Italian Journal of Pediatrics最新文献

Point-of-care ultrasound (POCUS) is a bedside diagnostic tool clinicians use to provide immediate insights and guide therapeutic interventions. It has become increasingly significant in pediatric emergency departments (EDs) for diagnosing conditions, managing critical scenarios, and guiding procedures due to its portability, ease of use, and lack of radiation. This study aims to systematically review and analyze the efficacy of POCUS compared to conventional diagnostic methods in pediatric emergency settings. A literature search was conducted across PubMed, SCOPUS, Web of Science, Embase, and Cochrane Library up to February 2025. The inclusion criteria were pediatric patients aged 1 month to 18 years in EDs, with studies comparing POCUS to conventional methods. Primary outcomes included first-attempt procedural success and overall success rates. Secondary outcomes included time to procedure completion, mean number of attempts, hospitalization rates, and discharge rates. Data analysis was conducted in R employing a random-effects model, with dichotomous data analyzed as risk ratio (RR) and 95% confidence interval (CI), and continuous data as unbiased standardized mean difference (SMD). Statistical significance was defined at p < 0.05. Eighteen randomized controlled trials involving 2264 patients met the inclusion criteria. POCUS significantly improved first-attempt success (RR = 1.25; 95% CI: 1.09-1.43). The overall procedural success showed a significant benefit with POCUS (RR = 1.12; 95% CI: 1.03-1.22). However, no significant differences were noted in the time to procedure completion, number of attempts for a successful procedure, and rates of hospitalization and discharge to home. POCUS significantly improves first-attempt and overall procedural success rates in pediatric emergency settings, although it does not significantly reduce procedure times or the number of attempts. These findings underscore the importance of integrating POCUS into pediatric emergency care to enhance diagnostic accuracy and procedural success, though further research is needed to optimize its implementation across different age groups and procedures.

Background: Complicated community-acquired pneumonia (CCAP) in children can result in severe morbidities. While computed tomography (CT) is the gold standard for diagnosis, its radiation exposure has led to the increased use of lung ultrasound (LUS) as a safer radiation-free alternative. This study aimed to evaluate the diagnostic accuracy of LUS in detecting complications in pediatric patients with CCAP and determine its value in their follow up as well as its value in determining patients liable for surgical intervention as pleural decortication comparing its efficacy with chest CT.

Methods: This is a prospective observational cohort study that was conducted on 56 pediatric patients with CCAP at our tertiary-level referral pediatric hospital. Patients underwent clinical evaluation, laboratory investigations, chest X-ray, CT, and LUS. The sensitivity, specificity, and accuracy of LUS were compared with CT for detecting consolidations, pleural thickening, effusions, lung abscesses, and hydropneumothorax.

Results: Compared to CT chest, LUS showed high sensitivity (92.6% for the right lung and 94.1% for the left lung) and specificity (88% and 100%, respectively) in detecting pleural effusions and consolidations, with substantial agreement with CT (p < 0.001). However, it had lower sensitivity in detecting lung abscesses (33.3% for the right lung, 0% for the left lung) and hydropneumothorax. Pleural thickness measured by LUS was a predictor for surgical intervention (cut-off > 2.2 mm). Follow-up LUS indicated significant improvement in lung lesions after one month.

Conclusion: LUS is a reliable tool for detecting pleural effusions and consolidations in pediatric CCAP, reducing the need for CT in many cases. However, its limitations in identifying abscesses and hydropneumothorax highlight the need for combined diagnostic approaches.

Background: Infectious mononucleosis (IM) may lead to severe complications and present diagnostic challenges in certain clinical settings. This study aimed to preliminarily evaluate the clinical utility of novel CBC-derived graphical and numerical indicators as potential tools for rapid, accurate early diagnosis and monitoring of IM in children.

Methods: A total of 204 pediatric patients with IM, exhibiting a favorable prognosis, 109 pediatric patients diagnosed with other infectious diseases, and 86 healthy controls were enrolled from the Third Affiliated Hospital of Zhengzhou University. Multiple complete blood count (CBC)-derived indicators-including the machine learning-based "IM" flag, high-fluorescence lymphocyte percentage (HFLC%), and platelet-to-lymphocyte ratio (PLR)-were analyzed at initial diagnosis and on days 7, 14, and 21.

Results: The "IM" flag, HFLC%, and PLR were independent predictors of IM (all P < 0.01). The "IM" flag and PLR demonstrated high diagnostic efficacy across all pediatric age groups, while HFLC% showed significant diagnostic utility specifically in children over 72 months (all P < 0.001). Optimal diagnostic cutoff values were 1.95 for HFLC% and 46.35 for PLR. During follow-up, the "IM" flag gradually turned negative within 7 days (P < 0.017), HFLC% decreased significantly (all P < 0.01), whereas PLR levels showed a progressively increasing trend over 14 days (all P < 0.001).

