and other connective tissue diseases. Logistic regression assessed associations between ARD types and outcomes, including AKI, dialysis, and major adverse events.

Results: Among 13,891 children with ARDs, 8.2% developed AKI and 1.3% required dialysis. Compared to inflammatory arthritis, ANCA-associated vasculitis significantly increased the risk of AKI (aOR = 11.20, 95% CI: 8.08-15.51) and dialysis (aOR = 40.60, 95% CI: 13.54-121.71). SLE also elevated risks of AKI (aOR = 4.16, 95% CI: 3.20-5.40) and dialysis (aOR = 11.34, 95% CI: 4.15-31.01). Children with SSc had increased risks of infection/pneumonia (aOR = 2.51, 95% CI: 1.84-3.41) and sepsis (aOR = 2.13, 95% CI: 1.26-3.58).

Conclusions: Children with ARDs, especially those with ANCA-associated vasculitis and SLE, face elevated risks of AKI and dialysis. These findings underscore the importance of vigilant monitoring and tailored management in this population.