Italian Journal of Pediatrics最新文献

Background: Severe pulmonary infection is the primary cause of death in children aged < 5 years. The early identification of pathogenic bacteria and targeted anti-infective therapies can significantly improve the prognosis of children with severe infections. This study aims to provide a reference for the rational use of antibiotics at an early stage in children with severe pulmonary infections.

Methods: A retrospective, single-center longitudinal study included children with severe pulmonary infections between January 2017 and December 2022 by obtaining their bacterial culture results of bronchoalveolar lavage fluid.

Results: This study included 4080 samples. The age of onset for severe pulmonary infection increased annually. The proportion of severe pulmonary infections across the different age groups and years was statistically significant (p < 0.001). Among children with severe pulmonary infections, bacilli were the most prevalent, followed by cocci and fungi. The predominant bacilli were Acinetobacter baumannii and Klebsiella pneumoniae. The predominant cocci identified in this study were Streptococcus pneumoniae and Staphylococcus aureus. The primary fungi included Candida albicans and Aspergillus fumigatus, which showed significant differences (p < 0.05). The incidence of drug-resistant bacteria has gradually declined, with infection rates of multidrug-resistant bacteria and extended-spectrum beta-lactamases consistently decreasing annually. For carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, the infection rates peaked in 2018, with statistical significance (p < 0.001).

Conclusions: Severe pulmonary infections in children are significantly associated with age and types of infectious pathogens. Gram-negative bacteria are the primary cause of severe pulmonary infections in children. Clinicians should rationally use antibiotics according to the local distribution and drug resistance of pathogens, thereby enhancing therapeutic outcomes.

Background: Exogenous foreign body aspiration is a common high-risk condition in children. In a few cases, foreign body aspiration can lead to airway granulomas that interfere with tracheoscopic foreign body removal and threaten the life of the child.

Methods: This study was a retrospective analysis of the clinical data of 184 pediatric patients who were admitted to Quanzhou Children's Hospital from 2018 to 2021 with exogenous tracheobronchial foreign bodies.

Results: Respiratory foreign bodies tend to occur during the winter and spring seasons. The solid foreign bodies were mostly nut foreign bodies, the location of implantation was the left lung rather than the right lung in many patients, and complications such as pulmonary atelectasis, emphysema, mediastinal and subcutaneous emphysema, and granulomatous tissue formation were noted in these patients. Statistical models suggested that the time of foreign body impaction and the release of oil were risk factors for tracheal granulation, with the logistic model presenting an AUC of 0.948, precision of 0.676, and sensitivity of 0.895, whereas the XGBoost model presented an AUC of 0.902, precision of 0.912, and sensitivity of 0.875.

Conclusions: Tracheobronchial foreign bodies primarily develop in male children under the age of 3 and often lead to various complications. The time of foreign body insertion and the release of oil from the obstructed foreign body have been identified as high-risk factors for the development of tracheobronchial granulation tissue. When the time of foreign body insertion without oil release exceeds 99.98 h or when the time of foreign body insertion with oil release exceeds 47.94 h, tracheobronchial granulation formation strongly suggests that the child is at high risk of developing airway granulation. In such cases, family members must implement increased supervision of the child to prevent choking. Medical professionals should obtain a detailed medical history of the affected child and accordingly select the most appropriate method to promptly remove the foreign body to resolve the issue of airway obstruction and reduce the likelihood of pulmonary complications in the child.

Background: Recent studies have emphasized the association between prolonged screen exposure and neurodevelopmental disorders, though its correlation with tic disorders (TDs) remains ambiguous. We thus conducted this study to investigate the association between screen time (ST) and the severity of tic symptoms in children diagnosed with TDs.

Methods: We conducted a retrospective case-control study with 342 cases of TDs and 270 controls, collecting data from March 2021 to December 2023. The main exposure variable was daily ST for each child, and tic severity, evaluated using the Yale Global Tic Severity Scale (YGTSS), was the outcome variable. Statistical analysis included descriptive statistics, Pearson's correlation analysis to examine the relationship between screen time and tic severity, and multivariate regression analysis to evaluate the predictive power of screen time for tic symptoms.

Results: Our findings revealed that children with TDs had significantly longer ST compared to the control group, averaging 116.06 ± 147.9 min/day versus 43.23 ± 37.5 min/day, p < 0.001. We also noted a positive correlation between ST and TDs( r = 0.461, p < 0.01). Daily ST was a significant predictor of overall YGTSS scores (t = 9.58, p < 0.001), suggesting that increased ST is associated with heightened tic symptoms. However, age of first exposure to screens was not significantly correlated with tic severity (p > 0.05). Though we observed a negative correlation between ST and vitamin D levels, the results were not statistically significant (p > 0.05).

