Italian Journal of Pediatrics最新文献

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.

Off-label prescribing, the use of medications outside of approved indications, is a common practice in pediatric emergency medicine. This practice is driven by factors such as limited pediatric-specific clinical trial data, regulatory hurdles, and the urgent need to treat critically ill children. While off-label prescribing can be lifesaving, it raises significant ethical and legal concerns. This article explores the prevalence, challenges, and potential consequences of off-label drug use in pediatric emergency departments. A case study illustrates the complexities of off-label prescribing in a real-world clinical scenario. The discussion highlights the importance of balancing clinical needs with regulatory requirements and ethical considerations. Future research should focus on optimizing informed consent procedures, enhancing postmarketing surveillance, and developing evidence-based guidelines to ensure the safe and effective use of off-label medications in pediatric emergency care.

Henoch-Schönlein purpura (HSP) is a vasculopathic disease due to lesions in blood vessels, and patients with HSP presenting with renal injury are at risk of further progression to end-stage renal disease, resulting in a severe disease burden, the pathogenesis of which is currently unclear. By integrating multi-omics data, biomarkers and signaling pathways that are specifically expressed in HSP can be screened, thus finding new perspectives for resolving the pathogenesis of HSP. The aim of this review is to explore the developmental pathways of HSP and to reveal key biomarkers and therapeutic targets. Finally, we discuss the therapeutic approaches to HSP, with the hope that these insights will drive the future development of personalized medicine and improve patient prognosis and quality of life.

Background: Advances in neonatal medicine have improved survival rates in neonatal intensive care units, especially for high-complexity cases like congenital diaphragmatic hernia (CDH). Despite these advances, managing respiratory failure in CDH infants remains challenging due to lung hypoplasia, respiratory insufficiency, and pulmonary hypertension. Lung-protective ventilation strategies are crucial to minimize ventilator-induced lung injury, but weaning them from invasive mechanical ventilation remains complex, and extubation failure rates are high.

Case presentation: This retrospective case series describes the use of Flow-Synchronized Nasal Intermittent Positive Pressure Ventilation (sNIPPV) in four neonates with surgically corrected left CDH admitted to the "Bambino Gesù" Children's Hospital in Rome (Italy) from 2022 onwards. Flow-sNIPPV was administered using the Giulia^® ventilator, which features a flow sensor for synchronization. We observed improved outcomes in terms of extubation success, in comparison to non-synchronized Nasal Intermittent Positive Pressure Ventilation (NIPPV). Synchronization reduced work of breathing (WOB), improved lung ventilation, and enhanced gas exchange without increasing ventilation-related complications. Additionally, this study reviews the current literature on the use of sNIPPV in neonates, highlighting the need for more research on its role in weaning post-extubation in CDH infants.

Conclusions: Flow-sNIPPV shows promise in preventing extubation failure in neonates with CDH by improving ventilation and reducing WOB. Synchronization enhances lung ventilation, stabilizes the chest wall, and may reduce thoraco-abdominal asynchrony in CDH infants. While the findings are promising, larger multicenter studies are required to confirm the efficacy and safety of sNIPPV as a routine weaning strategy in CDH neonates after repair surgery.