Conclusions: The "IM" flag, HFLC%, and PLR demonstrate significant diagnostic and prognostic value in pediatric IM, supporting their potential for clinical application.

Streptococcus pneumoniae causes diseases such as meningitis and bacteremia, which lead to high morbidity and mortality rates among children under 5 years old. The invasive form of the disease, known as invasive pneumococcal disease, is a significant global health threat to children. Additionally, antimicrobial resistance in this bacterium has greatly hindered worldwide efforts to prevent and treat infections. In this meta-analysis, we reviewed published studies to provide a comprehensive overview of the global status of resistance to anti-cell wall antibiotics among S. pneumoniae strains causing invasive diseases. We searched PubMed, Scopus, and Embase for relevant studies published up to July 25, 2022. All statistical analyses were conducted using the R statistical software package. Our meta-analysis included 54 studies from 23 countries, spanning the period from 1994 to 2022. The average prevalence rates of antibiotic resistance were as follows: 30.1% for penicillin-non-susceptible pneumococci, 1.2% for amoxicillin, 2.5% for amoxicillin-clavulanic acid, 6.1% for ceftriaxone, and 0.6% for vancomycin. No significant differences were observed in resistance rates for vancomycin, amoxicillin-clavulanic acid, or amoxicillin. Additionally, no notable variations were found across age groups, over time, or based on different antibiotic susceptibility testing methods. The high prevalence of penicillin-non-susceptible pneumococci represents a significant challenge for global healthcare systems. Furthermore, our findings highlight considerable geographical variation in antibiotic resistance levels to cell wall-targeting antibiotics among S. pneumoniae isolates globally.

Background: Less invasive surfactant administration (LISA) is a gentle emerging technique for surfactant administration through a thin catheter in infants receiving noninvasive ventilation. It seems to offer some advantages to very preterm infants. The purpose of the FRee of Invasiveness & Neonatal Delicate LISA (FRI&NDLI) study was to evaluate the feasibility and safety of using videolaryngoscopy for positioning the thin catheter tip beyond the vocal cords.

Methods: We studied preterm infants with 24^+ 0-32^+ 6 weeks of gestation, born between September 2020 and January 2024. Data of infants with mild/moderate respiratory distress syndrome (RDS) who received surfactant through the FRI&NDLI procedure were recorded. Frequency of successes and incidence of related adverse effects of the procedure were also recorded.

Results: Twenty-three infants with 28.9 ± 2.8 weeks of gestational age and a birth weight of 1255 ± 458 g who received 25 procedures were studied. No episodes of apnoea, bradycardia, or desaturation were recorded during the glottis visualization in videolaryngoscopy. Two episodes of bradycardia, 8 episodes of desaturation, and 1 episode of surfactant reflux were observed during surfactant administration.

Conclusion: We found that the FRI&NDLI procedure was safe and associated with less adverse effects than previously reported for LISA procedure using direct laringoscopy. Our findings support the possibility of planning further studies to compare the effectiveness of FRI&NDLI and LISA procedure for surfactant administration in preterm infants.

Background: Kawasaki disease (KD) is a systemic vasculitis in children, with coronary artery lesions (CALs) presenting as severe complications. Early diagnosis is of paramount importance; however, current biomarkers lack both simplicity and reliability. This study assessed the predictive value of blood composite ratios (BCRs) for KD and CAL.

Methods: In this retrospective study, we analyzed data from 153 pediatric patients with febrile illness from 2016 to 2023. BCRs, including the neutrophil-to-lymphocyte ratio (NLR), the eosinophil-to-lymphocyte ratio (ELR), the eosinophil-to-monocyte ratio (EMR), and the eosinophil-to-basophil ratio (EBR), were calculated from admission laboratory data. The relationships between BCRs and the incidence of KD and CAL were evaluated using statistical and regression analyses.

Results: Patients with KD presented markedly elevated NLRs, ELRs, EMRs, and EBRs in comparison with those in the febrile control group. The NLR and ELR were found to be significantly associated with the incidence of KD and CAL, with optimal cutoff values of 0.632 and 0.01, respectively. The combined use of BCR indices resulted in increased predictive efficacy for the incidence of KD.

Conclusions: BCRs, particularly the NLR and ELR, are valuable for the early identification of high-risk KD patients and CAL damage. These ratios have the potential to enhance clinical management and optimize patient care, although validation in prospective studies is needed.