Conclusion: Children with TDs had longer ST compared to their control's counterparts, and prolonged ST was significantly associated with heightened tic severity, which highlights the critical need for careful monitoring and regulation of screen time in children with TDs.

Background: The PalliPed project is a nationwide, observational, cross-sectional study designed with the aim of providing a constantly updated national database for the census and monitoring of specialized pediatric palliative care (PPC) activities in Italy. This paper presents the results of the first monitoring phase of the PalliPed project, which was developed through the PalliPed 2022-2023 study, to update current knowledge on the provision of specialized PPC services in Italy.

Methods: Italian specialized PPC centers/facilities were invited to participate and asked to complete a self-reporting, ad-hoc, online survey regarding their clinical activity in 2022-2023, in the revision of the data initially collected in the first PalliPed study of 2021.

Results: 18 specialized PPC centers/facilities from 14 Italian regions and two autonomous provinces participated; 13 were identified as regional referral centers (72.2%), with the acquisition of three new centers in comparison to 2021. Full coverage of the regional territory was reported by 54% of them, compared with 45% in 2021, while a 24/7 service was offered by 23%, compared with 27% in 2021. Eight of 13 referral centers (61%) had a dedicated team, compared with 91% in 2021. Also, an overall increase in the number of followed patients was observed, rising from 1,209 (2019) to 2,734 (2023). In line with previous data, most PPC healthcare providers were nurses (n = 181) and physicians (n = 89), with an overall increased number of PPC providers from 2021.

Conclusions: The nationwide PalliPed project established the first comprehensive overview and monitoring of the state of specialized PPC in Italy. Data reported within the PalliPed 2022-2023 monitoring study suggest a general improving trend in the availability of the specialized PPC service in Italy, compared with data collected in 2021. At the same time, the need for a greater effort to provide better care models and resources for specialized PPC remains, especially considering that the number of children needing PPC is constantly increasing.

Background: Pompe disease is a rare genetic disorder caused by a deficiency of the enzyme acid alpha-glucosidase. This condition leads to muscle weakness, respiratory problems, and heart abnormalities in affected individuals.

Methods: The aim of the study is to share our experience through cross sectional study of patients with infantile-onset Pompe disease (IOPD) with different genetic variations, resulting in diverse clinical presentations. We evaluated their phenotype, genotype, radiological and laboratory findings including their cross-reactive immunologic material (CRIM) status. Infantile Pompe disease was diagnosed by measurement of the activity of the enzyme alpha-glucosidase. The diagnosis was confirmed by molecular genetic testing using PCR amplification and sequencing of the acid alpha-glucosidase (GAA) gene. Routine two-D echocardiography, and multi-parametric ECG-gated cardiac magnetic resonance imaging (CMR) were done to patients six months after starting enzyme replacement therapy (ERT).

Results: The results of our study revealed different genetic mutations among our patients, different CRIM status and also CMR abnormalities. CMR imaging revealed abnormalities in all cases that underwent the procedure, including myocardial and vascular changes, with feature tracking indicating issues across all parameters and LGE suggesting fibrosis. The patient with a positive immune response had the most severe cardiac abnormalities, despite improvements in muscle weakness and motor skills from ERT. This underscores that delayed diagnosis and ERT can lead to irreversible heart damage from autophagy buildup.

Conclusion: Pompe disease has various clinical presentations and results in significant CMR findings, which can be attributed to different genetic mutations. Early initiation of enzyme replacement therapy in infantile-onset Pompe disease is important to maximize its benefits.

Background: This study aimed to describe the epidemiological trends of Mycoplasma pneumoniae (MP) infection among children with acute respiratory tract infections (ARTIs) before, during and after the COVID-19 pandemic, and evaluating the impact of non-pharmaceutical interventions (NPIs) on the epidemiology of MP infection.

Methods: Children with ARTIs admitted to the Children's Hospital of Soochow University (SCH) from January 2010 to December 2023 and underwent MP nucleic acid PCR assay were included. Clinical data on age, sex, onset time and detection result were collected and analyzed.

Results: All of the 122,984 inpatients were enrolled, in which 20.8% (25659/122984) of the children with MP tested positive, including 19.4% (14139/72662) for male and 22.9% (11520/50322) for female. It was a statistically significant difference between the two genders (p < 0.05). In addition, the positive rate of MP was the highest in the age group > 6 years old each year (p < 0.05). During 14-year period, the detection rate of MP has experienced four peaks in 2012, 2013, 2019, and 2023. Before the NPIs the prevalence of MP showed seasonality, and the number and rate of MP positivity reached their peak in August. However, the rate of MP positivity remained at a low level during the NPIs. After the abolition of NPIs, the MP positivity rate obviously increased and remained at a high level.

