Italian Journal of Pediatrics最新文献

Background: Pertussis-related hyperleukocytosis is a major driver of pediatric mortality. While exchange transfusion (ET) improves survival, predictors of death in ET-treated children remain poorly defined. We sought to identify independent predictors of death to refine treatment strategies.

Methods: A single-center retrospective cohort study analysis of 44 children with pertussis-related hyperleukocytosis treated with ET was conducted. Patients were stratified into survival (n = 27) and mortality (n = 17) groups. Univariate comparisons of clinical, laboratory, and ET-related parameters were performed. Multivariate logistic regression identified independent mortality risk factors.

Results: The mortality group exhibited a younger median age at onset (55 vs. 103 days, p = 0.006), higher peak white blood cell (WBC) count (82.19 ± 21.95 vs. 68.10 ± 18.78 × 10⁹/L, p = 0.023), and greater incidence of pre-ET cardiovascular failure (94.1% vs. 22.2%, p < 0.001). In multivariable analysis using Firth's penalized logistic regression, pre-ET cardiovascular failure (OR 53.69, 95% CI 3.63-795.10), higher peak WBC count (OR 1.09 per 1 × 10⁹/L increase, 95% CI 1.02-1.17), and younger age at onset (OR 0.97 per day increase, 95% CI 0.95-0.99) showed significant associations with mortality.

Conclusion: Younger age at onset, marked leukocytosis, and pre-ET cardiovascular failure were associated with increased mortality in children with pertussis complicated by hyperleukocytosis. These factors may help identify patients at higher risk and highlight the importance of early recognition, close monitoring, and timely supportive management. Further prospective studies with larger sample sizes are warranted to validate these findings and to inform optimized management strategies in this vulnerable population.

Short stature is a frequent reason for pediatric referral, yet clear diagnostic criteria remain elusive. Variability in clinical definitions, reference growth charts, and laboratory screening tests complicates the evaluation of affected children. This systematic review aimed to analyze the diagnostic approaches used in clinical and biochemical assessments of short stature in children in the primary care setting. This systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251002215). Two independent literature searches were performed to address two domains: clinical and biochemical assessment. Studies were selected based on predefined inclusion and exclusion criteria, and risk of bias was assessed using the JBI critical appraisal tools. All procedures were conducted by independent reviewers, and discrepancies were resolved by consensus or through a third reviewer. A total of 424 studies were included, 35 in the clinical and 7 in the biochemical domain. Definitions of short stature considered in the studies varied considerably: 28 studies used a threshold of < 2 standard deviation score, while 19 applied percentile-based cut-offs (mostly the 3rd percentile); 8 studies considered both definitions, 3 studies do not report any definition. Growth velocity and target height were rarely used, despite their diagnostic value. Local growth charts were employed when available; otherwise, WHO and CDC references were most used. Laboratory assessments also varied greatly, with complete blood count and urine/stool analyses commonly performed, while thyroid function and celiac disease screening were inconsistently applied. There is substantial heterogeneity in the clinical and biochemical evaluation of children with short stature across studies. This reflects the absence of universally accepted diagnostic criteria and standardized screening protocols. These findings emphasize the need for internationally accepted, evidence-based guidelines to improve diagnostic accuracy and clinical management of children with short stature.

Background: Vesicoureteral reflux is the most common pediatric urological anomaly and a leading cause of urinary tract infections in children. Traditional follow-up typically relies on voiding cystourethrography, which exposes young patients to ionizing radiation. The introduction of contrast-enhanced ultrasound provides a radiation-free alternative with comparable diagnostic accuracy. This study aims to demonstrate that the use of contrast-enhanced ultrasound can shorten follow-up intervals, thereby reducing the duration of antibiotic prophylaxis.

Methods: A prospective observational study was conducted between 2019 and 2024, involving 1050 children with urinary tract infections, hydronephrosis, or a known history of vesicoureteral reflux. The cohort included both male and female children, aged between 1 and 15 years. Diagnosis was confirmed using conventional ultrasound and contrast-enhanced ultrasound. Patients with grade III to V vesicoureteral reflux underwent contrast-enhanced voiding urosonography at 12 months, replacing the standard voiding cystourethrography typically performed at 24 months. Clinical data were collected on reflux severity, gender distribution, and changes in antibiotic use.

Results: Early reassessment using contrast-enhanced voiding urosonography resulted in a significant reduction in the duration of antibiotic prophylaxis. A substantial number of patients showed resolution or downgrading of vesicoureteral reflux at 12 months, allowing for earlier discontinuation of treatment. The diagnostic accuracy of the ultrasound-based approach was consistent across age groups and genders.

Conclusions: In our single-center experience, the incorporation of contrast-enhanced voiding urosonography into follow-up protocols for pediatric vesicoureteral reflux has been demonstrated to be a safe and effective alternative to traditional imaging. By allowing earlier reassessment without radiation exposure, contrast-enhanced voiding urosonography facilitates the safe discontinuation of prophylactic antibiotics, thereby enhancing patient safety and contributing to the reduction of antibiotic resistance.

Trial registration: Not applicable. This is an observational study and does not meet the criteria for mandatory trial registration.