Italian Journal of Pediatrics最新文献

The recent article by Decembrino et al. highlights the burden of RSV-related bronchiolitis admissions to Italian Neonatal Intensive Care Units (NICUs) during the 2021 season and proposes extending NICU roles to compensate for the national shortage of Pediatric Intensive Care Unit (PICU) beds. While acknowledging the urgent problem, we argue that such a strategy risks fragmenting pediatric critical care. Evidence consistently demonstrates that critically ill children achieve better outcomes in high-volume, specialized centers equipped with multidisciplinary expertise, resources, and continuous training. Italy currently counts only 273 PICU beds, corresponding to one per 35,856 children, far below European standards and with significant regional disparities-most notably in Southern Italy and Sardinia. International data indicate that higher patient volumes are associated with improved survival, supporting the consolidation of PICUs within sustainable hub-and-spoke networks. Regional initiatives, such as the Ligurian model integrating a central hub with 24/7 pediatric transport, demonstrate the feasibility of this approach. Future planning should focus on strengthening national referral systems, enhancing transport capabilities, and consolidating pediatric intensive care. With RSV prevention strategies evolving, Italy must build a resilient and flexible system, ensuring that all critically ill children have timely access to specialized, high-quality care.

Respiratory syncytial virus (RSV) is one of the causes of lower respiratory tract infections (LRTIs) and related hospitalizations in neonates and infants. Clinical trials have shown that a single dose of nirsevimab can prevent this infection and its related complications. We systematically searched PubMed, Embase, Web of Science (WOS), Scopus, and Cochrane Central on 25 November 2024 and updated on 18 April 2025, without automated filters or language restrictions. Studies reported the outcomes after nirsevimab in infants were retrieved. A random effects model was applied for analysis. A total of 425,362 infants were pooled from 26 studies (6 randomized controlled trials and 20 observational cohorts studies). The immunization with nirsevimab reduced the incidence of RSV-LRTIs by 63% (risk ratio [RR]: 0.37; 95% CI [0.29; 0.47], p-value < 0.001, I² = 91.77%), hospitalization by 73% (RR: 0.27; 95% CI [0.20; 0.37], p-value < 0.001, I² = 97.46%). Nirsevimab also reduced the incidence of all-cause LRTIs and hospitalization, bronchiolitis, ICU admission, emergency unit visits, and all-cause mortality. The high heterogeneity was raised from pooling the real-world data across different clinical settings such as different geographical locations. There was no statistical significance regarding safety outcomes; serious, GIT adverse events, adverse events of special interest, and adverse events > grade 3 between the two groups. The time to event analysis showed that nirsevimab significantly reduced the RSV-LRTIs (Hazard Ratio (HR): 0.25; 95% CI [0.16; 0.37]) and hospitalization (HR: 0.14; 95% CI [0.08; 0.25]). The immunization with a single dose of nirsevimab significantly reduced the RSV-LRTIs and hospitalization in infants who were at risk for RSV infection without any identified safety concerns. The long-term safety concerns are still unclear across the current studies.

Background: Children and Youth with Special Health Care Needs (CYSHCN) represent a growing, though numerically limited, category of the paediatric population requiring care from multiple professionals across different settings. As such, they are at increased risk of experiencing fragmented care, lower quality of services, and unmet health needs. Continuity of care and care coordination are essential to ensure adequate assistance. This study aimed to assess the continuity and coordination of care for CYSHCN in a region of north-east Italy.

Methods: Over 21 months (2018-2020), CYSHCN meeting the inclusion criteria were enrolled at a public tertiary university hospital as part of a cross-sectional study. Data about care activities performed over 12 months by Family Paediatricians (FPs), General Practitioners (GPs), and Community Healthcare Professionals (CHPs) were collected using a structured tool. After 9-12 months, parents' perceptions of continuity of care were assessed using a 20-item questionnaire on a 5-point Likert scale. In 2020, families and professionals were also asked about perceived changes in care due to the COVID-19 pandemic.

Results: Most of the 51 children enrolled had oncological conditions (60.8%). FPs/GPs and CHPs reported 116 and 155 care activities respectively, with statistically significant differences in the type, setting, and intensity of care. Parents reported high levels of perceived continuity of care, though slightly lower ratings were observed for family paediatrician and care coordinator. Among 109 respondents (32 FPs/GPs, 20 CHPs, 32 parents), perceived changes in care during the pandemic were reported more frequently by professionals (58.4%) than by families (43.8%). However, most parents (85.7%) considered the care they received to be adequate.

Conclusions: Continuity and coordination of care for CYSHCN were generally well maintained in the region, even during the pandemic. Nonetheless, gaps remain in the role of primary care providers and informational continuity. Strengthening care integration-especially through better communication systems and the use of ICT-may enhance coordination, particularly for children with complex needs and those in rural settings.

Background: Head and neck area abscesses are severe bacterial infections that commonly arise as complications of viral upper respiratory tract infections in pediatric patients. These infections can affect various anatomical structures, including the tonsils, retropharyngeal spaces, paranasal sinuses, middle ear, and salivary glands. The most frequent clinical presentations include otomastoiditis, retropharyngeal abscesses, and periorbital cellulitis. Although traditionally considered rare in developed countries, in recent years, particularly in the post-COVID-19 (COronaVIrus Disease 19) pandemic period, we have observed a notable increase in these complications at our center.

Methods: We conducted a retrospective, single-center epidemiological study on our cases of septic complications involving the head and neck region, comparing two three-year periods (from January to December): 2017-2019 and 2022-2024. Cases were classified into four categories: otomastoiditis, periorbital cellulitis, retropharyngeal abscesses, and other abscesses (including lateral cervical and cerebral abscesses). For each year the incidence rate of these complications was calculated in relation to the total number of hospital admissions. Statistical comparison was performed using the Chi-square test.

Results: The comparison between the two three-year periods (2017-2019 vs. 2022-2024) revealed a dramatic increase in head and neck suppurative infections: 8 cases in 2017-2019 compared to 56 cases in 2022-2024. The incidence rose from 0.32% to 2.42%, a statistically significant difference (p < 0.01). The incidence rate peaked in 2024, reaching 3.3%. The most frequent complication was periorbital cellulitis, followed by otomastoiditis. Notably, in 2022, a case of cerebral abscess occurred, requiring transfer to intensive care.

Conclusions: Our study highlights an unexpected increase in head and neck suppurative-inflammatory complications. While recent publications have documented a rise in pediatric respiratory infections in the post-COVID-19 era, specific studies addressing the surge in these conditions remain scarce. This trend may be linked to the so-called COVID-19 immunity gap and/or to emerging patterns of antimicrobial resistance. However, given the retrospective observational design of our study, establishing a causal link is not possible. Pending further scientific evidence, enhanced surveillance remains essential to promptly identify these conditions, given their rapid progression and high morbidity.