Italian Journal of Pediatrics最新文献

Background: The global expansion of online gaming raises worries about its impact on adolescent well-being, particularly regarding Internet Gaming Disorder (IGD) and its association with social health and bullying. This study addresses a research gap in the Middle East by exploring gender-specific trends in gaming habits, social perceptions, and the prevalence of IGD among adolescents in Jordan. Utilizing the Social Cognitive Theory (SCT), the study aimed to identify predictors of IGD and exposure to social bullying.

Methods: 403 adolescents (aged 10-17) were selected from the northern Jordan in this cross-sectional, survey-based study. Participants responded to the Arabic version of the IGD-20 scale, in addition to items about their gaming habits, social perceptions, and exposure to social bullying. Furthermore, was used to measure IGD. Linear regression models were employed to identify factors predicting IGD scores and exposure to social bullying.

Results: 52.9% of the participants were at risk for or had IGD. Significant gender differences were found, with males spending more time gaming (p = 0.012) and preferring competitive games, while females favored "Fashion/dress" games. Key predictors of higher IGD scores were daily gaming hours, a perception of gaming as harmful, and poor social relationships. A higher IGD score also predicted increased exposure to social bullying. Crucially, gender did not significantly predict IGD or social bullying in the final models.

Conclusion: Our findings, guided by SCT, suggest that gaming habits are often gender-specific, however, the core risk factors for IGD are not. Developing IGD is more closely tied to excessive gaming, poor social relationships, and exposure to bullying. So, effective measures should promote healthy gaming habits and foster strong social support systems for all adolescents, rather than exclusively targeting a specific gender. No Patient or Public Contribution.

Clinical trial number: Not applicable.

Background: We investigated the use of mild procedural sedation/analgesia in children at community hospitals to describe current practices and identify challenges to its effective implementation.

Methods: Cross-sectional survey among all medical and nursing staff of the Paediatric, Emergency, Anesthesiology and Surgical Units of four secondary care hospitals in Italy, in the years 2021-2022.

Results: The response rate was 80% (range across centers 57%-100%); 346 complete questionnaires were analyzed (52.6% physicians; 47.4% nurses). Overall, procedural pain in children was considered a relevant topic by 90.8% of staff. Procedural sedation/analgesia was considered helpful for procedural success (97.4%) and for improving children's experience of pain/anxiety (98.6%). However, 47.7% were not satisfied with the management of procedural pain/anxiety at their workplace and 56.9% reported a lack of adequate knowledge. In fact, only 22.8% demonstrated adequate knowledge on fasting times and 39.6% on correct patient monitoring during procedural sedation. From a pharmacological perspective, midazolam was the most accessible (80.9%) and used (58.7%) medication, while intranasal fentanyl and nitrous oxide were less available (15.3% and 2.9% respectively) and used (7.2% and 2.6% respectively). Procedural sedation was generally practiced by anesthesiologists (65.9%). Overall, 91.9% of respondents performed/participated in < 4 pediatric sedations per month. For 64.3% lack of training represented the greatest barrier to pediatric sedation/analgesia implementation.

Conclusions: Despite staff awareness about the importance of pediatric procedural sedation/analgesia, lack of specific knowledge and training, as well as limited availability of sedative/analgesic medications represent current challenges to procedural sedation implementation in community hospitals without a pediatric emergency room.

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.

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.

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.