Conclusions: The NPIs could reduce the spread of MP infection and change its epidemic season, but it has not changed the susceptible population of MP infection.

Background: Neutrophil-to-Lymphocyte Ratio (NLR) has been postulated as a useful inflammatory biomarker in the prediction of complications in different pediatric diseases. Our aim is to analyze the predictive value of NLR in the development of complications in burned children, both in the short-term (need for grafting) and in the long-term (need for surgery of the sequelae).

Methods: A retrospective study was performed on burned patients under 18-years admitted to our Burn Unit between 2015 and 2021. Demographic, clinical and laboratory data at admission were evaluated. Predictive factors for the development of complications after burns (time of evolution, burned total body surface area, and acute phase reactants) were analyzed using sensitivity and specificity analysis (ROC curves).

Results: A total of 342 patients (198 males, 144 females) were included, with a median age of 27 months (interquartile range 15-83 months). In 97.4% of the cases, burns were primarily caused by thermal injuries (78.4% scald burns). Acute escharectomy and grafting were performed in 85 patients (24.9%), while long-term sequelae were observed in 112 cases (32.7%). NLR was the most sensitive and specific predictor for the need for escharectomy and grafting (Sensitivity 90%, Specificity 88.4%; AUC 0.920), for the development of long-term sequelae (Sensitivity 80.4%, Specificity 83.5%; AUC 0.849) and for the need for surgery of the sequelae (Sensitivity 83.5%, Specificity 80.9%; AUC 0.833).

Conclusion: NLR may be considered a useful predictor for the development of short- and long-term complications in childhood burns. It may help in the identification of high-risk patients to prevent sequelae.

Background: Under-five mortality and malnutrition are more common in many low- and middle-income countries, highlighting the grave consequences of improper nutrition for children. Infants that continue to be exclusively breastfed after six months are considered to be engaging in prolonged exclusive breastfeeding. Children with prolonged exclusive breastfeeding are more susceptible to anemia, atopic dermatitis, and food allergies. There is no evidence on the pooled prevalence and determinants of prolonged exclusive breastfeeding in sub-Saharan Africa. Therefore, this study is intended to determine the prevalence and associated factors of prolonged exclusive breastfeeding among children aged 6 to 23 months in sub-Saharan African countries.

Methods: Data from the recent demographic and health surveys of 21 countries in sub-Saharan Africa conducted between 2015 and 2022 were used. A total weighted sample of 63,172 mother-child pairs was included in the current study. Multilevel mixed-effects logistic regression was used to determine the factors associated with the outcome variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value < 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.

Results: The pooled prevalence of prolonged exclusive breastfeeding among children aged 6-23 months in sub-Saharan Africa was 17.32% (95% CI: 17.03%, 17.62%). Factors like child age [AOR = 4.39; 95% CI (4.17, 4.62)], wealth index [AOR = 1.15; 95% CI (1.07, 1.23)], maternal educational level [AOR = 1.56; 95% CI (1.36, 1.78)], marital status of the mother [AOR = 1.11; 95% CI (1.04, 1.19)], media exposure [AOR = 1.11; 95% CI (1.06, 1.17)], place of delivery [AOR = 0.82; 95% CI (0.78, 0.87)], postnatal checkup [AOR = 1.43; 95% CI (1.36, 1.51)], drinking water source [AOR = 1.06; 95% CI (1.01, 1.11)], sanitation facility [AOR = 1.15; 95% CI (1.10, 1.21)], antenatal care attendance [AOR = 1.27; 95% CI (1.16, 1.39)], community literacy [AOR = 1.08; 95% CI (1.02, 1.15)], and community media exposure [AOR = 1.06; 95% CI (1.01, 1.13)] were significantly associated with prolonged exclusive breastfeeding.

Conclusions: Nearly one out of five children aged 6-23 months in sub-Saharan Africa had prolonged exclusive breastfeeding. Both individual- and community-level factors were significantly associated with prolonged exclusive breastfeeding. Policymakers could find it very important to support maternal education, poverty reduction, media exposure, maternal healthcare services, and complementary feeding hygiene practices in order to encourage the timely initiation of complementary feeding.

Background: This study aimed to investigate deoxyribonucleic acid (DNA) copy number variations (CNVs) in children with neurodevelopmental disorders and their association with craniofacial abnormalities.

Methods: A total of 1,457 children who visited the Child Health Department of our hospital for unexplained Neurodevelopmental disorders (NDDs) between November 2019 and December 2022 were enrolled. Peripheral venous blood samples (2 mL) were collected from the children and their parents for whole-exome sequencing. Positive results were verified through Sanger sequencing for locus and pedigree validation. Simultaneously, a specific sign-scoring scale was created to evaluate characteristics related to the developments of eyes, nose, ears, eyebrows, head, mouth, face, trunk, limbs, and reproductive, urinary, and cardiovascular systems.

Results: A total of 536 children (36.78%, 536/1,457) were found to have genetic variations, with 379 (70.71%, 379/536) exhibiting pathogenic monogenic mutations. Furthermore, 157 children (29.29%, 157/536) harbored DNA copy number variants, encompassing microdeletions (68.15%, 107/157) and microduplications (31.85%, 50/157). Regarding the pathogenicity of CNVs, 91 (57.96%, 91/157) were identified as pathogenic, 28 (17.83%, 28/157) as variants of uncertain clinical significance (VOUS), and 38 (24.20%, 38/157) as benign according to the American College of Medical Genetics and Genomics (ACMG).Using a specific sign-scoring scale, the proportion of pathogenic CNVs in children graded 1 point or higher (64%, 58/91) was significantly higher than that of non-pathogenic CNVs (43%, 29/66) (P < 0.05). Furthermore, the proportion of microdeletions in children graded 1 point or higher (60.75%, 65/107) was significantly higher than those carrying microduplications (44%, 22/50) (P < 0.05). The proportion of pathogenic microdeletions in children graded 1 point or higher (73.43%,47/64) was significantly higher than those carrying pathogenic microduplications (40.74%, 11/27) (P < 0.05).

Conclusion: The positive rate of whole-exome sequencing for children with combined craniofacial abnormalities and NDDs exceeds the international average in our study cohort. Thus, whole-exome sequencing may be recommended for precise diagnosis of neurogenetic diseases in such cases.

Background: Both psychogenic pseudosyncope (PPS) and vasovagal syncope (VVS) in children and adolescents are diseases of transient loss of consciousness. It is difficult to distinguish them clinically. This paper will study the differential diagnostic value of P wave dispersion (Pd) and QT interval dispersion (QTd) between PPS and VVS.

Methods: The 31 children with PPS and 40 children with VVS from July 2014 to November 2023 were enrolled as the study group. Meanwhile, 30 healthy children who underwent a physical examination at the same hospital were matched to the control group. P wave duration and QT interval in the 12-lead electrocardiogram were measured at the baseline.

Results: (1) Comparison between groups: ① The Pd, corrected P wave dispersion (Pcd), QTd, and corrected QT interval dispersion (QTcd) in PPS group were significantly higher than those in control group (P < 0.05). The minimum P wave duration (Pmin) and corrected P wave duration (Pcmin) in PPS group were significantly lower than those in control group (P < 0.05). There were no significant differences in maximum P wave duration (Pmax), corrected maximum P-wave duration (Pcmax), maximum QT interval (QTmax), minimum QT interval (QTmin), corrected maximum QT interval (QTcmax), and corrected minimum QT interval (QTcmin) between PPS group and control group (P > 0.05). ② The Pd, Pcd, QTd, and QTcd in VVS group were significantly higher than those in control group (P < 0.05). The Pmin, Pcmin, and QTcmin in VVS group were significantly lower than those in control group (P < 0.05). There were no significant differences in Pmax, Pcmax, QTmax, QTmin, and QTcmax between VVS group and control group (P > 0.05). ③ The Pmax, Pd, QTmax, QTd, and QTcd in PPS group were significantly lower than those in VVS group (P < 0.05). There were no significant differences in Pmin, Pcmax, Pcmin, Pcd, QTmin, QTcmax, and QTcmin between PPS group and VVS group (P > 0.05). (2) ROC curve: Pmax, Pd, QTmax, QTd, and QTcd had a certain differential diagnostic value between PPS and VVS in children and adolescents (P < 0.05). QTd had the largest area under curve (0.735), with a sensitivity of 85.00% and a specificity of 53.30% at the cut off value of ≥ 28.11 ms for VVS diagnosis.

Conclusions: In children and adolescents, electrocardiogram parameters such as Pmax, Pd, QTmax, QTd, and QTcd all possess predictive value in differentiating between PPS and VVS. Among them, QTd has the greatest differential diagnostic value.